Optometry practice growth: business cases

The client. Dr. William C. Fruchtman’s Optometry Practice, owned and operated by Dr. William C. Fruchtman, O.D., is located in East Rutherford, New Jersey, an inner-ring suburb of New York City. With over 30 years of service to the community, the practice provides comprehensive eye care, including regular eye examinations, contact lenses, and glasses prescriptions. 

Dr. William Fruchtman’s practice continually seeks opportunities to add value to its services. He is cultivating his expertise in dry eye disease and macular degeneration, implementing advanced technologies, and using another effective strategy to expand his patient base – communicating with patients in their preferred language. Knowing that clear communication is vital to good care, Dr. William C. Fruchtman’s team includes members who speak Spanish and Polish. As such, their website is available in both Polish and Spanish, a valuable asset considering the area’s substantial Spanish-speaking population (up to 20% of the local demographic).

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While achieving fluency in every language spoken within your community may not be feasible, consider adapting your website and patient materials to include translations in commonly spoken languages. As Dr. Fruchtman’s experience confirms, even a simple greeting in a patient’s native language can create a bond with patients or, at the very least, prompt a genuine surprised smile.

The problem. To establish expertise in specialized services, Dr. William Fruchtman has been committed to effectively managing dry eye disease and macular degeneration. Not so long ago, the practice implemented Equinox Low-Level Light Therapy (LLLT). This advanced dry eye treatment utilizes LED lights to warm the eyelids gently, promoting meibomian gland function and oil release. With dry eye management addressed, Dr. Fruchtman sought an additional tool to both strengthen his decision-making when managing patients with other pathologies, particularly macular degeneration, and increase his optometry practice growth.

The solution. After researching Altris AI, an Artificial Intelligence platform for OCT scan analysis, Dr. Fruchtman was positive that he wanted to try the platform. Following introductory meetings and a quick onboarding with the Altris team, he started a two-week trial. After personally testing the platform, Dr. Fruchtman decided it was an invaluable addition to his practice.

Integrating Altris AI into the practice has notably enhanced Dr. Fruchtman’s confidence and precision in diagnosing and managing eye care disorders. The practice has also gained a significant competitive advantage, as the platform can routinely perform Glaucoma Risk Analysis on existing OCT scans, offering additional value to patients. 

Thanks to the color-coded and labeled OCTs, optometry facilitates patient education and enables practitioners and patients to monitor the progression or treatment results more effectively. 

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How to grow an optometry practice: more cases from optometry owners

Optometrists undergo years of education, training, practice, and continuous learning – understandably, it is hard to see additional time or resources to pursue business education. 

Many practitioners experience stress, balancing patient care demands with the realities of running a profitable business. This feeling can intensify when attending countless conferences and webinars highlighting thousands of ways to make business more efficient. While they offer valuable advice, it’s sometimes helpful to remember simple points of how successful optometry practice growth will look: attracting new patients, retaining existing ones, and ensuring a smooth and efficient workflow. These (even though overly simplified) points allow you to focus on the most critical details.

But before diving into ways of optometry practice growth, remember that the first step is a realistic assessment of your current situation. 

While you’re likely aware of some issues, feedback from your team and patients can provide insights, and sometimes even immediate solutions, for areas of improvement. 

Even though we cannot directly assist in assessing your specific practice, as you know it best, below we offer some key, proven strategies for growing your business.

Optometry practice growth: expanding your patient base

• Dry Eye Specialization

One effective strategy for optometry practice growth is to expand the scope of services to include the diagnosis and management of ocular diseases. For example, dry eye disease (DED) affects ∼344 million people worldwide and over 20 million in the United States alone, yet many remain undiagnosed and untreated. This presents a significant opportunity to care for a large and often underserved patient population. By developing expertise in DED and offering specialized treatments, you can not only attract new patients but also contribute to improving the quality of life for those suffering from this chronic condition.

There are numerous approaches to managing DED effectively. As mentioned, Dr. William C. Fruchtman’s practice utilizes Equinox Low-Level Light Therapy (LLLT). 

Dr. Shane Swatts, O.D., owner of Eastern Virginia Eye Associates, employs AI software to enhance DED diagnostics, conduct more comprehensive analyses, and keep detailed patient medical histories. This technology upgrades pre-and post-operative care, saving time without compromising accuracy.

• Aesthetic Optometry

Dr. Janelle Davison identified an opportunity for optometry practice growth by addressing patient needs while generating additional revenue by incorporating aesthetic optometry services into her practice. Within a single quarter, her practice generated $14,000 in revenue from aesthetic product sales alone. 

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Dr. Davison also collaborates with a licensed aesthetician who operates within the practice on a contract basis, sharing the revenue generated from aesthetic services.

• Glaucoma Management

Dr. James Deom, O.D., M.P.H., an optometrist from Pennsylvania, implemented a successful strategy for optometry practice growth based on attracting glaucoma patients, significantly increasing glaucoma-related revenue. He initiated internal marketing efforts by inquiring about patients’ family history of glaucoma and informing them about the practice’s newest technology for the early detection of vision loss.

Practices specializing in glaucoma management can significantly benefit from incorporating advanced software solutions to complement their existing diagnostic hardware. For instance, integrating Altris AI, AI for OCT,  into their OCT analysis workflow enables not only automated screening of 70+ pathologies and biomarkers but includes assessing retinal nerve fiber layer (RNFL) asymmetry for glaucoma risk evaluation.

• Patient-Centered Care

Offering diverse channels for patient interaction can broaden your practice’s reach and improve the patient experience. Dr. Melissa Richard, O.D., sought to provide patients with a preview of frame options before their appointments. To achieve this, she integrated Optify technology into her practice, a solution she discovered during a Vision Source Exchange lecture. This technology creates a virtual showroom where patients can explore and select their preferred frames in advance, streamlining the in-office experience.

Patient education is also key to patient-centered care and personalization, which not only empowers individuals and improves their outcomes but also fosters optometry practice growth. Those who understand their eye health are more likely to adhere to recommendations. 

A study demonstrates that 94% desire educational content, but a third don’t receive it. 

Providing color-coded OCT reports with pathologies, biomarkers, and pathology progression tracking not only satisfies this need but also elevates your practice above competitors.

Improve efficiency in the optometry office through strategic partnerships & team building

When optometrists consider further career development, they may seek additional support to achieve their goals. Dr. Linda Enciso, O.D., found such support when her practice joined the AEG Vision family in 2019. The transition brought numerous positive changes, boosting patient care and fostering growth opportunities for team members.

Although Dr. Enciso had already been operating her practice for 13 years and had implemented electronic health records (EHR) systems and third-party software to improve patient communication and boost optometry practice growth, her goal was to continue these advancements and expand the scope of practice.  Joining AEG Vision allowed her to transition to the training team, access continuing education opportunities to stay informed about advancements in optometry and healthcare, collaborate with other healthcare providers and cross-functional teams to enhance comprehensive patient care.

While the phrase “team building” might evoke images of complicated activities and extensive effort, fostering a strong team can be achieved through simple, engaging initiatives. Consider the inspiring example of Dr. Jonathan Cargo, O.D.  

Dr. Cargo recognizes the value of personal development through reading but finds it challenging to share his insights with his team effectively. Inspired by his wife’s long-standing book club, he initiated an office book club to encourage team connection and shared learning to improve efficiency in the optometry office.

The book club operates with team members suggesting relevant titles and collectively reading chapters over a month, dedicating time during team meetings for discussions. Dr. Cargo highlights the recent success of reading “Crucial Conversations,” a selection prompted by team members’ desire to deepen their communication skills, particularly in navigating challenging discussions with colleagues, patients, and even family members.  The shared reading experience gave a better understanding of effective communication strategies and empowered the team to navigate difficult conversations.

Summing up

When regarding optometry practice growth, consider the time, effort, and resources you are prepared to invest. To expand your patient base, explore the addition of new services.

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To optimize costs and efficiency and gain a competitive edge, investigate the possibility of implementing AI in your practice – it can be a second-opinion tool, or you can read here how practitioners use it for marketing, creating educational materials, and more. To encourage staff retention and nurture a positive work environment, prioritize team-building activities; even seemingly simple initiatives can produce significant benefits.

Optometry Trends in Action: 12 Real-World Success Stories

Optometry trends explained: showcasing real-world optometry practice owners who are adapting to the shift in patient needs, successfully implementing solutions to automate routine and laborious tasks, using AI to combat staff shortages, creating their own brand mascots, and more.

Optometry trends for the patient journey: digital communication

Online shopping, global deliveries, and instant brand replies through messengers have dramatically shifted client expectations and behaviors. The ‘convenience economy’ isn’t slowing down, pushing businesses to adopt technology for more streamlined consumer experiences. 

What does this mean for your practice? Your patients now expect fast and efficient communication across all touchpoints –  from online scheduling to contactless payments. Transforming your practice to meet these demands ensures satisfied patients and contributes to long-term success, as any optometry practice thrives on the individual experiences of the patients it provides.

46% of optometrists reported that patient expectations have risen since the pandemic.

Practices can optimize their workflows in various ways, but generally, the goal is to automate routine administrative tasks, free up staff, and reduce patient waiting time. Digital safety forms and document management systems eliminate physical paperwork, while online proofing and approval systems speed up document processing.

Dr. Justin Bazan, owner and optometrist at Park Slope Eye, New York, has taken this even further by eliminating phone calls at his office entirely and is pleased with the results. This solution was based on several months of analyzing data related to phone calls, including time spent on calls and the frequency of missed calls. The team recognized that while the staff could simultaneously chat with multiple patients, they could only handle one phone call at a time.

Chad Fleming, OD, Owner and OD at Wichita Optometry, Kansas, also identified the need for an enhanced digital presence to prioritize patient convenience. His practice faced the challenge of managing a high volume of phone calls and text messages, requiring either additional staff hiring without an immediate increase in revenue or a strategic reallocation of existing personnel.

Dr. Fleming optimized the patient experience by setting up automated checkouts at some of his practice locations. This approach enabled him to reassign three front desk employees to the digital communications team. While the transition required patient education to familiarize them with the virtual check-in process on iPads, it did not result in patient attrition.

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Brianna Rhue, OD, Owner and Optometrist of West Broward Eyecare Associates, Florida, agrees that the traditional approach of answering calls and checking emails once a day differs from today’s patient expectations. She advocates step-by-step optimizations throughout the patient journey to eliminate unnecessary wait times and increase productivity.

Upgrading to a more advanced EHR system is one of the significant opportunities to streamline practice operations, save practitioners time, money, and stress, and align with optometry industry trends. Unfortunately, once hailed as revolutionary, some widely adopted EHR solutions are now criticized for their burdensome workflows and counterintuitive interfaces. This has led some practitioners to describe their interaction with systems as “death by a thousand clicks.”

By leveraging up-to-date EHR features like customizable patient encounter templates, integrated imaging and diagnostic tools, and patient outcome tracking, eye care professionals can shift their focus from paperwork to patient care.

Another of optometry trends gaining momentum among optometry practice owners is offering flexible payment options. This reflects not only the growing demand for convenience but also the financial constraints of patients navigating the current economy that is heading to a recession.

Dr. Rhue encourages practices to adopt mobile payment solutions that enable patients to pay electronically using platforms like Apple Pay, Venmo, or PayPal at the point of service. For balances due after the visit, the ability to send secure payment links via text message can greatly enhance the collection process.

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Furthermore, providing patient financing options empowers patients to choose how and when they pay. This offers additional convenience for both parties and eliminates friction by allowing patients to spread the cost of their care over time rather than requiring full payment upfront.

If you are still determining which technologies of these optometry industry trends your patients will be eager to adopt, consider the approach taken by Scott Jens, OD, the owner of Isthmus Eye Care, Wisconsin. Dr. Jens has successfully implemented post-examination surveys to gather patient feedback. This strategy serves a dual purpose: demonstrating your commitment to patient satisfaction and gaining valuable insights into which technological advancements would most benefit your practice.

Optometry trends in the exam room: tech-driven precision and patient education

Optometry relies heavily on technology, and investing in hardware upgrades is a significant financial commitment. However, if your hardware needs are met, but you still want to be at the forefront of technological advancements, consider specialized software and platforms to extend the possibilities of your existing devices.

