Although the technology enables early detection of eye diseases, a lack of reimbursement and insurance coverage remains a major barrier to widespread adoption, said speakers at the 40th Annual Scientific Meeting of the American Society of Retinologists.
Technological improvements allow for earlier detection of eye diseases and therefore better outcomes, according to two presentations at the 40th Annual Scientific Meeting of the American Society of Retinopathologists held July 13-16, 2022 in New York, New York.
Dr. Michael J. explained. Knowing that switching to NAMD leads to poor outcomes in the long run, Elman and colleagues sought to understand whether a remote monitoring model for early detection could lead to better outcomes.
The form included a home test supported by a control center with regular medical follow-up. The home test was a preferential hypersensitivity circumference measurement test performed with the ForeseeHome device, which the patient tested regularly. Test results are automatically uploaded for analysis. Doctors heed all of the device’s warnings regarding switching to NAMD, as well as running routine tests. The monitoring center worked to ensure patients’ ability to participate in the program and ongoing compliance.
In the ALOFT study, Elman and colleagues conducted a retrospective study with more than 2,000 patients and 3,000 eyes at 5 training sites. Data were analyzed for a period of 10 years (August 2010 – July 2020).
“The visual results were exceptional,” Elman said. The median visual acuity for evidence of nAMD conversion was 20/39 and 20/32 after treatment and at the last visit. The mean visual acuity at baseline was 20/30 for the ForeseeHome group compared with 20/32 for standard care patients.
When switched, the mean visual acuity was 20/39 for the ForeseeHome patients compared with 20/83 for the standard treatment group. This represents about a double difference in visual acuity and referral for patients in the ForeseeHome program, Elman said.
Patient compliance with the program was also high. There was a mean (SD) of 5.2 (3.4) tests performed weekly, which was consistent over the 10-year test period.
The mean number of injections was similar between the two groups after detection of nAMD. However, he noted, early detection of ForeseeHome patients “prevents several months of poor treatment” and that “patients with good vision also stay on treatment for longer.”
Ultimately, the model enabled clinicians to detect nAMD early and improve patient outcomes. Approximately twice as many patients with ForeseeHome monitoring retained their functional vision.
“This is a proven model and can be extended to other remote monitoring applications,” he concluded.
During a question-and-answer session, someone asked why this program had stopped working, and Elman pointed out the reimbursement challenge. “I don’t get paid” to review ForeseeHome test results.
Another presentation provided insight into how tele-ophthalmology gives diabetic patients early access to ophthalmology. Parisa Emami-Naeni, MD, MPH, associate professor of ophthalmology at the University of California, Davis, and a retinal surgeon and uveitis specialist at UC Davis Eye Center, presented results of a study that used the OptumLabs data repository to analyze when the first eye contact was used to screen patients with diagnosed diabetes. newly.
She explained that diabetic retinopathy is the leading cause of vision loss and disability in older adults in the United States, and the American Academy of Ophthalmology recommends an expanded eye exam soon after a diabetes diagnosis. However, research has shown that only 30% to 40% of people newly diagnosed with diabetes receive an eye exam in the first year after diagnosis.
The study involved more than 180,000 people who applied from 2011 to 2020. Emami-Nene and colleagues found that only 22% of people diagnosed with new diabetes received any type of eye exam within the first year, and less than 1% had the tests. by remote shooting.
While tele-ophthalmology has generally increased during this period, there has been a decline in insurance coverage, with the proportion of claims paid falling from 88% in 2011 to 65% in 2020. This decline has also disproportionately affected vulnerable groups such as Seniors (65 years old). ), women, black patients, and those with low family incomes.
However, patients who received remote ophthalmology received their first test faster. The median time to first eye examination was 2.0 months for those who received tele-ophthalmology compared to 3.4 months for those who underwent in-person eye examination.
“Interestingly, 1 out of every 3 telephoto sessions was performed at the same time as the diagnosis of diabetes [primary care physician] Or the endocrinology office,” Emami Nani said. When people who had had eye exams on the same day were excluded, the examination time was the same in both groups.
In general, while tele-ophthalmology can reduce barriers to accessing care and improve the timeliness of eye exams, barriers to adoption of tele-ophthalmology remain.