Download Boomers and Disease Detection with OCT

Boomers and Disease
Detection with OCT:
Catalyst for Optometric
Practice Growth
COPE 38496-PD
Michael Chaglasian, OD
Boomers and Disease Detection with OCT
Boomers and Disease
Detection with OCT:
Catalyst for Optometric Practice
Growth
KOA 2014
Disclosure:
Boomers and Disease Detection with OCT:
Catalyst for Optometric Practice Growth
Michael Chaglasian, OD, FAAO
COPE # 38496-PD
This course material and information was
developed independently of any assistance.
I do have the following financial arrangements to disclose:
Michael Chaglasian, OD, FAAO
Alcon– Honorarium/Advisory Board
Allergan - Honorarium/Advisory Board
Carl Zeiss Meditec - Honorarium/Advisory Board
Illinois Eye Institute
Illinois College of Optometry
[email protected]
Objectives:
 1. Understand the increasing prevalence of
ophthalmic disease in the typical optometric
practice.
 2. Identify what the risk factors and clinical
indicators are in patient examinations that
suggest the need for OCT imaging.
 3. Learn how to read and review OCT images of
patients with diabetes, glaucoma, AMD.
 4. Understand how latest generation spectral
domain OCT instruments have improved their
ability to detect and monitor disease.
The “Problem” is an Opportunity
 America's 78 million baby boomers are turning
65 at a rate of one every 10 seconds
(3 million to 4 million per year).
Michael Chaglasian, O.D.
What is a “Boomer”
 A baby boomer is a person who was
born during the demographic postWorld War II baby boom,
between the years 1946 and 1964,
according to the U.S. Census Bureau.
Healthcare has become a big issue for
baby boomers.
 Over 60% of adults ages 50 to 64 who are
working (or have a working spouse) have
been diagnosed with at least one chronic
health condition, such as
arthritis, cancer, diabetes, heart
disease, high cholesterol, or high blood
pressure,
 according to a report from The Commonwealth Fund.
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Boomers and Disease Detection with OCT
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Possible Indications for Performing OCT



Where does optometry and OCT
technology fit?




Requirements of OCT Technology
 Validation / Accuracy / Improved Outcomes
 Peer reviewed articles in the literature
 Not sales/marketing hype
 Cost Effectiveness
 Can be challenging.
 Survey your patients for three months
 Consider “added value” to your practice
 Ease of Use / Ease of Interpretation
Elevated IOP > 21mm Hg
C/D >.5 or Asymm. > 0.2
Poor visual field test-takers
Narrow anterior chamber angles
High myopia
Personal or family history of
- diabetes
- glaucoma
- hypertension
- field defects
Suspicious Optic Nerves
- Marcus Gunn pupil
- Acquired color defect
- poor confrontation fields
- Disc pallor




Unexplained decreased vision
Drusen / AMD
Numerous maculopathies and
retinopathies
And Many Others
OCT out performs Photography
 Conclusions:
 For detection of a variety of retinal irregularities
evaluated in the current study, volume OCT scanning
was more sensitive than non-mydriatic retinal
photography in our asymptomatic individuals.
 OCT detected clinically relevant disease features,
such as subretinal fluid, that were missed by FP, and
had a lower ungradable image rate.
 It is likely that OCT will be added to photography
screening in the near future for chorioretinal disease.
 The Retinal Disease Screening Study: Prospective Comparison of
Nonmydriatic Fundus Photography and Optical Coherence
Tomography for Detection of Retinal Irregularities IOVS February
2013 54:1460-1468;published ahead of print January 15, 2013.
Michael Chaglasian, O.D.
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Boomers and Disease Detection with OCT
Growth of OCT (2009)
KOA 2014
OCT Coding / Billing 2013
 92132 Used for cornea and narrow angle diagnoses
 Some carriers/insurances are not covering
 92133 Used for ALL Glaucoma and optic neuropathy
diagnoses
 92134 Used for ALL (approved) Retinal diagnoses
 Mutually exclusive and cannot be billed on the same
day as 92133. Can be billed with 92132.
 None can billed on same day as fundus photos, 92250
OCT Coding / Billing 2013
 Must be based upon “Medical Necessity”
and entering CC / reason for visit




Reason for diagnostic test?
