CTS 2024: Home OCT and AMD monitoring

Christina Weng, MD, spoke with us about her presentation on the emerging technology of home OCT and its role in AMD. She gave this presentation at Clinical Trials at the Summit meeting being held in Park City, Utah on June 8, 2024.

Video Transcript:

Editor's note: The below transcript has been lightly edited for clarity.

David Hutton:

I'm David Hutton of Ophthalmology Times. Clinical Trials at the Summit is being held this year in Park City, Utah. Dr. Christina Weng made a presentation at the conference and is joining us today to discuss her topic. Thank you so much for joining me. Tell us about the key points in your presentation and their implications in ophthalmology.

Christina Weng, MD:

Thanks, David. First of all, for having me today. I'm honored to be part of the Clinical Trials at the Summit meeting again this year. And before I start, I want to give special kudos to Arshad Khanani, who founded the organization in 2021. Along with Peter Kaiser and Jeff Heier who brought it to such success in just a few short years.

As you said, at this year's meeting, I spoke about a really exciting, emerging technology called home OCT, and how it could transform the way we manage wet macular degeneration. As many of the viewers probably have heard about recently, the Notal Vision home OCT was just approved by the FDA a few weeks ago. And this is a first in class AI-supported device that allows patients to self capture high-resolution 3x3 OCT scans from the comfort of their own home. And even though this device is newly approved, it's actually been around for quite some time. And there have been smaller studies that have shown that; A: the device is accurate and its detection of fluid, and B: Can be easily operated by the vast majority of patients. And so all of that is promising, but what we don't have yet is a prospective large scale trial to evaluate whether home OCT can be utilized to guide wet AMD management in a more personalized way. And hence the birth of Protocol AO from the DRCR retina network, which launched at the top of 2024.

So Protocol AO is a multicenter, randomized clinical trial that will randomize 600 treatment naive eyes with wet AMD into one of two groups; They'll either be randomized to treat and extend or to a home OCT guided arm, where patients scan their eyes daily and only return to the clinic if fluid is detected. All eyes will receive faricimab. And the co-primary outcomes will be the main change in visual acuity and the number of injections at 2 years. And David I think this study is going to be critical for answering really 2 primary questions. The first is, is home OCT guided treatment better than what we're doing now? That's really key. I mean, using home OCT to tailor treatment to an individual patient's needs, could reduce the injection burden, or alternatively, could lead to better visual acuity outcomes. We don't know yet. But we'll find out. And then the second question I think this trial is going to answer for us is whether home OCT is practical and scalable to be used sort of on a wider scale. And based on the limited data so far, we can't say whether issues like patient compliance, workflow integration and financials will stand in the way of our adoption of home OCT. What we can say is that in the limited study so far that we have, patients who have scanned very well, they've scanned 5 to 6 plus times per week. And actually, the AI platform seems to be doing a lot of the heavy lifting in terms of image interpretation, which is a concern that I've heard amongst others. There's also some CPT codes that are in place for review of images every 30 days. So bottom line, home OCT is a disruptive technology. And if there really is a benefit to our patients, I think we're going to figure out a way to integrate it into our workflow.

David Hutton:

Ultimately, how could this impact ophthalmology, from ophthalmologists to the patients they treat?

Christina Weng, MD:

You know, David, we talk all the time about personalized medicine and yet we're just not quite there yet. As you know, the vast majority of American retina specialists utilize treat and extend which is effective, but does run the risk of over treating some patients and under treating others. So the way I see it is that home OCT takes us really one step closer to achieving truly personalized care where each patient gets injected exactly when, and only when they need it. So super exciting. Stay tuned for for data to come over the next few years.