Dr. Maria Sampalis, OD, the owner of Sampalis Eye Care, Rhode Island, utilizes two such programs in her practice. To support her specialization in dry eye management, she employs CSI Dry Eye. Additionally, she uses Altris AI, an AI-powered platform for OCT scan analysis, to provide a second opinion and enhance diagnostic accuracy.

Dr. Sampalis finds that the Dry Eye software allows her and her staff to analyze symptoms and images comprehensively, improving patient care, time savings, and increasing diagnostic precision.

Her patients also appreciate Altris AI, which analyzes OCT scans for over 70 pathologies and biomarkers while also calculating the risk of developing glaucoma.

Working with specialized software solutions improves diagnostic accuracy and aids in patient education. Visual representations of their conditions, facilitated by these technologies, empower patients with a clearer understanding, leading to increased treatment compliance.

Eye Place, an optometry center in Columbia, also leverages Altris AI, among other cutting-edge technologies. They capture images using the Topcon Maestro2 OCT and use Image Net6 software to export DICOM files to the Altris AI platform.

Beyond AI-powered OCT analysis, Eye Place utilizes state-of-the-art diagnostic tools, such as 3D OCT equipment, to screen for serious conditions, including glaucoma, diabetes, and macular degeneration. Furthermore, they work with AdaptDX Pro, a technology capable of detecting macular degeneration earlier than traditional methods.

Another case of optimizing and enhancing the exam process is West Broward Eyecare Associates. They implemented  Optify, a smart building solution offering full fiber connectivity. Patients can pre-select frames in the online optical store before their visit, streamlining the in-office experience. Additionally, the practice utilizes Dr. Contact Lens, a platform for convenient ordering, reordering, and prescription management for contact lens wearers, reducing paper waste.

There are also advancements in AI transcription technology that are poised to ease clinical documentation and automate a traditionally laborious task.

The adoption of AI in clinical documentation has been shown to reduce the time doctors spend on charting by approximately 2 hours per day. 

AI exam transcription is still in the process, and the existing possibilities are not yet flawless—struggling with patient responses like “mm-hm” and “uh-huh”—the technology is evolving, promising greater efficiency and accuracy in the future. For example, one such program starts the transcription process of the exam by confirming patient consent and a click of the record button by the optometrist. Then, AI captures, structures, and summarizes information in real-time, filtering for relevant details to generate documentation for each patient appointment. 

Optometry trends for competitive advantage: using AI in Marketing and Decision-making

Some practice owners may still believe their patient demographics do not necessitate an expanded online presence, particularly when considering elders. But you should be different from your competitors.

The reality is that today’s patients, regardless of age, are increasingly turning to the Internet for information and services. While word-of-mouth referrals remain valuable, a solid online presence is essential for practice growth and visibility in today’s competitive landscape.

Twin Forks Optometry and Vision Therapy in New York reports that their most effective marketing strategy involves a monthly-to-quarterly newsletter distributed to existing patients. This newsletter highlights practice updates, recent vision therapy graduates, new podcast episodes, and seasonal information. They’ve also observed that educational posts generate significant engagement and have even led to new patient visits.

Voice Search Optimization (VSO) is emerging as one of the new trends in optometry that has the potential to benefit practices significantly. Dr. Brianna Rhue, OD, co-owner of West Broward Eyecare Associates in Florida, asserts that a search engine optimized (SEO) website alone will soon be insufficient for patients to discover your practice online easily, especially in highly competitive locations.

Contrary to popular belief, it’s not just the tech-savvy individuals who rely on voice assistants. This technology is predominantly used by older individuals who haven’t mastered typing or face difficulties with it.

However, while the benefits of digital communication are undeniable, it’s crucial to acknowledge that it often adds up yet another layer of responsibility to already overburdened teams. This is why generative AI tools like ChatGPT and Gemini are gaining popularity among optometrists, offering solutions to this and other challenges.

For example, Dr. Ryan Cazares, the owner and founder of Scott Eye Care in Louisiana, utilizes ChatGPT to generate social media and educational content for his practice. He brainstorms with AI content ideas, creates visuals for social media and marketing campaigns, and has even developed a unique mascot (Dr. Seymour) that engages his audience.

The practitioner also uses AI to generate personalized educational materials for their patients. Traditionally, his practice relied on generic Optometric Association pamphlets, but now, it has transitioned to simple one-page educational sheets tailored to individual patient needs.

Dr. Haley Perry, owner of Elite Eye Care, New York, provides another example of AI’s potential in practice management. Her goal for this year was to increase patient volume without expanding her staff, and ChatGPT played a pivotal role in achieving this objective. 

Faced with the decision between two vendors for new exam room equipment, she used AI to analyze each vendor’s pricing and financing options, weigh the pros and cons of the equipment in relation to her goals, and forecast the return on investment (ROI) for each option. This analysis enabled her to select the most suitable vendor and estimate the timeframe for recouping her investment.

Dr. Perry also leverages AI to analyze patient feedback, demographic data, and treatment outcome statistics to ensure equipment investments align with patient needs. For instance, if data reveals a high prevalence of conditions like glaucoma, AI can help justify investing in advanced glaucoma screening tools.

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Summing up

The optometry landscape is evolving, driven by raised patient expectations for convenience and efficiency. Practices adapt to these changes by embracing emerging optometry trends to achieve more precise diagnostics, streamline patient journeys, enhance the exam room experience, and build trust and connection. Much of this technology is AI-based, with even more advancements on the horizon. So, optometrists implementing these solutions today are poised to secure a significant competitive advantage.

How we build Ethical AI at Altris AI

As the co-owner of the AI HealthTech startup, I get many questions regarding biases and the security of our AI algorithm. After all, Altris AI works directly with patients’ data, which is why these questions are inevitable and even expected. So, I decided to share our approach to building Altris AI as an ethical AI system. 

From the very first moments of the company’s creation, I knew that AI and healthcare were two topics that had to be handled very carefully. That is why we ensured that every aspect of the AI platform creation aligned with modern security and ethics guidelines.

It’s like building a house: you need to take care of the foundation before getting to the walls, roof, and decor. Without it, everything will fall sooner or later. Ethical principles of AI are this foundation.  

The following aspects of Ethical AI were the most important for us: machine training ethics, machine accuracy ethics, patient-related ethics, eye care specialists-related ethics, usefulness, usability, and efficiency.

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1. Machine Training Ethics

To create an accurate algorithm capable of analyzing OCT scans, we needed to train it for years. When it comes to machine training, we speak about data for this training. There are 2 major aspects of machine training ethics that need to be discussed: data ownership and data protection. 

Data ownership/Data privacy indicates authority to control, process, or access data. By default, all patients’ data belongs exclusively to patients; no one owns it and sells it to a third party. For Altris AI machine training, all the data was obtained from patients directly who voluntarily agreed to share it and signed relevant documents.

More than that, no client’s data, under any circumstances, is used to train the Altris AI.

Data protection

• GDPR

Currently, there are the following regulations to protect the confidentiality of patients’ data. The European Union (EU) has legislatures of General Data Protection Regulation (GDPR), Cybersecurity Directive, and Medical Devices Regulation.

• HIPAA

In the US, the Health Insurance Portability and Accountability Act (HIPAA) is suggested as a counterpart for European legislation to cover wider confidentiality issues in medical data.

At Altris AI, we obtained EU certification and ensured that all data is GDPR and HIPAA-compliant. This also applies to all the patients’ data we receive. 

• European Union Artificial Intelligence Act

Provider obligations

As a provider of a high-risk AI system, we comply with the obligations listed under Article 16.

High-risk obligations

Under Article 6, high-risk obligations apply to systems that are considered a ‘safety component’ of the kind listed in Annex I Section A, and to systems that are considered a ‘High-risk AI system’ under Annex III.

At Altris AI we followed these obligations:

• Established and implemented risk management processes according to Article 9.
• Used high-quality training, validation, and testing data according to Article 10.
• Established documentation and design logging features according to Article 11 and Article 12.
• Ensured an appropriate level of transparency and provided information to users according to Article 13.
• Ensured human oversight measures are built into the system and/or implemented by users according to Article 14.
• Ensured robustness, accuracy, and cybersecurity according to Article 15.
• Set up a quality management system according to Article 17.

Transparency Obligations

At Altris AI we also followed the transparency obligations under Article 50:

• The AI system, the provider or the user must inform any person exposed to the system in a timely,  clear manner when interacting with an AI system, unless obvious from context.
• Where appropriate and relevant include information on which functions are AI-enabled, if there is human oversight, who is responsible for decision-making, and what the rights to object and seek redress are.

2. Machine Accuracy Ethics.

Data transparency.

Where transparency in medical AI should be sought?

Transparency in Data Training:

1. What data was the model trained on? Including population characteristics and demographics.

The model’s proprietary training data set was collected from patients from several clinics who consented to share their data anonymously for research purposes. The dataset includes diverse and extensive annotated data from various OCT scanners, encompassing a range of biomarkers and diseases. It does not specifically target or label demographic information, and no population or demographic information was collected.

2. How was the model trained? Including parameterization and tuning performed.
The training process for the deep learning model involves several steps:

• Data Annotation: Medical experts annotated the data, creating the ground truth for biomarker segmentation.
• Data Preprocessing: The data is augmented using unsupervised techniques (e.g., albumentations library) to increase diversity during training.
• Model Architecture: The model’s architecture is based on the UNet model with ResNet backbones, incorporating additional training techniques specifically engineered for OCT images.
• Training Process: The model is trained using supervised learning techniques to predict the output biomarker segmentation mask and diagnosis label, employing backpropagation and gradient descent to minimize the loss function.
• Parameterization: The model has millions of parameters (weights) adjusted during training. Hyperparameters such as learning rate, batch size, and the number of layers are tuned to optimize performance.
• Tuning: Hyperparameter tuning is performed using techniques like grid search, random search, or Bayesian optimization to find the optimal set of parameters that improve the model’s performance on validation data.

3. How has the model been trained to avoid discrimination?
The model training uses a wide variety of data to ensure exposure to different perspectives, reducing the likelihood of reinforcing a single viewpoint. No data related to race, gender identification, or other sensitive attributes is used at any stage of the model’s lifecycle (training, validation, inference). The model solely requires OCT images without additional markers or information.

4. How generalizable is the model? Including what validation has been performed and how do you get comfortable that it generalizes well.

• Validation Methods: The model is validated using a variety of images that were not seen during training.
• Performance Metrics: Metrics like Dice and F1 score are used to evaluate the model’s performance.
• Cross-Domain Testing: The model is tested on images from different OCT scanners and time frames to ensure it can generalize well.
• User Feedback: Real-world usage and feedback help identify areas where the model may not generalize well, allowing for continuous improvement.

5. How explainable is the model? Including what explainability testing has been done, if any.

Explainability Techniques: Techniques like SHAP (SHapley Additive exPlanations), GradCAM, and activation visualization are used to understand which parts of the input images the model focuses on when making predictions.

Medical Expert Testing: Regular testing and analysis are conducted to ensure that the model’s detections make sense to medical experts and that the model’s decisions align with logical and reasonable patterns.

Any AI system is opaque (unintelligible) for two reasons:

• Innate complexity of the system itself.
• Intentional proprietary design for the sake of secrecy and proprietary interests.

Biases. In most instances, an AI tool that gives a wrong decision usually reflects biases inherent in the training data. Biases might be racial, ethnic, genetic, regional, or gender-based. 

There should not be any bias related to race and ethnicity because there is no evidence that biomarkers and pathologies manifest themselves differently in patients of different races and ethnicities. Altris AI uses sufficiently diverse gender and age-related data to provide accurate results for OCT analysis.

3. Patient-related ethics.

Patient-related ethics in AI are based on the rights of beneficence, nonmaleficence (safety), autonomy, and justice. Patients exercise their rights either explicitly through informed consent or implicitly through norms of confidentiality or regulatory protections.

Informed Consent. 

