Home monitoring may be useful for detecting progression of macular degeneration in conjunction with remote management.
A study, believed to be the first of its kind, assessed the false alarm rate and positive predictive value of smartphone-based home monitoring of neovascular age-related macular degeneration (nAMD) and diabetic macular oedema (DMO).
Participants performed the home monitoring test Alleye (Oculocare Ltd, Switzerland), which is based on a computerised version of a hyperacuity alignment task. The task required participants, with one eye covered and the mobile phone approximately 30cm from their face, to place the middle of three points on an invisible connecting line between the outer points. A total of 12 points were placed.
Each session was scored from 0–100 in addition to feedback from a traffic-light system via smartphone application. Three consecutive “red” scores were considered as a positive test or alarm signal. Specificity, 1-specificity (false alarm rate) and the predictive value for optical coherence tomography-based disease progression were analysed.
Researchers wrote that “home monitoring of hyperacuity showed a reassuringly low false alarm rate”. Just six of the 100 patients with nAMD or DMO had a false alarm during a defined monitoring period. Of those with a positive test, 80% showed signs of anatomical progression at the next visit. In a screening environment, however, a drop of 25 score points or more had a high accuracy for discriminating between disease and age-matched controls. Test performance characteristics were lower in older patients and those that tested more than recommended.
Livia Faes, Meriam Islam, Lucas M Bachmann, Kenny R Lienhard, Martin K Schmid, Dawn A Sim. False alarms and the positive predictive value of smartphone-based hyperacuity home monitoring for the progression of macular disease: a prospective cohort study. Eye (Lond). 2021 Jan 7;1-6. PMID: 33414531 PMCID: PMC7790308 DOI: 10.1038/s41433-020-01356-2