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SUG155 OCT Surveillance Pathway Guidance

Contents 1. General Information 3 2. OCT appointment 3

2.1 OCT Clinics and OCT appointment booking 3 2.2 Screening a patient in OCT 4 2.3 Reviewing a Patient’s Previous History 5 2.4 Verifying a Patient’s Identity 5 2.5 Updating Patient Details 6 2.6 The OCT Examination 6 2.6.1 Pre-screening 6 2.6.2 Capture 7

3. Grading an OCT Encounter 10 3.1 OCT Fundus Grading 10 3.2 OCT Scan Grading 12

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1. General Information

When entering new patients or updating/amending details, this guide will refer to clicking on the [Apply] or [Finish] button. These will be in the top left corner of the screen when in Patient registration or Patient Update:

The Health Board is shown in the top banner:

OCT Patients are colour coded yellow:

2. OCT appointment

2.1 OCT Clinics and OCT appointment booking

Note: Before you can screen a patient in OCT, you must already have clinic locations enabled as an OCT Surveillance Site. You can do this in System Management/Manage Locations and [Add Roles]. The example shown below is adding OCT to an existing Fundus clinic location (Figure 1).

Figure 1

Patients will need to be booked into an OCT clinic to enable screening. You can do this via Appointment Management and search by Pathway ‘Patients needing OCT surveillance appointments’ (if Closed booking) (Figure 2) or ‘Invited OCT surveillance patients’ (if Open booking).

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Figure 2

2.2 Screening a patient in OCT

Find and highlight your patient in the clinic list on the left; patients for OCT appointments will have a yellow box by the appointment time (Note: fundus=blue; SL-green) – the patient's state is shown as ‘ Pre-Screening – Awaiting OCT Surveillance pre-screening ’ (Figure 3):

Figure 3

Note : You can also select the Pre-screen option for OCT, if you wish to split the appointment into two parts. Please see the ‘Pre-Screening’ user guide for more information.

NOTE : The OCT Pre-Screening record does differ slightly to the Fundus Pre-Screening and these differences will be mentioned later on in this document.

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2.3 Reviewing a Patient’s Previous History

Before commencing the screening episode, you may wish to review the patient’s previous history and screening encounters, as this may help you decide if both OCT Fundus and OCT Scan Capture needs to take place. When reviewing the patient’s history you may decide that new OCT fundus images are not required, if, for example, this OCT appointment is a result of a recent referral from a standard Fundus screening visit.

From the Clinic List, highlight a patient and click [Review] from the list to the right of the patient list. You can alter the view to expand and pin ‘Grading summary’ to view the recent and previous history (Figure 4).

Figure 4

2.4 Verifying a Patient’s Identity

For a single step appointment , click Photograph on the central menu panel . This will take you to the Pre-screening: Confirm patient screen

At this stage, you will need to confirm the patient identity and may need to update their consent for carrying out the procedures.

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You will be unable to click [ Next ] until you have changed the ‘Are the above details correct?’ switch from ‘No’ to ‘Yes’. If for any reason you exit this screen and then return to it, you will need to select the ‘Yes’ switch again.

If the patient has already been taken through pre-screening, an extra option will be shown asking for you to confirm that you wish to add more images to the current screening.

2.5 Updating Patient Details

If there are inaccuracies in the patient information, you may be able carry out a quick update of the main patient information, depending on your user role.

Click on the [ Quick update] button to change details. The quick update pop-up dialogue will be shown.

Make the amendments as necessary and click [Finish] to close and save the changes.

Once you have confirmed the patient’s identity and made any updates (if required), click on the [Next] button to proceed to the next step.

2.6 The OCT Examination

2.6.1 Pre-screening

Enter pre-screening details if they have not been completed using the ‘Pre-screen’ function.

NOTE: the difference here from the standard Fundus pre-screen record (Figure 5).

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At the top of the screen, you can enter the date of OCT fundus capture and date of OCT scan capture, if it is different to today. If you don’t enter anything in either of these 2 fields, they will default to today’s date once you click forward.

NOTE: If NOT capturing new fundus images, but want to use the previous images captured, if there has been a recent referral to OCT, then enter date of previous fundus screen.

Figure 5

Complete the rest of the pre-screening form as explained in the Pre-screening User Guide, and click Forward.

2.6.2 Capture

In this screen you have the option to:

● capture fundus images only; in the same way as you do for a fundus visit (please refer to the Fundus Screening user guide for more details).

