1
|
Kielwasser G, Kodjikian L, Dot C, Burillon C, Denis P, Mathis T. Real-Life Value of the Odysight ® Application in At-Home Screening for Exudative Recurrence of Macular Edema. J Clin Med 2022; 11:jcm11175010. [PMID: 36078941 PMCID: PMC9457015 DOI: 10.3390/jcm11175010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 11/28/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Gauthier Kielwasser
- Service d’Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
- Service d’Ophtalmologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69003 Lyon, France
| | - Laurent Kodjikian
- Service d’Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
- Laboratoire UMR-CNRS 5510 Matéis, 69100 Villeurbanne, France
| | - Corinne Dot
- Service d’Ophtalmologie, Hôpital D’instruction des Armées Desgenettes, 69003 Lyon, France
| | - Carole Burillon
- Service d’Ophtalmologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69003 Lyon, France
| | - Philippe Denis
- Service d’Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Thibaud Mathis
- Service d’Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
- Laboratoire UMR-CNRS 5510 Matéis, 69100 Villeurbanne, France
- Correspondence: ; Tel.: +33-(0)-4-26-10-93-21
| |
Collapse
|
2
|
von der Burchard C, Sudkamp H, Tode J, Ehlken C, Purtskhvanidze K, Moltmann M, Heimes B, Koch P, Münst M, Vom Endt M, Kepp T, Theisen-Kunde D, König I, Hüttmann G, Roider J. Self-Examination Low-Cost Full-Field Optical Coherence Tomography (SELFF-OCT) for neovascular age-related macular degeneration: a cross-sectional diagnostic accuracy study. BMJ Open 2022; 12:e055082. [PMID: 35760534 PMCID: PMC9237881 DOI: 10.1136/bmjopen-2021-055082] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 05/04/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Self-Examination Low-Cost Full-Field Optical Coherence Tomography (SELFF-OCT) is a novel OCT technology that was specifically designed for home monitoring of neovascular age-related macular degeneration (AMD). First clinical findings have been reported before. This trial investigates an improved prototype for patients with AMD and focusses on device operability and diagnostic accuracy compared with established spectral-domain OCT (SD-OCT). DESIGN Prospective single-arm diagnostic accuracy study. SETTING Tertiary care centre (University Eye Clinic). PARTICIPANTS 46 patients with age-related macular degeneration. INTERVENTIONS Patients received short training in device handling and then performed multiple self-scans with the SELFF-OCT according to a predefined protocol. Additionally, all eyes were examined with standard SD-OCT, performed by medical personnel. All images were graded by at least 2 masked investigators in a reading centre. PRIMARY OUTCOME MEASURE Rate of successful self-measurements. SECONDARY OUTCOME MEASURES Sensitivity and specificity of SELFF-OCT versus SD-OCT for different biomarkers and necessity for antivascular endothelial growth factor (anti-VEGF) treatment. RESULTS In 86% of all examined eyes, OCT self-acquisition resulted in interpretable retinal OCT volume scans. In these patients, the sensitivity for detection of anti-VEGF treatment necessity was 0.94 (95% CI 0.79 to 0.99) and specificity 0.95 (95% CI 0.82 to 0.99). CONCLUSIONS SELFF-OCT was used successfully for retinal self-examination in most patients, and it could become a valuable tool for retinal home monitoring in the future. Improvements are in progress to reduce device size and to improve handling, image quality and success rates. TRIAL REGISTRATION NUMBER DRKS00013755, CIV-17-12-022384.
