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Time-in-Range and Time-in-Maintenance: Longitudinal Biomarkers in Home Vision Monitoring of Macular Disease - A
Andrew C Dieu1, Meet D Panjwani1, Nicolas Bodmer2,3
1University of Arizona, Tucson, United States.
Background:
Functional home vision monitoring in macular disease yields dense, longitudinal data streams, yet analytic strategies to interpret their day-to-day variability remain underdeveloped. Time-in-Range (TIR) and Time-in-Maintenance (TIM) represent novel longitudinal biomarkers, adapted from diabetes care, designed to quantify sustained functional stability and personalized disease control.
Methods:
We conducted a retrospective cohort study of patients with macular disease undergoing anti-angiogenic therapy and smartphone-based home monitoring of hyperacuity (Alleye, Oculocare medical Inc.). TIR and TIM metrics for hyperacuity, best-corrected visual acuity (BCVA), and central subfield thickness (CST) were calculated using established (TIR) and individualized (TIM) thresholds as personalized stability metrics. Multivariable models were applied to analyze associations between TIR and TIM and injection frequency, BCVA and CST change.
Results:
A total of 84 patients (149 eyes) were included. Greater TIR-hyperacuity was significantly associated with improvement in BCVA (β = 0.03, 95% confidence interval [CI] = 0.01-0.07, p < 0.05) and reduction in CST (β = -0.65, CI = -1.23 - -0.07, p < 0.05). In contrast, higher TIM-hyperacuity was associated with increased injection frequency (β = 0.0024, CI = 0.001-0.004, p < 0.01), but not with BCVA (β = 0.032, CI = -0.046-0.11, p = 0.42) or CST (β = -0.22, CI = -0.89-0.45, p = 0.52) changes. Sensitivity analyses confirmed the robustness of these findings across multiple threshold definitions.
Conclusions:
TIR and TIM serve as actionable longitudinal biomarkers, operationalized from high-frequency home monitoring, and may offer richer, patient-centric markers of disease control than traditional single-point measures.
