Latest in the Field of Optometry: Diagnostics and Imaging


  • Accurate optometric diagnostics and imaging techniques are vital for early detection and treatment of serious eye diseases. 
  • AI-based deep learning algorithms can now identify patterns in retinal images with a high level of accuracy, enabling early intervention. 
  • Non-invasive imaging techniques like optical coherence tomography angiography (OCTA) and anterior segment optical coherence tomography (OCT) offer excellent alternatives to traditional dye-based imaging.
  • A cloud-based integrated practice management tool can help you implement the latest diagnostic and imaging technologies in your practice.

With more than 150 million Americans wearing corrective eyewear to treat refractive errors, it is more important than ever for practices to improve the accuracy of optometric diagnostics and imaging. Accurate diagnoses are crucial for early detection of serious eye conditions like diabetic retinopathy, age-related macular degeneration, and glaucoma.

Staying informed on the latest optometric diagnostics and imaging developments can help you provide more effective patient care.

1. AI-Based Optometric Diagnoses and Imaging

Artificial intelligence (AI) technology has emerged as a powerful tool in eye care, transforming optometric diagnostics and imaging. AI-driven diagnostic systems can analyze large volumes of optometric data with exceptional accuracy and efficiency.

They can detect subtle changes in eye conditions, including glaucoma, diabetic retinopathy, and macular degeneration.

AI algorithms can identify patterns and anomalies in retinal images, helping optometrists make more accurate diagnoses and treatment decisions.

Diabetic Retinopathy Algorithms

A 2022 study comparing two AI-based diabetic retinopathy algorithms, IDx-DR and Retinalyze, found that both systems had high percentage agreements with a single reader.

IDx-DR achieved a 93.3% agreement for DR-positive cases and a 95.5% agreement for DR-negative cases. For Retinalyze, the agreement was 89.7% for DR-positive cases under the first screening strategy and 71.8% for DR-negative cases. Under the second strategy, the agreement was 74.1% for DR-positive cases and 93.6% for DR-negative cases.

The study concluded that both systems could analyze most images effectively. They were also considered easy to set up and use.

Convolutional Neural Networks (CNN)

Another 2022 study focused on the early identification of age-related eye diseases, such as cataracts, age-related macular degeneration (AMD), glaucoma, and diabetic retinopathy (DR), using retinal fundus images. The researchers used a convolutional neural network (CNN) optimized with a flower pollination optimization algorithm (FPOA) for feature extraction and trained the CNN with pre-processed images using maximum entropy transformation.

The CNN-MDD (CNN-based multiple disease detection) model was tested using the Ocular Disease Intelligent Recognition (ODIR) online dataset. The performance of the proposed model was compared with other optimized models, and it achieved impressive results. The CNN-MDD model demonstrated a precision of 98.30%, accuracy of 95.27%, specificity of 95.21%, recall of 93.3%, and F1 score of 93.3%.

The study concluded that the proposed method, using CNN-MDD, showed potential in assisting medical professionals with automatically classifying age-related eye diseases. The model’s high precision, accuracy, and specificity indicate its effectiveness in early disease identification.

2. Anterior Segment Optical Coherence Tomography (OCT)

Anterior segment optical coherence tomography (OCT) is a non-invasive imaging technique used to assess various ocular structures and conditions in the anterior segment of the eye. It provides cross-sectional, high-resolution images of the cornea, anterior chamber, iris, and angle structures.

Although the technology was introduced in 1994, technological advances have improved resolution, tissue penetration, and analysis techniques.

Angle Assessment

A critical application of anterior segment OCT is angle assessment. It enables the visualization of angle structures, aiding in diagnosing and managing angle-related conditions such as glaucoma. Anterior segment OCT can detect angle closure mechanisms, quantify angle parameters, and assist in treatment planning.

However, it may be limited by factors like corneal opacity, motion artifacts, and variability in image interpretation.

A 2021 study explored anterior segment OCT as an alternative to gonioscopy for grading anterior chamber angles (ACAs) in angle-closure disease. Using image alignment, automatic localization of the ACA region, and a multi-sequence deep network (MSDN) architecture, the researchers developed a method for precisely classifying ACAs into open, appositional, and synechial angles.

An evaluation of the proposed method on 66 eyes and 16,896 images demonstrated its superior applicability, effectiveness, and accuracy compared to existing methods. This approach could help clinicians to understand disease progression and guide appropriate treatment for angle-closure disease.

Corneal Visualization

In corneal disease, anterior segment OCT offers detailed visualization of corneal layers, allowing for corneal thickness and curvature measurement. It aids in diagnosing and monitoring corneal pathologies, including corneal edema, dystrophies, and ectasias.

A 2020 study aimed to assess the repeatability, reliability, and agreement between a new swept-source anterior segment optical coherence tomography (AS-OCT) device (CASIA2) and Oculus Pentacam for measuring anterior chamber depth (ACD) and corneal thickness (CT).

The study found that CASIA2 demonstrated good repeatability, with repeatability (COR) coefficients ranging from 0.31 mm for ACD to 28.32 µm for inferior corneal thickness (ICT). There were no significant differences in CT and ACD measurements between CASIA2 and Pentacam.