Directly stated or easily implied
Will it effect diagnosis or treatment?
Always requires an “Order” and an
Interpretation and Report
John Rumpakis, OD, MBA
2013 Avg. Reimbursement:
 $45-48
 Each of these new codes is considered unilateral or
bilateral
 Frequency varies with diagnosis
 Obtain List of covered ICD-9 codes
(Medicare LCD)
Optimize Revenue
•The OCT model can help you improve your billing and coding
•Help you build glaucoma and retina patients
“Here’s the bottom line:
•According to Dr. John Rumpakis, a new glaucoma patient can require
procedures valued up to $985 the first year.1
FIRST YEAR GLAUCOMA PATIENT REVENUE
Your patients’ medical
insurance is not the
same thing as your
malpractice insurance.”
VISIT # TOTAL FEES PER VISIT RUNNING TOTAL
FIRST
$164
$164
SECOND
$288
$452
THIRD
$224
$676
FOURTH
$ 55
$731
FIFTH
$144
$875
SIXTH
$ 55
$930
SEVENTH
$ 55
$985
http://www.revoptom.com/content/d/coding___and___practice_management/c/36039/
1Rumpakis,
Michael Chaglasian, O.D.
“Putting an Economic Spin on Glaucoma”, Optometric Management, Marc
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Boomers and Disease Detection with OCT
ADDITIONAL INCOME DUE TO IMPROVED
CASE DETECTION
KOA 2014
It’s definitely not getting easier.
One ROI Example:
OCT only 13.5 per month or 3.4 week for breakeven
Procedures for each Glaucoma suspect and diagnosed, 2nd and 3rd visits2
92014 Ophthalmological services, comprehensive medical examination
92250 Fundus Photography
92020 Gonioscopy
92083 Threshold Visual Fields
76514 Corneal Pachymetry
92012 Ophthalmological services, intermediate
92132 Dqiagnostic Anterior Digital Imaging, - Spectralis
92133 Diagnostic Posterior ONH Digital Imaging, -Spectralis
$ 113
$ 47
$ 26
$ 52
$ 12
$ 77
$ 38
$ 42
Income generated by two follow-up visits of each glaucoma suspect
$ 407
2. Rumpakis, Putting an Economic Spin on Glaucoma, Optometric Management March 2004, pp 53-54.
http://www.revoptom.com/content/c/22520/
There is no guarantee that your Medicare carrier will pay for these procedures when performed on the same
day. Please contact your local Medicare carrier to determine appropriate billing guidelines.
“3 Reasons your Optometry Practice is
decreasing in value”
Chad Fleming, OD, FAAO
1.Technology
2.New Patient Ratios
- Boomers!!
3.Resistance to the
Medical Model
CASE EXAMPLES
http://www.optometryceo.com/2013/01/23/3-reasons-your-optometry-practice-is-decreasing-in-value/
Spectral Domain Comparison
Spectral Domain OCT
Time Domain OCT
Stratus
SPECTRALIS
Typical
SD OCT
SD OCT
w/tracking &
Noise
Reduction
Michael Chaglasian, O.D.
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Boomers and Disease Detection with OCT
Spectral Domain: Many Options
KOA 2014
Spectral Domain: Many Options
Optical Coherence Tomography
RS-3000 Advance NOT FDA Approved for US Sales
Still Valuable: But Perhaps Limited Future
(I am unaware of any timelines)
SD-OCT - Heidelberg Engineering
SD-OCT Spectralis
40,000 scans per sec.
Stratus
GDx
SPECTRALIS®
Eye Tracking
Reference scan
Cross section scan
EYE TRACKING
Eye Movement
The reference image tracks eye movement,
and the cross section is moved to match
Michael Chaglasian, O.D.
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Boomers and Disease Detection with OCT
Eye-Tracker Controls Scan Location
in Real Time
KOA 2014
Cirrus™ HD-OCT
 Eye tracker
recognizes eye
movement and
repositions scan
pattern
 Data acquired during
eye movement is
discarded
 Stored data is free of
motion artifacts
Optovue: RTVue
Cirrus™ HD-OCT
X
6.5
Optovue Family
Optovue: iCam and Normative DB
35
Michael Chaglasian, O.D.
