Aleksandra Rachitskaya, MD, joins Rehan Ahmed, MD to discuss the clinical use of home optical coherence tomography to manage neovascular age-related macular degeneration (nAMD). The study, “Clinical Use of Home OCT Data to Manage Neovascular Age-Related Macular Degeneration,” published in the Journal of Vitreoretinal Diseases examines how home OCT affects retina specialists’ treatment decisions for nAMD. Dr. Rachitskaya explains why home monitoring merits study and outlines how the technology might change treatment decisions.
Dr. Rachitskaya says that clinicians are “extremely lucky” to be able to maintain vision for years in patients with nAMD. She emphasizes a persistent problem: treatment burden. She recalls common patient reactions: “It’s really lovely to see you, doctor, but I really don’t like my injections.” Dr. Rachitskaya adds that patients find the first injection to be “a little bit of a shocker.” Clinicians must balance frequent visits and injections with patient tolerance and quality of life.
Study Design And Unexpected Findings
Dr. Rachitskaya describes the study’s design as unique: patients performed home OCT imaging while receiving standard clinic-based treatment. The study then extracted segments of the home OCT data and asked 15 retina specialists, blinded to actual treatment dates, to review the images. The specialists answered whether they would treat and, if so, when.
The results yielded two major results. Dr. Rachitskaya reports that in about 40% of cases, images showed that patients who were treated in the clinic would not have required treatment based on the home OCT segments, indicating potential over-treatment. Conversely, she notes that among those reviewers who would have treated, about 60% of treatments would have occurred at least a week earlier, suggesting potential under-treatment under usual clinic schedules. She frames these findings as evidence that home OCT could both reduce unnecessary injections for some patients and enable earlier treatment for others.
AI As A Triage Assistant
Questions about the practical challenge of managing continuous home OCT data were raised by Dr. Ahmed. Dr. Rachitskaya says that patients are encouraged to use the device frequently and that the volume of images can overwhelm clinical teams without assistance. Artificial intelligence can help bridge that issue in eye care.
Dr. Rachitskaya notes that AI identifies and quantifies hyper-reflective spaces that typically represent intraretinal and subretinal fluid. The AI then triggers alerts so clinicians receive only actionable notifications rather than thousands of routine scans.
Clinicians can set thresholds for individual patients, so persistent but stable cysts do not generate constant alerts. She emphasizes that the AI is designed to integrate with workflow, serving as a triage tool that prioritizes clinically relevant changes for review.
Dr. Ahmed asks how home OCT fits with longer-duration treatments, including port delivery systems and gene therapy. Dr. Rachitskaya says home OCT has clear potential in that setting. When clinicians extend intervals between visits, home OCT provides ongoing reassurance and detects fluid recurrence before symptoms arise. She cautions, however, that the device has limits. It will not detect all complications, such as hemorrhage, and it cannot replace periodic clinical examinations.
Patient Usability And Accessibility Concerns
The home OCT device is portable and user-friendly. Dr. Rachitskaya says that patients can ship the device when they travel, and that trials included patients with reduced vision who still used it successfully. The system also includes reminders for patients who miss scans, addressing adherence challenges.
The device has regulatory approval but Dr. Rachitskaya notes that it is not yet widely commercially deployed, citing reimbursement and implementation questions. She encourages clinicians interested in the DRCR Retina Network trial or the company’s information to pursue those resources, noting that the company remains “extremely approachable and very proactive.”
Home OCT paired with AI has the potential to personalize therapy for nAMD by reducing unnecessary treatments, enabling earlier intervention and improving monitoring for patients on extended-interval therapies — all while integrating into clinician workflow as a targeted triage system.
For more on this conversation, listen to this episode of Real Talk.
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