Eric Jung, MD
Cole Eye Institute, Cleveland Clinic, Cleveland, OH
RETINA Editorial Board Member Dr. Anat Loewenstein, MD, MHA received Retina Society’s Award of Merit in Retina Research this year. In conjunction, she gave the Charles L. Schepens Lecture at the Annual Meeting on Thursday, September 12, 2024 in Lisbon, Portugal.
The Award of Merit in Retina Research was started in 1978 by the Retina Research Foundation to recognize an outstanding vision scientist. Each year, the awardee is invited to give the Charles L. Schepens Lecture – named after the founder of the Retina Society, a historic innovator who brought us the binocular indirect ophthalmoscope among other inventions, and often credited with establishing surgical retina as a subspecialty.
Dr. Anat Loewenstein is the Chair of Ophthalmology at Tel Aviv Medical Center, and Vice Dean and Sidney Fox Chair of Ophthalmology at the Sackler Faculty of Medicine. She serves as the president of EURETINA and the Israeli Ophthalmological Society. Dr. Loewenstein has won several awards, including Macula Society’s Arnall Patz Medal, Rosenthal Award, and Michelson Award, ARVO’s Silver Fellow Medal, and most recently, the ASRS Pyron Award.
She has authored / co-authored over 500 publications and is regarded as a true innovator, with early involvement in the prototypes of the port-delivery system as well as significant contributions to research in gene therapy and home monitoring of macular disease. She has a significant interest in the early detection of diseases such as AMD. During the Charles L. Schepens Lecture award, she shared recent developments in home OCT as it pertains to neovascular AMD (nvAMD).
Dr. Loewenstein started the lecture by reviewing recent advancements in the treatment of nvAMD, including the advent of more durable anti-VEGF options for longer interval extensions between injections. Despite recent leaps in the field of retina, she identified some current unmet needs; namely, delays in the diagnosis of nvAMD conversion leading to visual decline in some patients as well as the burden of overtreatment in patients due to a lack of personalized, precision-based care.
Dr. Loewenstein introduced the concept of home monitoring as a potential solution for both problems. A precursor to home OCT was the ForeseeHome (Notal Vision) AMD monitor, a functional, perimeter-based machine that could detect the conversion from dry to wet AMD. While this technology was not widely adopted, early studies demonstrated improvement in letters lost from baseline compared to the Amsler grid and standard of care. Dr. Loewenstein then introduced the Scanly Home OCT (Notal Vison), the first at-home retinal imaging device approved by the FDA in May 2024. Patients can perform daily scans at home, and artificial intelligence-based interpretation allows for automatic updates to the physician when there is an increase in hypo-reflective spaces (HRS) indicative of fluid. This technology allows a physician to understand the temporal trajectory of a patient’s disease and allows a patient’s fellow eye to be monitored even in the midst of a long therapeutic extension for the treated eye.
Dr. Loewenstein shared early data that lead to the approval of Scanly Home OCT for nvAMD. In the pivotal trials, 96.1% of patients were able to activate the device successfully, and the adherence rate was high with 5.9 scans per week on average per patient. Total scanning time was on average 48 seconds. Agreement in visualization of hypo-reflective spaces (HRS) was measured between home OCT and in-office OCT, with 86.6% agreement for the presence of HRS and 86.1% agreement for the absence of HRS.
Cross-sectional performance data regarding the AI technology were also presented, which analyzed the repeatability of HRS volume estimates and agreement between AI and expert graders. Estimates were reasonably repeatable with a coefficient of variation of 11.1%. Overall agreement between AI and expert graders was noted to be similar to the agreement between two human graders. With AI-based processing of patient scans, treatments were able to be extended from a previous average of 8 weeks to 15.3 weeks with home OCT.
Dr. Loewenstein highlighted the ability of home OCT to quickly identify “non-responders” and reduce treatment burden in excellent responders. Home OCT often altered the decisions of retina providers in a retrospective hypothetical environment – guiding the decision to forego treatment 43% of the time and guiding the decision to treat earlier 61% of the time, compared to our standard of care with in-office OCT. She likened home OCT to similar endeavors in other fields, such as glucose monitoring or EKG monitoring with at-home medical devices. Overall, Dr. Loewenstein sees significant advantages of home OCT in all stages of nvAMD treatment – Initiation, extension, maintenance, and even cessation. As a final point, she acknowledged possible reimbursement obstacles with home OCT devices, but reminded us that innovation is advantageous for the field of retina as a whole.