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Boomers and Disease Detection with OCT
OCT Gives You a Powerful New Perspective on
These Most Common Ophthalmic Diseases
Pre & Post- Cataract
Complications
2 million patients
diagnosed annually
AMD
6 million patients
diagnosed annually
DME
5 million patients
diagnosed annually
GLAUCOMA
3 million patients
diagnosed annually
KOA 2014
What are practitioners' most common
misunderstandings of imaging technology?
“The thought that these devices can diagnose
glaucoma in the absence of corroborating
clinical evidence is, in my opinion, the most
common (and potentially dangerous)
misunderstanding.
The limited normative databases against which
scans are compared can never cover the
remarkably varied appearance and structure of
the optic nerve we encounter in normal
individuals.”
James Brandt, MD
Red Disease!
Red Disease
CASE AK
 54 year old woman
 Recently moved from Poland
 VA = 20/40 and 20/50
 -14D myope
 Current Medications
 Dorzolamide TID
 Timolol BID
 Complaints of topical SE’s with
drops
Michael Chaglasian, O.D.
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CASE AK
Glaucoma Madness
• Plethora of information
• Nothing Definitive in Early Stages
•
•
•
•
•
•
•
•
Nothing Stable
ONH –IOP-C/D Ratio
Pachymetry
Gonio – family history
Ethnicity –Stereo Photos
Pallor – Rim Area
Asymmetry-Blood Flow
Visual Fields
FRUSTRATION
Increasing Prevalence of Glaucoma
IOVS, Special Issue 2012, Vol. 53, No. 5
Michael Chaglasian, O.D.
Increasing Prevalence: African American
IOVS, Special Issue 2012, Vol. 53, No. 5
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Boomers and Disease Detection with OCT
Increasing Prevalence: Hispanic
KOA 2014
Glaucoma At Risk Review
 African-Americans
Glaucoma is the leading cause of blindness among African-Americans.
It is six to eight times more common in African-Americans than in
Caucasians.
 People Over 60
Glaucoma is much more common among older people. You are six
times more likely to get glaucoma if you are over 60 years old.
 Family Members with Glaucoma
Family history increases risk of glaucoma four to nine times.
 Hispanics in Older Age Groups
IOVS, Special Issue 2012, Vol. 53, No. 5
Glaucoma At Risk Review
 Asians
People of Asian descent appear are at higher risk for angle-closure
glaucoma.
 Steroid Users
OCT for Glaucoma
40% increase in the incidence of ocular hypertension and open-angle glaucoma in
adults who require approximately 14 to 35 puffs of steroid inhaler to control asthma.
 Other Risk Factors
Other possible risk factors include: high myopia (nearsightedness), diabetes,
Hypertension, Central corneal thickness less than .5 mm
65 yo with Hx of OHTN x 3 yrs
Michael Chaglasian, O.D.
RNFL
Optic Nerve Head
Ganglion Cell Thickness
38 yo
GAT= 22 OD 25 OS
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Boomers and Disease Detection with OCT
Cirrus
RNFL
KOA 2014
Optic Nerve Analysis
Optic Nerve Cross Sections
Visual Fields
Michael Chaglasian, O.D.
Combined Report
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Boomers and Disease Detection with OCT
The Ganglion Cell Complex (GCC)
KOA 2014
RTVue: RNFL and GCC
Inner retinal layers provide complete Ganglion cell assessment:
• Nerve fiber layer (g‐cell axons)
• Ganglion cell layer (g-cell body)
• Inner plexiform layer (g-cell dendrites)
Images courtesy of Dr. Ou Tan, USC
NEW for Glaucoma:
Ganglion Cell Analysis
Anatomy:
Ganglion Cell Layer and IPL
 Measures thickness
for the sum of the
ganglion cell layer
and inner
plexiform layer
(GCL + IPL layers)
using data from the
Macular 200 x 200 or
512 x 128 cube scan
patterns.
Carl Zeiss Meditec, Inc Cirrus 6.0 Speaker Slide Set CIR.3992 Rev B 01/2012
Cirrus: Ganglion Cell Analysis
Glaucoma Suspect
Initial
3 years later
The analysis contains:
 Data for both eyes (OU)
 Thickness Map –
 shows thickness measurements of the
GCL + IPL in the 6mm by
6mm cube and contains an
elliptical annulus centered about the
fovea.
