Eye care practitioners face a challenge in effectively organizing, storing, and retrieving digital images. Bulky paper charts are inefficient and hinder clinicians' ability to compare serial images. Physicians can export digital images to a computerized database, but this strategy is only useful if they can locate and retrieve the results of specific tests at a moment's notice.

The physicians from Sabates Eye Centers decided to overcome this challenge by implementing a centralized image management system for their eight locations in and around Kansas City, Missouri. When the first program they tried did not meet their needs, they switched to the EyeRoute ophthalmic image management system (Topcon Medical Systems, Inc., Paramus, NJ). In an interview with Glaucoma Today glaucoma specialist Rohit Krishna, MD, and IT director Patrick Beesley described how they use the EyeRoute system.

MULTIPLE LOCATIONS
"Each of Sabates Eye Centers' eight offices has between 10 and 20 examination lanes," Dr. Krishna told GToday. "Our specialists generate an impressive volume of diagnostic images as they move between locations. We therefore needed a system that could simultaneously transmit digital images to a central server and allow us to access stored images from any office."

Ready access is only part of the equation. Dr. Krishna commented, "Speed is also important. I should be able to retrieve digital images from a central server as quickly as I can print a hard copy directly from the diagnostic device."

According to Mr. Beesley, the key to quick retrieval is compression. "The EyeRoute system reduces the size of digital files by nine to one without degrading the quality of images," he said. "This process not only saves on storage, but [it] decreases the amount of time needed to transmit data to and from the server." When it comes to digital files, Mr. Beesley added, smaller is always better.

CLINICAL BENEFITS
During a typical office visit, glaucoma specialists evaluate patients with multiple imaging modalities (eg, Humphrey visual fields [Carl Zeiss Meditec, Inc., Dublin, CA], optical coherence tomography, disc photographs, and scanning laser polarimetry). "The EyeRoute system allows me to access the results of all of these tests with a single click," said Dr. Krishna. "Its Web-based interface allows me to display digital photographs and printouts on any computer connected to the Internet. I can compare images captured during different evaluations, sort them according to eye, or even request test results from specific years (Figure 1). Placing images side by side also helps me detect gross changes in the appearance of the optic nerve and the retinal nerve fiber layer."

PATIENTS' EDUCATION
According to Dr. Krishna, the EyeRoute system is a valuable tool for educating patients about glaucoma. "Before I see patients, they spend between 30 minutes and 1 hour undergoing various tests," he said. "I believe that showing patients their diagnostic images helps them understand why these tests are necessary."

Demonstrating how glaucoma affects the optic nerve may improve people's understanding of the disease's progression, Dr. Krishna said. "Patients tend to appreciate the real-life consequences of optic nerve cupping and visual field defects when they can see these changes in their own eyes," he explained. "If their vision has deteriorated since their last visit, I display the results of their current and previous tests on the computer and show them exactly why" (Figure 2).

A better understanding of glaucoma may improve patients' adherence to medical therapy. "When patients are confronted with the results of noncompliance, they might be more diligent about using their eye drops," he added.

FUTURE UTILITY
Although the EyeRoute system has enhanced Dr. Krishna's ability to access diagnostic images, he feels that the technology could be improved. "Unfortunately, the system does not import raw data from ancillary machines," he said. "Because the images collected by the EyeRoute system are essentially digital reproductions of the diagnostic devices' printed reports, I cannot use them to perform statistical calculations. In the future, for example, I would like to be able to use the EyeRoute system to analyze 10 years' worth of decibel points on a Humphrey visual field test and to perform other kinds of analysis."

Patrick Beesley acknowledged no financial interest in the products or companies mentioned herein. Mr. Beesley may be reached at (913) 261-2020; beesley@sabateseye.com.

Rohit Krishna, MD, is the director of the Glaucoma Service at Sabates Eye Centers and an associate professor of ophthalmology at the University of Missouri-Kansas City School of Medicine. He acknowledged no financial interest in the products or companies mentioned herein. Dr. Krishna may be reached at (913) 261-2020; krishnarohit@yahoo.com.