Informed consent is based on the principle of autonomy. It could authorize the partial or complete role of algorithms in health care services and detail the process of reaching diagnostic or therapeutic decisions by machines. Clinicians should explain the details of these processes to their patients. Patients should have the choice to opt in or out of allowing their data to be handled, processed, and shared.

As these rights can be enabled by eye care professionals, they remain on the side of eye care professionals in our case. However, eye care professionals who use Altris AI not only inform patients about using AI for OCT scan analysis but also use the system to educate patients with the help of color coding. 

Confidentiality.

Patients’ confidentiality is a legal obligation and a code of conduct. Confidentiality involves the responsibility of those entrusted to handle and protect patient’s data.

All the data that is used inside the Altris AI platform is anonymized and tokenized, and only eye care professionals who work with patients see any personal information. For the Altris AI team, this data is viewed as a programming code.

4. Eye care specialist-related ethics.

AI systems, like Altris AI, are unable to work 100% autonomously, and therefore, eye care specialists who use them should also make ethical decisions when working with AI. 

Overreliance on AI. One of the important aspects of physician-related ethics is overreliance on AI during diagnostic decisions. We never cease to repeat that Altris AI is not a diagnostic tool in any sense; it is a decision-making support tool. The final decision will always be made by an eye care professional. It is an eye care professional who must take into consideration the patient’s clinical history, the results of other diagnostic procedures, lab test results, concomitant diseases, and conclusions from the dialogue with the patient to make the final decision. 

Substitution of Doctors’ Role. Considering the information mentioned above, it is important to clarify the aspect of substituting eye care specialists. It should always be kept in mind that the aim of adopting AI is to augment and assist doctors, not to replace them.

Empathy. Empathetic skills and knowledge need to be further incorporated into medical education and training programs. AI performing some tasks offers space for doctors to utilize empathy in medical education and training.

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5. Usefulness, Usability, and Efficacy. 

According to the Coalition for Health AI (CHAI) checklist, AI in healthcare must be, first of all, useful, usable, and efficient.

To be useful, an AI solution must provide a specific benefit to patients and/or healthcare delivery and prove to be not only valid and reliable but also usable and effective. The benefit of an AI solution can be measured based on its effectiveness in achieving intended outcomes and its impact on overall health resulting from both intended and potentially unintended uses. An assessment of benefits should consider the balance between positive effects and adverse effects or risks. 

In the case of Altris AI, its usefulness is proved by the clients’ testimonials we receive regularly. 

Relatedly, an effective AI solution can be shown to achieve the intended improvement in health compared to existing standards of care, or it can improve existing workflows and processes.

With Altris AI, we make patient screening and triage faster and more effective. We also significantly improve the detection of early pathologies, such as early glaucoma, which are often invisible to the human eye. 

Usability presupposes that the AI tool must be easy for healthcare practitioners. Altris AI is actively used by more than 500 eye care businesses worldwide, proving its usability. Moreover, we constantly collect feedback from users and improve the platform’s UI/UX.

Conclusion

Optometry Technology: What to Expect? 

For this article, we surveyed eye care professionals on which optometry technology appears most promising to them. The answers were divided among AI for more precise diagnostics, advanced contact lenses, and new iterations of OCTs.

Of course, this is not the whole list of possible new tech in optometry, but these are the topics that draw the most attention today. 

The article delves deeper into each of these technologies, as well as explores oculomics, the new way of understanding the correlation between eye pathology and overall human health.

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New tech in optometry: AI for Medical Image Analysis

AI has blossomed in recent years, transforming not only how we work and relax but also how we manage our health. It’s no surprise that our survey of professionals revealed AI as the most promising technology in optometry.

The most immediate and practical AI implementation in optometry is the analysis of medical images, such as fundus photos and OCT scans.

They require no additional equipment beyond the OCT and fundus cameras many practitioners already own, are cost-effective, and add huge value to a practice. 

There are many companies that detect a number of biomarkers and help with diagnostic decision-making already, and their number will only increase from year to year for several reasons:

• AI systems for medical image analysis speed up patient triage
• AI systems help to detect early, minor, and rare pathologies which sometimes can be missed
• AI systems help with complex cases when a second opinion is needed
• Quantitative analysis of biomarkers improves treatment results monitoring making it more efficient

For instance, AI today can assess the early risk of glaucoma based on the GCC asymmetry measurements. Here is how AI-powered OCT workflow would look. 

AI-assisted readings of OCT scans are already helping not only with pathology detection but also with the analysis of its progression or response to treatment. This represents a new approach to monitoring, where practitioners no longer need to sift through various patient notes but can directly compare reports from previous examinations and observe how, for instance, shadowing has changed in micrometers.

AI programs are becoming even more invaluable with an aging population, as diseases prevalent in older individuals become increasingly common while ophthalmology and optometry face a shortage of specialists. This situation will transform the optometrist’s role, with AI empowering practitioners with the diagnostic capabilities to manage many conditions without referral. This will benefit patients, enabling timely routine screenings and diagnoses and preventing months-long waits that can sometimes lead to irreversible blindness.

AI systems are also being implemented in ophthalmic trials for biomarker detection, exploring the relationship between imaging biomarkers and underlying disease pathways. For instance, a recent study linked levels of various cytokines, including VEGF, MCP-1, and IL-6, with specific OCT-derived biomarkers like fluid parameters and outer retinal integrity. 

This significantly accelerates the research process, assisting in identifying the right target audience based on OCT scans, eliminating manual data annotation, and revealing the subtlest changes, progression or regression, and patient responses during trials. 

While material advancements allow us to build more precise machines, the new tech in optometry likely won’t involve some unheard-of device. Instead, AI software will enable us to extract the maximum potential from the technologies we already use.

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Optometry Trends: New Iterations of OCT

Even though OCTs entered the market relatively recently, they swiftly became indispensable ancillary tests in ophthalmic practice for many professionals. The primary reason is their high-quality imaging of the retina, nerve fiber layer, and optic nerve, offering a near in-vivo “optical biopsy” of the retina.

However, the technology continues to evolve – partly due to technological advancements and partly due to the ability to extract even more data from OCT machines through sophisticated software.

SD-OCT is undergoing continuous development, expanding its range of applications. Multimodal imaging, which combines SD-OCT with other imaging techniques like autofluorescence and angiography, now allows for improved diagnosis and management of a wider array of diseases. 

Several prominent OCT evolutions combine technological advancements and promise widespread adoption. They are:

Optometry Trends: En-face OCT

En-face OCT in current systems is based on software reconstruction of OCT images. Image slices are selected retrospectively from full recorded volumes or calculated by depth projection along specific depth ranges, enabling three-dimensional data visualization in a fundus projection. This technique allows the projection of specific retinal and/or choroidal layers at a given depth onto an en-face view.

While we are more accustomed to working with cross-sectional images (B-scans), microstructural changes and the retinal and choroidal vasculature morphology are challenging to evaluate using B-scans alone. En-face OCT offers numerous advantages, including the ability to precisely localize lesions within specific subretinal layers using their axial location on OCT cross-sections and to register projected OCT images to other fundus imaging modalities using retinal vessels as landmarks.   

Currently, en-face OCT is being applied to various specialized areas within the eye, encompassing the anterior segment, glaucoma, infectious diseases, and the retina.

Optometry Technology: SS-OCT

Like SD-OCT, swept-source OCT (SS-OCT) utilizes Fourier domain technology to optimize higher-quality wavelength transduction within the frequency domain. This enables rapid sweeping scan patterns across a broad bandwidth.

However, instead of a broad-bandwidth light source projected all at once, as in SD-OCT, SS-OCT employs a single tunable laser that sweeps through different frequencies to cover the entire spectrum swiftly. The light reflected from the eye is captured by a photodetector significantly faster than the charge-coupled device (CCD) camera used in SD-OCTs. This difference translates to a faster scanning speed of up to 400,000 axial scans per second, eliminating the typical depth-dependent signal drop-off associated with SD-OCT. Additionally, the faster scanning speed reduces image distortions caused by eye movements and allows for wider B-scans, facilitating widefield imaging.

Furthermore, many SS-OCT systems utilize a light source centered at an approximately 1050 nm wavelength, providing better tissue penetration than SD-OCT. This allows for visualization of structures like the choroid, lamina cribrosa, and structures at the anterior chamber angle. This enhanced penetration is crucial in diseases like Central Serous Chorioretinopathy, where evaluating the entire thickness of the choroid can be challenging.

Moreover, volumetric analysis of the choroid and various pathological features can aid in monitoring the progression of Wet AMD, CSCR, and Diabetic Retinopathy, as well as assessing the response to treatments such as anti-VEGF agents, laser photocoagulation, and photodynamic therapy (PDT).

Optometry Trends: OCT Angiography

Given that many ocular diseases are associated with vascular abnormalities, the ability to visualize and quantify blood flow in the eye is crucial. Traditionally, fluorescein angiography (FA) and indocyanine green angiography (ICGA) have been used for this purpose, but these procedures require intravenous injection of contrast agents, which is not only time-consuming but may lead to allergic reactions or potentially serious side effects.   

OCTA, on the other hand, produces high-resolution, 3D angiograms of the retinal and choroidal vascular networks, taking advantage of the eye’s unique characteristic as the only organ allowing noninvasive, direct observation of its blood vessels’ structure and function. OCTA detects blood flow using intrinsic signals to capture the location of blood vessels. While it has limitations such as insensitivity to leakage and a relatively small field of view, the development of OCTA has the potential to significantly enhance our understanding of the eye’s physiology and pathophysiology, providing depth-resolved angiographic maps of the tissue’s vascular structure down to the capillary level.

OCTA is particularly valuable in clinical settings where pathologies like diabetic retinopathy, age-related macular degeneration, retinal vein occlusions, and macular telangiectasia are frequently encountered. These conditions often alter blood flow or the blood vessels themselves in the retina, making imaging these vessels essential for diagnosis and management.

Wide-Field and Ultrawide-Field OCT (WF-OCT and UWF-OCT)

While OCT is a powerful ocular imaging tool, it has traditionally been limited by a relatively narrow field of view (FOV) – typically around 20 degrees × 20 degrees. To address this limitation, two advancements have emerged:

• Wide-field OCT (WF-OCT) with an FOV of approximately 60-100 degrees captures the retina’s mid-periphery up to the posterior edge of the vortex vein ampulla.
• Ultrawide-field OCT (UWF-OCT) with an FOV of up to 200 degrees, mapping the far periphery of the retina, including the anterior edge of the vortex vein ampulla and beyond.

WF-OCT provides additional information compared to routine 6-9 mm scans in conditions such as diabetic retinopathy (DR), central serous chorioretinopathy (CSCR), polypoidal choroidal vasculopathy (PCV), peripapillary choroidal neovascular membrane (CNVM), or uveitic entities. It facilitates easier visualization of anatomical details of peripheral retinal changes like ischemic areas in DR, retinal vein occlusions, or sites of retinal breaks, peripheral retinal detachment, retinoschisis, and choroidal lesions (melanoma, nevus, hemangioma, choroidal metastasis).   

As with other OCT iterations, WF and UWF OCT will likely provide the most significant insights when routinely combined with other modalities, such as OCT angiography.

New Tech in Optometry: Advanced contact lenses

In our lifetime, contact lenses have evolved from mere corrective devices to sophisticated optical instruments. There are several ways that contact lenses (CLs) continue to advance:

• Manufacturing optimization: Automation and robotization of the process for higher precision and a shift towards a more environmentally friendly approach.
• Design: More precise designs tailored to the wearer’s eye with the help of 3D printing.
• Material advancements: Nanotechnology/surface modifications for improved wettability, lubricity, and antimicrobial properties. Increased focus on biomimetic design.
• Technological advancements: Smart lenses with thin and ultra-thin transistors capable of reacting to or registering the wearer’s stress levels, glucose levels, etc.

Let’s take a closer look at a few examples of Smart Contact Lenses (SCLs) that combine some of the characteristics mentioned earlier.