 Deviation Maps –
 shows a comparison of GCL + IPL
 thickness to normative data.
 Thickness table –
 shows average and minimum thickness
within the elliptical annulus.
Michael Chaglasian, O.D.
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Boomers and Disease Detection with OCT
RTVue and Cirrus OCT
KOA 2014
Topography of Retinal Ganglion Cells
• Large variation in total ocular
axonal count (0.5 to 1.2 mil)
amongst normals and thus
large variation in normative
databases.
• However, the variation in
ganglion cell numbers in the
central macula is small.
Curcio CA, Allen KA..
J Comp Neurol 1990;300(1):5-25
Posterior Pole Asymmetry Analysis
Glaucoma Case Study 1:
Asymmetry of Ganglion Cell Analysis
• A new SPECTRALIS
software feature to help
assess RNFL and GCL
loss by mapping retinal
thickness across the
posterior pole
• Potential to detect earlier
RNFL loss compared to
RNFL thickness circle
scans, fundus photos or
visual fields
Glaucoma Case Study 1:
IOP 28 OD, Early VF Defect, Inferior RNFL
defect
Michael Chaglasian, O.D.
Posterior Pole Case Study 2
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Boomers and Disease Detection with OCT
New Reports – RNFL & Post. Pole
Posterior Pole Assessment
RNFL & P. Pole Asymmetry
KOA 2014
Progression Analysis:
Absolutely Essential
Progression Analysis:
Absolutely Essential
Detecting Structural Progression of Glaucoma
A Key Component of Glaucoma Management
GPA Analysis
Cirrus HD-OCT GPA Analysis
Guided Progression Analysis
Image Progression Map
SS = 10
Baseline
Registration 
SS = 10
Baseline
Baseline
Registration 
SS = 8
Registration 
SS = 9
TSNIT Progression Graph
250
RNFLT (microns)
Cirrus HD-OCT
200
150
100
50
Two baseline exams are required
0
0
50
100
150
TSNIT
200
250
 TSNIT values from each exam are shown
 Significant difference is colorized yellow or red
 Yellow denotes change from both baseline
exams
 Red denotes change from 3 of 4 comparisons
 Third exam is compared to the two baseline exams
 Sub pixel map demonstrates change from baseline
Yellow pixels denote change from both baseline exams
Trend Analysis:
Summary Parameter
Third and fourth exams are compared to both baselines. Change identified in
three of the four comparisons is indicated by red pixels; yellow pixels denote
change from both baselines
 A Regression Line is drawn to
determine rate of change for all the
data that has been collected over time.
Change refers to statistically significant change, defined as change that exceeds
the known variability of a given pixel based on population studies
Michael Chaglasian, O.D.
 Less variability with Structural/OCT
testing as compared to Functional/
Visual Field testing.
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Boomers and Disease Detection with OCT
New Updates on Cirrus HD-OCT (Zeiss):
Ganglion Cell Analysis
KOA 2014
Updated Guided Progression Analysis (GPA™)
Optic Nerve Head information now included
• Average Cup-to-Disc Ratio plotted on graph
with rate of change information.
• RNFL/ONH Summary includes item “Average Cup-toDisc Progression”.
• Printout includes an optional second page with table of
values, including Rim Area, Disc Area, Average & Vertical
Cup-to-Disc Ratio and Cup Volume. Each cell of the
table can be color coded if change is detected.
Ver 6.0
Ver 6.0
Updated Guided Progression Analysis
(GPA™)
Provide the best possible
glaucoma care to your patients
Page 1
Page 2
•Find more glaucoma suspects
•Diagnose glaucoma earlier
Glaucoma is a leading cause of blindness in the US
Over a million people in this country have glaucoma but
don’t know it.1
Failure to diagnose open-angle glaucoma is a leading
cause of liability claims involving eye care practitioners.2
Ver 6.0
Retina
81
1The
Eye Diseases Prevalence Research Group. Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol. 2004;122(4):477485.
JG. Glaucoma--a clinicolegal review. J Am Optom Assoc. 1997; 68:389-394.
