Hogg, Ruth E., Sivaprasad, Sobha and Wickens, Robin , (2024) The diagnostic accuracy of three home-monitoring vision tests to detect active neovascular age-related macular degeneration during the post-treatment monitoring phase: MONARCH study. BMJ Open.
Abstract
Importance: most neovascular age-related macular degeneration (nAMD) treatments involve long-term follow-up of disease activity. Home-monitoring would reduce the burden on patients and their caregivers, and release clinic capacity.
Objective: the study aimed to evaluate three vision home-monitoring tests for patients to use to detect active nAMD compared to diagnosing active nAMD at hospital follow-up. during the post-treatments monitoring phase.
Design: Diagnostic Test Accuracy (DTA) Study
Setting: six UK Hospital Eye Clinics
Participants: patients aged 50 years or above, with at least one eye first treated for active nAMD at least ≥ 6 months to a maximum of 42 months before approach . Participants were stratified by time since starting treatment.
Main outcome measure: estimated area under receiver operating curves (AUROCS). The study had 90% power to detect a difference of 0.06, or 80% power to detect a difference of 0.05, if the AUROC for 2 tests was 0.75.
Methods: the reference standard was detection of active nAMD by an ophthalmologist at hospital follow-up. The three home-monitoring tests evaluated were: (i) KeepSight Journal (KSJ): paper-based near vision tests presented as word puzzles; (ii) MyVisionTrack® (mVT®) application (app), viewed on iPod TouchTM device; (iii) MultiBit (MBT) app, viewed on an iPod TouchTM device. Participants were asked to test weekly; mVT and MBT scores were transmitted automatically and KSJ scores were returned to the research office six-monthly. Raw scores between hospital follow-ups were summarizeized as averages.
Results: 297 patients took part. The mean age (SD) was 74.9 (6.6) years. At least one hospital follow-up was available for 312 study eyes in 259 participants (1,549 complete visits). Median home-monitoring testing frequency was 3 times/month. Estimated areas under receiver operating curves (AUROCs) were <0.6 for all home-monitoring tests, and only the KSJ summary score was associated with lesion activity (OR=3.48, 95% confidence interval 1.09-11.13, p=0.036).
Conclusions and relevance: no home-monitoring vision test evaluated provided satisfactory diagnostic accuracy to identify active nAMD diagnosed in hospital eye service follow-up clinics. Implementing any of these evaluated tests, with ophthalmologists only reviewing test positives, would mean most active lesions were missed, risking unnecessary sight loss.
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