Podcast Summary

Hadley Presents: A Conversation with the Experts

Episode: Monitoring Macular Degeneration from Home: Notal Vision
Date: October 9, 2025
Host: Ricky Enger
Guest: Kester Nahan, CEO of Notal Vision
Special Feature: Julia Spencer (from Insights and Sound Bites podcast)

Episode Overview

This episode explores advances in home monitoring technology for people with macular degeneration. Host Ricky Enger welcomes Kester Nahan, CEO of Notal Vision, to discuss the FOSSI Home AMD monitoring device and other innovations that empower patients to actively participate in the early detection and management of age-related macular degeneration (AMD) from the comfort of home. The episode wraps up with a moving story from Julia Spencer on overcoming vision loss and the impact of guide dogs on her life.

Key Discussion Points & Insights

1. Introduction to Kester Nahan & Notal Vision

• Kester’s Background: Physicist specializing in biomedical optics, particularly interested in eye care technology (01:55)
  • “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.” – Kester Nahan (01:58)
  • Moved to Notal Vision to extend diagnostic care from clinics to patients’ homes.

2. Understanding Macular Degeneration

• What is Age-Related Macular Degeneration (AMD)?
  • Leading cause of blindness in older adults in the U.S. (03:38)
  • Early stages: Often symptomless; later, blurry or wavy vision (04:07)
  • Two late-stage types:
    • Wet AMD: Abnormal blood vessel growth leads to fluid leakage and vision loss
    • Dry AMD with geographic atrophy: Photoreceptor loss and gradual vision decline (04:21)
  • Notal Vision focuses on monitoring the progression from early/intermediate dry AMD to the more visually threatening wet AMD.

3. Traditional Monitoring vs. New Technologies

• Traditional Method:
  • In-office fundus exams and photos; use of paper-based Amsler grids for home monitoring (05:34)
  • Limitations: “It’s rather subjective and it's not so easy to really identify when there is sort of that abrupt change from dry to wet AMD.” – Kester Nahan (06:49)
• Digital Advancement: FOSSI Home AMD Device (07:00)
  • Home device simulates Amsler grid tests using digital technology
  • Patients click on distortions with a mouse; the device distinguishes between artificial (test) and actual vision-induced distortions
  • Detects subtle changes, enabling early intervention—data are sent directly to eye care providers for real-time review.

4. Ease of Use & Support for Patients

• User Experience:
  • Device designed for simplicity; over 50,000 users span a range of ages and tech confidence (09:04)
  • Comprehensive onboarding: “We spend 30 minutes, sometimes 45 minutes on the phone with the patient explaining exactly how to use the device.” – Kester Nahan (09:16)
  • Ongoing support from Notal Vision's monitoring center.

5. Access & Insurance Coverage

• Getting Started:
  • Often prescribed by ophthalmologists or optometrists; patient can suggest the program to their eye care provider (10:20)
  • Website for information: fossehome.com
• Cost and Coverage:
  • “The FOSSI Home AMD monitoring program is Medicare covered and depending on patients coinsurance, it may be completely free of charge. If not, there's a copay of $15 for the patient.” – Kester Nahan (11:48)

6. Next-Generation Home Monitoring: Scanli Home OCT

• Introducing Home OCT:
  • New device allowing patients to perform optical coherence tomography at home, just like in a specialist’s office (12:35)
  • Intended for post-conversion (wet AMD) patients receiving anti-VEGF injections
  • Helps specialists precisely time office visits and treatments, improving disease management flexibility
  • “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 great new way to manage this disease.” – Kester Nahan (14:11)
• Availability:
  • FDA-approved, working on Medicare/insurance coverage, currently available via cash pay (14:30)
  • More info: notalvision.com

Memorable Quotes & Moments

• On Early Detection:
  • “Catching subtle changes as they happen can have a huge impact on a treatment plan that works best for you.” – Ricky Enger (00:01)
• On Device Accessibility:
  • “The device is really easy to use...we’re very experienced and we've seen that patients, you know, can, can operate this device really well.” – Kester Nahan (09:14)
• On Insurance:
  • “Free is great, but $15 is not so bad either. So I think that's really encouraging for people to hear.” – Ricky Enger (12:02)
• On Evolving Care:
  • “We sort of fill the gap in between office visits for the intermediate stage of the disease.” – Kester Nahan (12:38)

Timestamps of Important Segments

• 03:38 – Explanation of AMD, its types, and progression
• 05:34 – Traditional monitoring (office exams, Amsler grid)
• 07:00 – Explanation of FOSSI Home AMD device and its functioning
• 09:04 – Accessibility, onboarding, and user support for the device
• 10:20 – How patients can access the monitoring program
• 11:48 – Insurance, cost, and Medicare coverage
• 12:35 – Introduction of Scanli Home OCT and its impact on care
• 14:30 – Status of home OCT device, insurance, and how to find more info

Special Segment: Julia’s Story (from Insights and Sound Bites) [16:09–22:16]

Brief Overview

Julia Spencer (age 91) recounts her journey with retinitis pigmentosa, coming to terms with her vision loss, the emotional impact of giving up driving, and ultimately, how getting a guide dog transformed her life.

Key Points & Quotes

• Diagnosis and Coming to Terms

  • Misdiagnosed as unlikely to lose vision; vision loss progressed over decades
  • “My biggest fear was to kill somebody. If I was driving the car, I would have killed you.” – Julia Spencer (18:53)

• Emotional Impact and Independence

  • Struggled with the loss of independence; depended on her husband for transportation
  • “I didn't want to give up my car, but I had to. So I did. And that was the beginning of it.” – Julia Spencer (19:57)

• Experience with the Guide Dog

  • Initially discouraged, learned she qualified and decided to try a guide dog
  • “I got a guide dog; that was the best that I ever did in my life. I'll tell you why... When you go down the street with a guide dog, people stay right there. In fact, they cross the street to meet you... I made more friends from just walking any place.” – Julia Spencer (20:58)

• Advocacy & Human Connection

  • Frustration with people ignoring her and talking to companions instead of directly to her:
    • “I'm not stupid. I'm just blind. And please talk to me.” – Julia Spencer (20:06)

Conclusion

This episode provides an empowering look at how advancing technology is closing gaps in care for macular degeneration, giving patients new ways to monitor and manage their health from home. Through both expert insights and patient stories, listeners learn the value of early detection, accessible devices, supportive care networks, and the transformative power of adaptive strategies such as guide dogs in maintaining independence and social connection.

Resources Mentioned:

• FOSSI Home AMD program: fossehome.com
• Notal Vision (for FOSSI Home & Scanli Home OCT): notalvision.com
• Hadley Podcasts: hadleyhelps.org
• Contact: podcast@hadleyhelps.org