2Classe
Retina AMD
1.47% >40 age have Macular Degeneration
Over 7 Million at risk for AMD Drusen >125um
1.75 million individuals in US w/significant AMD
15% of the white women older than 80 years
AMD will increase by 50% to 2.95 million in 2020
Source National Eye Institute Citations and Abstracts from April 2004 Archives of Ophthalmology
Prevalence of Age-Related Macular Degeneration in the United States
The Eye Diseases Prevalence Research Group
Michael Chaglasian, O.D.
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Boomers and Disease Detection with OCT
KOA 2014
AMD Risk Factors
Many faces of AMD
Smoking
Smoking may increase the risk of AMD.
Obesity
Research studies suggest a link between obesity and the
progression of early and intermediate stage AMD to advanced
AMD.
Race
Whites are much more likely to lose vision from AMD than African
Americans.
Family History Those with immediate family members who have AMD are at a
higher risk of developing the disease.
Gender
Women appear to be at greater risk than men.
Dry AMD
HD Raster with Enhanced Depth
Imaging (Cirrus)
HD 5 Line Raster
Michael Chaglasian, O.D.
Dry AMD
Classic CNVM
20/40
CF@ 5 ft
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KOA 2014
Advanced RPE Analysis
Gain new insights on your AMD patients
• RPE Elevations. If the RPE is
raised above a baseline plane,
a new proprietary algorithm
for Cirrus maps and measures
the area and volume of the
elevations.
RPE Elevations
Sub-RPE Illumination
• Sub-RPE Illumination. If the
RPE is absent or has lost
integrity, the OCT beam
penetrates into the choroid. A
new proprietary algorithm for
Cirrus can determine when
this occurs and then map and
measure the affected area.
92
Missed PED
PED
Idiopathic CNV
Retina-Diabetes
 1 in 17 Americans or 16 Million with Diabetes
 10.2 million US adults 40 years and older known to have
Diabetes Mellitus (Proliferative/Non or DME)
 4.1 million US adults 40 years and older have diabetic
retinopathy
 3.4% or 4.1MM of Population w/vision threatening
retinopathy
Retina
Michael Chaglasian, O.D.
Source National Eye Institute Citations and Abstracts from April 2004 Archives of Ophthalmology
The Prevalence of Diabetic Retinopathy Among Adults in the United States
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Boomers and Disease Detection with OCT
KOA 2014
CSME
DME
Full Thickness Macular Hole
Macular
Hole
Vitreo Macular Traction: OCT
Anterior Segment Imaging
Anterior Segment Module
provides a close up view of
chamber angles
Michael Chaglasian, O.D.
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Boomers and Disease Detection with OCT
Lasik Flap
Cirrus HD-OCT Anterior Segment
Imaging
Images courtesy of Martha Leen, M.D. & Paul Kremer M.D. Achieve Eye and Laser Specialists, Silverdale, WA
Cirrus Anterior Segment Imaging
Cirrus HD-OCT image with a visible angle recess (blue arrow). Schlemm’s canal is very well clearly
seen (red arrow).
Michael Chaglasian, O.D.
KOA 2014
Cornea, Angle & Sclera Mode
Cirrus Anterior Segment Imaging
Cirrus HD-OCT scan of normal cornea. Layers identified with colored arrows as follows: tear film
(blue), epithelium (white), Bowman’s layer (red), Descemet’s/endothelium (green).
RTVue Clinical Applications
Retina
Glaucoma
Anterior
Chamber
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Boomers and Disease Detection with OCT
MultiColor Technology
 MultiColor image composed of three selective colour
laser images
 Infrared, green and blue reflectance
MultiColor
 Automatic color balance to
match fundus appearance
on photographs
 Limitations:
KOA 2014
The Versatility of MultiColor
Imaging
View images of individual laser colors
to gain better understanding of
anatomic and pathologic detail at
different depths within the retina
ERM, RNFL,
macular pigment
blood vessels,
blood, excudates
drusen, RPE,
choroid
 Optic disc colour does
not match natural
appearance
 Uveal pigment appears pale
blue reflectance
green reflectance
infrared reflectance
Image courtesy of S. Wolf, MD, PhD, Bern, Switzerland
Online Education Widely Available
How do you view all of this
data and image imformation?
