Comparison of Clinician Review Time and Confidence with Optical Coherence Tomography Digital versus Print-Based...

Optical coherence tomography (OCT) is essential for the management of retinal disease. Digitalization is a potential means of optimizing work practices and improving confidence in treatment decisions. This study compared digital and print/analog image review workflows for OCT images of eyes that underwent intravitreal injection (IVI).

This pilot study was an observer based workflow comparison study. Ten retinal specialists evaluated the OCT image sets of 30 eyes that had undergone IVI treatment. Each reviewer then rendered a simulated treatment decision (treat or not treat) for the most recent image of each set. The amount of time utilized by each specialist to review an image set or image review time (RT), self-rated decision confidence level, and ease-of-use ratings for digital and analog workflows were compared. Inter- and intra-rater variability was determined using exploratory analyses.

The mean RT for print and digital workflows were 55.5 ± 37.2 and 28.6 ± 16.5 seconds, respectively (p = 0.007). The use of digital workflow reduced the mean RT by 48.5%. Stratified by disease chronicity, the digital workflow reduced the mean RT for acute, intermediate, and chronic patients by 35.2, 40.2%, and 59.6%, respectively. Treatment decision confidence levels and ease-of-use ratings were significantly higher when using digital workflows than print workflows. The inter-rater reliability was fair to moderate.

Digital image review workflows resulted in a shorter RT, higher treatment decision confidence, and enhanced ease of use. Digital workflows may optimize OCT image review efficiency, while also improving decision-making confidence. Gains in RT efficiency were correlated with disease chronicity.