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Purpose: To investigate how home optical coherence tomography (OCT) influences the clinical decision-making of retina specialists for the management of neovascular age-related macular degeneration (nAMD). Methods: In this retrospective imaging review, 15 retina specialists each evaluated 10 home OCT data segments from 29 eyes being treated for nAMD. Based on OCT data, indications were identified for when eyes should be treated, which antivascular endothelial growth factor should be used, and the specific retinal fluid and time thresholds for notification. Results: Withholding treatment was recommended in 64 (42.7%) of 150 data segments (95% CI, 34.7-50.6), whereas 100% of eyes received treatment on the last day of each data segment. Treatment was recommended in 86 cases (57.3%), with treatment occurring 7 or more days before the actual treatment was advised in 52 (60.5%) of 86 data segments. This earlier treatment would have prevented the accumulation of intraretinal fluid (IRF), subretinal fluid (SRF), and total retinal fluid for 69.1 nL, 162.2 nL, and 231.2 nL days. Retina specialists chose a different type of treatment agent in 35 (40%) of 86 cases. The following notification values were set: IRF, mean 9.8 ± 14.9 nL (median, 5; IQR, 5); SRF, mean 10.2 ± 16.1 nL (median, 5.5; IQR, 5); total retinal fluid, mean 15.2 ± 24.0 nL (median, 10; IQR, 5). The time-based notification interval was set at a mean of 34.7 ± 21.9 days (median, 30; IQR, 2). Conclusions: Home OCT-based decision-making by retina specialists differed substantially from actual clinical care. Home OCT has the potential to facilitate personalized care in nAMD., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: G: Grant, C: Consultant, H: Honorarium, T: Travel Support, S: Shareholder: A: Advisory or Safety Board Member, L: Leadership. JSH: 4D Molecular Therapuetics (G,C,S), Annexon (G,C), Apellis (G,C), AsclepiX Therapeutics (G,C), Ashvattha (G), Bayer (G), Cognition Therapeutics (G), Curacle (G,C), Genentech/Roche (G,C), Gyroscope Therapeutics (G,C), Iveric Bio (G,C), Janssen R&D (G,C), Kodiak (G), NGM (G,C), Novartis (G,C), OcuTerra (G,C), Perceive Bio (G), Regeneron Pharmaceuticals (G,C), RegenexBio (G,C), Abpro (C), Adverum (C,S), AffaMed Therapeutics (C), Applied Genetics Technologies Corporation (C), Akouos (C), Aviceda (C,S), Bausch + Lomb (C), Biovisics (C), Clearside (C), DTx Pharma (C,S), Exegenesis (C), Glaukos (C), Gyroscope Therapeutics (C), Immunogen (C), jCyte (C,S), Kriya (C), Nanoscope (C), Notal Vision (C), Ocular Therapeutix (C,L), Ocuphire (C,S), OliX (C), ONL Therapeutics (C), Outlook Therapeutics (C), Palatin Technologies (C), Perceive Biotherapeutics (C), Ray Therapeutics (C), RetinAI (C), RevOpsis Therapeutics (C,S), Stealth BioTherapeutics (C), Théa Pharmaceuticals (C), Vanotech (C), Aldeyra Therapeutics (S), Allegro (S), Vinci Pharmaceuticals (S), Vitranu (S); YL: Genentech (H), Horizon Therapeutics (H), Apellis Pharmaceuticals (H), Regeneron Healthcare Solutions (H), Notal Vision (T), Center for Eye Research and Education (T); NMH: Notal Vision (G,A,S);MHA: Notal (M), Alimera Science (C), Abbvie (C); KJB: Notal Vision (M), Regeneron (C,H), Genentech (C,H), Bausch & Lomb (C,H), Biogen (C); MAB: Notal Vision (M,C,H,T); MAC: Notal Vision (M,C); MJE: Notal Vision (G, T); JGF: Notal Vision (M), Roche (C, A, H), Regeneron (C, A, H); PH: Notal Vision (M), Adverum (G,C), Apellis (G,C,A), Eyepoint (G,C,H,A), Genentech (G,C,H,A), Regeneron (G), RegenxBio (G), Samsara (G), Alcon (C,A), DORC (C,A), ASRS (L); NL: Notal Vision (M), Roche (C), Regeneron (C,A), RegenxBio, (C), Ionis (C), Apellis (C,H), Annexon (C), Genentech (H,A), Iveric Bio (H), EyePoint Pharmaceuticals (A), Opthea (A); TM: Notal Vision (M); YSM: Notal Vision (C), Alimera (C), Allergan (C), Genentech (C), DORC (C), Thea (C), Zeiss (C), Iveric Bio (C), Apellis, Regeneron (C); AR: AGTC (G), Apellis Pharmaceuticals (G,C,), DRCR Retina Network (G), Roche/Genentech (G,C), Abbvie/Allergan (C), Alcon (C), Regeneron (C), Iveric Bio (C), Ocular Therapeutix (C); EWS: Notal Vision (M,C), Carl Zeiss (C); JCW: Genetech (C,A), Carl Zeiss (C); ARS: Notal Vision (M,C), RegenxBio (C), Regeneron (C), Apellis (S). The sponsor of the study is a provider of home OCT monitoring services., (© The Author(s) 2024.)

Purpose: To evaluate the incidence and clinical characteristics of intravitreal injection-related endophthalmitis cases with antivascular endothelial growth factor (anti-VEGF) medications manufactured as prefilled syringes or non-prefilled preparations. Methods: This retrospective chart review comprised eyes that received intravitreal anti-VEGF at a single-specialty retina practice from January 1, 2014, to December 31, 2019. Eyes diagnosed with injection-related endophthalmitis were identified. Demographic and clinical data were abstracted from medical records, including the type of anti-VEGF agent, baseline and follow-up corrected visual acuity (VA), and microbiologic findings. Results: The review identified 88 cases of intravitreal anti-VEGF injection-related endophthalmitis and 325 990 total injections. Total injections included 32 045 (9.8%) bevacizumab (BEV), 93 073 (28.6%) ranibizumab (RAN), 122 947 (37.7%) aflibercept (AFL), and 77 925 (23.9%) ranibizumab prefilled syringe (RANPFS). Ten of the endophthalmitis cases were related to BEV, 21 to RAN, 45 to AFL, and 12 to RANPFS. The endophthalmitis rate was lowest for RANPFS (0.0154%) (BEV, 0.0312%; RAN, 0.0226%; AFL, 0.0366%) ( P = .030). Thirty-four (41.5%) of 82 samples were culture positive. RANPFS had a significantly lower rate of culture-proven postinjection endophthalmitis than the other agents ( P = .003). The mean VA for endophthalmitis cases related to RANPFS vs non-prefilled agents was similar at presentation (Snellen 20/2092 vs 20/2327) and at the 3-month follow-up (Snellen 20/201 vs 20/272) (both P > .05). Conclusions: Anti-VEGF medications in prefilled syringes may reduce the risk for medication contamination during injection preparation. RANPFS was associated with a lower rate of injection-related endophthalmitis than non-prefilled anti-VEGF medications., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Roth is a consultant to Alimera Sciences, and has received royalties from Genentech., (© The Author(s) 2023.)