As the COVID-19 pandemic spread around the world, people began isolating or limiting their interactions with healthcare providers. In the UK alone, more than 10 000 people are estimated to be at risk of irreversible vision loss owing to missed care during lockdown. The risk of vision loss is particularly pronounced in patients with neovascular age-related macular degeneration (nAMD) because many are reliant on continual treatment to preserve their eyesight. According to Jill Hopkins, Global Head of Ophthalmology Personalised Healthcare at Roche–Genentech, who is working closely with the University of Birmingham and Moorfields Eye Hospital, the cancelled visits are “putting a tremendous stress on both physicians and patients in terms of what do we do. Are we going to lose vision? Do we risk bringing people in? Can we limit the work-up or can we limit the time that we spend in the clinic and just deliver treatment? There is a lot of concern about prolonged extensions of treatment intervals for people.” In a recent analysis conducted by four major eye treatment hospital groups in England, Thomas et al. reported a drop in referrals for nAMD of 65–87% in April 2020 during coronavirus lockdown restrictions versus the same period in the previous year. Thomas et al. also estimated that a treatment delay of three months could lead to a relative increase of more than 50% in the number of eyes with severe vision impairment and a 25% relative decrease in the number of eyes with driving vision at one year. Most people with nAMD, who are typically 70 years of age or older, are also considered clinically vulnerable to COVID-19, underscoring the importance of finding new ways to restrict in-clinic time and to monitor vision remotely. In response to this urgent need, Roche rapidly mobilised a global team to release its remote vision monitoring technology to support people at risk of vision loss due to interruptions in treatment for nAMD.
Home Vision Monitor – what is it?
The Home Vision Monitor® app, which is designed to detect vision changes in patients with maculopathy, including nAMD, received a CE mark in Europe and FDA 510K clearance in the USA. In May 2020, a pre-commercial initiative was started in the UK in collaboration with Moorfields Eye Hospital. Patients can use the app on their smartphone or tablet. They typically test their vision 1–2 times a week using a simple shape discrimination hyperacuity test that can detect vision changes in people with retinal disease. This test has been demonstrated to be both easy to understand and use by the patient, and sensitive at detecting changes in vision function, as illustrated in the main image of the article. Each eye is usually tested twice, and the test takes 6–8 minutes to complete. Although test–retest repeatability is high, if the first two results are variable, a third test is requested. Patients can be sent reminders to test using push notifications. Patients don’t see their results, but their care team has access to a web-based portal that enables them to monitor changes in vision using a dashboard that shows a longitudinal view of the patient’s test data. If a significant vision change is detected, an alert is triggered. The care team can then decide whether a patient needs to come into the clinic for assessment.
Patients with active nAMD require regular intravitreal injections with anti-vascular endothelial growth factor (anti-VEGF) therapy, but the need for repeat injections varies widely among individuals, so the app can be used to personalise care and minimise time spent in the clinic and waiting rooms. The app can also provide a safety net for patients with stable nAMD in the absence of regular clinic visits – these patients require monitoring every 6 weeks to 3 months. A significant worsening in vision could trigger a remote consultation when the patient can safely confer with their doctor using telemedicine or over the phone.
Personalised Healthcare at Roche
It is clear that telehealth and home vision monitoring solutions will play a significant role in the future of routine ophthalmological care. COVID-19 has hastened the push toward virtual care, with some telehealth platforms reporting an increase in virtual patient visits of 257–700%. Virtual clinic adoption requires digital screening and monitoring tools to enable virtual assessments of vision. Development of Home Vision Monitor® has been accelerated to address this urgent gap in care for patients. However, this is an example of just one of the digital patient monitoring and management solutions that is being developed as part of Roche’s Personalised Healthcare programme. The Personalised Healthcare approach is much broader than digital health solutions. It aims to improve patient outcomes across the care continuum and make R&D more efficient by harnessing the power of large, multimodal data sets that include valuable real-world data from digital technologies and by applying sophisticated advanced analytics, such as machine learning algorithms, to discover new insights that improve decision-making at the bench and the bedside. The data sets are more than big data because they are carefully curated with a specific research question in mind. The research question also determines the analytical approach and the technologies used. It’s this unique combination of data, technology and analytics applied to each gap in care that defines the Personalised Healthcare approach. It goes beyond the medicine to improve the care of patients and their overall experience of healthcare.
For more information on Roche’s innovation in ophthalmology during the pandemic click here or Roche’s Personalised Healthcare approach click here. Visit Roche’s booth at the HIMSS & Health 2.0 European Digital Event (7–11 September 2020).