Clinical Use of Home OCT Data to Manage Neovascular Age-Related Macular Degeneration

On this episode of the JVRD Author’s Forum podcast, Dr. Jeffrey Heier of Ophthalmic Consultants of Boston discusses ‘Clinical Use of Home OCT Data to Manage Neovascular Age-Related Macular Degeneration,' published in the March/April 2025 issue of JVRD.

Host Dr. Timothy Murray and Dr. Heier discuss the clinical use of home optical coherence tomography (OCT) for managing patients with neovascular age-related macular degeneration (AMD). Dr. Heier shares study findings showing that 42% of patients would have had a different treatment decision based on home OCT monitoring, highlighting the technology’s potential to catch fluid recurrence earlier and safely extend treatment intervals, from an average of 8 weeks to over 15 weeks. They also discuss the high usability of home OCT devices, with over 95% of patients successfully setting up and using the device independently. The conversation underscores how home OCT can improve outcomes, reduce undertreatment, and drive meaningful cost savings.

For more information, visit www.ASRS.org/JVRDForum.

Welcome to ASRS’s Journal of Vitreoretinal Diseases (JVRD) Author’s Forum. JVRD is the official scientific peer-reviewed journal of the American Society of Retina Specialists (ASRS), offering the highest quality and most impactful research and clinical information in the field. Join host Dr. Timothy Murray, Editor-in-Chief for JVRD, as he discusses cutting-edge developments featured in JVRD with the lead authors who share clinical pearls and explore their significance for advancing patient care.

Episode Transcript

SPEAKER_00 (00:00):
Welcome to ASRS's Journal of Veterinal Diseases
Authors Forum.
I'm your host, Dr.
Timothy Murray, editor-in-chiefof JVRD.
On each episode of the JVRDAuthors Forum, I will interview
innovative retinal researcherson their studies featured only

(00:22):
in JVRD and how these studieswill impact our patients' care
in our clinics.
Tune in to hear directly frominvestigators about the clinical
implications of the newest andhighest quality research in the
field of retina.
Welcome to JVRD's Author Forumpodcast.

(00:44):
It's my pleasure to be joined bymy friend and colleague, Dr.
Jeffrey Heyer from theOphthalmic Consultants of
Boston.
Jeff has been a member of theexecutive committee for the ASRS
for a decade.
He's an outstanding director ofthe Veterinal Service and Retina
Research for the OCB, and hewill be discussing with us today

(01:05):
clinical use of home OCT data tomanage neovascular age-related
macular degeneration.
Welcome, Dr.
Heyer.
Thank you, Dr.
Murray.
Pleasure to be here.
Always a pleasure to have you.
Can you take me through a littlebit of how you guys structured
the manuscript and the study forour listeners?

SPEAKER_01 (01:27):
Happy to.
So as you know, Homo CT has thepotential to be an extremely
valuable tool for helping us tomanage our macular degeneration
patients.
In this study, what we did is 15retina specialists evaluated 29
patients, images that wereobtained with the Homo CT and

(01:53):
compared that to images thatcompare that to what was decided
in clinical practice.
And they looked at such issuesas, would you have treated as
was done in the clinicalpractice?
Would you have held therapy?
Would you have changed drugs?

(02:14):
Would you have used the sameintervals?

SPEAKER_00 (02:17):
So Jeff, those are sort of the key things we deal
with every day.
So you have an incredibly busypractice.
You're seeing 65 or 70 patientsfor injections a day.
That's exactly what we do in thereal time with our patients.
So how are we going to be ableto shift that technology to a
home-based system?

SPEAKER_01 (02:37):
Well, it's a great question, Tim.
And the first thing to thinkabout is we're making these
decisions based on essentiallysingle scans at a single point
of time.
And what the Homo CT offers usis the ability to monitor these
patients over time.
So patients image daily, and wecan actually see from that how

(03:02):
they respond to a treatment,when they have recurrent fluid,
if they have recurrent fluid, Isthat fluid variable?
Does it start an increase andcontinued increase over time,
telling us, hey, that's where weshould look to treat these
patients?
Or is there variability in thefluid?
And at least for parts of that,we don't need to treat them.

(03:25):
So it would be valuable to helpus to treat patients, especially
as we look at all the advancesthat are being studied now in
durable treatments, whether it'sTKIs or gene therapy or
longer-acting anti-VEGF agents.
So

SPEAKER_00 (03:44):
I think you and I have both felt many times that
undertreatment is the majorcause of lost vision over five-
and ten-year windows oftreatment.
So you're thinking that thiswould allow the patient who
needed to be treated earlier,who was on an extended
follow-up, to be brought intothe office earlier than they

(04:04):
would have been scheduled for?

SPEAKER_01 (04:06):
without a doubt, because yes, you and I have had
this discussion.
What happens when you'veextended a patient, we've used
treat and extend, and let's saythat patient is now out to three
months.
What we often do is they'redoing well.
We continue to extend, right?
We go 14, 16 weeks, six months.

