🎙️ Guest Introduction
- Dr. Christina Weng is a retina specialist from Baylor College of Medicine.
- She chairs DRCR Retina Network’s Protocol AO and is active in ASRS and Women in Ophthalmology.
- Her background includes training at Johns Hopkins and Bascom Palmer, with expertise in neovascular AMD and innovative imaging.
🧪 Protocol AO Overview
- Protocol AO studies the use of home OCT (Optical Coherence Tomography) for monitoring neovascular age-related macular degeneration (AMD).
- The device allows patients to self-scan daily from home, enabling earlier detection and personalized treatment.
🏠 Home OCT Technology
- Compact (16 lbs), AI-supported, cloud-based platform.
- Captures high-resolution 3×3 mm scans.
- Enables daily monitoring, potentially improving outcomes by detecting fluid changes earlier.
🎯 Study Design
- Randomized clinical trial with 600 treatment-naive wet AMD eyes.
- Compares home OCT-guided treatment vs. standard treat-and-extend regimen.
- Primary outcomes: visual acuity change and number of injections over 2 years.
- Secondary outcomes: visit frequency, fibrosis, macular atrophy, fluid dynamics, patient-reported outcomes.
🔍 Key Insights
- Daily monitoring reveals fluid fluctuations that may not require immediate treatment.
- Fluid alert threshold set at 10 nanoliters to distinguish meaningful changes.
- Potential to redefine fluid tolerance and reduce unnecessary injections.
👁️ Fellow Eye Monitoring
- Ancillary study tracks dry AMD fellow eyes for early conversion signs.
- May improve outcomes through earlier detection and intervention.
⚠️ Challenges & Roadblocks
- Workflow disruption: alerts require timely clinician response.
- Reimbursement: FDA-cleared but not yet commercially available.
- Legal concerns around AI-guided treatment decisions.
🔮 Future Applications
- Potential use in diabetic macular edema, retinal vein occlusion, and glaucoma.
- Could complement long-acting therapies and gene therapy by enabling remote monitoring.
🤝 Final Thoughts
- Dr. Weng emphasizes the paradigm-shifting potential of home OCT.
- Personalized, PRN 2.0 treatment approach may emerge.
- Results from Protocol AO could influence broader adoption and future studies.