● capture fundus images and import a 2D image file (from a separate OCT machine) as a representation of the OCT scan, or import a macula report (from a separate OCT machine).

● simply confirm the OCT scan has taken place (without importing a 2D image or a macula report file).

Note: OptoMize will not be connected directly to an OCT machine and will not be importing the OCT scan files. OptoMize will be used solely to report the OCT Scan has taken place and to record the grading of the OCT scan.

Capture Option 1 – OCT Fundus Screener – capture OCT Fundus images only

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If you have captured fundus images today, as part of the OCT visit, import those images as you do for standard Fundus screening (using folder capture or direct connection to a fundus camera) and then ensure you select ‘yes’ in the drop down box next to [OCT Fundus captured] (Figure 6).

Figure 6

Capture Option 2 – OCT Fundus AND OCT Scan Screener – Capture both in same encounter

If you have captured fundus images and confirming the OCT scan capture has also taken place, you should import the fundus images and can also optionally import a 2D screenshot of the OCT scan or macula report via the folder capture option

Note: it is not a requirement to import OCT scan screenshots or reports; OCT video files cannot be imported into OptoMize.

Ensure you record [OCT Fundus Captured] as ‘Yes’.

Before you record the OCT Scan capture a yellow warning triangle is displayed alongside the text [OCT Scan captured] (Figure xx). Tick this box – this will change to a green tick symbol once you have selected Yes or No from the OCT Fundus Captured drop down box, and ticked the OCT Scan Captured box (Figure 7).

Figure 7

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Capture Option 3 – OCT Scan only Screener – record capture of OCT Scan only

If you don’t need to capture or import new fundus images the dropdown box gives option in the bottom right of the screen gives the option to record – ‘ No – Use previous images’ (Figure 8).

Figure 8

Ensure you record the OCT Scan has been completed during this encounter by checking the tick box next to [OCT Scan captured], as shown above.

Alternatively the OCT Fundus images may be captured by a different screener, whilst you are only recording the OCT Scan capture. In this case, you only record the OCT Scan capture has taken place and leave the ‘OCT Fundus captured’ box blank (Figure 9). The yellow warning triangle will still display to indicate the OCT encounter is not yet complete.

Figure 9

It is mandatory to triage and assign priority of grading at this stage, and finally click Finish to return to the Main Activities screen

Note:

● If you have only completed one of the two steps required for an OCT encounter (i.e. only OCT Fundus capture, or only OCT scan capture) then the patient will appear in that day’s Clinic List as ‘Photography – Awaiting OCT surveillance photography’, and the blue warning icon displayed, as shown in Figure 10 below.

Figure 10

● A Patient will only move to the OCT Grading queues once both OCT Fundus and OCT Scan captures have been recorded in OptoMize.

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3. Grading an OCT Encounter

Once a patient has been screened in an OCT clinic it will only move to a grading queue once both steps – OCT Fundus Capture and OCT Scan Capture - have been recorded as complete. This includes where new fundus images might not be required and you have ticked that previous fundus images will be used.

Once both captures are complete then the patient will move state to ‘Awaiting Fundus OCT Surveillance grading’

If you have permission to both screen and grade patients in the OCT pathway, you can refresh the Clinic List by clicking [Search] to move a patient to a grading queue state. (Note: this will be dependent on what was just captured and dependent on your rights as a grader.)

The ‘ Grade ’ option on the central menu panel will become available to select for this patient. Alternatively select ‘Grade a specific patient’ if you have the patient’s name or ID.

If you selected ‘No - use previous fundus images’ during Capture, the system will rely upon the previous fundus grades too, and therefore will be no new OCT fundus images to grade. In this case the patient goes straight to OCT scan grading queue and you will be able to view the previous Fundus grade.

If you selected ‘Yes’ to OCT fundus capture and imported OCT fundus images, the patient will be in the OCT Fundus grading queue . Only after this patient’s OCT Fundus grading is complete does it move to OCT Scan grading.

3.1 OCT Fundus Grading

As an OCT Fundus Grader only, you should only have access to the OCT Fundus Grading queue (and any other standard Fundus Grading you may have permission to access). The OCT Fundus Grading queue will appear on your Main Activities screen when you log into OptoMize (figure 11).