Image Management System.
Designed for EyeCare
http://www.elearning.zeiss.com/
Michael Chaglasian, O.D.
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Boomers and Disease Detection with OCT
KOA 2014
“Why would I need more than an
Electronic Health Record (EHR) system
for my ophthalmic practice?
A Few Definitions
Acronym
Term
DICOM
Digital Imaging and Communications in Medicine
EHR
Electronic Health Record
EMR
Electronic Medical Record
IMS
Image Management System
PACS
IMS
The IT Landscape in an Ophthalmic Practice
IT integration is key
Picture Archiving and Communication System
HIS
Health Information System
PMS
Practice Management System
What does an EHR alone offer?
Clinical Management
PMS or HIS
Manages the practice business
(administration, scheduling, accounting, billing)
EHR / EMR
Medical charts. Documentation of clinical
decisions, treatments and prescriptions
Medical data
standard
protocols
IMS
Manages and archives diagnostic reports and images.
Viewing, comparing and reviewing ophthalmic data
What can EHR + an IMS offer?
EMR/EH
R
Medical charting
√
Treatment Plan
√
Ophthalmology exam templates
√
e -prescribing
√
Report storage
√
√
Treatment Plan
√
Ophthalmology exam templates
√
e -prescribing
√
Report storage
√
√
Central scheduling of patient tests
√
Side-by-side report viewing
√
Customizable viewer for images and reports
√
Combined reports from instruments
√
Full resolution images (Fundus Images)
√
Billing
√
CCHT Certification
√
AARA Certification
√
What clinical needs can an IMS uniquely
address?
IMS
(PACS)
Clinical Need IMS Feature
An Image
Management
System helps:
√
Store all test data & reports on a Broad device connectivity via DICOM & file
server imports
•Reduce
errors
Perform change analysis (GPA) Centralized, raw data storage
√
Central scheduling of patient tests*
√
•Save time
See your HFA data in your EHR
Side-by-side report viewing
√
Customizable viewer for images &
reports
√
Combined reports from instruments
√
Full resolution images (Fundus
Images)
•Better
appreciate
patient’s
diagnostic
data
√
Billing
Michael Chaglasian, O.D.
√
√
Raw data storage from instruments
Raw data storage
Practice Management
IMS (PACS)
Practice Management
117
Clinical Management
EHR/EMR
Medical charting
A single FORUM - EHR interface with many
EHRs supported
Review reports in context
Display VF, OCT, fundus photos, structurefunction GPA side by side
Clean up legacy records
Merge tool to find & merge multiple patient
records using a variety of match criteria.
Innovative analyses Combined Visual Field - OCT Reports
* A feature that helps
reduce errors in formatting
patient records
Patient education Customizable viewer for images and reports
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Boomers and Disease Detection with OCT
An IMS can integrate patient data in unique
ways
KOA 2014
Zeiss Forum Viewer Software
Example: VF-OCT combined report
Zeiss Forum Viewer Software
Zeiss Forum Viewer Software
Zeiss Forum Viewer Software
Zeiss Forum Viewer
Michael Chaglasian, O.D.
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Boomers and Disease Detection with OCT
Zeiss Forum: Combined Report
KOA 2014
Forum Glaucoma Workplace
FORUM 3.2
Forum Glaucoma Workplace
What‘s new ?
Clinical Displays – Auto-selection rules
Clinical Displays – Auto-selection rules
Cataract
Glaucoma (OCT-VF-FI)
1. Display is set to 3 x 1 (fixed arrangement)
2. The following documents are selected
automatically
1. Display is set to 3 x 1 (fixed arrangement)
2. The following documents are selected
automatically
A. Left panel:
Overview report from CZM Atlas
B. Middle panel: Macular Thickness Analysis Report from CZM Cirrus or Stratus
C. Right panel: IOLMaster report
3. The most recent visit date will be selected. All
documents must be from the same date
4. Laterality (R/L) according to the user selection:
IOLMaster report with laterality ‘Both‘ is selected
in both cases (R/L)
131
Michael Chaglasian, O.D.
