title: The accuracy of home monitoring to detect disease activity during maintenance therapy for neovascular ARMD.
abstract: OBJECTIVE
  To report the reproducibility, sensitivity, specificity, and predictive value of home monitoring for disease activity in neovascular age-related macular degeneration (ARMD).
  
  
  METHODS
  Participants were trained to complete three separate home monitoring tasks, designed to identify subtle changes in visual function that may indicate increasing neovascular ARMD disease activity. These included measurement of near acuity and assessments of environmental distortion and overall visual function. The need for repeat intra-vitreal injection, as predicted by home monitoring, was compared to standard clinical assessment involving ETDRS distance acuity, slit lamp examination, and spectral domain ocular coherence tomography.
  
  
  RESULTS
  Although all participants were able to complete the home monitoring tasks, the reproducibility of each of the three tasks was modest. Cohen's kappa was 0.118 (p = 0.54) for the comparison of the outcome of the home monitoring exercise with the gold standard of hospital assessment to determine disease activity. The sensitivity of the home monitoring exercise was 33.3 % (95 % CI 15.2-51.4) and the specificity was 77.8 % (95 % CI 61.8-93.8).
  
  
  CONCLUSIONS
  This study suggests that current tests of visual function, which are readily completed at home, cannot replace traditional clinic-based assessments for neovascular ARMD disease activity. Instead, such tests are likely to remain complementary to standard assessment in clinic.
authors.affiliation: Eye Clinic, St. James's University Hospital, Leeds, LS9 7TF, UK, martin.mckibbin@btinternet.com.
authors.forename: Martin
authors.initials: M
authors.lastname: McKibbin
authors.forename: Lucy
authors.initials: L
authors.lastname: Baker
authors.forename: Paul
authors.initials: P
authors.lastname: Baxter
authors.forename: Carolyn
authors.initials: C
authors.lastname: Czoski-Muray
authors.forename: Roopa
authors.initials: R
authors.lastname: Setty
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D060046:Maintenance Chemotherapy; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000592:standards; D010865:Pilot Projects; D011237:Predictive Value of Tests; D000069579:Ranibizumab / Q000627:therapeutic use*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014786:Vision Disorders / Q000175:diagnosis* / Q000188:drug therapy; D014787:Vision Tests / Q000592:standards*; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab