An Australian company has developed a possible solution to the global problem of undertreatment of age-related macular degeneration (AMD) with intravitreal injections.
Developed by the Victorian start-up Macuject Pty Ltd, the clinical decision support software combines a configurable decision support protocol with proprietary AI-based computer vision models for optical coherence tomography (OCT) scan analysis to help ophthalmologists in their decision making for patients with AMD.
Founder Dr Devinder Chauhan and his team were awarded the BioMedtech Horizons 2 Grant (AU$950K) last year to continue their work. They are now pursuing investment to fund a clinical trial and regulatory, product, clinical and commercialisation strategies.
“Intravitreal injections deliver truly remarkable results, however unfortunately, the results achieved in clinical trials are not globally achieved in real-world clinics because patients are simply not getting enough injections to stabilise their AMD. Real-world studies have found that, by two years, many patients’ vision is no longer maintained but instead has returned to what it was when first diagnosed.”
Dr Chauhan said part of the problem is insufficient resources.
“Currently 80% of anti-VEGF injections are given by retinal specialists yet retinal specialists make up just 10% of the ophthalmologist population. Ophthalmologists who are not retinal specialists often don’t feel comfortable reading retinal scans and making decisions about treatment intervals for anti-VEGF.”
Driven “by a desire to ensure the highest level of care is delivered to the most people at the least cost to society”, Macuject has developed a platform that Dr Chauhan says should both improve patient outcomes and clinic efficiencies. He said the software as a service platform, which has already been successfully trialled in some Australian clinics, will be increasingly valuable as AMD prevalence climbs due to a global aging population.
The software sends OCT scans to the cloud where they are read by AI in the context of the patient’s historical scans, and medical record of injection treatment intervals.
However, this is in no way a ‘set and forget’ solution for managing AMD treatment.
The ophthalmologist enters their own treatment parameters and preferences into the system – such as their preferred drug and acceptable intervals when extending or switching treatment.
“The software is able to measure macular intra-retinal and sub-retinal fluid collections at a level that retinal specialists might even miss,” Dr Chauhan said. “All of this information and their treatment history is taken into account before providing a suggested treatment. It’s then up to the ophthalmologist to decide whether to follow the suggested pathway or not.
“This is a tool that we’ve designed to ‘jog’ an ophthalmologist through their treatment decision making tree… it helps speed up the decision making process, minimising fear of missing anything.”
Dr Chauhan said as well as enhancing the decision making process, there are other significant benefits for both practice management and ongoing research into treatment protocols.
“Through this software, we’re collecting an enormous amount of data that hasn’t previously been collected – already we have data on 28,000 injections given over the last four years. So we’re able to benchmark patient outcomes over time, to monitor and measure adherence, and to observe the effect on vision of planned versus actual treatment intervals. In the future, this could potentially be a tool for auditing clinical outcomes and benchmarking outcomes against peers.”
Dr Chauhan said eye clinics have been using the software platform with success and others are helping develop the platform to meet the needs of differing clinical practices and workflows.
“Our next step is to raise funds for a clinical trial and for submission of the platform to regulatory bodies for approval prior to commercialisation.
To find out more visit macuject.com.