Researchers at Moorfields Eye Hospital in London investigated enablers and barriers of engagement with app-based home monitoring of vision in patients with retinal diseases.
“The strongest predictor of uptake in our patient cohort was age, with older individuals relatively less likely to become active users, representing a risk factor for digital exclusion,” authors wrote.
Better vision was positively associated with uptake and compliance.
According to the study, the Home Vision Monitor app (HVM, Genentech) is an FDA-cleared, CE-marked self-test that detects metamorphopsia in the central degrees of vision using shape discrimination hyperacuity.
The app is linked to a web-based review portal that sends an alarm message to the clinician whenever the patient's eyesight changes. Between May 2020 and February 2021, the app was offered to 417 patients treated with intravitreal injection who owned a smartphone. Self-testing was required twice a week.
The analysis of HVM data was integrated with an engagement survey to evaluate uptake, compliance and use rate and their association with patient characteristics.
The success of installing and utilizing the app at least once was defined as uptake. Regular use of the app for at least four weeks was defined as compliance. The total number of tests performed throughout the study period was referred to as the use rate.
Two hundred and fifty-eight patients (61.9%) were identified as active users, and 166 patients (64.3%) met the compliance criteria. Mean weekly app use was 1.83.
Uptake and compliance were favorably linked with younger age, better vision, and the number of injections at baseline. Patients with age-related macular degeneration were more likely than those with macular edema to follow instructions.
The survey, completed by 117 active users, revealed a clear link between comfort with current technology and increased app use rates. The most popular reason for using the app was the hope that better vision monitoring will lead to better eye health.
Within the study, 26 alerts for vision worsening were triggered. In eight cases, changes were not subjectively perceived by the patients. Notification alerts demonstrated high sensitivity (84.6%) and specificity (88.5%).
According to the authors, studies in controlled research conditions have indicated that using smartphone-based home monitoring apps can help patients manage retinal diseases.
On the other hand, “for real-world translation of such benefits to occur, potential barriers to adoption not manifested in controlled research environments require careful consideration,” the authors added.
To adress digital exclusion, targeted interventions such as educational efforts focused at promoting digital literacy should be developed.
“As health care systems increasingly adopt digital and remote models of care, issues such as digital exclusion require careful consideration to both ensure equitable access and avert disparate outcomes,” the authors concluded.