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Pathologies Come to Life

Software facilitates comparison of digital photographs

MICHAEL B. MAIZEL, O.D.

When glaucoma, diabetes or age-related macular degeneration suspects or patients have presented for pathology visits, we've typically used two options to determine whether their condition has remained the same, gotten better or worse: comparison of last visit's retinal photos with the current visit's photos by placing them side-by-side on a computer screen, or using a stereo viewer and comparing separate pairs of stereo photos. Now, however, we have a third option. It's called Matched-Flicker, from EyeIC.

Moving pictures

MatchedFlicker is Windows-compatible software (see "Matched-Flicker Requirements," right) that imports your patient's retinal images from your fundus camera or any digital camera (ie. attached to a biomicroscope) and allows you to select two of these images to compare. It then automatically aligns the chosen images and creates a "Flicker" that brings the images to life as motion to aid in your identification of changes in pathology.

As a result of this technology, I've been able to determine subtle changes, such as whether the neural rim is thinning or an alteration or deflection in the vessels is emanating from the disc.

Should the two retinal images you select for comparison appear similar, or almost identical, MatchedFlicker asks you whether you imported the same image twice. This is an important feature for two reasons: First, it acts as a safety net for swamped practitioners — most of us, I think. Second, if indeed the two similar-looking photos are separate from one another, the software immediately informs you that, that patient's pathology has likely undergone minimal change since his last visit. This can save you chair time.

MatchedFlicker Requirements

A PC or Virtual Machine running Windows XP SP2 or greater, or Vista.Net 2.0 or greater 1 GHz or better processor 512 MB or RAM or more Display with a resolution of 800 x 600 or higher, running in High or True color At least 2 gigs of free disc space.

Annotation ability

After assessing the images, MatchedFlicker enables you to mark the pathology on both the "Flicker" and the individual still images, allowing you to easily locate the pathology at the patient's next appointment.

Most recently, this feature came in handy when the software helped me, on a follow-up examination, identify the early subtle hypertensive arterial/venous (A/V) compression defects in a 35-year-old black male. I "marked" the defects on the retinal images and referred him back to his internist. His internist agreed with the diagnosis and provided appropriate treatment. On the scheduled follow-up visit, I referred to the pathology markings on the "Flicker" to determine the current status of the A/V compressions — very convenient.

Something else to consider: The software gives you the option of saving all the images as well as your marks as an .flk file, allowing you to share the information with fellow healthcare providers. (Any healthcare provider can download the reader version of MatchedFlicker for free at www.EyeIC.com)

In addition, MatchedFlicker can convert your marks to the same location on all the patient's stored retinal images, enabling you to accurately track disease progression.

Additional benefits

As a result of using Matched-Flicker in my own practice, identifying retinal disease and changes in pathology is no longer as time consuming as it once was. This has allowed me to spend more time on patient education. In fact, in addition to utilizing the software as a diagnostic aid, I've been using it to demonstrate to patients the change or stability of their retinal pathology through time — something that I've found has helped me instill adherence to my treatment recommendations.

As a brief aside, although EyeIC has designed the MatchedFlicker for retinal image comparison, I've had success in using it to compare external lesions, such as conjunctival pigment spots, iris nevi and lid lesions as well.

Identifying changes in pathology in retinal disease can mean the difference between blindness and sight, as our ability to do so dictates management decisions. Therefore, it's essential we employ technology that can aid us in this endeavor. Because the Matched-Flicker software helps determine changes in pathology via its ability to bring retinal images to life as motion for comparison purposes, I believe it�s a tool every practitioner who manages retinal disease patients should have. OM