When dealing with progressive conditions such as glaucoma or age-related macular degeneration, constant monitoring is key to ensuring successful treatment. Unfortunately, most patients cannot be monitored around the clock by a healthcare professional. At-home monitoring systems allow the patients to keep track of their visual changes and can help alert providers of changes in ocular health and vision.
Home testing capabilities and limitations
There are several home testing devices that are currently available for patients. These devices can potentially measure visual acuity, intraocular pressure, visual fields, and more. While each device has its benefits and limitations, they are all designed to be helpful to clinicians and to help improve patient care.
iCare Home
The iCare Home allows glaucoma patients to self-monitor their intraocular pressure (IOP). The iCare Home utilizes a disposable probe and is designed for easy positioning and accurate measurement. The device boasts high accuracy and can upload information into an online portal for easy access by doctors via the LINK app, which can be installed on a PC.
How it works: The patient can position the device against the forehead for stability and measure their IOP with the click of a button via the rebounding probe. The device comes with multiple probes that can either be sanitized or thrown away after use. IOP measurements can be stored in the device or uploaded to the LINK app for consistent provider monitoring.
Pros:
- Easy to use
- Allows doctors to monitor patient IOP between visits as well as diurnal IOP measurement
Cons:
- Depends on patient compliance; they actually have to do the measurements
- Requires PC for LINK Installation
Triggerfish
Triggerfish from SensiMed allows for round-the-clock IOP monitoring. The device consists of a contact lens, an adhesive antenna that is placed around the eye, and a wire that connects the antennae to a portable recorder.
How it works: The device is designed to be worn for 24 hours and can provide a clear clinical picture of both diurnal and nocturnal IOP. The consistent monitoring via Triggerfish can help provide a clearer clinical picture and explain progression in patients who show otherwise stable IOP in-office. Triggerfish is applied and removed in the office by the clinician over two separate appointments. The application and removal take approximately 15 minutes each.
Pros:
- Helps provide a 24 hour look at IOP fluctuations, including at times when the patient would not usually measure IOP
- Does not require the patient to measure; the device is placed and removed by the clinician
Cons:
- Some patients may experience red-eye, dryness, and irritation due to the contact lens
- The device needs to be worn by the patient for a 24 hour period (can be cumbersome)
Notal Vision: Foresee Home
The Foresee Home from Notal Vision is designed for patients with age-related macular degeneration (AMD) who are at risk of converting to the wet form of the disease. The device can be used between doctor visits and allows patients to track subtle vision changes that may otherwise go unnoticed. The device is shaped like a pair of binoculars on a stand and comes with a mouse.
How it Works: The patient is asked to view a series of dots and click the mouse when distortions are noted. Results from the test are sent to the Notal Vision Center for evaluation and then to the clinician for monitoring. If a result raises concern, the patient can be seen sooner for further evaluation.
Pros:
- Earlier detection of conversion of AMD
- Monitoring between visits
Cons:
- Patient needs to test consistently
- Patient needs to be honest when noting distortions during the test
MyVisionTrack
MyVisionTrack is a relatively new app that received FDA approval in 2013 to be marketed as an at-home tracking device for patients with maculopathy. MyVisionTrack is available on iPhone 4S and higher.
How it Works: The app can be downloaded and installed on the phone. Upon opening the app, the patient can enter a ten-digit code, provided by the clinician, to allow for monitoring. The patient is then asked to choose between several similar shapes.
Pros:
- The app can be conveniently downloaded on the patient’s phone
- Allows for monitoring of various maculopathy types, including diabetic maculopathy
Cons:
- While it is FDA cleared, limited information about the app is available
- Depends on the patient for monitoring consistency
Olleyes VisuALL H
Olleyes VisuALL H offers portable goggles that can be worn by patients for home monitoring. The device primarily offers visual field testing for glaucoma monitoring, but can also be modified to provide visual acuity, color vision, and pediatric visual fields. Preliminary research shows a strong correlation between the Olleyes virtual perimeter and standard automated perimetry.
How it Works: Olleyes VisuAll H looks like a large pair of goggles that can be worn in virtually any position. The patient is then guided through the test by the program and the results can be monitored by the healthcare provider to track potential glaucoma progression.
Pros:
- Allows for at-home visual field monitoring
- Repeated uses help patients become better at the test, yielding more reliable results at home and in the office
Cons:
- Patients have to remember to test consistently
- Some patients may find the device too complex
EyeQue
EyeQue offers at-home vision testing for patients with the help of their smartphone. Patients can choose between Insight, which checks visual acuity, color vision, and contrast sensitivity; Vision Check, which measures refractive error and provides prescription and add recommendations; and the Vision Monitoring Kit, which combines both tests.
How it Works: The device can be attached to the cell phone and the patient is asked to match different colors on the screen. The device uses a combination of their extension and a smartphone camera to measure refractive error. While EyeQue is advertised to patients, and can even deliver PD, the website cautions individuals that the measurements do not replace a comprehensive examination.
The app can also be used at home to monitor visual acuity changes.
Pros:
- Convenient for patients
- Can help detect subtle vision changes, prompting patients to schedule an eye exam sooner
Cons:
- The test is partially subjective, and patients might end up with an incorrect prescription
- Patients may be confused when their numbers do not “match” the test readout
Kubota PBOS
Kubota PBOS is a very new device that offers low-cost, home ocular coherence tomography measurements that can be used to monitor a variety of retinal and optic nerve conditions. Kubota presented a poster at the American Academy of Optometry on November 7, 2021. While the device is very new, it will likely be available soon:
How it Works: The patient uses a handheld device that is connected to their cell phone. The data is then sent for analysis after which the patient and healthcare provider are alerted.
Pros:
- The device will allow patients to self-monitor for retinal changes
- Device alerts the eyecare provider when changes are detected
Cons:
- Patient will need to remember to use the device for monitoring
Implementing at-home care technology at your practice
The first step in implementing at-home testing is identifying the patients who can benefit.
Patients who can benefit from at-home testing are those who:
- Have a condition that can be monitored by one or more of the above devices
- Are not afraid of technology or who have a caregiver that is willing to learn
- Seem to have a good understanding of the potentially progressive nature of their condition
- Will likely be compliant with at-home testing
Once a patient matches the criteria, the idea of at-home monitoring can be discussed. Many of the above tests can be either purchased by the patient and some are covered by insurance. If a patient is enthusiastic about the idea of home monitoring, the appropriate device can be acquired. In most cases, the companies that offer at-home testing are there to provide support for the doctor and the patient, both during the initial stages and later as questions arise.
Educating your patient about at-home testing
Offering at-home testing as an option to patients who meet the criteria and who are interested can be a great way to not only retain patients but also to provide better care. Education can be done in-office by a doctor or staff member. In addition, information can be added to the practice website and social media as well as to the lobby in the form of informational handouts and brochures.
Takeaways
- At-home monitoring devices allow patients to self-monitor their ocular health while also keeping providers in the know
- Currently available devices can monitor a variety of factors including IOP, visual fields, and AMD progression
- Companies that provide home-monitoring devices are often there to help support both the patient and the eye care provider
- Not all patients will be ideal candidates for home monitoring
At-home monitoring devices can benefit both patient and eyecare providers by tracking conditions between office visits. This additional information gathered can help guide treatment decisions, prevent further vision loss, and ultimately lead to better patient outcomes.