Figure 11

The OCT Fundus Grading queue works in the same way as standard Fundus Grading queues, in that it displays patients according to priority High, Medium and Low, as triaged by the screener. When you

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click on the Grading queue title, or the High/Medium/Low sub-queue you will automatically be taken to the patient that has been in the queue the longest.

Just like standard Fundus grading, you can ‘Grade a specific patient’ if you know the name, ID, or encounter date, as shown in the search below (Figure 12):

Figure 12

Either select a specific patient, or click on the OCT Fundus Grading queue itself and the next screen that appears will be the OCT Fundus Grading form (Figure 13).

Figure 13

The OCT Grading form is the same as the standard Fundus Grading form: you can view information from the Screening visit on the Screening tab, view details of previous encounters, view any procedure or patient notes and view images from the current or previous encounters.

The only difference is on the Screening tab that will show the date of the OCT Fundus Capture and OCT Scan capture, including if these took place on different days, as entered by the Screener (Figure 14 and Figure 15).

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Figure 14

Figure 15

As an OCT Fundus Grader you should grade the features seen and once completed the worst grade will be displayed. The Outcome will be predefined as ‘Refer to scan OCT surveillance’ as the OCT Scn result needs to be entered before this encounter is complete (Figure 16).

Figure 16

You will be required to triage the patient for urgency of next grading step. Select Finish and the patient will now move to the OCT Scan Grading queue for completion.

3.2 OCT Scan Grading

As an OCT Scan Grader you are deemed to be a higher level grader and therefore have access to both the OCT Fundus Grading queue and the OCT Scan Grading queue, as shown in Figure 17 on your Main Activities screen.

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Figure 17

The OCT Scan Grading queue works in the same way all other Grading queues, in that it displays patients according to priority High, Medium and Low, as triaged by the screener (or OCT Fundus grader). When you click on the Grading queue title, or the High/Medium/Low sub-queue you will automatically be taken to the patient that has been in the queue the longest.

Just like other grading, you can ‘Grade a specific patient’ if you know the name, ID, or encounter date, as shown within the OCT Fundus Grading section above.

As an OCT Scan Grader therefore you can just perform OCT Fundus grading from here, or could perform OCT Fundus and OCT Scan grading at the same time, by going straight to the OCT Scan grading queue.

To enter the grade for an OCT Scan patient, either find and select a specific patient (‘Grade a specific Patient’), or click on the OCT Scan Grading queue itself; the next screen that appears will be the OCT Scan Grading form (Figure 18).

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Figure 18

Note, the Grading form is the same as the OCT Fundus grading form, with the addition of the features for OCT Scan grading, highlighted here within the red box (Figure 19).

Figure 19

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Within the OCT Grading Scheme there are the following clinical features that can be selected:

Features based description

Result Abbreviation Outcome

Outer Ring Oedema

Visible intra-retinal fluid within outer ETDRS ring

OCT observable outer ring oedema

OBS-ORO OCT 12mth

Inner Ring Oedema

Visible intra-retinal fluid within inner ETDRS ring

OCT observable outer ring oedema

OBS-IRO OCT 6mth

Central Oedema

Visible intra-retinal fluid within centre of ETDRS ring, foveal contours preserved

OCT observable central oedema

OBS-CO OCT 6mth

Visible intra-retinal fluid within centre of ETDRS ring, foveal contours lost

OCT referable central oedema

REF-CO Refer to Ophthalmology

If an OCT Scan cannot be graded there are two options:

● Select one or more of the 3 clinical features that determine inadequacy:

🡺 ILM – not visible within 5 ETDRS circle

🡺 5 central ETDRS zones outside scan area

🡺 Severe artefacts present.

Selecting any of these options will result in an ‘OCT Technical Failure’ result and the outcome will be predetermined as ‘Refer to Ophthalmology’

● Select ‘Scan inadequate for grading’ only, if a repeat Scan capture is required and another appointment needs to be rebooked – this option will allow the OCT Scan grader to request ‘Repeat Photography’ as an outcome option.

If ‘repeat photography’ is selected it is recommended that the OCT Scan Grader messages the DRS Admin team to advise why a repeat examination is being required, using the ‘Send Alert’ function, found near the top of the grading form (Figure 20).

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Figure 20

As in other grading functions, the Grader can add notes to the patient record or to results/referral letters by clicking Add within the options shown here (Figure 21)

Figure 21

Once grading is complete, click Finish to return to the Main Activities screen, or the Blue forward arrow to move onto the next patient in the OCT Scan Grading queue.

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