Imaging Interoperability

The Academy believes the Digital Imaging and Communications in Medicine (DICOM) standard is the gold standard for enabling interoperable ophthalmic imaging, and supports broader conformance with DICOM standards to improve care coordination, patient access, and innovation in eye care. Many ophthalmic imaging systems have not fully aligned with DICOM standards, limiting reliable image exchange between imaging devices, electronic health records, and other health IT systems. The Academy supports policies and incentives that encourage manufacturers to achieve full, meaningful DICOM compliance — not merely nominal conformance.

The Academy works with federal agencies and has advocated with Congress to advance ophthalmic imaging interoperability and promote broader adoption of DICOM standards across the ophthalmic imaging ecosystem.

Advocacy for stronger imaging interoperability

In response to a federal request for information by the Office of the National Coordinator for Office of the National Coordinator for Health Information Technology (ONC), the Academy submitted comments urging policies that promote greater interoperability by encouraging broader compliance with DICOM standards among ophthalmic imaging manufacturers. The Academy emphasized that greater interoperability is essential to improve patient and physician access to images, strengthen care coordination, and support clinical research and emerging artificial intelligence applications.

Developing and maintaining standards

The Academy has developed DICOM-based imaging standards for common ophthalmic imaging modalities, available on the Academy's Medical Information Technology webpage. These resources support more consistent and interoperable imaging exchange across devices, EHRs, and image management systems. Standards documentation is updated regularly — most recently in December 2025.

Joint advocacy with ARVO

In 2022, the Academy and the Association for Research in Vision and Ophthalmology (ARVO) jointly published a policy statement calling on the ophthalmic imaging community — manufacturers, clinicians, researchers, and government agencies — to commit to full implementation of DICOM standards. The statement called the current state of partial compliance insufficient and argued that full adoption is justified by patient safety and quality-of-care considerations.

Federal engagement

The Academy has also engaged with ONC, the United States Food and Drug Administration (FDA), and the National Eye Institute (NEI) on ophthalmic imaging interoperability. In 2022, NEI, FDA, and ONC jointly hosted a workshop on promoting adoption of ocular imaging standards — a direct result of advocacy and public input from the ophthalmic community. The Academy continues to engage with these agencies to advance policy solutions, including incentives for manufacturer compliance and potential regulatory requirements. 

Ask your vendors about DICOM compliance

When purchasing or renewing contracts for imaging devices, ask manufacturers for their DICOM conformance statements and whether their devices natively store and export data in DICOM format. Market demand is one of the most effective levers for driving manufacturer adoption.

Stay informed

Visit the Academy's Medical Information Technology webpage  for the latest DICOM standards and resources for ophthalmic imaging modalities.

Get involved

Contact healthpolicy@aao.org to learn more about the Academy's work on imaging interoperability and how to participate.

Ophthalmology is one of the most imaging-intensive specialties in medicine. Devices such as optical coherence tomography (OCT), fundus cameras, visual field analyzers, and anterior segment imagers generate large volumes of data that are critical to diagnosis, treatment planning, and ongoing disease monitoring. Yet unlike radiology and cardiology — where DICOM-based interoperability is well established — ophthalmic imaging has historically relied on proprietary, manufacturer-specific file formats that do not communicate reliably with one another or with EHR systems.

This fragmentation has significant consequences. Images may be lost when a patient transfers care between providers. Practices using multiple devices from different manufacturers often cannot aggregate imaging data in a single, searchable system. Researchers and AI developers cannot build large, standardized datasets from imaging collected across institutions. And as AI-based diagnostic tools for ophthalmology become increasingly viable, the absence of standardized data threatens to limit their development and real-world utility.

The DICOM standard — used widely in radiology and cardiology — provides a well-established technical framework for addressing these problems in ophthalmology. DICOM supplements for ophthalmic imaging modalities have been developed and are available, but adoption by manufacturers has been slow. Currently, FDA market authorization does not require DICOM compliance for ophthalmic imaging devices, and conformance claims by manufacturers are not independently certified — meaning "DICOM compliant" labels may not reflect full, meaningful implementation.

The Academy and ARVO have called on manufacturers, regulators, and federal agencies to work together to close this gap — through clearer requirements, stronger incentives, and a commitment from the ophthalmic imaging industry to make interoperability a priority.