Use of smartphone home vision monitoring is negatively associated with increasing age

Due to the aging of the population, modern ophthalmic practices are faced with an increasing prevalence of the disease and the need for regular monitoring of chronic diseases.

Additionally, recent social distancing practices paralleling advances in technology have proven the potential of telemedicine in medicine and ophthalmology, benefiting the elderly or those with blinding eye disorders who may have difficulty getting to. their appointments.

Led by Konstantinos Balaskas, MD, NIHR Biomedical Research Center at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, a team of researchers reported the results of an actual development of a smartphone home vision monitoring application , Home Vision Monitor (HVM), in patients attending a high volume intravitreal injection clinic.

The data show that absorption was negatively associated with age and positively associated with visual acuity in a patient who sees the eye better and the baseline number of intravitreal injections, while the rate of use was higher. high with an increasing level of comfort with the use of modern technologies.

The study

The patient population consisted of consecutive patients attending Moorfields Eye Hospital (MEH) between May 2020 and February 2021 for planned intravitreal anti-VEGF injections. Those who owned a smart device during the study period were offered the HVM smartphone app and were advised to self-test twice a week.

The app uses pattern discrimination hyperacuity to detect metamorphopsia in central degrees of vision as a measure of visual function. Thus, a change in visual function equivalent to a preset threshold of 2 SD above baseline on the longMAR scale on 2 consecutive occasions triggered an alert message sent to the clinician.

The demographic variables included were age at baseline, self-reported biological sex and ethnicity, obtained from the patient’s hospital record.

Additionally, investigators defined patient metrics including adoption as a successful installation and subsequent use of the app at least once and defined as “active.”

Engagement of active app users was assessed based on compliance and usage rate. Compliance was defined as any continuous period of ≥ 4 weeks in which vision tests were performed each week. Average usage rate was the total number of tests performed by a patient divided by the total time since the app was prescribed.

Results

Of the 417 patients included, 236 (56.5%) were women with a mean age of 72.8 years. Of this number, a total of 258 patients were considered active users (61.9%), with 166 of 258 (64.3%) meeting the definition of adherence.

Each ETDRS line of best VA in the best seeing eye was associated with a 1.7% increase in the likelihood of being an active user (OR: 1.02; 95% CI: 1.00 – 1 , 03, P = .01). Then, each additional injection before inclusion was associated with a 0.8% increase in the probability of being an active user (OR, 1.01; 95% CI, 1.00 – 1.02, P = .02).

Increased age was negatively associated with use, with a 1.8% decrease in the likelihood of being an active user with an increase of one year (OR, 0.98; 95 CI %: 0.97 – 0.998; P = .02).

In terms of compliance among the 258 active patients, 166 (64.3%) met the definition. Those diagnosed with neovascular age-related macular degeneration (OR, 1.94; 95% CI, 1.07 – 3.53, P = 0.002) had associations with conformity, as well as white British ethnicity (OR, 1.69; 95% CI, 0.96 – 3.01, P = 0.02) and visual acuity of the best seeing eye at baseline (OR, 1.02; 95% CI, 1.01-1.04, P = .04).

For average weekly use per patient, data show patients with poor vision in the less seeing eye (β = 0.001; 95% CI, 0 – 0.002, P = .03) and a higher number of previous injections (β = 0.001; 95% CI, 0-0.001, P = .03) had associations with an increased weekly utilization rate.

In addition, usage rates were higher with increased comfort levels thanks to modern technologies (β = 0.031; 95% CI, 0.007 – 0.055, P = .02). A total of 119 patients (98.4%) found the app easy to use, while 96 (82.1%) noted greater confidence in using the app.

Take away food

“A strong association was found between weekly usage rate and comfort surveyed with modern technologies, suggesting substantial potential gains in increasing digital literacy through educational initiatives, patient outreach, feedback and outreach. support networks, ”investigators wrote.

The study, “Facilitators and Obstacles to the Deployment of Smartphone Home Vision Monitoring in Clinical Practice Settings, ”Was published in JAMA Ophthalmology.