Perspectives on remote patient monitoring with self-operated OCT for management of neovascular age-related macular degeneration

ABSTRACT

Introduction

Neovascular age-related macular degeneration (AMD) is one of the most common causes of blindness among the elderly population. Treatment adherence requires frequent and sometimes unnecessary follow-up clinic visits that might contribute to physician, patient and caregiver burdens, especially, nowadays, when the elderly population is apprehensive about physically attending the ophthalmology clinic. Daily patient self-imaging with automated artificial intelligence-based OCT image analysis permits detailed characterization of the dynamics of fluid exudation and treatment response and facilitates treatment adherence. Metrics describing the temporal fluid volume dynamics may become important disease biomarkers. Home OCT telemedicine systems represent an alternative paradigm of disease monitoring; they may allow highly personalized retreatment decisions, with fewer unnecessary injections and clinic visits as well as well-founded selection of drug and drug delivery method.

Areas covered

This review will discuss recent progress in home OCT monitoring, its role in quantification of disease biomarkers, the mode of operation of these type of devices and what is required for such a system to operate successfully.

Expert opinion

In our opinion, various models of AI, machine learning and telemedicine will be implemented into medicine and will be feasible in the near future.

KEYWORDS:

• Telemedicine
• oct
• NV-AMD
• biomarker
• artificial intelligence
• personalized medicine

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Article highlights

• Remote monitoring systems, like the Notal OCT Analyzer, have proven to be as accurate as human graders in quantification and localization of retinal fluid volume among NV-AMD patients

• The cumulative fluid volume may clarify differences in visual acuity outcomes between eyes

• The self-operated monitoring system combined with telemedicine may facilitate a personalized model of care and patient adherence.

• Cooperation between clinicians and remote monitoring provider companies is crucial in the implementation of remote monitoring

• Despite technological and financial barriers, various models of AI, machine learning and telemedicine are feasible and will be implemented in the future

Declaration of interest

A Loewenstein has been a consultant for Allergan, Beyer, Beyeonics, Notal Vision, Roche and Web MD, and has received grants from Novartis and Roche. T Keenan is a co-inventor on a patent application (‘Methods and systems for predicting rates of progression of age-related macular degeneration’). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.