-: With macular degeneration, catching subtle changes
as they happen can have a huge impact on a treatment plan
that works best for you.
In this episode, CEO Kester Nahen joins us
to discuss a powerful home monitoring option from
Notal Vision.
I'm Ricky Enger, and this is Hadley Presents.
You know, I always love
that moment when someone discovers something
that really makes all the difference for them, whether
that happens to be the right piece of technology,
or maybe it's a new treatment approach they didn't know
about, or sometimes it's just something that someone said
that struck the right chord at the right time.
So with that in mind, in this episode,
we have two cool things to share with you.
First, we'll hear from Kester Nahen about a really
fascinating and useful option
for monitoring macular degeneration at home.
And then after that, stay tuned
for a short episode from our sister podcast
Insights and Sound Bites.
We'll hear Julia talk about the best thing she ever did
after her vision loss diagnosis.
If you like what you hear,
there's plenty more stories on the Insights
and Sound Bites podcast page.
Plus you can add to those stories by sharing your own.
You can find that page on our website
or you can just check out the show notes
and we'll have a link for that there.
And now onto the show. Welcome to the show, Kester.
So happy to have you,
-: Ricky.
Thank you so much for having me.
-: Yes, it is wonderful that you could be here with us.
And I know we're gonna learn a bit more about Noal vision
and what you all do as we move along here.
But I'm wondering if we can just start out
with a quick intro, tell us a bit about you, kind of
who you are and what your background is.
-: Yeah, hap happy to. So my name is Keshan.
I'm a physicist by training.
I was always drawn to the field of medicine
and specialized in a field that's called biomedical optics,
which today encompasses everything from laser medical
procedures to diagnostic imaging.
And really over the last 20 years,
I've been very much focused on eyecare and my work
and improving the diagnosis of diseases.
And so of course it was very drawn when I saw a company not
our vision, developing diagnostic technologies, not just
for the doctor's office,
but actually extending the care to the patient's homes.
And this, that is something that brought me six years ago
to Northern Virginia
where we operate our remote monitoring center for patients.
So we're gonna talk about, in detail about
the programs that we offer.
-: Yeah, that's so cool.
And I always love hearing
how people made their way from something
that they were generally interested in to, you know, kind
of the specifics, Hey, I get to combine my passion for this
with another thing and it, it works out great.
So in this particular case, we're going
to be talking about some ways
to maybe improve the diagnosis in treatment
of macular degeneration and how it progresses.
And I think before we get into how that might work,
it would help to sort of be on the same page as far as
what macular degeneration is, what does it look like,
how does it progress, that kind of thing.
So I'm wondering if you could just give a quick
overview of that.
-: Yeah. So age-related macular degeneration is the leading
cause of blindness in the United States.
And elderly patient populations is an age-related disease,
as the name says.
And it's, it's very slowly progressing over time.
At first, patients don't notice any changes,
but over time it can lead to first some blurry vision, then
to some more sort of distinct meta ophia, meaning
that sort of lines appear sort of wavy.
And in, in a late stage,
which is called the wet form
of age-related macular degeneration,
there is actually development of vessels
that leak fluid into the retina.
And this can lead to vision loss.
Let you also mention that there's also a late stage
of the dry age-related macular degeneration
that's called also geographic atrophy.
And that also leads to vision loss
for the receptors die over time.
And that the damage there also expands over
time here at not vision.
We're very much supporting patients that have the early
to intermediate dry form that then leads
to wet H related macular degeneration with the goal to one,
identify the progression to the wet form,
the site threatening form early,
and then patients need treatment
to better personalize the treatment.
-: Yeah, that, that makes a lot of sense actually.
And that's kind of a nice segue into my next question,
which is traditionally how does this work?
So if someone goes to their eye doctor
and they get that diagnosis of dry macular degeneration,
what happens at that point?
So how does the eye care professional know kind of
where the person is in terms of progression,
and then how do they figure out when those changes happen?
-: Yeah, so the, the eyecare professional will perform a
fundus exam or take a photo of the, the back of the eye.
And when small lipid deposits, they're called dren
appear on the back of the eye.
And that sets an indication that, so the early phase
of Dry MD has developed now with the progressive development
of larger drusen patients then make classified
as intermediate EMD patients.
And this is where the risk of a conversion
to the wet form really increases.
That's exactly then early disease detection becomes very
relevant in, in most practices today patients are asked
to use what's called an amsler grid.
It's a, a grid of lines
that the patients should look at periodically.
And if patients notice any distortions
or wavy lines there in this grid in the subjective
assessment, then that's an indication
that the disease is progressing.
The challenge with this approach is that it's,
it's rather subjective
and it's not so easy to really identify when there is sort
of that abrupt chain from dry to wet A MD.
And this is where we come in with a new digital tool
that is the Foresee home EMD monitoring device
that operates very similar to an amsler grid,
although we are artificially presenting distortions
to patients and ask them with a mouse on a,
on a little screen to identify these distortions.
And if patients identify them sort of correctly,
these artificial distortions, we know
that everything is okay.
They're recognized when the line is wavy.
