With the population aging and the success of anti-VEGF therapies, retina specialists are seeing and treating more patients than ever. Coupled with the increasing availability of new and more sensitive diagnostic imaging devices, this creates a “data overload” problem that can overwhelm a practice’s ability to function efficiently. Thankfully, integrated image review has arrived as a possible solution.

New platforms and software suites allow visualization and interpretation of data from different imaging modalities all on a single screen. Switching among various instrument software and waiting for multiple programs to load while seeing patients are now chores of the past. Integrated imaging not only improves day-to-day clinic efficiency, but also has the potential to drive better patient care through greater analytic capabilities and improved patient education.

SEEING WHAT WE’VE BEEN MISSING

For our image integration needs, our practice chose the Integrated Diagnostic Imaging (IDI) platform from Zeiss. We had the ambitious goal of being able to review any image obtained at any of our nine office locations. With the necessary IT infrastructure in place, the server-based IDI platform accomplishes that for us. We also preferred the platform’s advanced data analytics compared with that of others we considered.

Zeiss IDI consists of two pieces of software: Forum review and Retina Workplace. We also have a dedicated Forum server that serves as a single repository for images obtained with any DICOM-compliant instrument.

Forum review interacts with the server to give me a quick and easy review, using just a few clicks, of all current and historical images from a single patient. I can click between and compare optical coherence tomography (OCT) scans with fundus photography, fluorescein angiography (FA), OCT angiography (OCTA), and any other imaging modality I’ve utilized for a given patient.

The real strength of Forum review, however, is its ability to use point-to-point registration technology to create multimodal overlays. This allows me to review all of a patient’s images on a single screen that’s easily navigable. Additionally, I can ensure I’m evaluating the same location on clinical exam or photographs as I am on OCT scans. I can also see the vascular structure, imaged by OCTA, that underlies leakage on FA or visualize choroidal blood flow changes or ischemia on OCTA before changes appear on FA or fundus photographs, as often occurs in certain forms of inflammatory chorioretinitis.

While Forum review integrates OCT with other imaging modalities, Retina Workplace analyzes OCT data over time, quickly revealing insights that would otherwise be difficult to detect without spending an inordinate amount of time reviewing innumerable historical scans. Instead of comparing only a patient’s current scans with the prior visit’s scans as is typically done, I can view and manipulate three sets of scans at once, from any three different dates.

Furthermore, imaging data from the entirety of a patient’s history with our practice, which in many cases is 5-10 years, can be macroscopically reviewed in line graph format (Figure 1). A variety of measures can be viewed in this manner, including OCT thickness metrics (central subfield thickness, macular cube volume), advanced retinal pigment epithelium analyses (geographic atrophy area and distance to fovea), and angiometrics (foveal avascular zone size, total vessel density, and so on). These can be automatically plotted over time so trends are easily recognized.

It’s easy to imagine how advanced analytics inform patient management decisions. For instance, I can clearly see whether improvement in a patient’s retinal thickness with a new anti-VEGF medication is due to a switch in medication or perhaps following his or her typical pattern of variation in response to treatment over time. Similarly, the analysis of historical data can reveal the most effective treatment interval for patients on a treat-and-extend regimen.

MOVING RETINA PRACTICES INTO THE FUTURE

Image integration already makes our practice more efficient and optimizes the vast amount of data we have collected in a manner that allows us to actually apply it to real-world clinical decision-making, and this is only the beginning.

Having all imaging in one place nicely positions our practice to take advantage of potential artificial intelligence algorithms capable of extracting deeper insights and correlations. In this coming paradigm shift, we’ll have even more advanced analytics that will further elevate and individualize patient care.

Dr. Schneider is a vitreoretinal specialist with Tennessee Retina. His clinical and research expertise and interests include diseases of the vitreoretinal interface and novel applications of ophthalmic imaging technology.