title: Qualifying to Use a Home Monitoring Device for Detection of Neovascular Age-Related Macular Degeneration.
abstract: OBJECTIVE
  Patients with intermediate age-related macular degeneration (AMD) using a home monitoring device have less loss of visual acuity, on average, at detection of choroidal neovascularization than do individuals using standard care monitoring techniques. Understanding the frequency with which patients are likely to initiate using a home monitoring device successfully is important in planning implementation of the device into practice.
  
  
  OBJECTIVE
  To determine the frequency with which patients with intermediate AMD qualify to use a home monitoring device and to establish a reliable baseline reference value with the device to monitor their AMD for progression to choroidal neovascularization.
  
  
  METHODS
  Between October 8, 2010, and May 20, 2011, a total of 131 eligible participants within a university-based retina practice with intermediate AMD in the study eye and visual acuity of 20/63 or better completed an in-clinic qualification test for the home device. Intermediate AMD was defined as multiple intermediate-sized drusen or at least 1 large druse. If both eyes were eligible, the eye with better visual acuity was selected as the study eye. If both eyes had the same visual acuity, the patient used the eye with subjectively better vision. Analysis was performed between August 1, 2011, and January 11, 2014.
  
  
  METHODS
  The proportion of patients with reliable qualification test results and a test score predictive of successful home use of a monitoring device for detecting neovascular AMD, and the proportion who established a baseline reference value at home.
  
  
  RESULTS
  A total of 129 participants (98.5%; 95% CI, 96.4%-99.9%) had reliable qualification test results; 91 participants (69.5%; 95% CI, 61.6%-77.4%) who completed this test attained a score that suggested they would be able to successfully use the home device. Among the 91 participants who could initiate home testing, 83 did so, including 80 participants (87.9%; 95% CI, 81.2%-94.6%) who established a baseline value that could be used as a reference for future monitoring. Younger participants were more likely to qualify for home testing (mean [SD] age, 73.1 [8.4] vs 81.1 [7.1] years; P < .001). Visual acuity at study enrollment did not appear to be associated with successful qualification (mean visual acuity for those who did and did not qualify was 20/28 and 20/31, respectively; P = .10).
  
  
  CONCLUSIONS
  These data suggest that the in-office qualification test is a useful screening tool to identify patients who may benefit from the home device. In any given retina practice, our data suggest an estimated 61.6% to 77.4% of patients with intermediate AMD should be able to produce reliable initial test results in the office test using the home monitoring device and pass a qualification test to initiate home monitoring. Subsequently, 81.2% to 94.6% of patients should be able to establish a home baseline reference value for future monitoring.
authors.affiliation: Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland2University of Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois Hospital and Health System, Chica.
authors.forename: Merina
authors.initials: M
authors.lastname: Thomas
authors.affiliation: Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Yulia
authors.initials: Y
authors.lastname: Wolfson
authors.affiliation: Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland3Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Shiri
authors.initials: S
authors.lastname: Zayit-Soudry
authors.affiliation: Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Susan B
authors.initials: SB
authors.lastname: Bressler
authors.affiliation: Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland4Editor, JAMA Ophthalmology.
authors.forename: Neil M
authors.initials: NM
authors.lastname: Bressler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000295:instrumentation*; D011446:Prospective Studies; D015203:Reproducibility of Results; D017216:Telemedicine / Q000379:methods*; D014786:Vision Disorders / Q000145:classification / Q000175:diagnosis*; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests / Q000295:instrumentation*; D057135:Wet Macular Degeneration / Q000145:classification / Q000175:diagnosis*