SCLs are wearable ophthalmic devices that offer functions beyond vision correction. These devices are integrated with sensors, wireless communication components, and microprocessors to measure biological markers. They can treat ocular pathologies by delivering drugs, light, heat, and electrical stimulation, or they can aid in diagnosing. Currently, some SCLs can help manage glaucoma, cataracts, dry eye syndrome, eye infections, and inflammation. In development are lenses to treat age-related macular degeneration (AMD), diabetic retinopathy (DR), retinitis, and posterior uveitis. An artificial retina (retinal prosthesis) is in its early developmental stage, with the potential to restore vision to some degree for specific types of blindness caused by degenerative diseases.

Scientists from the School of Medical Sciences in New South Wales have implanted epithelial stem cells (ESCs) from a healthy eye into a contact lens. This innovation has shown promise in repairing vision loss caused by a damaged cornea. In another breakthrough, scientists from Oregon State University have utilized ultra-thin transistor technology to design SCLs that can monitor the wearer’s physiological state. While this futuristic contact lens is still in the prototype phase, several biotech companies have already expressed interest in its development.

Smart lenses also show great promise in drug delivery. One of the main challenges with eye drops is their low bioavailability (less than 5%), primarily due to high tear turnover rates, blinking, nasolacrimal drainage, non-productive absorption by the conjunctiva, and the cornea’s low permeability. Therefore, improving bioavailability by increasing the drug’s residence time on the ocular surface remains a critical research focus. 

Additionally, drug delivery via SCLs can offer more precise dosing. With traditional eye drops, dosage accuracy relies on the patient’s ability to tilt their head and squeeze the inverted bottle correctly, leading to inconsistent application. Consequently, compliance rates for eye drops are low. In contrast, the drug delivery process with SCLs involves lenses loaded with medication for a day or several days, potentially enhancing compliance, especially for individuals accustomed to wearing contact lenses as part of their routine.

Just as artificial intelligence is merging with ophthalmic devices for detection and analysis, opening new possibilities, optometry trends are also venturing contact lenses into the multidisciplinary field of theranostics, which combines therapeutics and diagnostics. This field is uncovering new avenues of research, shedding light on disease mechanisms, and driving drug and medical device development. Theranostics leverages knowledge and techniques from nanotechnology, molecular and nuclear medicine, and pharmacogenetics to achieve goals such as in vitro diagnostics and prognostics, in vivo molecular imaging and therapy, and targeted drug delivery. This approach is shifting patient care towards proactive strategies and predictive treatments.

Optometry Technology: Oculomics

For decades, researchers have sought to measure retinal changes to identify ocular biomarkers for systemic diseases, a field now known as oculomics.

As mentioned earlier, the eye provides a unique opportunity for direct, in vivo, and often non-invasive visualization of the neurosensory and microvascular systems:

• The eye shares a common embryological origin with the brain, and the neurosensory retina and optic nerve are considered extensions of the brain, allowing direct observation of the nervous system.
• Due to the length and continuity of the visual pathway, along with trans-synaptic degeneration mechanisms, damage to the central nervous system often manifests as changes in the inner retina.
• The blood-retina barrier, similar to the blood-brain barrier, selectively allows the transport of essential substances to these metabolically active structures.
• The aqueous and vitreous humors are plasma-derived and transport lipid-soluble substances through diffusion and water-soluble substances through ultrafiltration.
• The lens, which grows continuously throughout life, accumulates molecules over time, providing a potential map of an individual’s molecular history.

The link between the eye and overall human health is not new. However, with the increasing availability and complexity of large, multimodal ocular image datasets, artificial intelligence-based ocular image analysis shows great promise as a noninvasive tool for predicting various systemic diseases. This is achieved by evaluating risk factors, retinal features, and biomarkers. Thanks to the massive datasets generated through recent ophthalmic imaging, which are now being used for deep learning and AI training, oculomics is starting to yield more precise answers. For example, the NHS alone has been conducting eye tests for over 60 years, resulting in databases containing millions of images, complete with patient records and long-term health outcomes. These datasets have been fed into AI algorithms, leading to models that can already predict cardiovascular risk factors with accuracy comparable to the current state-of-the-art methods.

It’s a significant opportunity because, with the aging population, a primary healthcare focus will be not only extending lifespan longevity but also maintaining crucial healthspan functions. The primary obstacles to both longevity and healthspan are chronic diseases, referred to as the “Four Horsemen of Chronic Disease” (Cardiovascular disease, Cancer, Neurodegenerative disease, and Metabolic disease). Many of these can be, if not entirely prevented, at least minimized in terms of progression through timely detection and intervention.

One major advantage of discovering biomarkers that can predict diseases is that eye screenings are generally less intimidating than other procedures. For example, a person might regularly visit an optometrist for prescription glasses but avoid routine cervical screenings. A less anxiety-provoking and familiar procedure could significantly impact healthcare engagement. Such screenings could also make a substantial difference for chronic conditions like dementia, diabetes, and cardiovascular disease, which constitute a significant portion of the “burden of disease.”

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Summing up

Artificial intelligence has already significantly impacted our lives. It holds immense promise in optometry technology, as its primary capability—analyzing massive datasets—aligns perfectly with eye care, where thousands of images are generated daily. Training on such vast amounts of data will lead to breakthroughs in pathology and biomarker detection and their correlation with overall human health. It will enable us to take a giant leap towards proactive and predictive medicine, helping our patients live longer, healthier lives.

Altris AI Announces the Appointment of Grant Schmid as the VP Business Development

Altris AI, a leading AI software provider for OCT scan analysis, announces the appointment of Grant Schmid as the Vice President Business Development. Mr. Schmid is a proven leader in the eye care industry and has solid experience that will help him establish new partnerships for the company and lead corporate sales.

The recent surge in AI (artificial intelligence) applications across industries has transformed the technology landscape, especially in healthcare. While AI companies have existed for years, the explosion of tools like ChatGPT has popularized the integration of AI in everyday processes.

Grant was drawn to Altris AI for its focus on harnessing AI capabilities to assist doctors in making faster and more informed decisions.

According to Mr. Schmid, 

“Healthcare professionals are inundated with more data than most other professions, particularly in the eye care segment. Eye care specialists are subjected to multiple tests and instruments, generating a vast amount of data that must be reviewed comprehensively. A single Optical Coherence Tomography (OCT) test can contain over five hundred thousand data points. This necessitates that doctors carefully analyze results from various tests, often overlapping with different devices, which can be time-consuming and detract from the time they have with their patients.”

 

At Altris AI, the mission is not to replace the vital human connection in medicine but to enhance it.

Grant also remarked that, 

“Some AI companies are positioning their products as replacements for human doctors, which undermines the essential aspects of patient care. Patients need to feel heard, and doctors choose this profession to help individuals. Altris AI enables doctors to spend more time with their patients, allowing them to focus on the human aspects of care rather than getting lost in data analysis.” 

About Altris AI.

Altris AI is a part of the Altris Inc. ecosystem that includes Altris AI( a standalone AI platform for OCT scan analysis that improves diagnostic decision-making for eye care specialists) and Altris Education OCT (a free mobile app for OCT education interpretation). The mission of the company is to set higher diagnostic standards in the eye care industry and improve patient outcomes as a result. To achieve this mission the company created an AI-powered platform for OCT scan analysis that detects the biggest number of biomarkers and retina pathologies on the market today: 70 + including early glaucoma. More than that, the company offers an automated quantitative analysis of biomarkers and a progression analysis module for monitoring treatment results more efficiently.

Ophthalmology has the highest average number of patients waiting, but up to 75% of patients make preventable trips to eye hospitals and general practitioners. Some of these patients are referred by optometrists who, more often than not, receive no feedback on the quality of their referrals, perpetuating this cycle. Optometry referral is puzzling for both primary and secondary education. This article examines the referral procedure and potential solutions for increasing referral efficiency in eye care that practitioners can implement.

More than 25% of U.S. counties lack a single practicing eye care provider, and the situation isn’t unique to the U.S. In the UK, ophthalmology has been the most overburdened healthcare sector for some time. With a globally aging population and an increasing prevalence of age-related diseases, ensuring accessible eye care is crucial. Unfortunately, the reality is quite the opposite. One contributing factor is the high number of failures in the referral process.

How did we arrive at this point, and what can be done to improve it?

Altris AI’s survey identified a lack of data and increased patient wait times as the top problems with referrals for practitioners, while lack of co-management tools and poor communication/feedback ranked lower.

Let’s dive into more details:

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Optometry referral: top problems 

• Lack of diagnostic data

The ultimate goal of optometry referral is to ensure patients receive appropriate treatment for their specific pathology or confirmation of its absence. The receiving specialist’s first step is to review the referral report, making its completeness and clarity paramount. While there is a clear need for specialised assessment and treatment, almost 80% of those attending eye casualty do not require urgent ophthalmic attention following triage, and up to 60% of patients are seen and discharged on their first visit.

In eye care, both text information and accompanying images are crucial in ensuring efficient and accurate diagnoses. 

However, handwritten and fragmented data continue to pose significant challenges in the patient referral process. Despite the prevalence of electronic health records (EHRs), over half of referrals are still handled through less efficient channels like fax, paper, or verbal communication. This can lead to fragmented or doubled patient data, potential gaps in care, and delays in treatment. 

The study on the Impact of direct electronic optometric referral with ocular imaging to a hospital eye service showed that, given some limitations, electronic optometric referral with images to a Hospital Eye Service (HES) is safe, speedy, efficient, and clinically accurate, and it avoids unnecessary HES consultations. 

Direct electronic referrals with images reduced the need for hospital eye service appointments by 37% compared to traditional paper referrals. Additionally, while 63% of electronic referrals led to HES appointments, this figure was 85% for paper referrals. 

While incorporating images like OCT scans can significantly enhance understanding, some subtle or early-stage pathologies might still be overlooked. This is where detailed and customized reports become invaluable.

To illustrate the point, here is a handwritten referral compared to one of the types of customised OCT report from the Altris AI system, a platform that automates AI-powered OCT scan analysis for 70+ pathologies and biomarkers. This screenshot, in particular, shows segmented retina layers and highlights biomarkers of Dry AMD alongside a comparison of the patient’s macular thickness over visits.

• Lack of experience and access to second opinion

Research reveals a notable inverse relationship between clinician experience and the frequency of false-positive referrals in optometry, echoing findings in other medical fields where diagnostic proficiency typically improves with experience. This highlights the importance of recognizing the learning curve inherent in optometric practice and supporting less experienced practitioners. 

The challenge is amplified by the fact that optometrists often practice in isolation, lacking the immediate professional support network available to their hospital-based counterparts. Unlike colleagues in hospital settings who have ready access to peer consultation for other opinions or guidance, optometrists often face limited opportunities for collaborative decision-making and skill development. 

Another problem specialists often face is a lack of confidence in diagnosing, which may or may not be linked to experience. Knowing that their patients could potentially suffer irreversible vision loss from a pathology not yet detected during an exam, they often err on the side of caution and refer to a hospital. While this “better safe than sorry” approach is understandable, it places a significant burden on hospitals, extending wait times for those already at risk of blindness.

These concerns primarily revolve around glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy (DR). AI can help identify these and other eye diseases at their earliest stages during routine visits. Some retinal changes are so minute that they escape detection by the human eye, making the program’s ability to detect tiny retinal changes invaluable.

Another significant benefit of AI systems lies in their approach to OCT analysis for glaucoma. Traditional methods rely on normative databases to assess retinal normality, but these databases are often limited in size and represent a select group of individuals. This can result in missed diagnoses of early glaucoma in those who deviate from the “norm” or unnecessary referral from optometry to ophthalmology for those who don’t fit the “normal” profile but have healthy eyes. AI can overcome this limitation by providing more personalized and comprehensive analysis.

• Increased wait times for patients with eye doctor referral

The National Health Service (NHS) is grappling with significant backlogs in ophthalmology services, which account for nearly 10% of the 7.8 million patients awaiting treatment. 

The consistently high average number of patients waiting per trust in Ophthalmology, with high follow-up waitlists, delays care that poses substantial risks. The Royal College of Ophthalmologists reported that the risk of permanent visual loss is nine times higher in follow-up patients than in new patients. With 30% more patients on ophthalmology waitlists than pre-pandemic, the number of people at risk of sight loss may have increased.

Community Eyecare (CHEC), a provider of community-based ophthalmology services, received around 1000 referrals per week before the pandemic, further highlighting the strain on the system.

