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AMD management – analysis of effectiveness in the detection of CNV following the integration of the foreseehome tele-monitoring system in the management of intermediate AMD patients

Session Details

Session Title: AMD I

Session Date/Time: Friday 12/09/2014 | 08:00-10:00

Paper Time: 09:20

Venue: Boulevard C

First Author: : A.Augustin GERMANY

Co Author(s): :                  

Abstract Details

Purpose:

Current monitoring strategies of Intermediate AMD for the detection of CNV typically result in treatment initiation when significant visual loss has already occurred and lesion size is significant. Both parameters have been demonstrated to affect treatment outcomes and it is therefore important to question the effectiveness of our current management of intermediate AMD and in particular the frequency and randomness of office visits scheduled to the entire intermediate AMD population. The purpose of this presentation is to report the effectiveness of different modalities as monitoring aids in the detection of CNV in the HOME study.

Setting:

44 AREDS2 clinical centers

Methods:

The HOME study, a randomized controlled clinical study, monitored prospectively 1520 participants with Intermediate AMD with a mean age of 72.5 years enrolled at 44 AREDS2 clinical centers. The study compared monitoring with standard care (which included routine office visits and monitoring for symptoms) to standard care combined with tele-monitoring with the ForeseeHome visual field system. In case of either device alert, clinical suspicion following routine visit or symptoms realization, FA and OCT were performed and the physician determined the presence of absence of CNV. Following the completion of HOME study visits, the office charts were reviewed and the number of total office visits during the study was recorded. The effectiveness of each of the three modalities for alerting for CNV in terms of the ratio between the numbers of CNV cases to the total number of visits generated by each of the three modalities was calculated. In addition in the case of the FSH device arm, the effectiveness of FSH alerts and symptoms combined (informed visits) was calculated. Visual acuity for each of the three modalities was determined as well.

Results:

4259 office visits occurred during the study and 82 CNV cases were detected. In the device arm, 1927 routine office visit were required to detect 14 CNV cases (1 CNV case per 138 office visits), 263 device alert visits were required to detect 26 CNV cases (1 CNV per 10visits) and 55 symptoms visits were required to detect 11 CNV cases (1 CNV per 5 visits). Three-hundred and eighteen (318) informed visits were required to detect 37 CNV cases (1 CNV per 9 visits) making them 16 times more effective than routine office visits in aiding in the detection of CNV. In the standard care arm 1949 routine office visit were required to detect 14 CNV cases (1 CNV case per 139 visits) and 65 symptom realization visits were required to detect 17 CNV cases (1 CNV per 4 visits). While both FSH alerts and symptom realization demonstrated improved effectiveness over routine office visits as aids in the detection of CNV, in the standard care arm symptom realization brought in patients with CNV when vision was significantly impaired compared to patients brought for informed visits in the device arm (11.5 letters vs. 3 letter loss from baseline, p=0.03).

Conclusions:

Random routine office visits have poor effectiveness in aiding the detection of CNV and result in worse visual acuity compared to home monitoring with the FSH device. This finding may suggest that in patients at risk for developing CNV who are monitored with the FSH, routine office burden may be reduced.

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