The power of home monitoring

Image provided by Christina Y. Weng, MD, MBA

As part of the Johns Hopkins Wilmer Eye Institute’s MACULA 2025 and the 5th Annual Retina Festival, Christina Y. Weng, MD, MBA, gave a presentation titled “Home Monitoring for Age-Related Macular Degeneration” (AMD). Sydney M. Crago, managing editor for Modern Retina, had the chance to speak with Weng following the event to learn more about this topic. In the interview, they discussed how the practice of home monitoring can impact the treatment burden of patients with AMD, how the technology may evolve in the coming years, and the benefits of daily retina monitoring.

The following interview has been lightly edited for clarity.

Sydney M. Crago: What would you say are the key takeaways from your presentation at this event?

Christina Y. Weng, MD, MBA: I spoke about the use of home optical coherence tomography [OCT] for wet AMD [age-related macular degeneration]. As many know, the Notal [Vision] home OCT was FDA approved last spring. It’s a compact AI [artificial intelligence]–assisted device that allows patients to self-obtain high-resolution OCT scans from the comfort of their own home. Basically, the way it works is that patients scan their eyes daily, which typically takes less than 45 seconds, and the OCT scans are stored in the cloud, where they’re interpreted by a proprietary and validated AI platform. Then the provider and staff are alerted if fluid is detected so that the patient can be brought in for evaluation and treatment.

What’s really neat is that while the AI platform does the heavy lifting in terms of image interpretation, the provider can remotely view the scans and data analytics at any time. As I alluded to, [data from] prior smaller studies have confirmed that the home OCT device is accurate in its detection of fluid and easily operated by this demographic of patients who, as you know, can be in their 80s and 90s. So really what we need now is a large-scale study that will assess whether home OCT can be used to revolutionize the way that we manage wet AMD, and that’s exactly what Protocol AO (NCT05904028), from the DRCR Retina Network [formerly known as Diabetic Retinopathy Clinical Research Network] seeks to do.

Protocol AO is a multicenter trial [that] will randomize 600 treatment-naive eyes with wet AMD into either a treat-and-extend regimen or home OCT–guided regimen. The co-
primary outcomes are mean change in visual acuity and the number of injections at 2 years. I’m honored to serve as the protocol chair and delighted that recruitment is underway because we will learn an incredible amount from this clinical trial.

As I alluded to, it could lead to a paradigm shift in the way that we manage wet AMD, and it brings us one step closer to truly personalized medicine. Additionally, we’ll gaininsights about how to incorporate this technology into our daily practice in terms of workflow integration.

Crago: As we’re discussing AMD monitoring, what specifically are retina specialists looking for in these images, or what results are they getting from these AI tools?

Weng: I’d say we’re looking for 2 things. The first is that we’re looking for evidence of disease activity so that we can customize treatment to an individual patient. The treatment schedule that most American retina specialists use today is treat and extend. Unfortunately, this approach results in overtreatment of some patients and undertreatment of others [because] we can’t currently gauge how patients are doing in between their office visits. With home OCT, we’re able to monitor patients remotely and treat them precisely when their fluid recurs.

The second thing we want from AMD monitoring is to detect conversion from dry to wet AMD as early as possible. We know that about 15% of patients with dry AMD will eventually convert to exudative disease, and [findings from] plenty of studies have shown that the single greatest predictor of their visual prognosis is their baseline visual acuity at the time of conversion. The bottom line is that earlier detection means earlier treatment, and it gives the patient the best chance to preserve their vision. In Protocol AO, we actually have an ancillary study running in parallel, which will monitor fellow eyes with dry AMD, and I think those results will also be very insightful.

Crago: You have discussed this briefly, but how can this home monitoring benefit patients and providers regarding treatment burden?

Weng: When I think about the goals of treatment of wet macular degeneration, it’s really to maximize visual acuity outcomes using the fewest number of injections and the fewest number of visits. Home OCT really helps us to achieve this because it allows us to inject patients when and only when they need treatment. So not only does this potentially decrease the treatment burden for patients by avoiding overtreatment, which, as I mentioned, can occur with fixed or treat-and-extend schedules, but…the fact that patients are also receiving active surveillance on a daily basis brings assurance and confidence to both patients and their providers; at least, that’s been my experience thus far.

Crago: Are there any additional AI technologies in this space in use or development that you wanted to mention or that others should be aware of?

Weng: The potential of AI in our space is really tremendous, and the advent of home OCT is just one example of how AI’s presence is growing. The incorporation of AI and imaging modalities is probably the furthest along at this point. For example, there are several AI systems approved for diabetic retinopathy screening, and AI is also being applied to fundus photographs and OCT images to do anything from predict[ing] a patient’s risk of developing geographic atrophy to quantifying volumes of retinal fluid. Of course, we’re still in the infancy of artificial intelligence, so it’s important to remember that there are several pragmatic issues that we’ll need to sort out, such as workflow integration, reimbursement models, and medical-legal implications. But I do believe that AI will enhance our ability to provide the best care for our patients moving forward. •

Christina Y. Weng, MD, MBA

Weng is an associate professor of ophthalmology and the Vitreoretinal Disease and Surgery Fellowship program director at Baylor College of Medicine in Houston, Texas. She has a faculty appointment at Ben Taub General Hospital, a level I trauma center in Houston. Weng graduated from Northwestern University in Evanston, Illinois, and attended medical school at the University of Michigan. While in Ann Arbor, she pursued a master of business administration degree from the University of Michigan Stephen M. Ross School of Business.

Weng completed her ophthalmology residency at the Wilmer Eye Institute, Johns Hopkins School of Medicine in Baltimore, Maryland, and her surgical retina fellowship at Bascom Palmer Eye Institute, University of Miami Health System in Florida. Weng is involved with multiple clinical trials, leads research studies in her areas of interest, and is coeditor of the book Women in Ophthalmology:
A Comprehensive Guide for Career and Life.

Disclosures: Alcon, Alimera Sciences, Allergan/AbbVie, Apellis, Carl Zeiss Meditec, DORC, EyePoint Pharmaceuticals, Genentech, Iveric Bio/Astellas, Novartis, Opthea, Regeneron, REGENXBIO (consultant); AGTC, Alimera Sciences, DRCR Retina Network (research); Springer Publishers (royalties)