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  • Assessing Use of App-Based Home Vision Monitoring in Retina Patients

    By Jean Shaw
    Selected and Reviewed by Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, February 2022

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    Korot et al. set out to quantify the drivers of—and barriers to—the use of smartphone-based home vision monitoring in a high-volume clinical setting. They found that those patients with better baseline visual acuity (VA) in the better-seeing eye were more like­ly to use the app. In addition, patients with age-related macular degeneration (AMD) were more likely to use the app than were those with macular edema, and older patients were less likely to use it than were younger participants.

    For this cohort and survey study, the researchers evaluated consecutive adult patients who received anti-VEGF injec­tions for retinal disease at Moorfields Eye Hospital in London between May 2020 and February 2021. The patients (N = 417; mean age, 72.8 years) were offered the Home Vision Monitor (HVM) smartphone app to self-test their vision twice weekly. They also were surveyed about their experience. App data, demographic characteris­tics, survey results, and clinical data from the electronic health record were analyzed via regression and machine learning.

    Uptake was defined as successful installation and subsequent use of the app at least once, and patients who met this requirement were defined as active users. Compliance was defined as any continuous period of at least four weeks in which vision tests were performed at least twice a week.

    All told, 258 (61.9%) of the patients actively used the app, and 166 fulfilled the definition of compliance. At week 4, mean weekly app use was 1.83. Uptake was negatively associated with age (odds ratio [OR], 1.02; confidence interval [CI], .97-.998; p = .02) and positively with better baseline VA in the better-seeing eye (OR, 1.02; 95% CI, 1.00-1.03; p = .01) as well as with baseline number of intravitreal injec­tions (OR, 1.01; 95% CI; 1.00-1.02; p = .04). Patients with neovascular AMD were more likely to be compliant (OR, 1.94; 95% CI; 1.07-3.53; p = .002), as were those who were White and British individuals (OR, 1.69; 95% CI; .96-3.01; p = .02). A total of 119 patients found the app either easy or very easy to use, while 96 experienced increased reassur­ance from using it. The most common motivation to use the app was the expectation that doing so would benefit one’s eye health.

    Going forward, the authors said, issues such as digital exclusion “require careful consideration to both ensure equitable access and avert disparate outcomes.” (Also see related commentary by Dina Zur, MD, and Anat Lowenstein, MD, MHA, in the same issue.)

    The original article can be found here.