Optimizing retina workflows with OCT and widefield imaging - Dr. Jesse Jung

Founded in 1967 by Dr. George F. Hilton, one of the original founders of pneumatic retinopexy, East Bay Retina Consultants, Inc. has been serving the East Bay community for over 50 years. Based on the principle of compassionate service, our board-certified vitreoretinal specialists are committed to each individual patient and the referral doctors in the community.

As the first retinal practice in the East Bay, we continue to dedicate ourselves towards providing the utmost best care, and the continued development of state-of-the art treatments for medical and surgical retinal disease. With 5 locations in the East Bay, we rely heavily on ophthalmic imaging technologies like spectral-domain OCT and ultra-widefield imaging to optimize retinal disease diagnosis and management and improve patient care.

OCT is considered standard-of-care for the management of most retinal diseases. Despite the myriad of imaging technologies available to retinologists—including fundus photography, fundus autofluorescence (FAF), and fluorescein (FA) and indocyanine angiography (ICGA)—spectral-domain OCT may be the most heavily relied on, non-invasive imaging tool in clinical practice. While once considered a luxury item, OCT has become a mainstay in ophthalmic practice, and an indispensable tool in our practice.

East Bay Retina Consultants relies heavily on integrated imaging as part of the workflow for every patient, and we are actively participating in various clinical trials and imaging research. OCT imaging has enabled our offices to better manage a greater number of patients with more diagnostic accuracy and efficiency. Among the additional imaging technologies utilized in our practice, advancements in ultra-widefield imaging such as the ZEISS CLARUS 700 have made it possible to capture high quality, true-to-color images while combining multiple imaging modalities like FAF, anterior segment external photography and FA all in one device.

Coordinating patient flow to prioritize imaging before the patient enters the exam room helps prevent excessive, unnecessary movement throughout the office and can eliminate bottlenecks in clinic flow. This is especially important when offices are seeing a high volume of patients, some of whom may have mobility issues and now even more important during the Covid-19 pandemic to minimize exposure and maximize social distancing.

Unfortunately, many patients were lost to follow up during the Covid-19 pandemic and did not receive the necessary care they needed. Despite temporary office closures, ophthalmic imaging played an integral role in launching the widespread use of telemedicine in ophthalmology. While most clinicians were unable to see their typical patient volume at the height of the pandemic, ophthalmic imaging enabled the remote monitoring of patients’ retinal pathologies and helped supplement telemedicine calls between doctors and patients.

In our patient workflow, we rely on ophthalmic imaging as an excellent tool for educating patients on their particular retinal disease. The imaging is done before a patient is settled in the exam room, and our doctors utilize a separate monitor with remote reviewing software to walk patients through their images to help them understand their disease diagnosis, progression, and status. OCT, in particular, helps us not only determine the as-needed treatments for our patients, but gives us visual aids for explaining their prognosis and what to expect in terms of future treatments or progression.

For example, when a patient with AMD or a retinal tear views a photo or image of their own eye, they are better able to understand the disease process as well as the required management and treatment they are undergoing. Without a visual depiction of the ocular anatomy, patients may not understand or fully comply with their treatment. Retinal ischemia, assessed via FA or OCT-A, can also help explain decreased best-corrected visual acuity to patients with otherwise unremarkable clinical exams.
At East Bay Retina Consultants, we have also been involved in numerous clinical trials that use imaging to assess treatment outcomes for various retinal diseases. Ophthalmic imaging is now a mainstay in clinical trials. Whether its OCT to assess central foveal thickness or FAF to measure growth of geographic atrophy, imaging serves to determine an objective primary endpoint. Unlike clinical trials in years past, subjective outcomes such as visual acuity alone are no longer always the primary end point that researchers use. By enabling the objective assessment of structural changes to the retina, clinicians and researchers are better able to determine best practices for treating retinal pathology. Imaging research has played a significant role in improving how clinicians diagnose and treat a wide variety of retinal diseases.