Home Monitoring

Are you ready to reccomend it to your patients?

Dr. Kaiser: Let’s take a moment to discuss home monitoring. Do you offer any type of home monitoring aside from the Amsler grid? There are a variety of iPhone- and iPad-related apps, as well as other home-monitoring devices. What do you recommend to your patients? Do you recommend a new kind of device, or do you stick with old-fashioned advice, such as “When you’re at home, take a look at the telephone poles on the side of the road?”

Dr. Brown: Excellent question. I was not a fan before of the Foresee home device (Notal Vision) , but base on data I presented at the Macula Society, and, truly shows that a monitoring device that is used in 3 minutes, three to seven times a week, picks up lesions earlier. Is it the hyperacuity algorithm in Foresee, or is it just doing it for that length of time? If the patient stared at an Amsler for that period of time would you pick it up? I don’t know. We were investigators for the Foresee home device, and in my patients — particularly those who are one-eyed, worried, or driving the RV between here and Chicago, back and forth — they want to do anything to pick up lesions earlier. These patients obtain the Foresee home device. It’s about $65 a month. It notifies patients when they neglect to do the monitoring, and I think it picks up lesions earlier. Before I used this device, I really pushed the iPad or iPhone devices in younger patients. If it’s on their phone, then they can look at it when they’re bored. I just want to make sure they’re monitoring themselves. Outside of that, we’re back to Mark Amsler’s grid from the 1940s. I think the grid is better than nothing. I know some people don’t believe in it, but I think anything you can do to monitor and catch lesions extrafoveally is going to help patients more than if they wait until their vision is impaired by a hemorrhage or a large PED.

Dr. Kaiser: Dr. Kitchens, I know you find value in a number of electronic gadgets, do you think these iPhone apps are worthwhile? I’m thinking of the DigiSight. It’s an app that basically has a central server and keeps tabs on a patient’s acuity. Is that good enough, or do they need a device such as the Foresee?

Dr. Kitchens: I’ll tell you, I reviewed the Digisight handbook, the i-Handbook, the iBook device, and it was pretty novel and intriguing. I’ll tell you that our younger patients and our myopic patients have had a good deal of success with it. However, our AMD patients in general may have Kindles, but they don’t tend to have iPhones. So most of the time, they will use just the Amsler grid. We were also in the Foresee study and I was impressed by the data. The question is going to be whether this is something that patients can afford — a $65 out-of-pocket expense. I would tell you that 90% of our patients would not be able to afford that on a routine basis.

Dr. Singh: I’ll add that we actually did a study to test the newer algorithm designed to determine the activity of CNV after a patient has received treatment. It actually was a very well done study, which has resulted in some really exciting data. I believe that’s going to come out in the fall, and it’s going to have some more information regarding how to follow patients with the Foresee home device, and those who have exudative AMD, who are diagnosed and undergoing treatment.

Dr. Brown: Let me just add one thing: I absolutely agree with Dr. Kitchens that I thought, with a price tag of $65, my patients were going to look at me as though I had three eyes in my head. However, when I pitched it to the first five or six people — who are arguably part of a higher-income clinic than maybe others — they all said, “Oh, yes. I do that for my sleep apnea,” or, “I do that for my pacemaker,” or something similar. I found that the patients are so enthusiastic about this home monitoring, that they’re willing to either pay for it or have their insurance company pay for it. I was surprised by how well it was accepted.