An analysis of electronic waitlists revealed that administrative issues, such as deceased patients or those already under care remaining on the list, artificially inflate wait times by up to 15%. 

Improving administrative processes and reassessing referrals for appropriateness could help address this problem. Additionally, interim optometric examinations could revise referral information or determine the necessity of hospital visits, further reducing wait times.

Artificial intelligence can significantly speed up the screening process while reducing the controversy around diagnoses. This faster and more accurate diagnostic tool will enable more patients to be seen, allow for quicker responses to pathologies that pose a risk to eyesight, and reduce the burden on strained hospitals with needless patient referrals, as well as free up patients from unnecessary stress and wasted time.

International studies have shown that collaborative care also can increase screening and detection rates of eye disease.

• Lack of comanagement tools for optometry referral

The increasing demand for Hospital Eye Services, projected to grow by 40% in the next two decades and currently accounting for 8% of outpatient appointments, necessitates a re-evaluation of referral pathways and comanagement strategies between optometrists and ophthalmologists.  

The lack of digital connectivity between primary, community, and secondary care creates a significant barrier to effective collaboration. In many cases, optometrists cannot make direct digital referrals to Hospital Eye Service, often relying on general practitioners as intermediaries, causing delays in diagnosis and treatment.

The COVID-19 pandemic highlighted the vital role of optometrists as first-contact providers for eye health, relieving pressure on hospitals. However, better integration between primary and secondary care is essential to build upon this and create a more sustainable eye care system. The current lack of digital connectivity hinders efficient communication and impedes the timely transfer of patient records, potentially leading to unnecessary referrals and delays in care.

As David Parkins, the ex-president of the College of Optometrists, emphasizes, the solution lies in increased integration and streamlined communication between primary and secondary eye care services. Implementing integrated digital platforms for referrals and feedback can enhance collaboration, improve patient outcomes, and reduce the burden on hospitals.

Leveraging optometrists’ expertise through shared care programs and direct digital referral pathways can alleviate the strain on eye hospitals and ensure timely access to care for patients with eye conditions.

• Poor communication/lack of feedback

A recent study published in Ophthalmic and Physiological Optics revealed that in 73% of cases, the referring optometrist was unaware of the outcome of their referral. 

This lack of closure can lead to unnecessary re-referrals, patient anxiety, and potential treatment delays that could result in preventable vision loss, especially considering the extended waiting times for hospital eye service appointments.

Effective referral in eye care requires a closed feedback loop, where referring providers receive timely updates and reports from specialists. However, studies have shown that up to 50% of primary care providers (PCPs) are unsure whether their patients have even been seen by the referred specialists. This disconnect necessitates time-consuming follow-up calls and manual data integration, increasing the risk of errors and jeopardizing patient care.

The absence of consistent feedback also impacts optometrists’ professional development. Without knowing the accuracy of their referrals, optometrists cannot identify areas for improvement or refine their diagnostic skills. This is particularly relevant for newly qualified practitioners who may benefit from feedback to enhance their clinical judgment.

Implementing electronic referral systems that include feedback mechanisms can significantly improve communication and close the feedback loop. This would enable optometrists to track the progress of their referrals, receive timely updates on patient outcomes, and make informed decisions about future referrals. 

Technology is also bridging the gap in specialist communication by enabling secure online consultations, such as live chat with dedicated ophthalmologists. A notable example in the UK is Pocket Eye, a platform designed to empower eye care professionals with clinical advice, diagnostic and image support, and AI-powered OCT analysis. 

Summing up

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Implementing digital platforms that foster collaboration between eye care providers, increasing confidence in complex cases, and utilizing AI technologies to expedite diagnostics is crucial in a world where an aging population will increasingly rely on healthcare.

The average OCT device is a significant investment, costing upwards of $40,000. As eye care specialists, we recognize the revolutionary power of OCT. However, patients often receive only a standard OCT report from this investment. Unfortunately, many patients are unaware of OCT’s true value and may not even know what it is. This raises a crucial question: are these standard reports truly reflecting the full diagnostic potential of such an expensive and sophisticated device? Are we, as professionals, maximizing the capabilities of this technology to ensure optimal patient care?

This article explores how OCT Reports address these shortcomings, enhancing diagnostic accuracy, treatment monitoring, referral efficiency, patient education, and audit readiness. 

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Common OCT reports and their limitations

How does the standard report look?

OCT has become a golden standard for diagnosing and monitoring many ocular pathologies, thanks to its unparalleled level of detail in ophthalmic imaging.

While retinal reports vary among OCT models, they typically include:

• a foveally centered B-scan, 
• a quantitative thickness map, 
• and a semi-quantitative thickness map.

The B-scan offers a visual snapshot of foveal architecture and confirms proper scan centering. The quantitative thickness map employs the ETDRS sector map to measure retinal thickness within a 6mm circle around the fovea, with specific measurements for the foveal sector (1mm), inner macular ring (3mm), and outer macular ring (6mm).

Progression analytics enable comparison of serial macular scans, which is invaluable for managing vitreomacular interface disorders and macular edema. The semi-quantitative thickness map provides a broader overview of retinal thickness throughout the scan.

Given this amount of data, it is challenging to identify subtle and localized retinal pathological changes. As a result, entire OCT datasets are represented by few aggregated values, and the standard OCT reports generated by most devices often rely on significant data reduction to simplify interpretation, which you can usually not customize. 

OCT report interpretation: 3 methods exist for displaying OCT data

Firstly, acquired 2D image slices are presented individually. This allows for detailed examination, but navigating through numerous images can be cumbersome, particularly with large datasets.

Secondly, a fundus image is displayed with superimposed retinal layers. This facilitates linking layers to the fundus, but only one layer can be examined at a time, hindering the analysis of multiple layers simultaneously.

Thirdly, the OCT tomogram is visualized in 3D, providing a comprehensive overview, but adjusting the visual representation often has limitations. Additionally, combined 3D visualizations of the tomogram and layers are typically unavailable, potentially obscuring spatial relationships.

While existing reports offer diverse approaches to managing, analyzing, and presenting OCT data, each solution focuses on specific aspects and lacks customization. The situation becomes even more complex if scans come from different OCT devices, as manufacturers only provide software for the data for proprietary OCT scanners. Consequently, no approved way of viewing, analyzing, or comparing data from different manufacturers exists.

Furthermore, there are limited possibilities for implementing prototypes to perform such tasks since software libraries are provided with exclusive licenses and incomplete data specifications. Hence, managing and analyzing OCT data and relating them to other information are challenging and time-consuming tasks.

Often, supplementary software is utilized to overcome these limitations by providing additional information, visualizing and emphasizing data differently, and enabling the selection of relevant subsets.

How can customized reports for OCT help?

Altris AI’s recent survey has revealed that the key benefits of OCT technology for eye care specialists lie in treatment monitoring, patient education, and referral optimization.

• Measuring treatment progress: biomarkers tracking, pathology progression

Imaging biomarkers are a particularly attractive option for clinical practice due to their non-invasive and real-time nature. Quantitative measurements of retinal thickness, fluid volume, and other biomarkers relevant to diseases like diabetic retinopathy and age-related macular degeneration aid in treatment monitoring.

OCT reports with customized measurements and selected biomarkers, retinal layers, or segments allow for precise focus on treatment monitoring and patient response to therapy. This personalized approach enhances clinical decision-making by highlighting each case’s most relevant information. 

In current clinical practice, macular damage assessment typically involves measuring the distance between the ILM and RPE layers, summarized in a post-scan report. 

However, these reports often fall short of visualization best practices, employing ineffective or inconsistent color schemes. Additionally, they lack flexibility, with static visuals preventing in-depth examination of specific details. Despite these limitations, these reports remain valuable for many clinicians by distilling complex data into a manageable format. 

Enhanced OCT data visualization offers a promising solution to these challenges. It enhances report clarity and comprehensibility while preserving the richness of the underlying data. 

Let’s explore how this applies to a clinical case, such as monitoring a patient with Wet AMD during follow-up visits.

Data demonstrates that OCT findings can reveal the onset or progression of neovascular AMD before a patient reports new symptoms or changes in visual acuity. In fact, OCT images are reported to have the best diagnostic accuracy in monitoring nAMD disease states. This underscores the importance of key OCT findings or biomarkers in personalizing anti-VEGF treatment, achieving disease control, and reducing monitoring burdens.

Central Retinal Thickness emerged as one of the earliest OCT biomarkers used as an outcome measure in clinical trials for nAMD.

However, due to confounding factors, CRT’s use in outcome-based assessments of nAMD varies. Thus, it is essential to evaluate additional morphological changes alongside retinal thickness and their relationships with functional outcomes.

It has been reported that OCT images have the best diagnostic accuracy in monitoring nAMD disease states.

Another finding that is correlated with a worsening VA due to the associated photoreceptor defects is any damage to the four outer retina layers, including the RPE, interdigitation zone (IZ), ellipsoid zone (EZ), and external limiting membrane band (ELM). 

OCT is a valuable imaging tool for visualizing subretinal hyperreflective material (SHRM). It can automatically identify and quantify SHRM and fluid and pigment epithelial detachment to calculate the overall risk of worsening visual outcomes associated with SHRM.

Subsequent follow-up visits will then display the most relevant picture, highlighting the most pertinent biomarkers for tracking a particular pathology (wet AMD in our example) and comparing their volume, progression, or regression through visits.

Another helpful option is retinal layer segmentation, which focuses solely on the retinal layers of interest for the specific case. 

This level of customization empowers clinicians with a comprehensive yet targeted view of the patient’s condition. It saves time from manually detecting anomalies on scans and facilitates informed decision-making and personalized treatment plans.

• Glaucoma risk evaluation

Millions risk irreversible vision loss due to undiagnosed glaucoma, underscoring the need for improved early detection. Current tests often rely on observing changes over time, delaying treatment assessment and hindering early identification of rapid disease progression. OCT frequently detects microscopic damage to ganglion cells and thinning across these layers before changes are noticeable through other tests. However, the earliest signs on the scan can still be invisible to the human eye.

AI algorithms offer insights into glaucoma detection by routinely analyzing the ganglion cell complex, measuring its thickness, and identifying any thinning or asymmetry to determine a patient’s glaucoma risk without additional clinician effort.

Another significant benefit of AI systems is that OCT for glaucoma usually utilizes a normative database to assess retinal normality. However, these databases are limited in size and represent an average of a select group of people, potentially missing early glaucoma development in those who deviate from the “norm.” Conversely, individuals may be unnecessarily referred for treatment due to not fitting the “normal” profile, even if their eyes are healthy.

• Crafting effective referral

In the UK, optometrists are crucial in initiating referrals to hospital eye services (HES), with 72% originating from primary care optometric examinations. While optometrists generally demonstrate proficiency in identifying conditions like cataracts and glaucoma, discrepancies in referral thresholds and unfamiliarity with less common pathologies can lead to unnecessary or delayed referrals.

At the same time, an evaluation of incoming letters from optometrists in a glaucoma service found that 43% of the letters were considered “failures” because they did not convey the necessity and urgency of the referral.

 So, having an elaborate record of the entire clinical examination in addition to a referral letter is crucial.

Customized OCT reports solve this challenge by streamlining the referral process and improving communication between optometrists and ophthalmologists. These reports can significantly reduce delays and ensure patients receive timely care by providing comprehensive and relevant information upfront.

• Patient Education

Patient education and involvement in decision-making are vital for every medical field and crucial for ophthalmology, where insufficient patient engagement can lead to irreversible blindness.

Research specifically targeting the ophthalmology patient population, which often includes older and potentially visually impaired individuals, reveals a clear preference for materials their eye care provider endorsed.

Providing explicit visual representations of diagnoses can significantly improve patient understanding and compliance. Seeing photos of their condition, like glaucoma progression, builds trust and reinforces the importance of treatment recommendations.

Surveying eye care professionals specializing in dry eye disease revealed a strong emphasis on visual aids during patient education. 

Photodocumentation is a favored tool for demonstrating the condition to asymptomatic patients, tracking progress, and highlighting treatment’s positive outcomes.

