The integration of Artificial Intelligence (AI) into Ophthalmology has opened new frontiers in diagnosing and managing complex retinal diseases, notably Age-related Macular Degeneration (AMD).

Dr. Trusit Dave, an Optometrist running his own clinic in the UK and passionate about AI's role in medicine, started to explore the capabilities of RetinAI’s Discovery platform, and how this technology can be applied to AMD patient management.

Dr. Dave's interest in AI came from a Singapore study demonstrating AI's ability in identifying children at risk of developing myopia with an area under the curve (AUC) of 9.93 to 0.95 for internal validation and 0.91 to 0.93 for external validation using fundus images. This study underscored the untapped potential of AI in preemptive healthcare and drove him to learn more about RetinAI's Discovery platform and its use in clinical practice, marking the beginning of a significant shift in how AMD, Geographic Atrophy (GA) and other retinal conditions are approached in his practice.
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In this article, we explore how Discovery and AI models are reshaping patient management in Dr. Dave’s workflow, and how they have become indispensable tools in his arsenal against AMD and other retinal diseases.

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Empowering Precision in Diagnosis
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In Ophthalmology, precision from detailed data review is paramount to effective diagnosis management. Discovery's integration of AI-driven analytics and comprehensive data management allows for a more nuanced approach to retinal diseases, facilitating early detection, accurate diagnosis, and effective treatment planning. All these assets are supported by the assurance that only a certified medical device software can provide.

Indeed, RetinAI Discovery has been certified as a Class IIa medical device under the Medical Device Regulation (MDR), and also received FDA 510k clearance. Similarly, our AI modules (Macula Biomarkers, Layer Segmentation, Fluid Segmentation and Diabetic Retinopathy Screening) are CE-marked under the MDR as Class IIa medical devices and, thus, approved for clinical use in Europe.

Dr. Dave's clinical application of Discovery highlights its impact on enhancing diagnostic accuracy and treatment efficacy, notably in these 3 key areas:
1. Disease monitoring & treatment adjustments with the fluid progression view
2. Visualization of retinal layers & biomarker detection
3. A whole new approach to supporting AMD and GA Management through predictive analysis

Let's dive into these three areas now.

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Disease monitoring & treatment adjustments with the fluid progression view

Imagine having the capability to track fluid progression within the retina over time, directly from your OCT scans. This advanced feature isn’t just a concept - it’s part of Discovery.

Immediately after OCTs are captured across different device manufacturers, Discovery CONNECT automates data sync and sends the images directly to our platform for analysis. Our platfrm Discovery then identifies and measures Intraretinal Fluid (IRF), Subretinal Fluid (SRF), and Pigment Epithelium Detachment (PED), compiling the results into a graph that combines current and past OCT data to track your patient’s disease progression.

Such precise monitoring allows for tracking subtle changes over time, empowering clinicians to make more informed decisions and personalized treatment adjustments.

Dr. Dave shares a compelling application of this feature: "I had a patient with Geographic Atrophy in his right eye and wet AMD in his left. The Discovery AI system tells me how much fluid is in the retina. This immediate insight into fluid dynamics within the retina is something you never get from any standard OCT. The ability to differentiate between Intra-retinal fluid, Subretinal fluid, and even Pigment Epithelial Detachment provides a depth of understanding crucial for effective monitoring and treatment planning." says Dr Trusit.

The ability to differentiate between Intra-retinal fluid, Subretinal fluid, and even Pigment Epithelial Detachment provides a depth of understanding crucial for effective monitoring and treatment planning.

He goes on to say, “Consider the scenarios where a patient undergoes intraretinal injections or presents with Cystoid Macular Edema - conditions prevalent in diabetic individuals or post-cataract surgery. When prescribing treatments such as steroids, the quantification measure of edema absorption becomes indispensable. With Discovery, you can objectively assess fluid volume in the retinal layers, and that makes it a really powerful tool!”

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Visualization of retinal layers & biomarker detection

In AMD diagnosis, the thickness of retinal layers offers critical insights into the disease’s progression and patient prognosis. With Discovery, you can have an enhanced understanding of the retina’s structure: Discovery’s AI models delineate up to 7 retinal layers, Choroid, SRF, IRF, PED/Drusen, HRF, and Amorphous Material (model in Research Use Only), granting a better view of the anatomical changes.

Discovery’s expert-level capabilities of identifying and quantifying an ample range of retinal biomarkers parallel those provided by an experienced retinal specialist or a reading center.

With Discovery’s interface you get an easy view of the retina’s multiple layers through an intuitive ETDRS grid for each, pinpointing the exact location of biomarkers. Dr. Dave highlights how it empowers clinicians to diagnose with greater precision: “I instantly know if there’s something wrong, what layer I’m in, and what’s wrong”. This real-time access to detailed retinal data demystifies complex diagnoses, guiding targeted interventions.

