Confident image interpretation

Zachary Tomlinson, imaging clinical application specialist for Zeiss Medical Technology, emphasised that, with the universal use of OCT from primary to secondary care supporting optometrists to pass on any findings to hospital eye care services: “This has quickly made OCT invaluable in primary care.” 

When it comes to using OCT and interpreting scans, clinicians can experience uncertainty around whether an abnormality could be significant, the pair noted. 

Tomlinson said: “OCT shows incredible detail – not only in the images and scan taken, but also with the amount of analytical data provided. So, interpreting all the information provided can sometimes feel like a difficult task.” 

“However, with the support of educational resources, CPD events, and the emergence of artificial intelligence (AI)-guided interpretation assistance, this will give optometrists the confidence to overcome the concern: ‘Have I missed anything?’” he added.  

Zeiss has a reference database with colour-coded analysis to highlight differences compared to a healthy eye of the same age.  

The company also recently introduced the PathFinder software, an AI guided decision support tool that streamlines the review of macular OCT scans by automatically identifying B-scans that may need closer review.  

The software is integrated into the Cirrus OCT, with areas of concern flagged in red once the scan has been completed. Yellow areas indicate low scan quality requiring recapture.  

This supports practitioners to delve deeper into the identified areas, Martin suggested.  

Tomlinson added that, with the PathFinder indicating which B-scans are abnormal or normal, “this will reduce the risk of abnormalities being missed within the OCT.” 

The manufacturer highlighted that its MyZeiss online platform enables customers to access educational material, including certified courses and practice building material.  

AI-supported tools

As care shifts towards community settings, Tim Cole, head of clinical education at Heidelberg Engineering UK, told OT that he believes one of the main roles of OCT in the near future will be to aid early diagnosis and monitoring of glaucoma. 

“Our glaucoma waiting lists and systems can be radically different depending on the local pathway, particularly in England and Wales. I would like to see the Scottish model implemented UK-wide, where optometrists play a much more involved role using OCT,” he said.  

In the intermediate, Cole suggested, he expects to see AI being implemented with OCT to further refine referrals and support early referrals for other diseases, not just for ophthalmology.  

When it comes to interpreting images, Cole shared that a common concern from many clinicians is when to refer conditions that display red warnings against normative data, or difficult to interpret retinal OCT structures, such as sub retinal hyper reflective materials and retinal pigment epithelium disruptions.  

“Many of these concerns are simply down to experience, so I always advocate as much self-education as possible,” he said. 

Heidelberg Engineering enables clinicians to connect with a host of AI providers through the latest version of its software platform, Heyex2. 

“There are now several AI applications which have full medical device clearance ensuring they are safe and reliable to use for patients, which can enable clinicians to pick up early disease, even before the patients’ sight is affected,” he said.  

Cole suggested that the use of AI-supported technology could support clinicians in identifying subtle changes.  

He explained: “They say the future of health care isn’t experts being replaced by AI tools, it’s experts using AI correctly who will replace the more traditional clinician. I can see some truth in that.” 

“Certainly, from my own experience, I’ve seen that AI can sometimes provide us with clues or help us notice very subtle things we might not have noticed before. I think using this tool ultimately can sharpen clinicians to be more sensitive themselves,” he added. 

The Heidelberg Academy has a library of material for practitioners, including interactive diagnosis quizzes and downloadable e-books. The Heidelberg Engineering YouTube hosts webinars and ‘how2’ workshops.

Cole also noted that having a routine methodology is “essential” to ensure all OCT scans receive the same level of scrutiny, starting by assessing the image quality.  

“Next is the segmentation itself, did it correctly define the anatomical boundaries? Not all algorithms are perfect. Once this is established it’s pretty much pattern recognition, and with that it’s simply down to ‘flying hours’ in my experience,” Cole said.  

This is the same process an AI algorithm will work through. “What do all AI algorithms need? Data; good quality and as much as possible,” he noted. 

Multi-modal imaging 

Sharon Ormonde, sales director Northern Europe at Optos, said: “As the NHS continues facing capacity challenges, community practices equipped with advanced imaging technology represent a vital extension of eye care services, ensuring limited hospital resources are directed towards patients who genuinely need specialist intervention.”  

With care moving to the community, devices incorporating ultra-widefield imaging with integrated OCT are becoming more important, offering a comprehensive view, Ormond suggested.  

This provides a baseline that can serve as a reference point for monitoring subtle changes over time, she noted, adding: “This allows practitioners to distinguish between normal variations and pathological progression, leading to more personalised care plans and appropriate referral decisions.” 

Ormonde noted that studies have found integrated devices, such as the MonacoPro, which combines OCT with Optomap ultra-widefield (UWF), show 29% more pathology, which can help address concerns around missing pathology.  

Correlated UWF and OCT imaging supports practitioner confidence when interpreting complex ocular findings, Ormonde said, and serves as a verification tool, with each modality validating and enhancing the information provided by the other.  

A multi-modality approach “dramatically reduces diagnostic uncertainty, particularly for subtle or ambiguous presentations,” Ormonde said, she added that presenting a wide panoramic view and structural analysis offer assurance when distinguishing between normal anatomical variations and genuine pathology.  

The imaging can also enhance communication confidence when discussing findings with patients or consulting with colleagues.  

“Being able to demonstrate abnormalities from multiple perspectives makes explanations clearer and referrals more compelling when necessary, ultimately leading to better-informed clinical decisions and improved patient care,” she said.  

Optos devices include the OptosAdvance software, featuring proprietary automated analysis algorithms which provide instant segmentation of retinal layers.  

Ormonde added: “Our normative database in MonacoPro, meticulously developed through years of clinical research, enables confident comparison against age-matched populations. Practitioners particularly value how these tools highlight subtle deviations that might otherwise be missed.” 

Optos offers onboarding, educational resources, training videos and accredited CPD opportunities to “flatten the learning curve” for practitioners adopting the technology.