And that's because the line that is shown
to the patient indeed has a little bump.
But patients start
to click on this little screen on locations
where there was no artificial bump, then we know
that somehow in the retina there is a change
that actually gives the patients the impression
of a distortion.
And that is caused by changes in the retina initially.
These can be these drusen that I mentioned,
but if there's an abrupt change
and a lot stronger distortions are being seen
by the patient, then that's a very strong indicator
that the patient may have converted from dry tot a MD.
And that is information that we feed back
to the prescribing eyecare provider so
that the patient can be brought into the office
and then seen for further diagnostic testing.
-: Wow. So this is really fascinating.
So what you are doing is person can look at this ANSULAR
grid at home
and they might have an appointment
with their eye doctor every six months, every nine months,
whatever that thing is.
And whatever happens
between those times doesn't really get caught.
But with this, you're putting this sort
of into the patient's hands, so you're not waiting
for that appointment.
That could be four months from now
to find out if some progression might
have happened.
One thing I know people always wonder is you talk about,
you know, you've got this thing
and you're clicking with a mouse, it, it's a thing
that you're doing at home
and some people are thinking, you know,
sometimes I need help with the TV
because it's super complicated these days and so on.
So can you describe what this device is like how
is it to use
and kind of what's the process for, if you get this,
how much assistance are you gonna have?
How complicated is it gonna be?
-: Yeah, the device is, is really easy to use.
We have over 50,000 patients
that have used it over the last decade
and if patients have,
have questions Yeah, how to operate it.
This is where our monitoring center staff is available.
Actually, the, the first encounter when we first provide the
device to the patient, we spend 30 minutes,
sometimes 45 minutes on the phone
with the patient explaining exactly how to use the device.
We also educate about the need for daily testing. Yeah.
So that we really detect the disease conversion early.
So yeah, we're, we're very experienced
and we've seen that patients, you know, can,
can operate this device really well.
-: That's great. It's really encouraging to hear that.
So if you are someone who's listening
and you think, okay,
I've got dry macular degeneration right now,
and I think it would be very helpful to be able
to monitor my condition and send this data to my eye.
Doctor, if you're curious about this,
what's the process then for getting set up with it?
So you all work with the eyecare provider,
so you know, how do we get from here to there?
-: Yeah, so we have a large network of ophthalmologists,
also optometrists,
that prescribe this monitoring program to patients.
So if patients are lucky, they may have already a provider
that has a a, a partnership with our monitoring center.
If not, it's always a good idea to visit our website
for foresee home.com to learn more about the program
and then perhaps share that information
with the iCare provider that you heard about this program
and to see whether this is really the right thing
for a particular patient, which of course depends on the,
the correct diagnosis and staging of the disease.
And then, you know, iCare providers can get in touch
with us, we take their contact information
and they can start to prescribe this program.
-: That's great. And of course we'll have that website,
that contact info in our show notes,
or you can call our 800 number,
that's 803 2 3 4 2 3 8
and we're happy to give you that info as well.
You know, a lot of times when people hear about something
that's really exciting, they get hopeful
and then it's like, you know, I might
as well not even investigate this
because I doubt that my insurance is going to cover this.
It's gonna be too expensive for me.
And so what's the status of that?
Is this covered under Medicare
and other insurance? How does that work?
-: Yeah, so the Foster Home,
a MD Monitor program is Medicare covered.
And depending on patient's co-insurance,
it may be completely free of charge.
If not, there's a copay of $15 for the patient.
-: Free is great, but $15 is not so bad either.
So I think that's really encouraging for people to hear.
So Foresee Home is the name
of this home monitoring device,
and that is available right now.
You're already set up with eyecare providers
and hopefully adding more all the time, which is amazing.
I imagine you haven't stopped there though.
So are there other things that you can talk about
that may be either coming in the near future
or maybe are available right now?
-: Yeah, so with with the foresee Home Monitoring program,
we sort of fill the gap in between office visits
for the intermediate stage of the disease.
Once patients convert to wet EMD,
they usually receive anti-VEGF injections.
This is a drug that is injected into the eye
and to give physicians insights
into the disease reactivation.
And when it occurs and when an office visit
and a treatment is needed, we have developed a tool
that is called the Scan Lee Home, O-C-T-O-C-T stands
for Optical Coherence Tomography.
This is an imaging modality
that is very frequently used in
ophthalmologist offices today exactly
to determine whether patients show disease reactivation
and meet treatment.
Now, wet age-related macular degeneration is a very
heterogeneous disease.
It's not so easy to predict of how long it's gonna take
for the disease to reactivate.
So having a device at home
that uses the exact same technology that's standard in the,
in the office setting to today, allows a retina specialist
to exactly identify when the patient needs
to be seen in the office.
And then standard imaging is performed
to make a treatment decision.
So this is a, a new device that we developed motivated
by the Edmond of longer acting treatment solutions
that we've seen in recent years where the intervals
between treatments can be extended from four to eight 12,
sometimes even more weeks.
