ASRS’s Journal of Vitreoretinal Diseases (JVRD) Author’s Forum

Clinical Use of Home OCT Data to Manage Neovascular Age-Related Macular Degeneration

• American Society of Retina Specialists (ASRS)

Share episode

On this episode of the JVRD Author’s Forum podcast, Dr. Jeffrey Heier of Ophthalmic Consultants of Boston discusses ‘Clinical Use of Home OCT Data to Manage Neovascular Age-Related Macular Degeneration,' published in the March/April 2025 issue of JVRD.

Host Dr. Timothy Murray and Dr. Heier discuss the clinical use of home optical coherence tomography (OCT) for managing patients with neovascular age-related macular degeneration (AMD). Dr. Heier shares study findings showing that 42% of patients would have had a different treatment decision based on home OCT monitoring, highlighting the technology’s potential to catch fluid recurrence earlier and safely extend treatment intervals, from an average of 8 weeks to over 15 weeks. They also discuss the high usability of home OCT devices, with over 95% of patients successfully setting up and using the device independently. The conversation underscores how home OCT can improve outcomes, reduce undertreatment, and drive meaningful cost savings.

For more information, visit www.ASRS.org/JVRDForum.

Welcome to ASRS’s Journal of Vitreoretinal Diseases (JVRD) Author’s Forum. JVRD is the official scientific peer-reviewed journal of the American Society of Retina Specialists (ASRS), offering the highest quality and most impactful research and clinical information in the field. Join host Dr. Timothy Murray, Editor-in-Chief for JVRD, as he discusses cutting-edge developments featured in JVRD with the lead authors who share clinical pearls and explore their significance for advancing patient care.

SPEAKER_00:

Welcome to ASRS's Journal of Veterinal Diseases Authors Forum. I'm your host, Dr. Timothy Murray, editor-in-chief of JVRD. On each episode of the JVRD Authors Forum, I will interview innovative retinal researchers on their studies featured only in JVRD and how these studies will impact our patients' care in our clinics. Tune in to hear directly from investigators about the clinical implications of the newest and highest quality research in the field of retina. Welcome to JVRD's Author Forum podcast. It's my pleasure to be joined by my friend and colleague, Dr. Jeffrey Heyer from the Ophthalmic Consultants of Boston. Jeff has been a member of the executive committee for the ASRS for a decade. He's an outstanding director of the Veterinal Service and Retina Research for the OCB, and he will be discussing with us today clinical use of home OCT data to manage neovascular age-related macular degeneration. Welcome, Dr. Heyer. Thank you, Dr. Murray. Pleasure to be here. Always a pleasure to have you. Can you take me through a little bit of how you guys structured the manuscript and the study for our listeners?

SPEAKER_01:

Happy to. So as you know, Homo CT has the potential to be an extremely valuable tool for helping us to manage our macular degeneration patients. In this study, what we did is 15 retina specialists evaluated 29 patients, images that were obtained with the Homo CT and compared that to images that compare that to what was decided in clinical practice. And they looked at such issues as, would you have treated as was done in the clinical practice? Would you have held therapy? Would you have changed drugs? Would you have used the same intervals?

SPEAKER_00:

So Jeff, those are sort of the key things we deal with every day. So you have an incredibly busy practice. You're seeing 65 or 70 patients for injections a day. That's exactly what we do in the real time with our patients. So how are we going to be able to shift that technology to a home-based system?

SPEAKER_01:

Well, it's a great question, Tim. And the first thing to think about is we're making these decisions based on essentially single scans at a single point of time. And what the Homo CT offers us is the ability to monitor these patients over time. So patients image daily, and we can actually see from that how they respond to a treatment, when they have recurrent fluid, if they have recurrent fluid, Is that fluid variable? Does it start an increase and continued increase over time, telling us, hey, that's where we should look to treat these patients? Or is there variability in the fluid? And at least for parts of that, we don't need to treat them. So it would be valuable to help us to treat patients, especially as we look at all the advances that are being studied now in durable treatments, whether it's TKIs or gene therapy or longer-acting anti-VEGF agents. So

SPEAKER_00:

I think you and I have both felt many times that undertreatment is the major cause of lost vision over five- and ten-year windows of treatment. So you're thinking that this would allow the patient who needed to be treated earlier, who was on an extended follow-up, to be brought into the office earlier than they would have been scheduled for?

