Toward Earlier Detection of Choroidal Neovascularization Secondary to Age-Related Macular Degeneration

Loewenstein, Anat; Ferencz, J. R.; Lang, Yaron; Yeshurun, Itamar; Pollack, Ayala; Siegal, R; Lifshitz, Tova; Karp, Joseph S.; Roth, Daniel B.; Bronner, Guri; Brown, Justin C.; Mansour, Sam E.; Friedman, Scott M.; Michels, Mark; Johnston, Richards; Rapp, Moshe; Havilio, Moshe; Rafaeli, Omer; Manor, Y.

doi:10.1097/iae.0b013e3181d1a75e

Cited by 42 publications

(15 citation statements)

References 24 publications

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“…The sensitivity and specificity of the ForeseeHome device in distinguishing between newly diagnosed CNV and intermediate AMD in an unsupervised manner (at home) was on average 85%, thus comparable to PHP used in a clinical setting [61]. Moreover, the sensitivity of the ForeseeHome device is not influenced by type, size, or location of the CNV lesion [61]. …”

Section: Home Monitoring Testsmentioning

confidence: 97%

“…Data obtained from patients are compared to a normative database, and the system determines whether there are visual responses which may be associated with progression of AMD to CNV [60]. The sensitivity and specificity of the ForeseeHome device in distinguishing between newly diagnosed CNV and intermediate AMD in an unsupervised manner (at home) was on average 85%, thus comparable to PHP used in a clinical setting [61]. Moreover, the sensitivity of the ForeseeHome device is not influenced by type, size, or location of the CNV lesion [61].…”

Section: Home Monitoring Testsmentioning

confidence: 99%

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Metamorphopsia: An Overlooked Visual Symptom

2015

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Metamorphopsia is a common symptom in different macular disorders. Micropsia and macropsia are special types of metamorphopsia. Recent theories suggest that both retinal and cortical mechanisms are involved in the development and changes of metamorphopsia. Different functional tests have been proposed for the evaluation of metamorphopsia: from the Amsler grid to the hand-held mobile devices for home monitoring. This review addresses some new insights into the pathophysiology of metamorphopsia and different available tests for the evaluation of this symptom in most common macular disorders. The importance of quantification of metamorphopsia in macular diseases is confirmed by the most recent therapeutic approaches.

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Section: Home Monitoring Testsmentioning

confidence: 97%

Section: Home Monitoring Testsmentioning

confidence: 99%

Metamorphopsia: An Overlooked Visual Symptom

2015

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“…This monitoring strategy was previously tested in an out-patient setting in a cross-sectional evaluation. 14 This monitoring, coupled with telemedicine is currently tested for home use prospectively.…”

Section: Home Monitoring Devicementioning

confidence: 99%

Randomized Trial of a Home Monitoring System for Early Detection of Choroidal Neovascularization Home Monitoring of the Eye (HOME) Study

et al. 2014

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Objective To determine whether home monitoring with ForeseeHome device, using macular visual field testing with hyperacuity techniques and tele-monitoring, results in earlier detection of age-related macular degeneration associated choroidal neovascularization (CNV), reflected in better visual acuity, when compared with standard care. The main predictor of treatment benefit from anti-vascular endothelial growth factor (VEGF) agents is the visual acuity at the time of CNV treatment. Design Unmasked, controlled, randomized clinical trial. Participants 1970 participants, aged 53 to 90 years, at high risk of developing CNV were screened; 1520, mean age 72.5 years enrolled in the HOme Monitoring of the Eye (HOME) Study in 44 Age-Related Eye Disease Study2) clinical centers. Interventions 1) Standard care arm: investigator-specific instructions were provided for self-monitoring vision at home followed by report of new symptoms to clinic. 2) Standard Care and Device arm: device provided with recommendation for daily testing. The device monitoring center received test results and reported changes to the clinical centers who contacted participants for examination. Main Outcome Measures The difference in best-corrected visual acuity scores between baseline and detection of CNV. The event was determined by investigators based on clinical exam, color fundus photographs, fluorescein angiography, and optical coherence tomography. Masked graders at central reading center evaluated the images using standardized protocols. Results 763 participants were randomized to device monitoring and 757 to standard care, and followed for a mean of 1.4 years between July 2010-December 2013. At the pre-specified interim analysis, 82 participants progressed to CNV, 51 in the device arm and 31 in the standard care arm. The primary analysis achieved statistical significance with the participants in the device arm demonstrating a smaller decline in visual acuity with fewer letters lost from baseline to CNV detection (median (interquartile range [IQR]):−4 [−11.0, −1.0] letters) compared with standard care (median [IQR]:−9 [−14.0, −4.0] letters) (p=0.021), resulting in better visual acuity at CNV detection in the device arm. The Data and Safety Monitoring Committee recommended early study termination for efficacy. Conclusions Persons at high risk for developing CNV benefit from the home monitoring strategy for earlier detection of CNV development which increases the likelihood of better visual acuity results following intravitreal anti-VEGF therapy.

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“…This has led to the development of a home device, after several modifications to the original device, including reduction in its physical size; enclosure of the screen viewer in a closed hood in order to control distance from the display, ambient light conditions, and occlusion of the non-tested eye; and addition of infrared sensors to ensure correct positioning of the head [55]. This device was evaluated in a phase III, unmasked, randomized clinical trial: the HOME (Home Monitoring of the Eye) study [56].…”

Section: Reviewmentioning

confidence: 99%

Early detection of age related macular degeneration: current status

Schwartz

Loewenstein

2015

Int J Retin Vitr

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Early diagnosis and treatment of choroidal neovascularization (CNV), a main cause of severe vision loss in age related macular degeneration (AMD), is crucial in order to preserve vision and the quality of life of patients. This review summarizes current literature on the subject of early detection of CNV, both in the clinic setting and mainly in the patient’s home. New technologies are evolving to allow for earlier detection and thus vision preservation in AMD patients.

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Toward Earlier Detection of Choroidal Neovascularization Secondary to Age-Related Macular Degeneration

Abstract: A home device preferential hyperacuity perimeter has good sensitivity and specificity in discriminating between patients with newly diagnosed CNV and intermediate AMD. Sensitivity is not dependent on lesion characteristics.

Cited by 42 publications

References 24 publications

Metamorphopsia: An Overlooked Visual Symptom

Metamorphopsia: An Overlooked Visual Symptom

Randomized Trial of a Home Monitoring System for Early Detection of Choroidal Neovascularization Home Monitoring of the Eye (HOME) Study

Early detection of age related macular degeneration: current status

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