At a private practice in a rural town along the scenic coastline of British Columbia, ZEISS FORUM software is helping an ophthalmology practice provide modern comprehensive eye care to its residents. The Sunshine Coast is predominantly a retirement and tourism community and is accessible only by ferry from Vancouver. Dr. Brian Nelson has been practicing there since 2014, serving the local community of approximately 30,000 residents. His team provides cataract and minor surgery, glaucoma management, retinal disease monitoring and management, and manages all urgent referrals for the area.
ZEISS FORUM - A strong foundation for the modern diagnostic clinic
While assembling his first office, Dr. Nelson chose a ZEISS CIRRUS-OCT 500, VISUCAM 200, HUMPHREY Visual Field Analyzer II 740i, IOL Master 500, and ATLAS 9000 Corneal Topographer after researching his options. Due to his earlier career experience as an electrical engineer with a passion for information technology, he saw the great benefit in integrating all diagnostic equipment with Electronic Medical Records (EMR). For him the choice of “ecosystem” for his ophthalmic equipment was just as important as choosing his EMR. Fortunately, ZEISS FORUM had recently been released and proved to be the final piece of the puzzle for managing his equipment. In the last two years, his clinic upgraded to the IOL Master 700, the CIRRUS 6000, and CLARUS 500.
Speeding up our workflow with CLARUS 500
As an early adopter of the CLARUS 500, Dr. Nelson has seen additional benefits since adding true colour wide-field fundus photography to his practice in the COVID-19 era. For many patients, the close contact required for a retinal exam can be abbreviated, or avoided all together. This allows for shorter time spent in close proximity to his patients, shorter total visit time and improved use of telehealth. “I obtain an ultrawide field fundus photo on most new patients coming to the office, and for those with risk of peripheral retinal pathology such as posterior vitreous detachment symptoms, a 4-shot montage. This allows me to review the photo and examine only the far periphery myself when clinically appropriate. Diabetic retinopathy monitoring and screening is also streamlined with high-resolution ultrawide field photography.”
The CLARUS 500 brings next-generation fundus photography with leading-edge detail, colour and acquisition speed.
“The FORUM diagnostic ecosystem is built for today’s clinicians, office staff and patients.”
Having graduated with an electrical engineering degree before moving to medicine, Dr. Nelson plays an active role in managing his office and IT operations. For him there is a big benefit in having a single piece of software to train his staff on, whether performing biometry measurements for cataract surgery, doing visual field testing for glaucoma, or using OCT and fundus imaging for retinal diseases. Data security from both internal and external threats is an ever-increasing concern. However, by having a single local server to securely store his data, Dr. Nelson’s IT demands are streamlined. “I feel comfortable that with FORUM, my growing database is protected with simple backup solutions, including nightly cloud-based backups and weekly local off-site backups. I know I can recover from data loss very easily, should a problem arise.” Dr. Nelson has chosen a secure Canadian cloud backup provider that complies with his local privacy laws. He is able to access his data in the event of a total loss from the cloud, or can request a hard drive with the data with a very short turnaround time. The simplicity of data collection and storage provided with FORUM can reduce IT costs and complexity.
Continuous patient monitoring with Retina Workplace
The most important benefits to his practice come from the use of FORUM with his patients, in the examination room. For patients with retinal diseases, especially in the anti-VEGF era, Retina Workplace1 shines. Patients are very anxious at the idea of starting treatment with eye injections, especially when facing active vision loss. “We give patients their first anti-VEGF injections a few times a week in our practice and it requires a careful conversation with every patient. By showing patient’s their macular pathology in the exam room, with a combination of true colour photography and OCT bridges the knowledge gap for patients, helping them to understand their disease. I find it very rare that a patient declines to pursue an appropriate treatment with this technique. For patients referred out for macular surgery, it is also very gratifying to show patients their pre and post-op macular anatomy, which gives them encouragement along the way while recovering from surgery. ” Once treatment has begun, it is very reassuring for the patient to see their progress in both a graph of retinal thickness, as well improvement in macular fluid. Retina Workplace allows Dr. Nelson to review a trio of macular cubes in front of the patient. “Retina Workplace also provides an intuitive view of injection intervals, which can be charted along with the macular thickness data. During treat-and-extend, I find this the simplest way to review current and past treatment intervals for our many long term anti-VEGF patients. Many patients keenly await seeing their data for themselves at their visit, and I know they understand their pathology and treatment plan.”
Seeing the big picture: Glaucoma Workplace and the new workflow
Dr. Nelson manages a large cohort of patients with glaucoma, and many who are at high risk of developing this disease. Glaucoma Workplace is designed with practitioners in mind, in this data-heavy area of ophthalmology. Structural and functional analysis of the optic nerve over time is the backbone of glaucoma monitoring. “When making a decision to start treatment, Glaucoma Workplace provides a clear and concise view of optic nerve disease progression for both patients and clinicians. With patient compliance on glaucoma treatment often being an issue, we work hard to motivate our patients to be a partner in the treatment plan and that requires them to understand our treatment decisions. As my practice ages, I see increasing value on my oldest baseline data in monitoring for and treating glaucoma, which as we all know is a chronic disease.”
With benefits like integration, data security and patient education, ZEISS FORUM has become a comprehensive solution for meeting the needs of a demanding rural town practice. “I had the great fortune in building my practice from the very beginning, using an EMR and ZEISS FORUM software. Over the last 6 years, I have seen enhancements to FORUM arrive that continue to improve my workflow and ability to provide big-city calibre eye care in a rural area. Synergy between diagnostic equipment is only available when all your technology works perfectly together, and in our practice, the ZEISS FORUM software suite certainly delivers.”
ZEISS Retina Workplace and Glaucoma Workplace are ZEISS FORUM plug-ins.
The author of this article doesn't have a contractual or other financial relationship with Carl Zeiss Meditec, Inc.