Is current age related macular degeneration self-monitoring a good tool for detecting exudative recurrence?

Abstract

To assess the ability of patients with exudative AMD to detect exudative recurrence. Another objective was to assess if self-monitoring, as currently taught, improves this ability. An observational cross-sectional study was carried out in the ophthalmology center of BeauSoleil clinic in Montpellier between March 1 and April 1 2016. Inclusion criteria were presence of neovascular age related macular degeneration treated with the loading dose of three monthly intravitreal anti-VEGF injections, with at least one injection in the past 12 months and at least one exudative recurrence. All patients underwent a visual acuity measurement with ETDRS charts at 4 meters. A questionnaire assessed familiarity with the Amsler grid and its proper use, performance of and type of self-monitoring at home and the subjective feeling of an exudative recurrence at the visit with a 5-level Likert scale. A total of 94 eyes of 70 patients were included in this study with 69.0% women and a median (interquartile range) age of 83 (77-96) years. Among them, 81% performed regular self-monitoring, mostly with environmental Amsler tests (70%). Only 63% of the patients knew of the Amsler grid, among which 52% used it correctly. Sensitivity (95% confidence interval, 95% CI) and specificity (95% CI) of the subjective sensation of exudative recurrence were 0.32 (0.14-0.55) and 0.85 (0.74-0.92), respectively, for the entire population. Sensitivity (95% CI) and specificity (95% CI) were 0.33 (0.13-0.59) and 0.85 (0.74-0.93); 0.25 (0.0063-0.81) and 0.82 (0.48-0.98), respectively, in patients performing and not performing self-monitoring. Patients' prediction in wet AMD is insufficient in detecting exudative recurrences, even if regular self-monitoring with Amsler grid or environmental Amsler is performed.