Technology Allows for Earlier Detection of Eye Conditions

Improvements in technology are allowing for earlier detection of eye conditions and therefore improvements in outcomes, according to 2 presentations at the American Society of Retina Specialists 40th Annual Scientific Meeting, held July 13-16, 2022, in New York, New York.

Few patients who convert to neovascular age-related macular degeneration (nAMD) are detected early when their vision is still excellent, explained Michael J. Elman, MD, of Elman Retina Group. Since it is known that conversion to nAMD results in poor long-term outcomes, Elman and his colleagues sought to understand whether a remote monitoring model for early detection could result in better outcomes.

The model involved the home-based testing supported by a monitoring center with regular physician care. The home test was a preferential hyperacuity perimetry test performed by the ForeseeHome device, which the patient used to test on a regular basis. The results of the test were automatically uploaded for analysis. Clinicians responded to any alerts from the device regarding conversion to nAMD in addition to conducting routine checkups. The monitoring center ensured patients could get onto the program, as well as continued compliance with it.

Elman and colleagues conducted a retrospective study of more than 2000 patients and 3000 eyes across 5 practice sites in the ALOFT Study. The data was analyzed for 10 years (August 2010-July 2020).

“The visual outcomes were extraordinary,” Elman said. Median visual acuity when nAMD conversion was detected was 20/39 and 20/32 after treatment and at the most recent visit. The mean visual acuity at baseline was 20/30 for the ForeseeHome group compared with 20/32 for patients on standard of care.

At conversion, the mean visual acuity was 20/39 for the ForeseeHome patients compared with 20/83 for the standard of care group. This represents nearly a twofold difference in the visual acuity and conversion of patients on the ForeseeHome program, Elman said.

Patient compliance with the program was also high. There was a mean (SD) of 5.2 (3.4) tests performed weekly, which was consistent across the testing period of 10 years.

The average number of injections was similar between the 2 groups after detection of nAMD. However, he noted that early detection among ForeseeHome patients “prevents several months of undertreatment” and that “patients with good vision also remained on treatment longer.”

Ultimately, the model allowed clinicians to catch nAMD sooner and improve outcomes for patients. Nearly twice as many patients on ForeseeHome monitoring kept functional vision.

“This is a proven model that can be extended for other remote care monitoring applications,” he concluded.

During a question and answer period, someone asked why this program hasn’t taken off more, to which Elman pointed out the challenge with reimbursement. “I don’t get paid for reviewing” the results of the ForeseeHome tests.

Another presentation provided a look at how teleophthalmology provided earlier access to eye care for patients with diabetes. Parisa Emami-Naeni, MD, MPH, assistant professor of ophthalmology at University of California, Davis, and vitreoretinal surgeon and uveitis specialist at UC Davis Eye Center, presented the findings of a study using the OptumLabs Data Warehouse to analyze the time to initial eye screening among patients with newly diagnosed diabetes.

Since diabetic retinopathy is the most common cause of vision loss and disability among older adults in the United States, the American Academy of Ophthalmology recommends a dilated eye exam soon after a diabetes diagnosis, she explained. However, research has shown that only 30% to 40% of patients with newly diagnosed diabetes get an eye exam in the first year after their diagnosis.

The study included more than 180,000 individuals with claims from 2011 to 2020. Emami-Naeni and her colleagues found that only 22% of individuals with a new diabetes diagnosis had received any type of eye exam within the first year and less than 1% of these exams were done via teleimaging.

While overall teleophthalmology increased during this time period, there was a decrease in insurance coverage with the proportion of claims paid dropping from 88% in 2011 to 65% in 2020. This decrease also disproportionately affected vulnerable populations, such as the elderly (≥65 years), females, Black patients, and people with lower household income.

However, patients who received teleophthalmology received their first exam faster. The median time to first eye exam was 2.0 months for those receiving teleophthalmology compared with 3.4 months for those receiving in-person eye exams.

“Interestingly, 1 out of 3 remote imaging was done at the same time of diabetes diagnosis in the [primary care physician] office or endocrinologist office,” Emami-Naeni said. When those individuals who received same-day eye exams were excluded, the time to exam was the same time between the 2 groups.

Overall, while teleophthalmology can decrease barriers to access to care and improve timing of eye examination, barriers to more widespread use of teleophthalmology still exist, she concluded.