Abstract
ObjectiveAn educational, interactive journal [Vision and Memory Stimulating (VMS) journal] was developed to boost patient confidence and promote long-term adherence with weekly vision self-monitoring in age-related macular degeneration (AMD) patients at risk for vision loss from new-onset neovascularization.MethodsIn a multicenter randomized controlled trial, 198 subjects with intermediate stage, non-neovascular AMD received the VMS journal or followed usual care (e.g. their doctor’s instructions for vision monitoring; Amsler grid). At 6 and/or 12 months post-enrollment, 157 subjects completed a questionnaire on vision self-monitoring.ResultsAt 6 and 12 months, respectively, 85% and 80% of the VMS journal subjects reported vision monitoring at least weekly, which represent statistically significant 7.1 and 4.2 times greater odds than the 50% of controls who monitored weekly at both follow-up times (p<0.001). At 6 and 12 months, respectively, 29% and 25% of controls indicated that they had not checked their vision in the past 6 months, while only 1.5% and 5% of the VMS journal subjects reported no vision self-monitoring. At 6 and 12 months, respectively, only 15% and 13% of the VMS journal subjects vs. 53% and 44% of the controls reported that they did not feel confident that they were taking care of their sight by self-monitoring (p<0.001). Usual care controls had statistically significant 6.7 and 5.0 times greater odds of reporting non-confidence at 6 and 12 months, respectively. There was no statistically significant change in weekly vs. less frequent self-monitoring between the groups (p=0.68), with 81% of all subjects reporting no change in frequency between 6 and 12 months.ConclusionsThese findings support the efficacy of the VMS journal for increasing vision self-monitoring adherence and confidence, in addition to promoting persistence in weekly monitoring over the course of a year in AMD subjects at risk for exudative retinal changes.
Highlights
Interest in remote, home-based monitoring of chronic diseases is greatly increasing, especially for diseases in which early intervention improves patient outcomes
There was no statistically significant change in weekly vs. less frequent selfmonitoring between the groups (p=0.68), with 81% of all subjects reporting no change in frequency between 6 and 12 months. These findings support the efficacy of the Vision and Memory Stimulating (VMS) journal for increasing vision self-monitoring adherence and confidence, in addition to promoting persistence in weekly monitoring over the course of a year in age-related macular degeneration (AMD) subjects at risk for exudative retinal changes
One example is the neovascular form of age-related macular degeneration (AMD), for which treatment can halt or partially improve vision loss if not delayed
Summary
Home-based monitoring of chronic diseases is greatly increasing, especially for diseases in which early intervention improves patient outcomes. One example is the neovascular form of age-related macular degeneration (AMD), for which treatment can halt or partially improve vision loss if not delayed. AMD continues to be the leading cause of vision loss in those over age 60, primarily because many patients wait until they have suffered significant vision loss before making a decision to seek help. In order to optimize clinical outcomes, patients must take the initiative to routinely self-monitor their vision and present promptly upon new symptoms of vision loss. Seeking timely evaluation and treatment would help reduce the risk of damage to the fovea from neovascularization, which expands across the retina at 25 microns/day on average [3]
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