Imagine a patient with wet age-related macular degeneration (AMD) who is stable on treatment but knows that a delay of even a couple of weeks, if the disease reactivates, can mean permanent loss of vision. They travel to their local clinic, sit in a busy waiting room, have an OCT (Optical Coherence Tomography) scan, a quick, painless imaging test that produces cross-sectional “slices” of the retina. In AMD, it’s central to monitoring because it lets us detect and track retinal fluid. They are told, “All quiet, see you next month.” For many, that reassurance is the main product of the appointment.
Home OCT promises a different model: Frequent retinal imaging without the trip, with alerts when disease activity returns. In the US, the first home OCT system has received FDA De Novo authorisation as a prescription self-imaging device [1]. In the UK, diagnostic accuracy work has explored home monitoring pathways for neovascular AMD in older adults [2]. Earlier generations of home monitoring, such as hyperacuity-based testing in the HOME study, also demonstrated that home strategies can detect conversion earlier than standard self-monitoring [3,4]. Taken together, it is easy to see why clinicians and patients are interested.
But moving OCT from a clinic to a living room is not a simple change of location. It changes what the data means to patients, how they behave between visits, and how services absorb demand. If we want home OCT to reduce burden rather than redistribute it, we need to design around human psychology as deliberately as we design around retinal fluid.
Why home monitoring feels like the obvious next step
Figure 1. Amsler grid appearance in normal vision (left) compared with distorted central vision in age-related macular degeneration (right).
The Amsler grid is simple, but it’s a blunt tool. Its limitations in screening and early detection have been highlighted for years, and many patients only notice change when their vision is already meaningfully affected [5]. Meanwhile, the NHS reality is familiar: logistical difficulty in attending clinics which can involve , reliance on family or hospital transport, time off work for carers, and clinic capacity that never quite matches demand.
Home OCT is attractive because it seems to offer three things at once: Earlier detection, fewer unnecessary visits, and a tighter feedback loop between disease activity and treatment. The MONARCH work, a UK study evaluating home monitoring approaches for neovascular AMD, is partly motivated by the same pressure every retina clinic feels, which is that long-term follow-up is essential, yet the system is stretched [2]. If a home device can reliably flag activity, the visit becomes targeted rather than routine.
That is the clinical story. The human story is slightly messier.
Continuous monitoring changes the patient experience
An OCT scan is not just information; it’s an event. In a clinic, that event is surrounded by a wider context: a technician, a clinician, and a plan. At home, the event is often solitary and repetitive. When you give someone the ability to check, you also give them a reason to check.
We have already seen versions of this in other areas. Continuous glucose monitoring can improve outcomes, but it can also produce frustration, worry, and a sense of being tethered to numbers [6]. Consumer wearables offer another parallel: false atrial fibrillation alerts have been associated with worse perceived wellbeing and confidence in symptom management in a cohort study [7]. The data is not neutral; it changes attention, and attention changes experience.
Ophthalmology has a particular vulnerability here because vision carries existential weight. People can tolerate a high blood pressure reading for months, but a hint of vision loss feels immediate and personal. If home OCT becomes a weekly (or daily) ritual, the psychological cost of waiting to see can increase, even if the clinical pathway is safer on paper.
Should patients see their AMD metrics?
If a home OCT system produces a signal, who should see it, and in what form. Raw OCT-derived outputs (for example fluid volumes or probability scores) can look authoritative while still being uncertain, especially at the margins of what is considered “normal”.
Health systems have already grappled with what happens when patients gain immediate access to clinical results. Direct release can increase engagement, but it can also increase utilisation and demand [8]. In a JAMA Network Open study, repeated portal refresh behaviour while awaiting results was associated with subsequent patient-initiated messaging, suggesting that easy access can translate into worry and workload [9]. That is not an argument against transparency, but it is a reminder that access without interpretation has consequences.
For home OCT, a tiered output may be the least harmful option. A simple, patient-facing status update (for example “no change detected” versus “please contact the service”) with optional detail for those who want it, and clinician-facing quantitative data reserved for triage and decision-making. Without this necessary framing we risk breeding anxiety.
The hidden workload problem
Home OCT is often sold as a way to reduce clinic visits. In reality, it can convert scheduled workload into unscheduled workload.
If a patient is scanning frequently, they have more opportunities to become concerned. Even when the device is working perfectly, the service needs a response standard. How quickly are alerts reviewed? Who responds? What happens at weekends? What does “reviewed” mean? Without clear expectations, uncertainty drives repeated checking and repeated contact.