SPEAKER_01:

without a doubt, because yes, you and I have had this discussion. What happens when you've extended a patient, we've used treat and extend, and let's say that patient is now out to three months. What we often do is they're doing well. We continue to extend, right? We go 14, 16 weeks, six months. Well, We know that the large majority of these patients are going to recur somewhere in that time span. And if we don't capture that recurrence quickly, they lose vision. This will enable us to follow these patients and capture when they start to develop recurrent fluid and capture it hopefully before they're largely symptomatic or before they lose a significant amount of vision.

SPEAKER_00:

You know, my experience is it's often difficult for my patients to appreciate the reaccumulation of fluid. We ask them to look at an AMSA grid or monitor, you know, for the metamorphopsia, but typically they'll come in and they know something's not right, but they won't really have appreciated that. So this should direct us directly to a reaccumulation of fluid and a need for follow-up.

SPEAKER_01:

Yeah, you're exactly right, Tim. It's not uncommon to have patients come in and say, I'm doing well, and they have recurrent fluid, and you know that the vision was going to follow the anatomy. Similarly, it's not uncommon to have patients come in and say, I'm doing poorly, I'm losing vision, and the scan looks perfectly fine. both the patient and the clinician can have a level of comfort knowing that we're following this very sensitive biomarker of fluid.

SPEAKER_00:

So, Jeff, you know, people have had concerns within our field about the delivery of this technology and our patients' ability to use it. You've had some extensive experience. What are your thoughts on this?

SPEAKER_01:

Yeah, so there are a couple things that I've really been impressed with. First of all is the remarkable sensitivity and resolution of a home device. And we've all seen these images in the meetings, and they're really outstanding and enabling us to pick up even subtle amounts of fluid. The second thing that's been impressive is how easily patients ADAPT use of the HOMO-CT. So in several of the studies we performed, the test was the physician would determine who were the study patients. The monitoring center would then mail the device to the patients. And just through the instructions and possible interaction with the monitoring center, patients would have to see if they could use the device. In the study that resulted in FDA approval, different than this study we're showing here, over 95% of patients could set up and adapt to the use of the device without any outside help.

SPEAKER_00:

And then I think that we've identified that the cost potential to savings for our insurers and our patients greatly overweighs any concerns for the cost and maintenance of the device. Is that correct?

SPEAKER_01:

Well, it's certainly how I feel about it. If you look at the study that we were just talking about, with reviewing the patients, 42% of the patients would not have been treated as they were treated in clinical practice. So the potential savings of that is quite significant. Now, to be fair, there was another proportion who were treated earlier, treated a week or more earlier because the accumulation of fluid was such that they felt it would be better to treat them earlier. So it will enable us to not treat certain patients, to extend treatment in other patients. And overall, that will result in savings to the healthcare system, but it'll also result in savings of vision. There was a study where we looked at our ability to extend patients, and going into the study, the patients were treated on average every eight weeks, and based on decision-making from the home OCT, it extended to over 15 weeks.

SPEAKER_00:

Well, you know, from a retina specialty perspective, I think we are image-driven and really interested in incorporation of technology that both benefits our patients but enhances our care. So in many ways, this seems like just an extension of the impact of OCT in our clinics to our patients.

SPEAKER_01:

Yeah, right. We know that right now our best monitor of when and how to treat patients is based on OCT and historically office-based OCT. And that patients come in and we determine from that, are they leaking? Are they responding appropriately to the drug? Questions like step therapy, right? Are these drugs, is this a good drug for our patient? The Homo CT enables us to evaluate that on a much more dynamic ability, right? We're able to see how patients respond to therapy. We're able to see the responses of different drugs. We're able to see when they start to leak and what's the cadence of that leakage. Is it quick? meaning we really need to get them in immediately, or is it relatively slow and we have several days or a week to be able to treat them? So we determine the parameters that are resulting alerts to the clinician, and we're able to do that based on the individual patients.

SPEAKER_00:

And one of the things you and I know is that new technology really changes as we see its broader application. So I think you and I are both excited and I'd like you to thank you, Dr. Heyer, for joining us to talk about the clinical use of HOMO-CT data to manage neovascular AMD and also to drive our readership to your original manuscript. Thank you. Thanks for tuning in to the JVRD Authors Forum. You can watch and listen to more episodes on the ASRS YouTube channel and on popular podcast directories, including Apple Podcasts and Spotify. Visit www.asrs.org forward slash JVRD forum on the ASRS website to learn more. See you soon.