Clinical Scorecard: Update on Retinal Imaging

At a Glance

Key Highlights

• FDA authorized the first home-use OCT device (Notal Vision Home OCT) for monitoring chronic retinal conditions, enabling remote disease progression tracking and early intervention.
• Swept-Source OCT and OCT-Angiography provide deeper, non-invasive, and detailed visualization of retinal and choroidal structures, enhancing diagnosis and management.
• AI integration in retinal imaging automates image analysis, improves early detection, reduces clinician workload, and supports decision-making with continuous validation.

Guideline-Based Recommendations

Diagnosis

• Utilize OCT as the cornerstone imaging modality for retinal disease diagnosis and monitoring.
• Incorporate Swept-Source OCT for detailed imaging of choroid and vitreoretinal interface in complex cases.
• Employ OCT-Angiography as a non-invasive alternative to dye-based angiography for vascular assessment in diabetic retinopathy and AMD.
• Use Fundus Autofluorescence imaging to assess retinal pigment epithelium health, especially in macular degeneration and inherited retinal diseases.
• Reserve fluorescein and indocyanine green angiography for precise vascular imaging in vasculitis and polypoidal choroidal vasculopathy.

Management

• Adopt home OCT devices for remote monitoring of chronic retinal diseases to reduce in-office visits and enable timely treatment adjustments.
• Integrate wide-field imaging systems with OCT and angiography to obtain comprehensive retinal views for managing peripheral retinal diseases.
• Consider adaptive optics imaging for research and potential early detection of subtle retinal changes as technology becomes more accessible.

Monitoring & Follow-up

• Leverage AI-based image analysis to detect early retinal changes and quantify disease features such as fluid volumes and drusen.
• Use faster OCT scan speeds (>150 kHz) to improve workflow efficiency and patient comfort during imaging sessions.
• Implement longitudinal data analysis from home and clinical imaging to track disease progression and treatment response.

Risks

• Ensure AI systems are trained on robust, diverse datasets to avoid bias and maintain diagnostic accuracy.
• Monitor patient safety during angiography by optimizing light exposure and using laser-based systems to reduce discomfort.
• Recognize that some advanced imaging modalities like adaptive optics remain investigational and may not yet be standard of care.

Patient & Prescribing Data

Patients with chronic retinal diseases such as neovascular AMD, diabetic retinopathy, and other complex retinal conditions

Home OCT devices enable real-time disease monitoring and early detection of changes, facilitating timely interventions and reducing the frequency of in-office visits.

Clinical Best Practices

• Incorporate multimodal imaging approaches combining OCT, OCT-A, FAF, and angiography for comprehensive retinal assessment.
• Utilize AI-assisted image analysis to enhance diagnostic accuracy and reduce clinician workload without replacing clinical judgment.
• Adopt home monitoring technologies where appropriate to improve patient engagement and disease management outside traditional clinical settings.
• Stay updated on emerging imaging technologies such as adaptive optics and wide-field integrated platforms to expand diagnostic capabilities.
• Ensure patient safety and comfort by using advanced imaging systems with optimized scan speeds and laser-based angiography.

References

• FDA Clearance of Notal Vision Home OCT
• Advances in Optical Coherence Tomography
• Role of AI in Retinal Imaging