Digital healthcare evolves in the aftermath of the pandemic


At-home digital eye care technology is revolutionizing the way eye care is delivered and will play an increasingly important role in this area. Home digital eye care technology has the potential to significantly improve patient outcomes and satisfaction by improving patient convenience, access to care and self-management. (Adobe Stock/Proxima Studio)

The recent COVID-19 pandemic has led to an explosion of at-home digital technologies eye care professionals can incorporate into their practice.

Are these new devices beneficial? When should they be implemented? We explore new technologies that have emerged in recent years: the iCare HOME tonometer and Notal Vision’s ForeseeHome (FSH) monitoring device.

These tools allow patients to monitor and manage their eye health from home, greatly improving convenience, adherence, and access to care. Artificial intelligence technology is the wave of the future. It is the eye care provider’s responsibility to investigate the design, effectiveness, and clinical utility of each digital device.

The iCare HOME device is a handheld, battery-powered rebound tonometer that received FDA approval in March 2017. The latest version of iCare HOME2 received FDA approval in March 2022. The compact, portable and easy-to-use design allows patients to perform intraocular pressure (IOP) measurements at home.

With this iCare device, patients can obtain reliable IOP measurements without the need for local anesthesia and with minimal training. Of the subjects trained in self-measurement of intraocular pressure, 84% agreed that the device was easy to use and 91% agreed to use the device at home.1

Additionally, the new model features easy patient-doctor communication via the cloud-based software iCare CLINIC and daily monitoring via the PATIENT2 app. Through these Bluetooth-enabled software features, patients and clinicians have 24/7 access to all her recorded IOP data and diurnal variation in graphs on the app or web browser.

Physicians can rest assured that their patients have the proper training and certification before self-administering iCare HOME tonometry. Patients must pass a certification process before they can start using it at home. No further calibration or maintenance is required, and replacement probes can be easily purchased via a doctor’s prescription on her iCare website. Additionally, patients have easy access to customer service support.

These easy-to-use features give clinicians the confidence that their patients will be able to accurately measure IOP at home and that communications and alerts will be properly received. Rebound tonometers like the iCare HOME device have been shown to be comparable to Goldmann tonometers.2 This remains the gold standard for IOP measurement.

In a study comparing Goldmann tonometers to rebound tonometers, central corneal thickness equally affected IOP obtained from both rebound and applanation tonometers.3 Therefore, central corneal thickness measurements must be considered for accurate IOP measurements by either means.

Where is the iCare HOME digital application for intraocular pressure measurements most effective? Ideally, these intraday measurements will help you compare the effectiveness of glaucoma infusions and find the best glaucoma infusion regimen. It becomes clear whether glaucoma requires surgery or more aggressive treatment. Post-operative patients can be easily monitored without delay. It will also be invaluable for patients living in rural or remote areas with limited access to clinical care. At-home measurements are also essential during a pandemic. As digital eye care at home becomes more prevalent, more beneficial uses will emerge.

The FSH Amsler Grid is another FDA-cleared home monitoring device for the management and monitoring of age-related macular degeneration (AMD). This device is recommended for patients with moderate AMD and best corrected visual acuity (VA) her 20/60 or better, with the specific purpose of assisting in the detection of transition to choroidal neovascularization. Ideal patient candidates are those undergoing anti-VEGF therapy, those with wet AMD in one eye, monocular patients who are already blind due to neovascular AMD, and those considered high risk. .

Once a physician enrolls a patient for FSH monitoring, Notal Vision’s customer service representatives work closely with the patient from setup to troubleshooting and alerts. FSH devices give patients peace of mind knowing that test results are continuously monitored by the data center and clinician’s office.

For practitioners, the FSH report provides evidence of adherence and detects possible transition to wet AMD during the visit. If changes are detected, patients and clinicians are immediately alerted and an appointment is scheduled. In most cases, FSH is covered by the patient’s insurance along with a monthly co-payment.

FSH uses a patented technique called Preferred Hypervisual Perimetry (PHP) (commonly known as vernier vision), which allows the device to identify irregularities between two line segments or grids. measure the ability to This type of objective and reproducible detection helps detect changes in macular function with high sensitivity and specificity.

ophthalmic retina Recently, findings from an analysis of the long-term visual outcomes of the ForeseeHome Remote Remote Monitoring (ALOFT) study were published.

