Ophthalmologists rely on optical coherence tomography (OCT) to determine if a patient with age-related macular degeneration (AMD) needs treatment at their regular appointment or can delay treatment for a few more weeks. A recently approved home-based OCT device allows patients to test at home, so their doctor can continue to follow their response to treatment in between visits. A study presented today at AAO 2024, the 128th annual meeting of the American Academy of Ophthalmology, suggests that daily self-imaging can deliver better care while reducing the burden and costs on patients and the healthcare system.
The study included 15 retina specialists who reviewed treatment histories of patients with wet AMD (37 eyes) whose standard of care treatment decisions were based on in-office OCT scans only. The physicians were then given the patients’ home OCT scans and asked to reconsider the original treatment decisions using the additional data.
In nearly 42 percent of cases, the physicians felt that treatment administered could have been delayed. In 35 percent of cases, physicians recommended that treatment be given at least a week earlier than it was provided. In only 23 percent of cases did physicians agree with the timing of treatment given, within a range of one week.
“While I expected home OCT data to have some influence on decision making, the magnitude was certainly a surprise,” said lead researcher Paul Hahn, MD, PHD, a retina specialist. “However, once we consider that physicians now have 30 times more data than before and can now "fill in the blanks" between visits, this impact makes sense.”
Dr. Hahn’s statistical model estimates the reduced treatment suggested in this study would have resulted in a 28 percent decrease in drug costs, while reduced office visits resulted in proportional savings on in-office procedures and productivity loss, estimated at $159 and $117 per visit.
“Our current paradigms for treatment of retinal diseases, in particular wet AMD, require injections well in advance of disease reactivation because of the acuteness of the disease and lack of a monitoring safety net between treatment visits,” Dr. Hahn said. “The presence of home OCT data provides this much needed safety net, which not only limits unnecessary treatments but also provides a mechanism to promptly treat patients when needed.”
Notal Vision, the company that makes the home OCT device, says that physicians can now be reimbursed for remote OCT. Three established, dedicated CPT codes for remote OCT, 0604T, 0605T and 0606T, allow physicians and the monitoring center to bill for services every 30 days. Notal is also working with Medicare Administrative Contractors to establish coverage and payment for remote OCT billing codes.
The patient-operated scan typically takes less than one minute per eye to perform. Images are automatically transmitted through a built-in wireless connection to the Notal Health Cloud for analysis.
The proprietary AI (artificial intelligence)-based Notal OCT Analyzer segments and estimates the volume of hypo-reflective spaces on OCT images. Physicians can review data, set eye-specific notification criteria, including volume thresholds, and receive notifications through a HIPAA-compliant web portal.
About the American Academy of Ophthalmology
The American Academy of Ophthalmology is the world’s largest association of eye physicians and surgeons. A global community of 32,000 medical doctors, we protect sight and empower lives by setting the standards for ophthalmic education and advocating for our patients and the public. We innovate and support research to advance our profession and to ensure the delivery of the highest-quality eye care. Our EyeSmart® program provides the public with the most trusted information about eye health. For more information, visit aao.org.
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