MANATEE -- Dr. Joshua Mali of The Eye Associates is admired by fellow Manatee and Sarasota county retina specialists for the extent he will go for his patients, a co-worker said of him.
"He's a favorite of the retina doctors," said Peggy Shinn, who works with Mali at The Eye Associates, 6002 Pointe West Blvd., Bradenton as well as in their Sarasota office. "That's the word on the street."
Mali's fellow doctors may be envious to learn that in his zeal to save the eyesight of patients who already have dry macular degeneration from getting wet macular degeneration, Mali months ago began studying a piece of technology that has recently been approved by the Federal Drug Administration and Medicare. The technology, called ForeseeHome, is the first FDA-approved home-based monitoring system for macular degeneration patients.
Mali is among the first doctors in Bradenton to get the ForeseeHome AMD Monitoring System.
"I heard about it, started researching it by reading studies and I got excited about the results," Mali said in his office last week.
Patients use the ForeseeHome at home by looking through the foam eye-piece once a day, three minutes for each eye.
"The best part is that if the system notices a change in either eye from the baseline, it alerts me and I contact them to be examined," Mali said. "We will catch things sooner and have better outcomes."
He has written 10 to 15 prescriptions for ForeseeHome so far and, while there have been no vision-saving moments yet, he feels certain it will happen in the future.
"This machine is like going from the bicycle to the automobile," Mali said, excitedly. "It's streamlined."
Age-related macular degeneration
As we age, if we smoke or if genetics are not on our side, we may come down with age-related macular degeneration, which is the leading cause of severe vision loss and blindness in adults over age 50, Mali said.
The early stage of the disease causes damage to the part of the retina called the macula, which is responsible for detailed central vision tasks like reading, driving and facial recognition, Mali said.
Patients with dry age-related macular degeneration may progress to the wet form of AMD, in which blood vessels form and may leak fluid and blood onto the retina. Several studies indicate that early detection of warning signs of disease progression provides patients the best chance to start therapy and maintain good vision and a better quality of life, Mali added.
Making sure he knows exactly when his patients slip from dry to wet is important because Mali can administer drugs to treat the wet form before sight is lost, he said.
"There are exciting new medicines available now to fight wet AMD and they are effective if it is caught fast," Mali said. "If time is
lost, even days, a patient can lose their sight."
The machine is sensitive to changes in vision caused by the leaking of fluid and blood onto the retina, Mali added.
"In AMD, you get a breakdown in the center of the retina, which is called the macula, which is the most important vision," Mali said. "If that area of the retina is affected, your vision can become distorted, Straight lines become distorted and wavy. You can get black spots in the center of your vision. These are the things we see from changes from dry to wet macular degeneration. This machine mimics the wavy distortion to see if you are able to pick up little subtle differences in straight lines. That is essentially the change in macular degeneration."
Before the ForeseeHome came along, retina specialists like Mali would give patients with dry AMD a grid line paper. The patient would cover their eyes, one at a time, and stare at a dot in the center of that grid paper. If there was a change in their vision from dry to wet, it might show up by the lines in the grid paper becoming wavy to them, Mali said.
A key advantage to the machine is that it prevents the brain from masking or compensating for actual defects in vision, Mali said.
"It auto-reports the results, and is more sensitive than the Amsler Grid used in the past," Mali added.
Shinn served as Mali's patient to demonstrate how the ForeseeHome works to replace the grid paper.
Mali pointed out the white ForeseeHome Monitor with an eye piece in front.
"It has a block on one side so it can cover one eye," Mali said. "You see the open area is set on the left eye so it will be tested first."
Shinn put her face in the foam eyepiece and hovered her mouse's cursor on a bump in a line and clicked with the mouse where she thought the bump was. She then went back to the center point again. The machine recorded where Shinn thought she saw the bump
"She's doing perfect," Shinn said. "That's all there is to it. It's very self explanatory."
Once the patient has an prescription from the doctor, the company calls the patient and gets the device to them, Mali added.
The ForeseeHome does not require a home computer or internet connection, Mali said. It's simply plugged into a power outlet.
The company helps patients use the machine including navigating through the initial baseline test, Mali said.
The Eye Associates can be contacted at 866-865-2020.
Richard Dymond, Herald reporter, can be reached at 941-745-7072 or contact him via Twitter@RichardDymond.