Considerations for using a remote monitoring system for a patient who is diagnosed with intermediate dry age-related macular degeneration.
John Rumpakis, OD, MBA: Let’s take a common patient. Here’s a broad outline of a patient, then you can tell me how you would manage this case and where remote monitoring comes into play and how it affects the patient. Let’s say we have a typical patient, 67 years old, who presents with glare at night and intermittent blurred vision. They have intermediate dry AMD [age-related macular degeneration], some dry eye disease, and cataracts. Jaya, in your practice, what would be the plan for this patient?
Jaya Pathapati, OD: I’m going to talk to them about their smoking history if they had any, and family history, too. Both of those should be key. Then let’s start with their quality of vision right now and try to get the dry eye under control and do what we need to do. We’re not going to do a whole lot with our cataracts at this point until we make sure that it’s the right time. I tell patients if it’s bad, we’ll look at going into cataract surgery, considering all the studies that are iffy. But with intermediate dry AMD, after education, I would send them home with an Amsler grid and have them repeat testing in about 6 months with OCT [optical coherence tomography]. And of course lifestyle education, AREDS [supplements], or something similar. Talk to them about their diet; a lot of ranchers think that blood from steak is color food, colorful on their plates. And sunglasses, we are very fortunate with that, and of course cholesterol and other things in their overall health, and see them back in about 6 months.
John Rumpakis, OD, MBA: Steve, how about you, are you incorporating what Jaya says? And then are you doing remote monitoring of that patient as well?
Steven Ferrucci, OD, FAAO: I agree with a lot of what she said—patient education, AREDS2 supplementation, all those things. I would consider genetic testing, which might help further their risk for progression. Once these patients reach this intermediate stage, that’s a perfect time to start thinking about home monitoring.
I’ve been practicing almost 25 years, and I can seriously count on less than one hand the amount of patients that would call me or came in saying, “I have a change in this Amsler grid.” Patients just simply don’t do it quite frankly. There’s no compliance, there’s no way to check their compliance, and they don’t do it. And furthermore, I don’t feel it’s good enough to check the early changes. Usually by the time they notice a change, it’s frankly later in the disease process. With these intermediate patients, it’s a perfect time to have the discussion about home monitoring and see if that’s something that the patient would benefit from, and in many cases I think they will.
Jaya Pathapati, OD: I have a discussion as well. Before 6 or 7 months, that was my plan, Amsler, go home. Now I start with the conversation of remote monitoring because I do have a lot of elderly patients, and where we’re located, we have patients from 5 states who drive sometimes 2 hours to come for health care, eye care, and everything. They sometimes don’t have the ability to come in immediately, and elderly patients who don’t have access, sometimes they must wait for rides and so forth. The remote monitoring is a No. 1 thing that I’ve started incorporating, especially for my patients with intermediate AMD. Even patients with early AMD, there’s always a discussion about, “How would it be so you don’t have to worry, that we’re watching you?
Transcript edited for clarity.