And so having a safety net available in
between the office visits
and giving the retina specialist a prompter of when
to call the patient and bring the patient into the office is
seen as a, as a great new way to manage this disease.
-: That's great. And what's the timeline for this
to be available roughly?
-: Yeah, so we received FDA approval last year.
We're working right now with Medicare
and insurance companies to get this covered and paid for.
We are slowly starting to offer this sort of
as a cash pay model.
So if there are patients interested in this program,
they can reach out to us.
-: And could you just provide, once again,
that contact in forward that website for your organization
where maybe people can check out information on both
of these options?
-: Yeah, so for that it's best to visit our website know
how vision.com,
where information about both the foster home
and the scan, the home OCT monitoring program can be found.
-: Awesome. I wanna thank you so much for joining us
and sharing a bit about these really exciting options
for home monitoring, making sure
that you're not waiting all this time
between visits when things could be happening
that could be addressed immediately.
I think that's such an important thing.
Again, really appreciate your stopping by and sharing info.
-: Thank you so much, Ricky, it's been a pleasure.
-: Thank you all so much for listening.
And now stay tuned
for a short episode from our sister podcast,
insights and Soundbites.
And remember, if you wanna hear more like this,
you can visit the Insights
and Soundbites podcast page on our website.
You'll find lots more stories like Julia's plus,
you'll be able to submit one of your own.
All right, let's hear from Julia
as she shares the best thing she ever did
to help her cope and adjust.
-: My name is Julia Spencer.
I'm originally from New Jersey,
and just a year ago I moved down to Myrtle Beach to be
with my daughter, but I'm still a Jersey girl.
I'm 91 years old, so there's no short story that I have
a long story,
but I'll shorten my first idea of vision loss.
And the fact is it's a, it's a retinitis pigmentosa,
which is a hereditary, and my sister had it.
There were, because there were nine of us
and my sister was the only one that had it.
And I found out I had it by accident.
I was getting a pair of glasses when I was about
45, 47, something like that.
You know, when you need glasses just
because of getting that age
and you just need a pair of glasses for distance.
Well, the doctor said
that he saw a tiny little bit
of that night is pigmentosa.
So I went to a hospital in New York for research Columbia.
The doctors there, they said that my vision,
my RP gene was so small,
so little for a woman 50 years of age that
I would never go blind.
So I believed him,
had no problems for the genes.
Then, well, in 2002,
I had a problem with my eyesight, with cataracts,
got them removed
and all of a sudden I couldn't see a little bit.
And I was very upset
and my husband was, was worried about me driving.
And I just kept telling him, I'm never going blind.
I'm fine, I can drive. And I kept driving.
And then all of a sudden
I started having a little problem at night.
I couldn't see at night.
So I stopped driving at night
and he kept saying, you're gonna stop driving
during the day, please.
And I said, no, I'm not. I'm independent.
And one day I was sitting in a chair in the living room
and I called out to him, Ralph,
and I thought he was in the bedroom.
So I shouted and I heard a voice say,
I'm right here in front of you.
My heart stopped. My biggest fear was to kill somebody.
I said to him,
if I was driving the car, I would've killed Jill.
He said, I know. And that minute I gave it up.
I was just so frightened of killing someone.
He said, don't worry about it, hun.
We're a team I'll, you know, I'm here.
I'm, I can take you wherever you wanna go.
And I said, it's not the same.
And I didn't want to give up my car, but I had to. So I did.
And that was the beginning of it.
I was walking into the election with my husband
and oga his arm and using a cane.
And a person passed us by that my husband knew,
and she stopped and said, why doesn't your wife
have a guide dog?
She was a, a trainer for guide dogs.
Why doesn't your wife have a guide dog?
Well, right there, I didn't like the person
because I hate when someone talks to my husband
or anybody about me in front of me.
And I wanna say to them, I'm thinking, I'm not stupid,
I'm just blind.
And please talk to me.
And anybody who's buying notes that feeling,
and you have to fight it all the time with doctors
or anybody, you walk in, they, they talk
to the other person like, you are not there.
So I said to her, I'm right here, please,
you can talk to me.
And she said, why don't you get a guide dog?
And I said, well, I don't really wanna to him,
but I'm, I'm not completely blind, so you,
you can't get a guide dog.
I still have sight.
And she said, no, are you legally blind?
I said, yes, I'm legally blind.
So she said, okay, you can get a guide dog.
And gave me a car. I got a guide dog.
It was the best thing I ever did in my life.
I'll tell you why.
When you are walking down the street with a cane
and you're sweeping the the sidewalk
to make sure you don't fall into a hole or something
or a curb, people will, if they see you
and they're walking towards you, they'll,
they'll cross the street
because they don't wanna just get involved
with you sweeping along.
And they didn't realize, I could see
and they cross the street.
But when you go down the street with the guide door,
people stay right there.
In fact, they cross the street to meet you
and they wanna talk to you.
They say hello. They smile because I have sight.
I could see they smile at the dog
and they'd be so surreal to see a guy dog.
I made more friends just walking any place
with the guide dog, with my husband even.
And everybody would stop and talk to us. It was fabulous.
-: Got something to say.
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