Home-monitoring tests lack satisfactory diagnostic accuracy to identify neovascular age-related macular degeneration:JAMA

A recent study found home-monitoring tests as a potential solution to reduce the burden of neovascular age-related macular degeneration (nAMD) on patients and healthcare systems. The study published in the Journal of American Medical Association evaluated three such tests and found that they may not be as effective as hoped.

This study assessed the diagnostic accuracy of three vision home-monitoring tests when compared to traditional hospital follow-up for detecting active nAMD. The tests evaluated were the KeepSight Journal (KSJ), the MyVisionTrack (mVT) app and the MultiBit (MBT) app. This research was conducted across six UK hospital eye clinics and included a total of 297 patients who were over 50 years, with at least one eye treated for active nAMD. The participants were asked to perform the home-monitoring tests weekly, with mVT and MBT scores automatically transmitted, while KSJ scores were returned to the research office every 6 months.

Despite the potential promise of these home-monitoring tools, the results were not very promising. The study highlighted that the estimated area under the receiver operating characteristic curve (AUROC) for all three tests was less than 0.6. None of the tests demonstrated satisfactory diagnostic accuracy for identifying active nAMD when compared to in-hospital ophthalmologist examination.

Of the 3 tests evaluated, only the KSJ summary score showed association with lesion activity. But, even this association was not strong enough to provide reliable detection of active nAMD. These findings have significant implications for the management of nAMD. While home-monitoring tests may offer convenience and reduce the burden on patients and caregivers, their limited accuracy points that they may not be suitable as standalone diagnostic tools.

The study illuminates the importance of continued research and innovation in the field of nAMD monitoring. While home-monitoring tests may not be ready for widespread clinical use, the ongoing advancements in technology and healthcare delivery may eventually lead to more effective solutions. The patients and clinicians must remain cautious and rely on the established methods for monitoring and managing nAMD. While the promise of home-monitoring tests remains, further research and extensive studies are needed to ensure their reliability and effectiveness in clinical practice.

Reference:

Hogg, R. E., Sivaprasad, S., Wickens, R., O’Connor, S., Gidman, E., Ward, E., Treanor, C., Peto, T., Burton, B. J. L., Knox, P., Lotery, A. J., Donnelly, M., Rogers, C. A., & Reeves, B. C. (2024). Home-Monitoring Vision Tests to Detect Active Neovascular Age-Related Macular Degeneration. In JAMA Ophthalmology. American Medical Association (AMA). https://doi.org/10.1001/jamaophthalmol.2024.0918