A home pathway is only as good as its operational promise. If the promise is unreliable, patients will seek reassurance elsewhere, and that reassurance will land in GP, A&E, or already overloaded clinics.
Guardrails that make home OCT feel safe
Most of this can be improved with upfront choices. If I was building a home OCT pathway, these would be the non-negotiables:
1) Be explicit about purpose. Position home OCT as a safety net and triage tool, not a replacement for clinical assessment and not a decision tool for patients to self-manage treatment. The FDA De Novo documentation is clear that these are prescription devices with defined indications [1].
2) Decide what the patient sees. A simple, interpretable output by default which avoids exposing raw metrics without context.
3) Include patient-friendly interpretation. An alert should come with plain-language framing: what it might mean, what will happen next, and what not to do (for example, do not panic and do not change medication without advice).
4) Set a response standard. If scans are reviewed within a stated timeframe, say it, and meet it. If you cannot meet it, change the pathway rather than relying on goodwill.
5) Anticipate digital inequality. Older patients, people with limited digital confidence, and those without reliable internet will be over-represented in AMD clinics. If the pathway assumes a tech-confident user, it will widen gaps.
6) Treat reassurance as a resource. Some patients will scan more because they are anxious. Design the service so that reassurance is available without the patient needing to chase it.
Conclusion
Home OCT could improve outcomes by catching reactivation earlier, and it could reduce unnecessary travel for people who already carry a lot of burden. But if we treat it as a simple tech upgrade, we will miss the harder truth: home monitoring reshapes attention, worry, behaviour, and demand.
If we get the guardrails right, home OCT can feel like quiet reassurance delivered efficiently. If we get them wrong, it becomes a new way to create scanxiety at scale.
References
1. U.S. Food and Drug Administration. DEN230043: Notal Vision Home Optical Coherence Tomography (OCT) System. De Novo classification request. Decision granted 15 May 2024. Available from: https://www.accessdata.fda.gov/cdrh_docs/pdf23/DEN230043.pdf.
2. Hogg RE, Wickens R, O’Connor S, Gidman E, Ward E, Treanor C, et al. Home-monitoring for neovascular age-related macular degeneration in older adults within the UK: the MONARCH diagnostic accuracy study. Health Technol Assess. 2024;28(32):1-136. doi:10.3310/CYRA9912.
3. Chew EY, Clemons TE, Bressler SB, Elman MJ, Danis RP, Domalpally A, et al. Randomized trial of a home monitoring system for early detection of choroidal neovascularization: the HOME study. Ophthalmology. 2014;121(2):535-544. doi:10.1016/j.ophtha.2013.10.027.
4. Ho AC, Heier JS, Holekamp NM, Garfinkel RA, Ladd B, Awh CC, et al. Prospective trial of a home monitoring system for patients with age-related macular degeneration. J Clin Med. 2021;10(7):1355. doi:10.3390/jcm10071355.
5. Zaidi FH, Cheong-Leen R, Gair EJ, Weir R, Sharkawi E, Lee N, et al. The Amsler chart is of doubtful value in retinal screening for early laser therapy of subretinal membranes. The West London Survey. Eye (Lond). 2004;18(5):503-508. doi:10.1038/sj.eye.6700708.
6. Patton SR. Psychological reactions associated with continuous glucose monitoring in youth. J Diabetes Sci Technol. 2016;10(3):656-661. doi:10.1177/1932296816638109.
7. Tran KV, Filippaios A, Noorishirazi K, et al. False atrial fibrillation alerts from smartwatches are associated with decreased perceived physical well-being and confidence in chronic symptoms management. Cardiol Cardiovasc Med. 2023;7(2):97-107. doi:10.26502/fccm.92920314.
8. Pillemer F, Price RA, Paone S, Martich GD, Albert S, Haidari L, et al. Direct release of test results to patients increases patient engagement and utilization of care. PLoS One. 2016;11(6):e0154743. doi:10.1371/journal.pone.0154743.
9. Steitz BDTR, Turer RW, Salmi L, et al. Repeated access to patient portal while awaiting test results and patient-initiated messaging. JAMA Netw Open. 2025;8(4):e254019. doi:10.1001/jamanetworkopen.2025.4019.
Overall, this is a timely, well-made piece of work that points the way forward: with the right safeguards, home OCT has the potential to deliver earlier detection, greater reassurance, and more sustainable care for patients and services alike.
Very interesting article!