The visual approach provides tangible evidence of the benefits of their treatment investment, allowing for a deeper understanding of the “why” behind treatment recommendations and paving the way for ongoing collaboration with the patient.

Color-coded OCT reports for pathologies and their signs, severity grading, and pathology progression over time within its OCT analysis highlight the littlest bits that a patient’s unprepared eye would miss otherwise. With follow-up visits, patients can see what’s happening within their eyes and track the progress of any conditions during treatment.

• Updating EMR and Audit readiness

OCT reports are crucial components of a patient’s medical history and are essential for accurate diagnosis, personalized treatment, and ongoing monitoring. The streamlined process of integrating OCT data into EMR ensures that every eye scan, with its corresponding measurements, biomarkers, and visualizations, becomes an easily accessible part of the patient’s medical history.

This is crucial for continuity of care and simplifies the audit process, providing a clear and comprehensive record of the patient’s eye health over time. Just optometry chains alone can perform an imposing volume of OCT scans, with some reaching upwards of 40,000 per week. While this demonstrates the widespread adoption of this valuable diagnostic tool, it also presents a challenge: the increased risk of missing subtle or early-stage pathologies amidst the sheer volume of data.

Enhanced OCT reports offer a solution by providing a crucial “second look” at scan results. While not foolproof, this double-check significantly reduces the risk of overlooking abnormalities, ultimately improving patient outcomes and safeguarding the clinic’s reputation.

In audits, comprehensive OCT reports are critical in ensuring regulatory compliance. As the Fundamentals of Ophthalmic Coding states, “It is the responsibility of each physician to document the interpretations as promptly as possible and then communicate the findings with the patient… to develop a fail-safe way to ensure that your interpretations are completed promptly.”

Auditors typically look for several key elements in OCT reports:

• Physician’s Order: Document the test order, indicating which eye(s) and the medical necessity.
• Interpretation and Report: The physician analyzes the scan results, including any identified abnormalities or concerns.
• Timely Completion: Prompt documentation and communication of findings to the patient.

Customisable OCT reports can streamline this process by generating comprehensive reports that meet these requirements. These reports include detailed measurements, biomarker analysis, and clear visualizations, making it easier for physicians to review, interpret, and document their findings efficiently.

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Summing up

Standard OCT reports, while valuable, often need more customization due to data reduction and lack of customization. The inability to visualize multiple scans simultaneously or compare data from different devices hinders comprehensive analysis. Enhanced OCT reports address these limitations by offering detailed visualizations, customizable measurements, and biomarker tracking.

Customisable OCT reports aid in the early detection and monitoring of diseases like wet AMD and glaucoma, empowering clinicians with accurate diagnoses and personalized treatment plans. Additionally, they streamline referrals by providing focused information and clear visualizations, reducing delays and improving communication between optometrists and ophthalmologists.

These comprehensive reports also enhance patient education by offering clear visual representations of their conditions and treatment progress, fostering better understanding and compliance. Moreover, with detailed documentation and analysis, detailed reports ensure audit readiness for eye care professionals, mitigating the risk of missed pathologies and upholding regulatory compliance.

Despite increased research and development spending, fewer novel drugs and biologics are reaching the market today.

Large pharmaceutical companies invest an average of over $5 billion and 12+ years in research and development for each new drug approval.

The high failure rate of drug candidates (only 15% of Phase I drugs reach approval) further exacerbates the issue. This risk often leads pharmaceutical companies to favor lower-risk investments like biosimilars or generic drugs over novel therapies. 

Due to the eye’s specialized anatomy and physiology, ophthalmic drug development faces unique challenges. Ocular barriers like the tear film and blood-ocular barrier can hinder drug efficacy. Many therapeutic endpoints in ophthalmology are subjective, making controlled trials difficult. The imprecise nature of some measurements further complicates trial design. Rare ophthalmic diseases pose additional challenges, as clinical trials may group diverse conditions, like multiple types of uveitic, together despite their distinct underlying mechanisms and therapeutic needs.

Here is where AI enters the game. With its ability to rapidly analyze vast amounts of data and detect subtle patterns, AI is revolutionizing how we approach clinical trials for ophthalmic drugs.

In this article, we will explore how AI for ophthalmic drug development transforms the landscape by accelerating the identification of biomarkers for conditions like diabetic retinopathy and age-related macular degeneration, ensuring the right patients are enrolled in trials, and providing quantitative metrics for evaluating treatment efficacy.

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How AI for ophthalmic drug development can accelerate the search for biomarkers in clinical trials

• Biomarkers for quantitative analysis before and after treatment

A biomarker, as defined by the BEST Resource FDA-NIH Biomarker Working Group, is a characteristic that can be objectively measured and evaluated as an indicator of normal biological processes, disease processes, or responses to therapeutic intervention. Key characteristics of a useful biomarker include specificity, sensitivity, simplicity, reliability, reproducibility, multiplexing capability, and cost-effectiveness.

Determining a biomarker’s performance involves assessing its:

• analytical validity – how accurately it measures what it claims to measure;
• clinical validity – how well it reflects a clinical feature or outcome;
• clinical utility – how it improves patient outcomes or guides treatment decisions. 

In the context of drug regulation, qualified biomarkers can serve as endpoints in clinical trials, potentially offering a more objective and less placebo-susceptible alternative to traditional patient-reported outcomes. 

Imaging biomarkers are a particularly attractive option for clinical use due to their non-invasive, real-time, and cost-effective nature.

In ophthalmology, AI-powered analysis of OCT scans can provide precise, quantitative measurements of retinal thickness, fluid volume, and other biomarkers relevant to diseases like diabetic retinopathy and age-related macular degeneration. These measurements can aid in diagnosis, disease staging, treatment monitoring, and prediction of treatment response.

Systems like Altris AI for pathology detection and segmentation enabled automated disease characterization and longitudinal monitoring of therapeutic response in AMD. Multiple studies have demonstrated the value of volumetric fluid characterization, compartment-specific OCT feature evaluation, and subretinal fibrosis and hyperreflective material quantification.

A study  has shown the potential of AI to predict conversion from early or intermediate non-neovascular AMD to the neovascular form, using quantitative imaging features like drusen shape and volume. 

The extraction of quantitative fluid features and assessment of retinal multi-layer segmentation from OCT scans have offered valuable insights into disease prognosis and longitudinal dynamics of Diabetic Retinopathy.

A recent study demonstrated that quantitative improvement in ellipsoid zone integrity following anti-VEGF therapy for DME significantly correlated with visual function recovery. Furthermore, novel imaging biomarkers, such as the retinal fluid index (RFI), are emerging as tools for precisely monitoring treatment response. Studies have shown that early RFI volatility can predict long-term instability in visual outcomes after treatment.

Building on these advancements, researchers are now exploring the relationship between imaging biomarkers and underlying disease pathways. A recent study linked levels of various cytokines, including VEGF, MCP-1, and IL-6, with specific OCT-derived biomarkers like fluid parameters and outer retinal integrity.

By automating the analysis of OCT scans, AI not only streamlines the process but also uncovers subtle details and patterns that might be missed by human observation. 

Enhanced by AI precision enables more accurate identification and quantification of biomarkers, leading to better patient stratification, treatment monitoring, and prediction of therapeutic responses.

•  Data Annotation for Clinical Trials

An ophthalmologist’s report noting the presence of edema on an OCT scan is not the same as stating that its height and length are 411 and 3213 µm, accordingly.

Imaging biomarkers can range from simple measurements of size or shape to complex computational models, providing valuable information to complement traditional diagnostic methods. They can also determine the presence and severity of a disorder, assess its progression, and evaluate treatment response.

While biomarkers can be derived from various imaging modalities, OCT stands out in ophthalmology due to its high resolution and ability to visualize subtle retinal changes.

Parametric images, which visually represent the spatial distribution of biomarker values, further enhance the analysis of OCT scans. This combination of quantitative data and visual representation empowers clinicians and researchers to make more informed decisions about diagnosis, treatment, and disease management.

Traditionally, medical image interpretation has relied heavily on visual assessment by experts, who recognize patterns and deviations from normal anatomy based on their accumulated knowledge. 

While semi-quantitative scoring systems offer some level of objectivity, the field is rapidly evolving towards more quantitative and automated approaches. This shift is driven by advancements in standardization, sophisticated image analysis techniques, and the rise of machine and deep learning.

In some clinical scenarios, automated image quantification can surpass manual assessment in objectivity and accuracy, interpreting subsequent changes with greater precision and clinical relevance by establishing thresholds for disease states. Unlike physical biomaterials, medical images are easily and rapidly shared for analysis, facilitating automated, reproducible, and blinded biomarker extraction.

This transition to quantitative analysis is particularly evident in the study of AMD. For instance, non-neovascular (dry) AMD has been extensively evaluated using various imaging biomarkers, such as intraretinal hyper-reflective foci, complex drusenoid lesions, subretinal drusenoid deposits, and drusen burden. 

While SD-OCT has traditionally described these features qualitatively, recent studies have demonstrated the predictive power of quantitative measures like ellipsoid zone integrity, sub-RPE compartment thickness, and automated drusen volume quantification.

These quantitative biomarkers have shown stronger associations with disease progression than qualitative features, particularly in predicting the development of geographic atrophy. 

This predictive power of AI extends to diabetic retinopathy as well. In DR, quantitative measures like central subfield retinal thickness and retinal nerve fiber layer thickness have been linked to disease severity. Disruption of retinal inner layers has been associated with worse visual acuity, and its presence is highly specific for macular nonperfusion. Both DRIL and outer retinal disruption are linked to visual acuity in DR and diabetic macular edema.

Furthermore, morphological signs like hyperreflective foci, representing lipid extravasation and inflammatory cell aggregates, have emerged as potential biomarkers for monitoring inflammatory activity in diabetic eye disease. AI-powered segmentation and quantification of HRF can track changes in response to anti-VEGF and steroid injections.

• Enrollment of the right patients

Due to their complexity and scale, clinical trials, particularly Phase III trials, consume a significant portion of the budget required to bring a new drug to the market. However, the success rate for compounds entering clinical trials is dismal, with only about one in ten progressing to FDA approval. This high failure rate stems largely from ineffective patient recruitment, as each clinical trial has unique participant requirements, including eligibility criteria, disease stage, and specific sub-phenotypes. 

Manual review of electronic medical records is time-consuming and prone to error, as staff must sift through vast amounts of data to identify eligible candidates.

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AI can automate this process, rapidly analyzing medical imaging and extracting relevant information to determine patient eligibility. This reduces the burden on staff and allows for faster identification and enrollment of suitable participants, streamlining patient selection and ultimately leading to more efficient and successful clinical trials. 

A targeted approach can dramatically improve recruitment efficiency by pinpointing ideal candidates and even revealing disease hotspots for geographically focused efforts.

In later phases of clinical trials (Phase II and III), AI-powered image analysis can also play a pivotal role. In ophthalmology, AI can analyze OCT scans to precisely quantify disease biomarkers, ensuring that the trial participants are those most likely to benefit from the investigated drug. This improves the success rate of trials and minimizes potential harm to patients who might not be suitable candidates.

AI-powered image analysis offers a crucial advantage: reducing variability in interpretation. 

AI algorithms can standardize the imaging overview process by consistently identifying and quantifying key biomarkers, ensuring that different readers arrive at similar conclusions.

• Real World Evidence

Randomized controlled trials have long been the gold standard for evaluating the efficacy and safety of new therapies. However, controlled environments with strict inclusion and exclusion criteria may not fully reflect the diversity and complexity of real-world patient populations. 

Real-world data (RWD) that is collected during routine clinical practice can provide critical insights into disease biomarkers and significantly impact the drug development process. This RWD can be transformed into real-world evidence (RWE) when appropriately analyzed.

RWE is bridging the gap between clinical trials and real-world patient care, providing a more representative view of disease progression, treatment patterns, and long-term outcomes in everyday clinical settings.

In ophthalmology, RWE already has played a crucial role in understanding the impact of anti-VEGF therapies for neovascular age-related macular degeneration. While RCTs demonstrated the initial efficacy of these treatments, RWE studies have shown variations in real-world outcomes and highlighted the need for continued and higher than previously provided treatment frequency and new treatment regimens such as treat-and-extend.