Collapse
Affiliation(s)
| | | | - Jan Tode
- Department of Ophthalmology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- Department of Ophthalmology, Hannover Medical School, Hannover, Germany
| | - Cristoph Ehlken
- Department of Ophthalmology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | | | | | - Britta Heimes
- Department of Ophthalmology, St. Franziskus-Hospital, Münster, Germany
| | - Peter Koch
- Medical Laser Center Lübeck GmbH, Lübeck, Germany
| | | | | | - Timo Kepp
- Medical Laser Center Lübeck GmbH, Lübeck, Germany
| | | | - Inke König
- Institute of Medical Biometry and Statistics, University of Lübeck, Lubeck, Germany
| | - Gereon Hüttmann
- Medical Laser Center Lübeck GmbH, Lübeck, Germany
- Institute of Biomedical Optics, University of Lübeck, Lubeck, Germany
| | - Johann Roider
- Department of Ophthalmology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| |
Collapse
|
3
|
von der Burchard C, Moltmann M, Tode J, Ehlken C, Sudkamp H, Theisen-Kunde D, König I, Hüttmann G, Roider J. Self-examination low-cost full-field OCT (SELFF-OCT) for patients with various macular diseases. Graefes Arch Clin Exp Ophthalmol 2021; 259:1503-1511. [PMID: 33346888 PMCID: PMC8166739 DOI: 10.1007/s00417-020-05035-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/22/2020] [Accepted: 11/28/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The treatment guidelines for many macular diseases rely on frequent monitoring with optical coherence tomography (OCT). However, the burden of frequent disease control leads to low therapy adherence in real life. OCT home monitoring would address this issue but requires an inexpensive and self-operable device. With self-examination low-cost full-field OCT (SELFF-OCT), our group has introduced a novel technology that may fulfill both requirements. In this pilot study, we report the initial experiences with a clinical prototype. METHODS Fifty-one patients with different macular diseases were recruited in a cross-sectional study. The most common diseases were age-related macular degeneration (AMD; 39/51), diabetic macular edema (DME; 6/51), and retinal vein occlusion (RVO; 3/51). Patients received a short training in device usage and then performed multiple self-scans with the SELFF-OCT device. For comparison, scans with a standard clinical spectral domain (SD-)OCT were taken. RESULTS After a brief training, 77% of the patients were able to successfully acquire images that were clinically gradable. No significant influence on success could be found for age (p = 0.08) or BCVA (p = 0.97). Relevant disease biomarkers in the most common retinal diseases could be detected. CONCLUSIONS SELFF-OCT was used successfully for retinal self-examination and in the future could be used for retinal home monitoring. Future improvements in technology are expected to improve success rates and image quality. TRIAL REGISTRATION The Trial was registered in the German Trial Register under the number DRKS00013755 on 14.03.2018.
Collapse
Affiliation(s)
- Claus von der Burchard
- Department of Ophthalmology, University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
| | - Moritz Moltmann
- Medical Laser Center Lübeck GmbH, Peter-Monnik-Weg 4, 23562, Lübeck, Germany
| | - Jan Tode
- Department of Ophthalmology, University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
- University Eye Hospital, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christoph Ehlken
- Department of Ophthalmology, University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Helge Sudkamp
- Medical Laser Center Lübeck GmbH, Peter-Monnik-Weg 4, 23562, Lübeck, Germany
| | - Dirk Theisen-Kunde
- Medical Laser Center Lübeck GmbH, Peter-Monnik-Weg 4, 23562, Lübeck, Germany
| | - Inke König
- Institute of Medical Biometry and Statistics, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Gereon Hüttmann
- Medical Laser Center Lübeck GmbH, Peter-Monnik-Weg 4, 23562, Lübeck, Germany
- Institute of Biomedical Optics, University of Lübeck, Peter-Monnik-Weg 4, 23562, Lübeck, Germany
| | - Johann Roider
- Department of Ophthalmology, University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| |
Collapse
|
4
|
Guigou S, Michel T, Mérité PY, Coupier L, Meyer F. Home vision monitoring in patients with maculopathy: Real-life study of the OdySight application. J Fr Ophtalmol 2021; 44:873-881. [PMID: 34024655 DOI: 10.1016/j.jfo.2020.09.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/19/2020] [Accepted: 09/30/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The goal of the present study was to analyze the implementation and clinical efficacy of OdySight, a mobile medical application for the remote monitoring of patients with maculopathy. MATERIALS AND METHODS In all, 60 patients with edematous maculopathies receiving traditional clinical treatment (PRN or Treat & Extend) were provided with OdySight to detect changes in visual acuity from home. To determine both the feasibility and reliability of the application, its use by patients (both testing and game play), as well as the processing of alerts by the clinical team, were analyzed during the first year. RESULTS The female-to-male ratio was 3:2, with a mean age of 64 years. 52% of patients presented with age-related macular degeneration, 31% with high myopia, 11% with retinal vein occlusion, and 6% with diabetic maculopathy. The conversion rate (defined as the percentage of patients completing at least one test following prescription) and the nine-month retention rate (percentage of active patients) were 61% and 24% respectively. Patients aged 50 to 70 years and those whose use of the app included game play represent 75% of active patients at 9 months. The 22 active patients performed 483 visual acuity tests, completed 1,667 game sessions, and underwent 77 in-person consultations. During the trial period, the clinical team processed 19 alerts, on average in fewer than 6 days. Decreases in visual acuity were detected with a sensitivity of 92% and specificity of 99%. DISCUSSION The use of connected and mobile devices today is widespread, as is interest in mobile medical applications. Long-term treatments for maculopathies can be a difficult burden to bear, both for patients and healthcare practitioners. Overcoming the challenges associated with the successful remote detection of recurrences thus represents a significant opportunity for improving patient care. The implementation of novel digital tools requires the cooperation of the clinical team as a whole, to both inform and motivate patients. OdySight demonstrates satisfactory detection rates, thanks to reliable and reproducible home testing, and can thus serve as a supplementary tool for patients whose consultations are often spaced several months apart. Implementation can be nonetheless improved by facilitating alert processing, a goal which necessitates active adaptation of clinical practices. In general, active patients were very satisfied with this personalized service. CONCLUSION Improved medical support, plus the amusing nature of the tests and games, both bolster long-term use of the OdySight app. The application allows for the remote monitoring of changes in visual acuity and affords patients and practitioners an added level of protection, particularly during long intervals between treatments and at the end of a treatment course. To ensure proper implementation, clinics should focus on reinforcing and modernizing the clinical pathway, from patient intake to the injection room.