A. Left panel:
ONH and RNFL Analysis report or RNFL Thickness Analysis report from CZM Cirrus
B. Middle panel: SFA report from Humphrey Field Analyzer
C. Right panel: COLOR Fundus Image
3. The most recent visit date will be selected. All
documents must be from the same date
4. Laterality (R/L) according to the user selection:
ONH / RNFL report with laterality ‘Both‘ is
selected in both cases (R/L)
132
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Boomers and Disease Detection with OCT
KOA 2014
Clinical Displays – Auto-selection rules
Clinical Displays – Auto-selection rules
Glaucoma OU (OCT-VF-FI)
Glaucoma Progression (FI)
1. Display is set to 3 x 1 (fixed arrangement)
2. The following documents are selected
automatically
1. Display is set to 2 x 2 (fixed arrangement)
2. The following documents are selected
automatically
A. Left panel:
COLOR Fundus Image of the right eye
B. Middle panel: HFA Visual Field and Cirrus ONH (/RNFL) Combined Report
C. Right panel: COLOR Fundus Image of the left eye
3. The most recent visit date will be selected. All
documents must be from the same date
A.
B.
C.
D.
Top left panel:
Top right panel:
Bottom left panel:
Bottom right panel:
COLOR Fundus Image
COLOR Fundus Image
COLOR Fundus Image
COLOR Fundus Image
from the patient’s latest ( / current) visit
from the patient’s 2nd latest ( / last) visit
from the patient’s 2nd earliest visit
from the patient’s earliest ( = first) visit
3. Laterality (R/L) according to the user selection
133
134
Clinical Displays – Auto-selection rules
Clinical Displays – Auto-selection rules
Glaucoma Progression (OCT-VF)
Retina Overview
1. Display is set to 4 x 1 (fixed arrangement)
2. The following documents are selected
automatically
1. Display is set to 3 x 2 (fixed arrangement)
2. The following documents are selected
automatically
A.
B.
C.
D.
Left panel:
2nd panel from left:
3rd panel from left:
Right panel:
GPA Optic Disc Cube report CZM Cirrus – Right eye
GPA report from Humphrey Field Analyzer – Right eye
GPA Optic Disc Cube report CZM Cirrus – Left eye
GPA report from Humphrey Field Analyzer – Left eye
3. The most recent GPA reports will be selected.
A. Top left panel:
COLOR Fundus Image
B. Top middle panel: RED FREE / GREEN Image
C. Top right panel and bottom panels (left to right): 4 phases of a FA or ICG series: i. Early phase (earliest image within 0 s and 25 s), ii. Earliest image
within 25 s and 1 min, iii. Earliest image within 1 min and 2 min, iv. First image after 2 min
3. The most recent visit date will be selected. All
documents must be from the same date
4. Laterality (R/L) according to the user selection
135
Clinical Displays – Auto-selection rules
136
Image Management Systems
AMD Progression (OCT)
1. Display is set to 4 x 1 (fixed arrangement)
2. The following documents are selected
automatically
A.
B.
C.
D.
Left panel:
2nd panel from left:
3rd panel from left:
Right panel:
Macular Thickness Analysis report (Cirrus or Stratus) from the patient’s earliest (= first) visit
Macular Thickness Analysis report (Cirrus or Stratus) from the patient’s 2nd earliest visit
Macular Thickness Analysis report (Cirrus or Stratus) from the patient’s 2nd latest ( / last) visit
Macular Thickness Analysis report (Cirrus or Stratus) from the patient’s latest ( / current) visit
3. Laterality (R/L) according to the user selection
 Topcon
 Synergy
 OIS
 Symphony Web
 Canon Retinal Imaging
Control Software
 Kowa
 DigiVersal
 EHR Systems
 Generally don’t offer as
much functionality
 All should be “DICOM”
compliant
137
Michael Chaglasian, O.D.
23
Boomers and Disease Detection with OCT
Retain the glaucoma/retina patients
that you identify
KOA 2014
OCT in Optometric Practice:
Increase patient retention rates by:
• Diagnosing patients early
• Educating them on glaucoma and retina pathology
• Managing them with state-of-the art technology
YOU WILL MAXIMIZE YOUR RETURN ON
INVESTMENT WHLE PROVIDING BETTER
PATIENT CARE
[email protected]
Michael Chaglasian, O.D.
24