Big data, encompassing a vast array of structured and unstructured information, is now an integral part of modern medicine, including ophthalmology.  By integrating RWE with traditional clinical trial data, researchers can better understand how a drug performs in the real world and conduct more pragmatic clinical trials designed to evaluate treatments in real-world settings with broader patient populations, ultimately accelerating the development of safer and more effective therapies.

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The future of ophthalmic drug trials

The global AI-in-drug discovery market is poised for significant growth, driven by advancements in machine learning, natural language processing, and deep learning.

Artificial intelligence has the potential to significantly impact drug discovery by enabling more creative and efficient experimentation. It can also reduce the cost and time associated with failures throughout the drug development process. By identifying promising leads earlier and eliminating less viable options, AI can streamline each stage, potentially halving the total cost of a single project. 

Advanced simulation and modeling techniques powered by AI are also poised to revolutionize our understanding of disease mechanisms and accelerate the discovery of new drugs.

The promising potential of AI in clinical trials extends to the proactive identification and mitigation of adverse events, enhancing patient safety and reducing trial risks. Data-driven AI tools are poised to revolutionize the entire clinical trial process, from design to execution. By streamlining patient recruitment, continuously monitoring participants, and facilitating comprehensive data analysis, AI can increase trial success rates, improve adherence, and yield more reliable endpoints.

The future of ophthalmic drug trials is here, and it’s powered by AI. By embracing this technology, researchers and clinicians can unlock new possibilities for preventing blindness and preserving vision for future generations.

Optometry Patient Education: Attracting Patients with AI

Today patients are curious about AI, but they may also have some reservations. Researches suggest a cautious attitude towards autonomous AI in healthcare, but what happens when AI becomes a collaborative tool, assisting eye care professionals in educating and treating patients? This shift in focus can significantly affect patients’ comfort levels and acceptance of AI.

Patients have some concerns about AI in healthcare. Let’s delve into the patient perspective and discover how addressing these apprehensions and implementing AI-assisted OCT in eye care can lead to a better understanding of the technology and, ultimately, healthier outcomes.

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How do patients react to AI?

Interestingly, while surveys extensively document how eye care professionals feel about and interact with AI, the perspectives of the main beneficiary—the patient—remain less understood. The limited research available indicates mixed feelings towards this technology. Few studies examine patient attitudes toward AI in healthcare and eye care, suggesting a degree of caution. 

However, these studies have focused on scenarios where AI fully replaces human healthcare providers. Patients demonstrated significant resistance to medical AI in these cases driven mostly by “uniqueness neglect” – concern that AI providers are less able than humans to account for a person’s unique characteristics and circumstances.

For example,  in the “Resistance to Medical Artificial Intelligence” study, participants demonstrated less interest in using a stress assessment and were willing to pay less for it when administered by an automated system rather than a human, even with equivalent accuracy. Additionally, participants showed a weaker preference for a provider offering clearly superior performance if it was an AI system. 

A survey of 926 patients reveals a mix of attitudes towards AI in healthcare but also gives us clues to understand the reasons behind it. While a majority believe AI could improve care, there’s also a significant undercurrent of caution:

• Desire for Transparency: Over 95% of respondents felt it was either very or somewhat important to know if AI played a significant role in their diagnosis or treatment.
• Unexplainable AI = Uncomfortable: Over 70% expressed discomfort with receiving an accurate diagnosis from an AI system that couldn’t explain its reasoning. This discomfort was more pronounced among those unsure about AI’s overall impact on healthcare.
• Application Matters: Patients were more comfortable with AI for analyzing chest X-rays than for making cancer diagnoses.
• Minority Concerns: Respondents from racial and ethnic minority groups expressed higher levels of concern about potential AI downsides, such as misdiagnosis, privacy breaches, reduced clinician interaction, and increased costs.

These findings highlight the importance of being transparent with patients about how AI is used in their care. Explaining the role of AI and reassuring patients that it’s a tool for assisting your clinical judgment (not replacing it) will be essential. Additionally, being mindful of potential heightened concerns among minority patients is crucial for providing equitable care.

A study solely focused on overcoming patients’ resistance to AI in healthcare found that demonstrating social proof (like highlighting satisfied customer reviews) increased trust in AI-involved help.

The team has identified several additional strategies for reducing patient apprehension of AI recommendations. One effective approach is to emphasize AI’s collaborative nature, where a human doctor endorses recommendations. This highlights AI as a tool to assist, not replace, physicians. Demonstrating AI capabilities through real-world examples where AI exhibits nuanced reasoning can also encourage greater reliance on the technology.  

How to attract patients with AI in eye care

AI offers a powerful way to transform your practice and set yourself apart. It brings world-class diagnostic expertise directly to your community, potentially saving patients’ sight by catching eye diseases in their earliest stages. Here’s how to position AI for patients:

• Emphasize Early Detection

It brings world-class diagnostic expertise directly to your community, potentially saving patients’ sight by catching eye diseases in their earliest stages, including early signs of glaucoma, AMD, and many other pathologies that would often be invisible during a regular visit. Some retinal changes are so microscopic that they elude the human eye, making the program’s ability to detect tiny retinal changes invaluable. This makes AI a powerful tool during routine exams, potentially uncovering issues you may not even have been aware of as a patient.

• More time for personalized care with optometry patient education

Patients expect personalized experiences, and AI empowers you to deliver exactly that. By analyzing each patient’s unique OCT image data, AI helps identify potential pathologies with greater accuracy. 

Additionally, since AI acts as a meticulous assistant, double-checking your assessments and minimizing the risk of missed diagnoses, it frees up your time. This allows for more meaningful one-on-one conversations with patients, where you can explain their results and discuss the next steps, setting your practice apart regarding patient satisfaction.

• Your old good eye care professional, but with superpower

With AI-assisted OCT, you have the combined knowledge and experience of leading eye care specialists at your fingertips for every patient. This technology leverages massive datasets of medical images and clinical data meticulously analyzed by retinal experts during AI development.  It is a valuable second opinion tool, helping you confirm diagnoses and identify subtle patterns the human eye might miss.

This offers your patients peace of mind – knowing their diagnosis has been informed by insights from a team of experts incorporated into the AI’s analysis.

It’s crucial to emphasize that AI will never replace the human touch. It’s a powerful tool that frees up your time for what matters most: building trust through personalized care and addressing patient concerns with empathy.

How to explain what AI is to patients 

Patient understanding is vital for building trust with you and any technology you use. It is especially important when talking about a sophisticated instrument like AI. In case of AI, which remains a mystery to many,  patient education in optometry is a must.

For instance, we’ve found that patients sometimes struggle to understand how Altris AI, our AI-powered OCT analysis tool, works. We’ve crafted an explanation that helps them grasp the concept more quickly, covering how retinal specialists have taught the system to do its job, the AI’s role as a doctor’s help, and direct benefits for patients.

OCT scans provide incredibly detailed images of the retina, the important layer at the back of your eye.  Eye doctors carefully analyze these scans to spot any potential problems.  To make this process even more thorough, AI systems are now being used to assist with OCT analysis.

How does the system know how to do that? Real doctors have taught it. It works by first learning from thousands of OCT scans graphically labeled by experienced eye doctors. 

The doctors analyzed images from real patients to detect and accurately measure over 70 pathologies and signs of pathology, including age-related macular degeneration and glaucoma, teaching the AI what to look for.

The system leverages a massive dataset of thousands of OCT scans collected from 11 ophthalmic clinics over the years. Carefully segmented and labeled by retinal professionals, these scans were used to train the AI. By analyzing each pixel of an image and its position relative to others, the AI has learned to distinguish between different biomarkers and pathologies.

The platform visualizes what is going on with the retina using color coding. This means that every problem on the OCT scan will be colored differently and signed so you will be able to understand what is going on with your retina.

As with any innovative tool, Altris AI partially automates some routine tasks, so clinicians have more time for what is important: talking to patients, learning more about their eye health, and providing treatment advice.

Why does this matter to you? Altris AI can help spot even the tiniest changes in your eyes, leading to earlier treatment and better protection of your eye health. Knowing a smart computer system is also double-checking your scans gives both you and your doctor extra confidence in the results.

With the help of Altris AI, you will be able to see how the treatment affects you.  For example, if you have fluid in the retina (that is not supposed to be there), you will be able to see if its volume is decreasing or increasing with the help of color coding. 

Altris AI was designed by eye doctors for eye doctors. It’s a tool to help us take even better care of patients.

AI color coding in eye care: how learning about diagnosis influences treatment adherence

Patient-centered care, a key principle outlined by the Institute of Medicine, emphasizes optometry patient education and involvement in decision-making. This is vital in ophthalmology, where insufficient patient engagement can lead to irreversible blindness.

Research specifically targeting the ophthalmology patient population, which often includes older and potentially visually impaired individuals, reveals a clear preference for individualized education sessions and materials endorsed by their eye care provider. 

According to Wolters Kluwer Health, patients crave educational materials from their providers, yet only two-thirds actually get them. This leaves patients searching for information, potentially exposing them to unreliable sources. 

Providing clear, accessible patient education is crucial to ensure understanding and treatment adherence. 

The human brain’s ability to process visual information far surpasses its speed with text, making visual aids a powerful tool for health education. In the field of eye care, this becomes even more critical. Patients often experience vision difficulties, potentially hindering their ability to absorb written materials. Providing clear visual representations of diagnoses can significantly improve patient understanding and compliance. 

A study shows a strong preference for personalized educational materials, especially among older visually impaired patients. Seeing photos of their condition, like glaucoma progression, builds trust and reinforces the importance of treatment recommendations.

Surveying eye care professionals specializing in dry eye disease revealed a strong emphasis on visual aids during patient education. Photodocumentation is a favored tool for demonstrating the condition to asymptomatic patients, tracking progress, and highlighting the positive outcomes of treatment.

A visual approach is particularly motivating for patients. It provides tangible evidence of the benefits of their treatment investment, allowing for a deeper understanding of the “why” behind treatment recommendations and paving the way for ongoing collaboration with the patient.

Understanding complex eye conditions can be challenging for patients. Altris AI aims to bridge this gap by using color coding for pathologies and their signs, severity grading, and pathology progression over time within its OCT analysis.

With Altris AI, scans are color-coded for instant interpretation: all the detected pathologies are painted in different colors, highlighting the littlest bits that the unprepared eye of a patient would miss otherwise.

This easy-to-understand visual system empowers patients. They can clearly see what’s happening within their eyes and track the progress of any conditions during treatment.

Eye care professionals are enthusiastic about its impact.

The power of visuals goes beyond understanding a diagnosis. When patients see the interconnected structures that make up their vision, they gain a deeper appreciation for its complexity and the importance of preventative care. This understanding fosters a true partnership between doctor and patient, where the patient is an active, informed participant in their own eye health.

Summing up

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Patient education in optometry is vital today and AI is the perfect tool for that. Patients are increasingly curious and open to AI’s potential in general healthcare and eye care in particular, but naturally, some questions and hesitation remain. They stem from a desire to ensure AI considers their individual needs. By addressing these concerns proactively and clarifying when and how AI is used in their care, emphasize the collaborative doctor-AI model—highlight that YOU review and endorse all AI recommendations.

You can successfully integrate this powerful technology into your practice by addressing patient concerns with empathy and highlighting AI’s benefits. This leads to better patient education in optometry and empowered patient experience, improving understanding, adherence to treatment, and, ultimately, better health outcomes.

Glaucoma’s silent progression highlights a challenge we all face as clinicians. Millions of individuals remain at risk for irreversible vision loss due to undiagnosed disease – 50% or more of all cases. This emphasizes our responsibility to enhance early detection strategies for this sight-threatening condition.

Existing clinical, structural, and functional tests depend on both baseline exams and the need to observe changes over time, delaying the assessment of treatment effectiveness and the identification of rapid progression.

In this article, we will consolidate our knowledge as eye care professionals about Glaucoma, explore current clinical detection practices, and discuss potential areas to optimize early Glaucoma detection.