Collapse
Affiliation(s)
- S Guigou
- Aix Vision, collectif P1,5, 44, avenue Maréchal-de-Lattre-de-Tassigny, 13090 Aix-en-Provence, France.
| | - T Michel
- Service d'ophtalmologie, centre hospitalier du pays d'Aix, Aix-en-Provence, France
| | - P-Y Mérité
- Aix Vision, collectif P1,5, 44, avenue Maréchal-de-Lattre-de-Tassigny, 13090 Aix-en-Provence, France
| | - L Coupier
- Service d'ophtalmologie, centre hospitalier du pays d'Aix, Aix-en-Provence, France
| | - F Meyer
- Aix Vision, collectif P1,5, 44, avenue Maréchal-de-Lattre-de-Tassigny, 13090 Aix-en-Provence, France
| |
Collapse
|
5
|
Ho AC, Heier JS, Holekamp NM, Garfinkel RA, Ladd B, Awh CC, Singh RP, Sanborn GE, Jacobs JH, Elman MJ, Loewenstein A, Eichenbaum DA. Real-World Performance of a Self-Operated Home Monitoring System for Early Detection of Neovascular Age-Related Macular Degeneration. J Clin Med 2021; 10:jcm10071355. [PMID: 33806058 PMCID: PMC8036735 DOI: 10.3390/jcm10071355] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 12/26/2022] Open
Abstract
The real-world performance of a home telemonitoring strategy (ForeseeHome AMD Monitoring System®, Notal Vision, Inc.,Manassas VA, USA) was evaluated and compared to the device arm of the AREDS2-HOME study among patients with intermediate AMD (iAMD) who converted to neovascular AMD (nAMD). All patients with confirmed conversion to nAMD who used the home monitoring system from 10/2009 through 9/2018 were identified by Notal Vision Diagnostic Clinic’s medical records. Selected outcome variables were evaluated, including visual acuity (VA) at baseline and at conversion, and change in visual acuity (VA) from baseline to time of conversion. In total, 8991 patients performed 3,200,999 tests at a frequency of 5.6 ± 3.2 times/week. The 306 eyes that converted from iAMD to nAMD over the study period (a 2.7% annual rate) were included in the analyses. There was a median (interquartile range) change of −3.0 (0.0–(−10.0)) letters among converted eyes, 81% [95% confidence interval (72–88%)] maintained a VA ≥ 20/40 at the time of conversion, while 69% of the conversion detections were triggered by system alerts. The real-world performance of an at-home testing strategy was similar to that reported for the device arm of the AREDS2-HOME study. The home telemonitoring system can markedly increase early detection of conversion to nAMD.
Collapse
Affiliation(s)
- Allen C. Ho
- Wills Eye Hospital, 840 Walnut St., Philadelphia, PA 19107, USA;
| | - Jeffrey S. Heier
- Ophthalmic Consultants of Boston, 50 Staniford St., Ste. 600, Boston, MA 02114, USA;
| | - Nancy M. Holekamp
- Pepose Vision Institute, 1815 Clarkson Road, Chesterfield, MO 63124, USA;
| | | | - Byron Ladd
- Virginia Eye Institute, 6946 Forest Ave Suite 100, Richmond, VA 23230, USA;
| | - Carl C. Awh
- Tennessee Retina, 345 23rd Avenue North, Suite 350, Nashville, TN 37203, USA;
| | - Rishi P. Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, i-32, Cleveland, OH 44106, USA;
| | - George E. Sanborn
- Notal Vision, 7717 Coppermine Dr., Manassas, VA 20109, USA; (G.E.S.); (J.H.J.)
| | - Jennifer H. Jacobs
- Notal Vision, 7717 Coppermine Dr., Manassas, VA 20109, USA; (G.E.S.); (J.H.J.)
| | - Michael J. Elman
- Elman Retina, 7671 Quarterfield Rd #100, Glen Burnie, MD 21061, USA;
| | - Anat Loewenstein
- Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv 6209105, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence:
| | - David A. Eichenbaum
- Retina Vitreous Associates of Florida, 4344 Central Ave, St. Petersburg, FL 33711, USA;
| |
Collapse
|