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  • American Academy of Ophthalmology Leads Call for Ophthalmic Equipment Manufacturers to Standardize Digital Imaging

    SAN FRANCISCO, Calif. – The American Academy of Ophthalmology, the world’s largest ophthalmic association, this week published a report urging ophthalmic imaging device manufacturers to standardize image formats to comply with the Digital Imaging and Communications in Medicine (DICOM®) standard. DICOM is recognized in the United States and throughout the world as the medical imaging standard. Widespread adoption of a uniform standard can revolutionize ophthalmology practices by promoting more efficient patient care, enabling the creation of comprehensive datasets for research and big data analyses, and developing algorithms for machine learning and artificial intelligence.

    This recommendation has already been endorsed by the American Society of Retina Specialists, the Asia-Pacific Academy of Ophthalmology, the Royal College of Ophthalmologists, and the Royal Australian and New Zealand College of Ophthalmologists

    Lead author, Aaron Y. Lee, MD, MSCI, makes clear that the current lack of standardization in ophthalmology is holding back progress in the profession.

    “One of the most important issues limiting clinical and research progress in the field of ophthalmology is the lack of standards for imaging and functional testing,” Dr. Lee said. “The new horizon of tools for digital healthcare rely on being able to interact algorithmically and extract data at scale. Right now, there has been great progress with electronic health record data becoming standardized and available directly to patients, but the same has not yet happened for imaging and functional testing data that we routinely collect in our clinics.”

    Dr. Lee stressed that the benefit to patients would be significant. As physicians gain better access to images and reports, they can provide faster and more coordinated care, he said.

    The Academy has long championed the DICOM standard, which includes a system of globally agreed-upon ophthalmological definitions. It promotes the seamless sharing of medical images by detailing how to format and exchange images and the information with which it is associated, such as the text describing the image and patient demographic information. DICOM compliance is low for ophthalmic imaging technologies. Even so-called “DICOM compliant” devices fail to fully meet DICOM standards. Currently, there is no easy way to exchange digital imaging data from one manufacturer’s equipment to another’s without creating a custom interface.

    The report cites two specific examples of how ophthalmologists would benefit:  

    • Provide machine-readable, discrete data for user selected reports of ophthalmic imaging or functional testing. Currently, when a patient’s OCT image or visual field test is stored, an ophthalmologist must retrieve and view that information separately, and then access the patient’s electronic medical record to obtain additional information about visual acuity and treatment history, etc. There is no way to bring all the data in one place to inform clinical decision making. 
    • Use of lossless compression for pixel or voxel data to encode the same raw data as used by manufacturers. When an imaging device or functional testing device captures data, it is often compressed to make the files smaller, which can degrade image quality. It is important for this data to be available from the manufacturers so ophthalmologists can provide the best quality care for our patients. Poor image quality can also lead to problems when AI models are being developed or new digital health tools are deployed.

    “Other fields of medicine like Radiology have blazed ahead of our field by utilizing these standards to their fullest extent,” Dr. Lee said. “In some ways, it is much harder in our field because we have such a diverse variety of imaging devices and testing modalities. This variety is what makes ophthalmology so rich with information but also makes it difficult for standards to keep up with the constant innovation. My hope is that not only would vendors be willing to adopt and conform to standards but also be willing to define them for new modalities where the DICOM standard does not currently exist. The recommendations in this statement are just the first step in the direction that we need to go.”

    Ophthalmologists around the globe agree that it is the direction to go:

    “For most of the commonest causes of sight-loss in the UK, we are highly dependent on the remarkable imaging systems we use,” said Alastair Denniston, Consultant Ophthalmologist & Hon Professor, RCOphth Audit & Informatics Subcommittee. “But that can be severely limited if systems ‘won’t talk to each other’. The Royal College of Ophthalmologists is supporting this important global initiative from the AAO, as it is a key step towards ensuring maximal interoperability for improving care and accelerating research into these sight-threatening conditions.”

    Daniel Ting, MD, Chair of the Asia Pacific Academy of Ophthalmology’s AI & Digital Innovation Standing Committee, adds:

    “The Asia-Pacific region, consisting of both developed and developing countries, is the home to 60% of the world's population, accounting for up to 4.3 billion. Given the ageing population made worse by COVID-19 pandemic crisis, there is a pressing need for digital transformation in healthcare. In ophthalmology, the standardization of ocular imaging can facilitate the push for artificial intelligence, deep learning and big data analytics to enhance patients' care and experience for global eye health. Thus, the Asia Pacific Academy of Ophthalmology (APAO) will support and endorse the AAO recommendation for ocular image standardization.”


    About the American Academy of Ophthalmology

    The American Academy of Ophthalmology is the world’s largest association of eye physicians and surgeons. A global community of 32,000 medical doctors, we protect sight and empower lives by setting the standards for ophthalmic education and advocating for our patients and the public. We innovate to advance our profession and to ensure the delivery of the highest-quality eye care. Our EyeSmart® program provides the public with the most trusted information about eye health. For more information, visit