‍ “Another Discovery functionality supporting diagnostics is the biomarker probability view. It gives you a probability of the presence of the biomarker on the OCT. I just pick out the yellow areas, and then just hovering over it tells me where it is. So this visualization makes it very quick and easy. Once, Discovery highlighted the IRF, PED, which I already found myself, but highlighted the HRF which I missed looking at the OCT image! That’s what Discovery is all about, it is your diagnostic companion.” He added.

Once, Discovery highlighted the IRF, PED, which I already found myself, but highlighted the HRF which I missed looking at the OCT image!

By integrating these analytical views, Discovery can support your diagnostic process and enrich patient consultations.

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A whole new approach to supporting AMD and GA Management through predictive analysis

Geographic Atrophy affects about 1.5 million people in the U.S., and for a long time, there wasn't any treatment. That changed with a new drug called Pegcetacoplan (Syfovre) developed by Apellis, which helps to slow the progression of vision loss. The catch? It's given through intravitreal injections by ophthalmologists, so optometrists need to refer their patients quickly once GA is detected.

‍"Discovery isn't just about identifying GA; it's also about offering a predictive view of the progression," Dr. Dave explains. "While this insight is for research use only, it supports us Optometrists in understanding how often we might need to see a patient based on algorithmic insights into potential GA progression. This tool brings a new perspective to managing age-related macular degeneration and Geographic Atrophy.”

The Geographic Atrophy View in Discovery (models in RUO) provides segmentation and related measurements of Retinal Pigment Epithelium (RPE) and Outer Retinal Atrophy (RORA) in OCT scans presenting atrophy secondary to age-related macular degeneration (AMD). When multiple acquisitions are available for a patient, a progression of the atrophic lesion size over time is also displayed, along with a prediction of how this lesion would develop. This information helps Optometrists decide when to send patients for those crucial injections.
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"For us, knowing when to refer a patient for injections can make all the difference," Dr. Dave notes. "And Discovery makes that call clearer."

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The aim isn't to scare patients with doom-and-gloom predictions. Instead, it's about education and enabling personalized care, understanding each patient's situation and planning the best course of action.

By turning AI predictions into actionable insights, Discovery is changing how Optometrists manage GA, thanks to both CE-marked and RUO AI models which are aggregated in the GA view in Discovery. ensuring patients get the help they need when they need it. Plus, with Discovery, you can share data securely and get an immediate evaluation with our real-time peer referrals module. No more unsecured emails, your data will be securely stored and shared with easy-to-give access.

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Enhancing Efficiency and Communication

Streamlining clinical workflow to focus on your patients

Discovery is making the workflow in Optometry practices simpler and more efficient.
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Dr. Dave has integrated a seamless process where every patient above the age of 50 or 60 undergoes a macular scan on their OCT. This scan is immediately uploaded to Discovery by the technical staff, and the system begins its analysis right away.

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RetinAI Discovery® Data Analysis Workflow

By the time a patient sits down for their consultation, their OCT images have been processed and analyzed, ready for review by Dr Dave. This streamlined process removes the need for Optometrists to spend time exporting OCT DICOM files themselves, and further aids in the quick interpretation of OCT scans.

"Once you've trained your tech to handle this part of the process, it significantly frees up your time to focus on what's important: the patient," Dr. Dave explains.

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Enriching Patient-Doctor Communication

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An aspect of Discovery highlighted by Dr. Dave is its role in bridging the communication gap between doctors and patients. By presenting complex retinal disease data in an intuitive, visually powerful and accessible format, the platform has significantly improved patient understanding and engagement.

‍"Seeing their condition in terms of fluid volumes and progression charts empowers patients to participate actively in their care,"

reflects Dr. Dave, underscoring the value of informed patient involvement. It allows us to engage with our patients' conditions more fully, guiding our decision-making process with unprecedented clarity,".

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Elevating Patient Outcomes Through AI
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Reflecting on his experiences, Dr. Dave envisions a bright future for AMD management with AI as part of the foundation for advancement. Discovery stands out not only for its precision but also for its alignment with personalized medicine's principles for better outcomes for patients with AMD.

Dr. Trusit Dave's application of the Discovery platform in managing AMD showcases the impact AI can have on Ophthalmology. From enhancing diagnostic precision and patient communication to leveraging predictive analytics for informed treatment strategies, Discovery is setting new standards in patient care.

As we look ahead, integrating AI technologies like Discovery promises not only to augment clinical practices but also to revolutionize the patient journey through proactive and personalized healthcare solutions.

If you want to know more, check out how Discovery for Clinics could help you drive better-informed results for your patients.

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