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What we know about Glaucoma

Glaucoma is a complex neurodegeneration fundamentally linked to changes occurring in two locations: the anterior eye (elevated pressure) and the posterior eye (optic neuropathy). Factors influencing glaucoma development include:

• age,
• ethnicity,
• family history,
• corneal thickness,
• blood pressure,
• cerebrospinal fluid pressure,
• intraocular pressure (IOP),
• and vascular dysregulation.

Early stages of Glaucoma are often asymptomatic, highlighting the importance of comprehensive eye exams, even without apparent vision issues. Current diagnostic criteria are insufficient and lack markers of early disease.

Glaucoma is broadly divided into primary and secondary types, with primary open-angle Glaucoma (POAG) representing approximately three-quarters (74%) of all glaucoma cases. 

Primary glaucomas develop independently of other eye conditions, while secondary glaucomas arise as a complication of various eye diseases, injuries, or medications.

POAG is characterized by an open iridocorneal angle, IOP usually > 21 mmHg, and optic neuropathy. Risk factors include age (over 50), African ancestry, and elevated IOP. While IOP is a significant factor, it’s unpredictable – some patients with high IOP don’t develop Glaucoma, and some glaucoma progresses even at normal IOP.

Normal-tension Glaucoma (NTG) shares POAG’s optic nerve degeneration but with consistently normal IOP levels (<21mmHg). Vascular dysregulation and low blood pressure are risk factors. While rarer than POAG, IOP lowering can still be beneficial.

Primary Angle-Closure Glaucoma (PACG) is caused by narrowing the iridocorneal angle, blocking aqueous humor flow. More common in East Asian populations, it can be acute (severe symptoms, IOP often > 30mmHg) or chronic.

Secondary glaucomas are caused by underlying conditions that elevate IOP. Examples include pseudoexfoliative, neovascular, pigmentary, and steroid-induced Glaucoma.

Age is a central risk factor for glaucoma progression, linked to cellular senescence, oxidative stress, and reduced resilience in retinal ganglion cells and the trabecular meshwork. Intraocular pressure (IOP) remains the most significant modifiable risk factor. Understanding individual susceptibility to IOP-related damage is crucial. Existing IOP-lowering treatments have limitations in both efficacy and side effects.

Glaucoma has a strong genetic component, with complex interactions between genes, signaling pathways, and environmental stressors. For now, we know that mutations in each of three genes, myocilin (MYOC), optineurin (OPTN), and TANK binding kinase 1 (TBK1), may cause primary open-angle Glaucoma (POAG), which is inherited as a Mendelian trait and is responsible for ~5% of cases (Mendelian genes in primary open-angle Glaucoma).

More extensive effect mutations are rare, and more minor variants are common. Genome-wide association studies (GWAS) reveal additional genes potentially involved in pressure sensitivity, mechanotransduction, and metabolic signaling. 

Recent research also suggests a window of potential reversibility even at late stages of apoptosis (a programmed cell death pathway, which is likely the final step in RGC loss). Cells may recover if the harmful stimulus is removed. This offers hope that dysfunctional but not yet dead RGCs could be rescued.

The Challenges of Early Glaucoma Detection

One of the most insidious aspects of Glaucoma is its largely asymptomatic nature, especially in the early stages. This highlights the limitations of relying on symptoms alone and underscores the importance of proactive detection strategies.

Relying on intraocular pressure (IOP) as a stand-alone glaucoma biomarker leads to missed diagnoses, especially in patients with normal-tension Glaucoma. Structural changes, such as optic disc cupping, also lack the desired sensitivity and specificity for early detection.  

Optic nerve head evaluations remain subjective, with studies indicating that even experienced ophthalmologists can underestimate or overestimate glaucoma likelihood.  

According to the research, even experienced clinicians can have difficulty evaluating the optic disc for Glaucoma. Both trainees and comprehensive ophthalmologists have been found to underestimate glaucoma likelihood in approximately 20% of disc photos. They may also misjudge risk due to factors like variations in cup-to-disc ratio, subtle RNFL atrophy, or disc hemorrhages.  

Current Glaucoma Diagnosis in Clinical Practice

Eye care professionals typically encounter new glaucoma diagnoses in one of two ways:

• Firstly, during routine preventive examinations. A patient may come in for various reasons, including work requirements, and be found to have elevated intraocular pressure. This finding prompts further evaluation, potentially leading to a glaucoma diagnosis.
• Secondly, it is a finding in older patients (often over 50-60). A patient may present with significant vision loss in one eye, and examination reveals Glaucoma. Unfortunately, vision loss at this stage is often irreversible.

Alternatively, a patient may seek care for an unrelated eye problem. During the comprehensive examination, the eye care professional may discover changes suggestive of Glaucoma.

As it is statistically prevalent, we most often work with primary Glaucoma, where no other underlying eye diseases are present. Functional changes, specifically as seen on visual field testing, help diagnose and stage glaucoma. During the test, a patient indicates which light signals are visible within their field of vision, building a map of each eye’s visual function. 

Vision Field Test for Glaucoma Detection

The optic nerve (a nerve fiber layer of the retina consisting of the axons of the ganglion neurons coursing on the vitreal surface of the retina to the optic disk) transmits visual information from the retina to the brain. Each part of the retina transmits data via a corresponding set of fibers within the optic nerve. Damage to specific nerve fibers results in loss of the associated portion of the visual field.

Challenges with this test include its complexity, especially for older patients, and its subjective nature.

Changes in the visual field determine glaucoma severity. These changes indicate how much of the visual field is already damaged and which parts of the optic nerve are compromised. We call these ‘functional changes‘ as they directly impact visual function.

Fundus photo for Glaucoma detection

Alongside functional changes, Glaucoma causes visible structural changes in the optic nerve that can be observed during a fundus examination. The optic nerve begins at a point on the retina where all the nerve fibers gather, forming the optic disc (or optic nerve head). The nerve fibers are thickest near the optic disc, creating a depression or ‘hole’ within it. As Glaucoma progresses, this depression deepens due to increased pressure inside the eye. This pressure causes mechanical damage to the nerve fibers, leading to thinning and loss of function.

Another crucial area on the retina is the macula, which contains a high density of receptors responsible for image perception. While the entire retina senses images, the macula provides the sharpest, clearest vision. We use this area for tasks like reading, writing, and looking at fine details. Therefore, the damage to the macular area significantly impacts a patient’s visual quality and clarity. Nerve fibers carrying visual information from this crucial region are essential when evaluating the visual field. We prioritize assessing the macula’s health because it directly determines the quality of a patient’s central vision.

Unfortunately, even if the macula is healthy, damage to the nerve fibers transmitting its signals will still compromise vision.

Glaucoma OCT detection

The most effective way to get information about nerve states is OCT, which allows us to penetrate deep into the layers to see the nerve fiber layer separately, making it possible to assess the extent of damage and thinning to this layer in much more detail. 

The Glaucoma OCT test provides valuable information about ganglion cells. These cells form the nerve fiber layer and consist of a nucleus and two processes. The short process collects information from other retinal layers, forming the inner plexiform layer. The ganglion cell layer comprises the cell nuclei, while the long processes extend out to create the nerve fiber layer.

Damage to the ganglion cells or their processes leads to thinning across these layers, which we can measure as the thickness of the ganglion cell complex. OCT often detects these microscopic changes before we can see them directly. This enables the detection of structural changes alongside the functional changes observed with standard visual field tests.

Ideally, OCT would be more widely accessible, as the human eye cannot detect early changes. However, how often a patient undergoes OCT depends on various factors. These include the doctor’s proficiency with the technology, the patient’s financial situation (as OCT can be expensive), and the overall clinical picture.  

Ways to Enhance Early Glaucoma Detection 

We surveyed eye care specialists, and there was a strong consensus that the most efficient ways to boost early glaucoma detection are regular eye check-ups (47%) and utilizing AI technology (40%). Educating patients was considered less significant (13%).

AI as a second opinion tool

AI offers valuable insights into glaucoma detection, analyzing changes that may not be visible to the naked eye or even on standard OCT imaging.

The Altris AI Early Glaucoma Risk Assessment Module specifically focuses on analyzing the OCT ganglion cell layer, measuring its thickness, and identifying any thinning or asymmetry. These measurements help determine a patient’s glaucoma risk. If the ganglion cell complex has an average thickness and is symmetrical throughout the macula, the module will assign a low probability of Glaucoma.

Asymmetries or variations in thickness increase the calculated risk, indicated by a yellow result color. Glaucoma GCC is often characterized by thinning or asymmetry, suggesting glaucomatous atrophy, indicating a high risk, and triggering a red result color.

Changes are labeled as ‘risk’ rather than a diagnosis, as other clinical factors contribute to a confirmed glaucoma diagnosis. Indicators of atrophy could also signal different optic nerve problems, such as those caused by inflammation, trauma, or even conditions within the brain.

It’s crucial to remember that AI ganglion cell layer OCT detection tools like this are assistive – they cannot independently make a diagnosis. Similarly, while helpful in assessing risk, they cannot completely rule out the possibility of developing a disease. This limitation stems from their reliance on a limited set of indicators. Like other technical devices, the module helps flag potential pathology but does not replace the clinician’s judgment.

AI can be incredibly valuable as a supplemental tool, especially during preventive exams or alongside other tests, to catch possible early signs of concern. However, medicine remains a field with inherent variability. While we strive for precise measurements, individual patients, not just statistical averages, must be considered. 

 Therefore, it is unrealistic to expect devices to provide definitive diagnoses without the context of a complete clinical picture.

Public Health Education 

The asymptomatic nature of Glaucoma in its early stages, paired with limited public awareness, creates a fundamental barrier to early detection. 

For example, 76% of Swiss survey respondents could not correctly describe Glaucoma or associate it with eye health. 

A Canadian study similarly shows that less than a quarter of participants understand eye care professionals’ roles correctly and that most people are unaware eye diseases can be asymptomatic.  

Crucially, these studies also found a strong desire across populations for more information about eye care, including Glaucoma (e.g., 97% of Swiss respondents agreed the public lacks knowledge, and 71% want more information). This indicates a receptive audience for targeted education initiatives.

Health education programs, like the USA EQUALITY study, demonstrate the potential to address this challenge. This study combined accessible eye care settings with a culturally sensitive eye health education program, targeting communities with high percentages of individuals at risk for Glaucoma. 

Participants showed significant improvements in both glaucoma knowledge (a 62% increase in knowledge questions) and positive attitudes toward the importance of regular eye care (52% improvement). 

These results show us that improving glaucoma detection involves more than medical tools. Successful education strategies should prioritize community outreach, partnering with community centers, primary care clinics, and local organizations to reach those lacking access or awareness of regular eye care. 

Information about Glaucoma must be presented clearly and accessible, focusing on the basics—what Glaucoma is, its risk factors, and the importance of early detection. Addressing common misconceptions, such as the belief that Glaucoma can’t be present if vision is good, is crucial, as is targeting high-risk groups, including older adults, those with a family history of Glaucoma, and certain ethnicities.

Screening Programs and Regular visits

Community-based studies consistently demonstrate the benefits of targeted screening programs for early glaucoma detection in high-risk populations. 

These programs are essential, as traditional glaucoma screening methods often miss individuals with undetected disease.

The USA Centers for Disease Control and Prevention (CDC) funded SIGHT studies focused on underserved communities, including those in urban areas with high poverty rates (MI-SIGHT, Michigan), residents of public housing and senior centers (NYC-SIGHT, New York), and the rural regions with limited access to specialist eye care (AL-SIGHT, Alabama). These programs successfully reached populations who often don’t have regular eye care. 

Notably, the results across all three studies demonstrate the effectiveness of targeted programs – approximately 25% of participants screened positive for Glaucoma or suspected Glaucoma. 

The SIGHT studies recognize that screening is just the first step, highlighting the importance of follow-up care, testing ways to improve follow-through, using strategies like personalized education, patient navigators, financial incentives, and providing free eyeglasses when needed.

Summing up

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Glaucoma’s insidious nature demands better early detection strategies. While existing methods are essential, we must also invest in new technologies like AI, enhance public health education about Glaucoma, and focus on targeted screening within at-risk populations. Combining these approaches can protect sight and reduce the burden of glaucoma-related blindness.