Allen C. Ho, MD, FACS


Retrospective real world study shows that only 34% of patients with nAMD initiate IVs with 20/40 or better VA.

Eyes with better than 20/40 visual acuity (VA) at the time of nAMD diagnosis on average maintain a mean of 20/40 or better after two years of anti-VEGF injection treatment, but only represent a minority, according to real-world study based on a large database. As pointed out by the authors, “early diagnosis prior to significant vision loss remains a substantial challenge in real-world clinical practice.” 

The study was based on the American Academy of Ophthalmology’s Intelligent Research in Sight (IRIS) Registry, and analyzed the data of patients diagnosed with nAMD in one or both eyes between January 2013 and June 2017

Of the 236.843 eyes identified in the registry, 162.902 eyes of 153,141 patients met inclusion criteria for the study and were included in the analysis.
Despite all pivotal trials of intravitreal anti-VEGF therapy demonstrate that significantly better VA results over time are obtained in patients who have better baseline VA, in real-world clinical practice patients treatment is often initiated when significant visual deterioration has already occurred, the authors noted.   

In the IRIS registry study, only 34.3% of the eyes had baseline VA of 20/40 or better at the time of treatment initiation and mean VA at presentation was 20/80 or worse.
According to the authors

“These results reinforce the importance of early detection methodologies to optimize visual acuity for patients who convert from atrophic to neovascular AMD,” the authors wrote. “This further supports the growing belief that identifying and treating nAMD patients early in their disease diagnosis can result in better functional vision over the long term.” 


The ForeseeHome AMD monitoring program

Current technologies may represent a solution to this problem, according to Allen Ho, MD, first author of the study. The ForeseeHome AMD monitoring program offered by the Notal Vision Diagnostic Clinic, includes a home-based patient self-testing device that allows to detect small changes in vision.  

“Patients look into the device and click on a dotted line when a bump appears.  It takes about two minutes per eye to perform the test daily, and results are made available through the cloud to the treating physician. When a change to the macula is detected by the AI algorithm, an alert is sent from the Notal Vison Diagnostic Clinic to the physician.”

Real-world analysis of the data collected since the approval of the device in the United States, showed that in 83% of the users, conversion to neovascular AMD was detected when patients had 20/40 or better vision. In contrast real-world IRIS registry data published in December showed that under current standard of care only 34% of patients are diagnosed at this level of vision*.  

“This confirmed the results of the AREDS2 HOME clinical trial, in which the percentage of patients maintaining functional vision at the time of wet AMD diagnosis was 94% with the use of ForeseeHome, as compared with 62% with the standard care of routine visits and patient-reported changes,” he pointed out.  



  • * Ho AC, Kleinman DM, Lum FC, et al. Baseline Visual Acuity at Wet AMD Diagnosis Predicts Long-Term Vision Outcomes: An Analysis of the IRIS Registry, Ophthalmic Surg Lasers Imaging Retina. 2020;51:633-639.
  • Real-World Performance of a Self-Operated Home Monitoring System for Early Detection of Neovascular AMD (ForeseeHome device), presented by Allen Ho, American Society of Retina Specialist Meeting 2020
  • Chew EY, Clemons TE, Bressler SB, et al; AREDS2-HOME Study Research Group. Randomized trial of a home monitoring system for early detection of choroidal neovascularization home monitoring of the Eye (HOME) study. Ophthalmology. 2014;121(2):535-544.