Use of Home-Based OCT for Neovascular AMD Could Lead to More Timely Treatment

A retrospective review of home-based optical coherence tomography (OCT) monitoring for neovascular age-related macular degeneration (AMD) found that treatment should have been performed earlier in more than half of the cases. The findings were presented last month at the American Academy of Ophthalmology meeting.

In this exclusive MedPage Today video, Paul Hahn, MD, PhD, of NJRetina in Teaneck, New Jersey, discusses the findings and what they mean for standard-of-care protocols.

Following is a transcript of his remarks:

This study that I presented at the Academy of Ophthalmology meeting was a study looking at home OCT. So as we know, OCT images provide really the backbone for a lot of our retina decisions that we perform every day in the office. Patients with retinal diseases often have fluid that we need to identify, and the OCT is the best way to identify that fluid.

But up until now, we’ve been limited to OCT performed in the office. All of our treatment protocols, our standard-of-care protocols, have evolved around treatment or imaging performed in the office, which has been helpful. But now we have an approved option of home OCT, and the purpose of our study was to see whether home OCT information would change our treatment paradigms.

So what we did was we looked at patients treated with standard of care, meaning OCT images performed in the office. Those patients were also receiving home OCT data, but their treatment decisions in the office were not based on those. In other words, the treating physicians did not have access to that home OCT data. But instead at the back end, we asked 15 retina specialists — different than the treating physicians — but 15 retina specialists, to review that home OCT data and try to identify if the treatment management would have been different than standard of care.

And briefly, we found that there were some differences. So in about 43% of cases, the retina specialist reviewing the home OCT data identified that a patient that received treatment at that time may not have required treatment, that they could have been delayed. And in the 57% of remaining cases, treatment should have been performed at that time or earlier. So in only one out of 150 cases did we identify that treatment given on the day of was actually recommended based on the home OCT data. And in the majority of those, 57%, patients should have been treated earlier.

So about 22% of those cases, patients were treated, or patients were recommended to have been treated about a week or shorter within the actual treatment timeframe. But in 35% of cases, treatment recommended by home OCT data was over a week earlier compared to standard of care.

So just kind of putting all that together, it tells us that our standard-of-care treatment paradigms may not be optimal based on home OCT data to treat the patient when they need treatment, either too early or too late.

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