Smartphone-based remote monitoring of vision in macular disease enables early detection of worsening pathology and need for intravitreal therapy

Islam, Meriam; Sansome, Stafford; Das, Rakesh; Lukić, Marko; Teo, Kelvin Yi Chong; Tan, Gavin Sw; Balaskas, Konstantinos; Thomas, Peter; Bachmann, Lucas M.; Schimel, Andrew M.; Sim, Dawn A

doi:10.1136/bmjhci-2020-100310

Cited by 17 publications

(16 citation statements)

References 17 publications

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“…Home vision monitoring with portable devices and smartphone-based apps has shown potential for common medical retinal disease. 13,18,19 The Notal Vision Foresee Home was shown to pick up more patients converting from dry AMD to nAMD than office visits. 20 Shape discrimination hyperacuitybased apps have also been used to detect fellow-eye conversion to nAMD.…”

Section: Discussionmentioning

confidence: 99%

“…9 Digital technologies, such as home vision monitoring devices and smartphone-based apps, have recently enabled reliable monitoring of visual function for patients with common retinal disease, allowing earlier disease detection and treatment. [10][11][12][13] In contrast to passive monitoring, solutions that encourage active patient engagement may lead to improved health outcomes. 14,15 It is reasonable to infer that an app that increases patient engagement through reminders may lead to improved compliance and clinical outcomes.…”

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confidence: 99%

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Enablers and Barriers to Deployment of Smartphone-Based Home Vision Monitoring in Clinical Practice Settings

et al. 2022

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IMPORTANCETelemedicine is accelerating the remote detection and monitoring of medical conditions, such as vision-threatening diseases. Meaningful deployment of smartphone apps for home vision monitoring should consider the barriers to patient uptake and engagement and address issues around digital exclusion in vulnerable patient populations.OBJECTIVE To quantify the associations between patient characteristics and clinical measures with vision monitoring app uptake and engagement. DESIGN, SETTING, AND PARTICIPANTSIn this cohort and survey study, consecutive adult patients attending Moorfields Eye Hospital receiving intravitreal injections for retinal disease between May 2020 and February 2021 were included.EXPOSURES Patients were offered the Home Vision Monitor (HVM) smartphone app to self-test their vision. A patient survey was conducted to capture their experience. App data, demographic characteristics, survey results, and clinical data from the electronic health record were analyzed via regression and machine learning.MAIN OUTCOMES AND MEASURES Associations of patient uptake, compliance, and use rate measured in odds ratios (ORs). RESULTSOf 417 included patients, 236 (56.6%) were female, and the mean (SD) age was 72.8 (12.8) years. A total of 258 patients (61.9%) were active users. Uptake was negatively associated with age (OR, 0.98; 95% CI, 0.97-0.998; P = .02) and positively associated with both visual acuity in the better-seeing eye (OR, 1.02; 95% CI, 1.00-1.03; P = .01) and baseline number of intravitreal injections (OR, 1.01; 95% CI, 1.00-1.02; P = .02). Of 258 active patients, 166 (64.3%) fulfilled the definition of compliance. Compliance was associated with patients diagnosed with neovascular age-related macular degeneration (OR, 1.94; 95% CI, 1.07-3.53; P = .002), White British ethnicity (OR, 1.69; 95% CI, 0.96-3.01; P = .02), and visual acuity in the better-seeing eye at baseline (OR, 1.02; 95% CI, 1.01-1.04; P = .04). Use rate was higher with increasing levels of comfort with use of modern technologies (β = 0.031; 95% CI, 0.007-0.055; P = .02). A total of 119 patients (98.4%) found the app either easy or very easy to use, while 96 (82.1%) experienced increased reassurance from using the app.CONCLUSIONS AND RELEVANCE This evaluation of home vision monitoring for patients with common vision-threatening disease within a clinical practice setting revealed demographic, clinical, and patient-related factors associated with patient uptake and engagement. These insights inform targeted interventions to address risks of digital exclusion with smartphone-based medical devices.