The results indicated a high level of agreement between the two devices. The Bland-Altman analysis showed consistency in measurements of CT and ACD obtained by CASIA2 and Pentacam. This suggests the two devices can be considered interchangeable for these parameters in healthy subjects, particularly in monitoring corneal conditions or planning ocular surgery.

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3. Ultra-Wide Field (UWF) Technology

The latest advancements in ultra-wide field (UWF) technology in optometry, such as Optos Ultra-Wide-Field (UWF) Retinal Scanning, offer significant benefits for practitioners.

UWF captures over 80% of the retina at a time, compared to older techniques that only capture 15% of the posterior pole. This allows for early detection and diagnosis of peripheral retinal conditions like detachment and lattice, which could be missed with older methods.

The high-resolution imaging (up to 200°) enables viewing through cataracts and small pupils while offering various imaging modes. The technology is fast, comfortable, and safe, requiring minimal dilation in most cases.

A 2022 study compared the performance of two confocal imaging modalities, ultra-wide-field (UWF) fundus imaging and true-color confocal scanning, in detecting glaucoma using a deep learning (DL) classifier. The DL-based UWF fundus imaging achieved an accuracy of 83.62% and an AUC of 0.904, while DL-based true-color confocal scanning attained an accuracy of 81.46% and an AUC of 0.868.

Both modalities showed comparable diagnostic power to traditional optical coherence tomography methods in diagnosing glaucoma, confirming their high value in glaucoma diagnosis.

4. Optical Coherence Tomography Angiography (OCTA)

Clinical studies on optical coherence tomography angiography (OCT-A) began as early as 2014, but the diagnostic technology has only recently become a popular form of non-invasive imaging of retinal blood vessels. It allows optometrists to visualize microvascular structures with high resolution and depth.

OCT-A can facilitate the early detection and monitoring of retinal diseases, such as diabetic retinopathy and macular degeneration, enhancing the accuracy of diagnosis and treatment planning.

A 2020 article published in the Review of Optometry highlights the benefits of OCT-A over other diagnostic methods in cases of suspected neovascular activity. Traditionally, clinicians had to rely on fluorescein angiography (FA) or indocyanine green angiography (ICGA) to visualize abnormal blood vessels. This required consultation with a retina specialist and used intravenous dyes with potentially adverse effects.

OCT-A now allows for in-office visualization of potential abnormal blood vessels, aiding in the precise identification of lesion location and characteristics, guiding management decisions, and reducing the need for unnecessary referrals.

5. Adaptive Optics

Adaptive optics (AO) is a technique that can correct the eye’s optical aberrations and produce high-resolution images of the retina at the cellular level. Adaptive optics can be combined with fundus photography, scanning laser ophthalmoscopy, or OCT to visualize the photoreceptors, retinal pigment epithelium, nerve fiber layer, and blood vessels.

Adaptive optics can help study the structure and function of the retina in normal and diseased states, such as inherited retinal dystrophies, age-related macular degeneration, glaucoma, and diabetic retinopathy.

A 2020 study assessed adaptive optics and its applications in understanding the role of optical aberrations in visual perception. Two AO systems (AOI and AOII) were evaluated, highlighting their use in measuring ocular aberrations and conducting psychophysical measurements.

The findings reveal insights into the visual benefits of AO correction, vision with simulated multifocal intraocular lenses (MIOLs), and the impact of aberrations in various eye conditions.

The study concluded that AO systems offer significant potential for industry and clinical practice, allowing the simulation of visual corrections before implementation.

optometric diagnostics

Streamline Diagnosis and Imaging in Your Optometry Practice with RevolutionEHR

RevolutionEHR is a comprehensive electronic health record (EHR) system for optometry practices. With its user-friendly interface and advanced features, RevolutionEHR empowers optometrists to streamline their diagnostic and imaging processes, enhancing patient care and practice efficiency.

RevolutionEHR’s RevImaging is a cloud-based solution that simplifies the storing, viewing, and comparing of multiple images.

By enabling precise disease progression monitoring and aiding in decision-making, RevImaging facilitates more accurate diagnoses and improved patient care. With its cloud-based advantages, clinicians can access patient images from anywhere, ensuring seamless collaboration and complying with HIPAA regulations.

RevConnect, a patient engagement software within RevolutionEHR, improves communication with patients. The dedicated dashboards enable tracking of performance metrics, while RevConnect Campaigns facilitate targeted messaging to inform patients about the latest diagnostic and imaging technologies and upcoming events.

RevolutionEHR goes beyond standard EHR functionality by providing specialized support for different eye care specialties.

Low vision doctors benefit from specialized tests and templates designed to assist in serving and caring for low-vision patients. Vision therapy doctors can document consultations and services using unique tests, ensuring exceptional care and educational resources for vision therapy patients.

Ophthalmologists can rely on RevolutionEHR for comprehensive secondary and surgical care documentation, including pretest results for cataract and refractive surgery.

Improved Diagnostics for Better Patient Care

Contact a RevolutionEHR Specialist to book a demo today and learn how integrated cloud-based practice management software allows you to focus on providing the latest diagnostic and imaging technologies in your practice to improve patient care and eye health outcomes.

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