According to this retrospective study, from August 2010 to July 2020, 2123 patients from five referral retinal clinics were monitored with FSH devices to analyze FSH device adherence and actual visual effects. The study demonstrated an excellent adherence rate of 5.2 times per week on average and an average VA of 20/32 at conversion to wet AMD, with 84% of patients maintaining a VA of 20/40 or greater years after initiation of treatment was emphasized.Four

ALOFT emphasizes the importance of early detection for better long-term vision. The clinical utility of FSH was also established in the HOME (Home Monitoring of the Eye) study, part of the National Eye Institute-sponsored AREDS2 study, in which FSH progressing to wet AMD was treated weekly. 94% of patients on 2 uses maintained 20/40. Visual acuity improved by 1 or more, compared with only 62% of patients diagnosed during routine eye exams or symptom-attributed visits.Five

FSH self-monitoring serves as adjunctive home care that can strengthen the patient-physician relationship. Patients perceive positively that their physicians have embraced digital technology and may appreciate the autonomy of being able to monitor their disease from the comfort of their own home. In direct research, the PHP technology utilized by FSH far outperforms Amsler Grid.6 It has been shown to detect functional changes in patients with geographic atrophy and accurately detect indicators of neovascular AMD with >80% probability.Four It shows a significant improvement over the Amsler grid.

A study by Kampmeier and Botros revealed that the Amsler grid was comparable to PHP tests against early-to-mid AMD. However, the PHP test turned out to be a more reliable indicator for late-stage AMD. In their study, PHP detected disease-associated functional changes.
85% of patients with geographic atrophy vs. 62% of patients using Amsler grids.6 These clinical data are helpful in deciding which patients to enroll in FSH and clearly argue that FSH is more beneficial in later stages of AMD.

In conclusion, at-home digital eye care technology is revolutionizing the way eye care is delivered and may play an increasingly important role in this field. Home digital eye care technology has the potential to significantly improve patient outcomes and satisfaction by improving patient convenience, access to care and self-management.

Clinicians can help these supporting digital tools strengthen the patient-clinician relationship, deliver precision medicine, detect disease early, predict disease progression, and effectively treat sight-threatening conditions. I am in need of finding a place. To adapt new technologies, it is important to continue to rigorously review their accuracy, feasibility, room for improvement, and potential for future applications. It is up to the clinician to decide how to use these wisely.

References
1. PL Dabathia, JG Lawrenson, IE Murdoch. Evaluation of a new rebound tonometer for self-monitoring intraocular pressure. Br J ophthalmol. 2016;100(8):1139-1143. Doi: 10.1136/bjohalftalmol-2015-307674
2. Quérat L, Chen E. iCare Home vs Goldmann applanation tonometer: method agreement and comparison of inter-observer variability in tertiary ophthalmic centers. Eur J Ophthalmall. 2023;33(1):312-318. Doi: 10.1177/11206721221099252
3. Iliev ME, Goldblum D, Katsoulis K, Amstutz C, Frueh B. Comparison of rebound tonometer and Goldmann applanation tonometer and correlation with central corneal thickness. Br J Ophthalmole. 2006;90(7):833-835. Doi: 10.1136/bjo.2005.089870
4. Loewenstein A, Ferencz JR, Lang Y, et al. Towards early detection of choroidal neovascularization secondary to age-related macular degeneration: A multicenter evaluation of a prioritized sensitive perimeter designed as a home device. retina. 2010;30(7):1058-1064. Doi: 10.1097/IAE.0b013e3181d1a75e
5. Matthew M, Reddy S, Elman MJ, et al. Aloft study group. Analysis of Long-Term Visual Outcomes of ForeseeHome Remote Telemonitoring: ALOFT Study. Retinal ophthalmology. 2022; 6(10):922-929. doi:10.1016/j.oret.2022.04.016
6. Zorn MM, Kampmeyer J, Botros YT, Lang GE. A comparison of the preferential super visual perimeter (PHP) test and the Amsler grid test in diagnosing different stages of age-related macular degeneration. Invest in Ospheremol Vis Sci. 2005;46(13):240.



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