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Enablers and Barriers to Deployment of Smartphone-Based Home Vision Monitoring in Clinical Practice Settings

et al. 2022

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“…92 Home OCTs and smart phone apps measuring vision, contrast sensitivity, ocular alignment, subretinal fluid, and metamorphopsia may be used for at-home monitoring and earlier detection of disease. [93][94][95] Fundus photographs, slit lamp photography, laser flare photometry, fluorescein angiography, OCTs, and OCTAs can be obtained with minimally trained staff, be remotely operated, or be self-operated. 93,96 Artificial intelligence (AI) or a remote screener can help evaluate the images.…”

Section: Teleophthalmologymentioning

confidence: 99%

Ocular and Systemic Complications of COVID-19: Impact on Patients and Healthcare

Leung¹,

Fan²,

Flynn³

et al. 2022

OPTH

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There is increasing information available about the effects of the SARS-CoV-2 virus on the systemic and ocular health of patients, as well as the effects of delayed health care. This mini-review summarizes the potential complications and treatments of COVID-19. Systemic findings include respiratory illness, risk of thromboembolic events, and neurologic findings. Some patients may develop persistent symptoms even after the infection resolves. Effective treatment options include glucocorticoids, antivirals, interleukin-6 antagonists, monoclonal antibodies, Janus kinase inhibitors and vaccines. Potential ocular findings of COVID-19 include conjunctivitis, cranial nerve palsies, and microvascular changes in the retina; most symptoms resolved over time. During the lockdown periods, teleophthalmology was utilized to triage non-urgent issues; patients who did present to emergency departments tended to have more severe disease with worse visual prognoses. While transient delays in outpatient ophthalmic care may be tolerated in some patients, others experienced significant vision loss with interruptions in treatments. Resumption of ophthalmic care as soon as possible may help mitigate the effects of delayed care due to the pandemic.

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“…However, applications using this system do not seem to have a PPV that is better than that found for Odysight ® in the present study; for instance, it is higher than that reported by Teo et al, who found an indication of intravitreal injection in only 5/33 alerts in a study evaluating the Alleye ® application [ 21 ]. Other studies do report higher PPV, but the 60% PPV found by Islam et al for the indication of reinjection was greatly overestimated because only those who had both an alert on the Alleye ® application and who had experienced a visual loss during the first UK lockdown due to COVID-19 were seen in consultation (i.e., only 28 patients of the total of 78 patients with an analyzable alert) [ 22 ]. In addition, the 80% PPV reported by Faes et al for the indication of reinjection following an alert triggered by Alleye ® is also overestimated, as the follow-up appointment was not brought forward in case of an alert, alerts with extreme variations in score were not considered, and only patients performing the test once or more times a week were included [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Real-Life Value of the Odysight® Application in At-Home Screening for Exudative Recurrence of Macular Edema

Kielwasser

Kodjikian

Dot

et al. 2022

JCM

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Background: The aim of this study was to describe the value of the Odysight® application in addition to a classical follow-up regimen in the detection of exudative recurrences in patients with macular edema. Methods: We conducted an observational, multicenter, retrospective study. The Odysight® application includes a visual acuity (VA) test that can lead to alerts in case of a drop of >5 VA letters on two successive tests. The efficacy of the alerts in detecting exudative recurrence was studied. Results: A total of 149 eyes of 123 patients were included. The sensitivity of alerts for the detection of recurrence was 30.8% (95% CI [17.6; 44.0]) and its specificity was 83.7% (95% CI [73.2; 94.3]. A better baseline VA was found to be significantly associated with a better retention of the application (OR = 0.05, 95% CI [0.002; 0.62]; p = 0.045). Of the 12/39 alerts that detected a recurrence, eight (20.5% of all alerts) resulted in the scheduling or advancement of an intravitreal injection. Conclusions: In the present study, the sensitivity and positive predictive value of the Odysight® application seems low but its use in addition to the usual follow-up of the patient can detect, in certain cases, an early recurrence and thus allow an anticipated readjustment of the treatment.

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Smartphone-based remote monitoring of vision in macular disease enables early detection of worsening pathology and need for intravitreal therapy

Cited by 17 publications

References 17 publications

Enablers and Barriers to Deployment of Smartphone-Based Home Vision Monitoring in Clinical Practice Settings

Enablers and Barriers to Deployment of Smartphone-Based Home Vision Monitoring in Clinical Practice Settings

Ocular and Systemic Complications of COVID-19: Impact on Patients and Healthcare

Real-Life Value of the Odysight® Application in At-Home Screening for Exudative Recurrence of Macular Edema

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