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Home-Monitoring Vision Tests to Detect Active Neovascular Age-Related Macular Degeneration.
Hogg, Ruth E; Sivaprasad, Sobha; Wickens, Robin; O'Connor, Sean; Gidman, Eleanor; Ward, Elizabeth; Treanor, Charlene; Peto, Tunde; Burton, Ben J L; Knox, Paul; Lotery, Andrew J; Donnelly, Michael; Rogers, Chris A; Reeves, Barnaby C.
Afiliação
  • Hogg RE; Center for Public Health, Queen's University Belfast, Belfast, United Kingdom.
  • Sivaprasad S; NIHR Moorfields Biomedical Research Center, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.
  • Wickens R; Bristol Trials Center, University of Bristol, Bristol, United Kingdom.
  • O'Connor S; Center for Public Health, Queen's University Belfast, Belfast, United Kingdom.
  • Gidman E; Bristol Trials Center, University of Bristol, Bristol, United Kingdom.
  • Ward E; Bristol Trials Center, University of Bristol, Bristol, United Kingdom.
  • Treanor C; Center for Public Health, Queen's University Belfast, Belfast, United Kingdom.
  • Peto T; Center for Public Health, Queen's University Belfast, Belfast, United Kingdom.
  • Burton BJL; James Paget University Hospitals NHS Trust, Great Yarmouth, United Kingdom.
  • Knox P; University of Liverpool, Liverpool, United Kingdom.
  • Lotery AJ; Department of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
  • Donnelly M; Center for Public Health, Queen's University Belfast, Belfast, United Kingdom.
  • Rogers CA; Bristol Trials Center, University of Bristol, Bristol, United Kingdom.
  • Reeves BC; Bristol Trials Center, University of Bristol, Bristol, United Kingdom.
JAMA Ophthalmol ; 142(6): 512-520, 2024 Jun 01.
Article em En | MEDLINE | ID: mdl-38662399
ABSTRACT
Importance Most neovascular age-related macular degeneration (nAMD) treatments involve long-term follow-up of disease activity. Home-monitoring would reduce the burden on patients and their caregivers and release clinic capacity.

Objective:

To evaluate 3 vision home-monitoring tests for patients to use to detect active nAMD compared with diagnosing active nAMD at hospital follow-up during the after-treatment monitoring phase. Design, Setting, and

Participants:

This was a diagnostic test accuracy study wherein the reference standard was detection of active nAMD by an ophthalmologist at hospital follow-up. The 3 home-monitoring tests evaluated included the following (1) the KeepSight Journal (KSJ [International Macular and Retinal Foundation]), which contains paper-based near-vision tests presented as word puzzles, (2) the MyVisionTrack (mVT [Genentech]) vision-monitoring mobile app, viewed on an Apple mobile operating system-based device, and (3) the MultiBit (MBT [Visumetrics]) app, viewed on an Apple mobile operating system-based device. Participants were asked to test weekly; mVT and MBT scores were transmitted automatically, and KSJ scores were returned to the research office every 6 months. Raw scores between hospital follow-ups were summarized as averages. Patients were recruited from 6 UK hospital eye clinics and were 50 years and older with at least 1 eye first treated for active nAMD for at least 6 months or longer to a maximum of 42 months before approach. Participants were stratified by time since starting treatment. Study data were analyzed from May to September 2021. Exposures The KSJ, mVT, and MBT were compared with the reference standard (in-hospital ophthalmologist examination). Main Outcomes and

Measures:

Estimated area under receiver operating characteristic curve (AUROC). The study had 90% power to detect a difference of 0.06, or 80% power to detect a difference of 0.05, if the AUROC for 2 tests was 0.75.

Results:

A total of 297 patients (mean [SD] age, 74.9 [6.6] years; 174 female [58.6%]) were included in the study. At least 1 hospital follow-up was available for 312 study eyes in 259 participants (1549 complete visits). Median (IQR) home-monitoring testing frequency was 3 (1-4) times per month. Estimated AUROC was less than 0.6 for all home-monitoring tests, and only the KSJ summary score was associated with lesion activity (odds ratio, 3.48; 95% CI, 1.09-11.13; P = .04). Conclusions and Relevance Results suggest that no home-monitoring vision test evaluated provided satisfactory diagnostic accuracy to identify active nAMD diagnosed in hospital eye service follow-up clinics. Implementing any of these evaluated tests, with ophthalmologists only reviewing test positives, would mean most active lesions were missed, risking unnecessary sight loss.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Testes Visuais / Acuidade Visual / Degeneração Macular Exsudativa Limite: Aged / Aged80 / Female / Humans / Male Idioma: En Revista: JAMA Ophthalmol Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Reino Unido

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Testes Visuais / Acuidade Visual / Degeneração Macular Exsudativa Limite: Aged / Aged80 / Female / Humans / Male Idioma: En Revista: JAMA Ophthalmol Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Reino Unido