A recent study published in Investigative Ophthalmology & Visual Science reports the growing popularity of artificial intelligence (AI) among optometrists: After the onset of the pandemic, 65.5% of study participants reported a willingness to incorporate AI in practice, an increase from 53.3% prior to the pandemic. Additionally, 72% of ODs believed AI would improve the practice of optometry.¹ AI, combined with remote monitoring, has improved my practice by making monitoring for disease progression more efficient.

Here, I explain.

THE CHALLENGE

We know that patients who have intermediate age-related macular degeneration (iAMD) are at increased risk for converting to neovascular AMD (nAMD). Since frequent patient visits (i.e., more often than every three to six months) to monitor for conversion can be impractical for patients and optometrists alike, ODs often turn to an Amsler grid for patient self-monitoring between visits. The hope is that patients will report signs of metamorphopsia that could suggest the presence of nAMD, but the Amsler grid is not without challenges: For example, in my clinical experience, I have found it may be underutilized (if not completely forgotten) or used incorrectly.

EMBRACING DIGITAL CARE

One alternative is employing a digital health eye care provider and at-home monitoring. My iAMD patients who enroll in the provider’s program perform daily preferential hyperacuity perimetry PHP testing with an easy-to-use device. Results from the daily tests are then securely uploaded to the cloud and are analyzed by an AI algorithm to detect aberrations from the patient’s baseline metamorphopsia map.

In the event a change that may indicate a conversion from iAMD to nAMD is detected, an in-house physician at the program’s monitoring center is alerted and reviews the patient’s most recent visual testing. If the in-house provider observes that nAMD may be present, the monitoring center alerts me via an encrypted email that contains a link to an online portal with the patient’s most recent at-home diagnostic examination. At this point, I decide the best course of action, which is usually an in-person examination that includes diagnostic imaging.

A retrospective study of 306 iAMD patients showed this home monitoring system can increase early detection of conversion to nAMD.² With better VA and a smaller lesion size at diagnosis of conversion, a prompt referral can ensure AMD patients more timely anti-VEGF therapy.

There are other benefits: Patients using home monitoring the prescribed number of times per week do not have to be monitored as often in the office. For example, patients who were monitored in-office every three months before remote monitoring and virtual/digital health providers can now be seen every four-to-six months. The extra appointments can then be used to care for other patients.

EXTENDING OUR CARE

Digital health care providers are a new partner in patient management that can bring the “internet of things” to our patients, educate them about the use of the devices, and monitor test compliance. The amount of data generated by test users becomes manageable through AI applications. The result is actionable data that allows optometrists to stay connected with the patient in between office visits and to be proactive when a patient needs attention. After all, early diagnosis and early intervention lead to the best visual outcomes. OM

REFERENCES

1. Shorter E, Kinnaird C, Kravets S, et al. Evaluation of Optometrist’s Perspectives of Artificial Intelligence in Eye Care Invest. Ophthalmol. Vis. Sci. 2021;62(8):1727.
2. Ho AC, Heier JS, Holekamp NM, et al. Real-World Performance of a Self-Operated Home Monitoring System for Early Detection of Neovascular Age-Related Macular Degeneration. J Clin Med. 2021;10(7):1355. Doi: 10.3390/jcm10071355.

DR. EARLEY serves as a therapeutic optometrist at Medina Vision Centre, Inc. in Medina, Ohio, where he spent 23 years as vice president/secretary and was director of human resources. He is the clinic director of Bright Eyes Vision Clinic, a free clinic serving the uninsured, and a member of the AOA and the Ohio Optometric Association. A speaker in the areas of specialty contact lenses, macular degeneration, and practice management, Dr. Earley is a consultant for Alcon, and serves as a KOL for Notal Vision, Maculogix, and MacuHealth. He can be reached at drearley@medinavisionandlaser.com