(04:28):
Well, We know that the largemajority of these patients are
going to recur somewhere in thattime span.
And if we don't capture thatrecurrence quickly, they lose
vision.
This will enable us to followthese patients and capture when
they start to develop recurrentfluid and capture it hopefully

(04:48):
before they're largelysymptomatic or before they lose
a significant amount of vision.

SPEAKER_00 (04:55):
You know, my experience is it's often
difficult for my patients toappreciate the reaccumulation of
fluid.
We ask them to look at an AMSAgrid or monitor, you know, for
the metamorphopsia, buttypically they'll come in and
they know something's not right,but they won't really have
appreciated that.
So this should direct usdirectly to a reaccumulation of

(05:19):
fluid and a need for follow-up.

SPEAKER_01 (05:21):
Yeah, you're exactly right, Tim.
It's not uncommon to havepatients come in and say, I'm
doing well, and they haverecurrent fluid, and you know
that the vision was going tofollow the anatomy.
Similarly, it's not uncommon tohave patients come in and say,
I'm doing poorly, I'm losingvision, and the scan looks

(05:42):
perfectly fine.
both the patient and theclinician can have a level of
comfort knowing that we'refollowing this very sensitive
biomarker of fluid.

SPEAKER_00 (05:57):
So, Jeff, you know, people have had concerns within
our field about the delivery ofthis technology and our
patients' ability to use it.
You've had some extensiveexperience.
What are your thoughts on this?

SPEAKER_01 (06:11):
Yeah, so there are a couple things that I've really
been impressed with.
First of all is the remarkablesensitivity and resolution of a
home device.
And we've all seen these imagesin the meetings, and they're
really outstanding and enablingus to pick up even subtle
amounts of fluid.
The second thing that's beenimpressive is how easily

(06:34):
patients ADAPT use of theHOMO-CT.
So in several of the studies weperformed, the test was the
physician would determine whowere the study patients.
The monitoring center would thenmail the device to the patients.
And just through theinstructions and possible

(06:55):
interaction with the monitoringcenter, patients would have to
see if they could use thedevice.
In the study that resulted inFDA approval, different than
this study we're showing here,over 95% of patients could set
up and adapt to the use of thedevice without any outside help.

SPEAKER_00 (07:18):
And then I think that we've identified that the
cost potential to savings forour insurers and our patients
greatly overweighs any concernsfor the cost and maintenance of
the device.
Is that correct?

SPEAKER_01 (07:34):
Well, it's certainly how I feel about it.
If you look at the study that wewere just talking about, with
reviewing the patients, 42% ofthe patients would not have been
treated as they were treated inclinical practice.
So the potential savings of thatis quite significant.

(07:55):
Now, to be fair, there wasanother proportion who were
treated earlier, treated a weekor more earlier because the
accumulation of fluid was suchthat they felt it would be
better to treat them earlier.
So it will enable us to nottreat certain patients, to
extend treatment in otherpatients.

(08:16):
And overall, that will result insavings to the healthcare
system, but it'll also result insavings of vision.
There was a study where welooked at our ability to extend
patients, and going into thestudy, the patients were treated
on average every eight weeks,and based on decision-making

(08:39):
from the home OCT, it extendedto over 15 weeks.

SPEAKER_00 (08:44):
Well, you know, from a retina specialty perspective,
I think we are image-driven andreally interested in
incorporation of technology thatboth benefits our patients but
enhances our care.
So in many ways, this seems likejust an extension of the impact
of OCT in our clinics to ourpatients.

SPEAKER_01 (09:05):
Yeah, right.
We know that right now our bestmonitor of when and how to treat
patients is based on OCT andhistorically office-based OCT.
And that patients come in and wedetermine from that, are they
leaking?
Are they respondingappropriately to the drug?

(09:26):
Questions like step therapy,right?
Are these drugs, is this a gooddrug for our patient?
The Homo CT enables us toevaluate that on a much more
dynamic ability, right?
We're able to see how patientsrespond to therapy.
We're able to see the responsesof different drugs.
We're able to see when theystart to leak and what's the

(09:49):
cadence of that leakage.
Is it quick?
meaning we really need to getthem in immediately, or is it
relatively slow and we haveseveral days or a week to be
able to treat them?
So we determine the parametersthat are resulting alerts to the
clinician, and we're able to dothat based on the individual

(10:09):
patients.

SPEAKER_00 (10:10):
And one of the things you and I know is that
new technology really changes aswe see its broader application.
So I think you and I are bothexcited and I'd like you to
thank you, Dr.
Heyer, for joining us to talkabout the clinical use of
HOMO-CT data to manageneovascular AMD and also to
drive our readership to youroriginal manuscript.

(10:33):
Thank you.
Thanks for tuning in to the JVRDAuthors Forum.
You can watch and listen to moreepisodes on the ASRS YouTube
channel and on popular podcastdirectories, including Apple
Podcasts and Spotify.
Visit www.asrs.org forward slashJVRD forum on the ASRS website

(11:00):
to learn more.
See you soon.