In this MD Newsline exclusive interview with vitreoretinal specialist Dr. Michael Singer, we discuss barriers to treatment adherence and COVID-19 as they relate to wet AMD.
What are the major barriers to wet AMD treatment adherence?
Dr. Michael Singer:
“In terms of treatment barriers and treatment adherence, treatment adherence is really a problem. There are two basic issues. When a doctor initiates treatment for wet macular degeneration, the issue of needle phobia, in which patients are fearful of getting a needle in their eye, is definitely a big issue.
The other issue is that the increases in vision due to the medication are short-lived. Patients get weary of coming to the doctor every month or every other month to get injections. In addition, doctor’s visits take a long time for both the patient and caregiver and this patient population usually has a number of different specialists to see to manage all their systemic conditions.
So, I am really excited about the new therapies that may decrease patient visits to every four to six months. So hopefully, there will be less patient burden and more patient compliance.”
What are the biggest challenges that ophthalmologists are tasked with in the wake of COVID-19?
Dr. Michael Singer:
“In terms of challenges for COVID-19, in our practice, we tried telemedicine. However, it’s not been very successful for us. One of the reasons, I believe, is that we are a visual field. I mean, in most cases, we really don’t need a history. We just need to look at the eye. The problem is it’s not so easy to look in the back of the eye, even remotely through an iPhone camera.
There are technologies that we’re working with that we can adapt to a phone, for example, by putting an ophthalmoscope on the back of a phone for screening, but still, someone has to be there, and someone has to actually look at the patient, and that defeats the concept of telemedicine or remote medicine. I’m actually working with a company that may allow patients to do their own retina selfies. But it’s still a work in progress and in the early stages.
Now, telemedicine may work for the front of the eye and if you can see if the patient has an infected eye or if it’s conjunctivitis. But for diseases like glaucoma, macular degeneration, or diabetic retinopathy, one needs to examine the back of the eye.
This requires dilation or a really good imaging system. So that’s a real problem since patients have to come to the office, or have to come somewhere, to capture the image. When it comes to therapy, patients need shots, and that can’t be done remotely.
Now, there are a couple of technologies that are on the horizon that are very exciting. There’s something called ForeseeHome. It’s a home detecting system for macular degeneration, with patients monitoring themselves at home. The patient is able to detect change in [their] test and notify the doctor’s office. It’s currently used [for] screening patients with dry macular degeneration to detect conversion to wet macular degeneration.
And then, for patients undergoing injections, it’s a little more complicated. We currently use an OCT machine to determine the response to therapy and to see if more treatment is needed. Well, there’s now a clinical trial being done looking at a home OCT machine that people use at home.
The patient looks in the machine daily, and if the machine notices a change in the swelling, it can notify the doctor’s office. This can be done using artificial intelligence. The hope is [that] through AI, the machine can determine a microscopic change on OCT and give patients treatment only when they need it, thereby decreasing patient burden and increasing compliance.
I think that’s where the future is going, not only just for COVID, but to monitor people in different parts of the world, especially where healthcare is really limited. I believe this technology is going to have great potential.”
Responses have been condensed and lightly edited.