Optimising Anterior Segment Slit-Lamp Imaging Through Workflow And Equipment Redesign: A Quality Improvement Project

Anterior segment slit-lamp imaging has emerged as a valuable tool for clinical documentation, communication, and longitudinal monitoring of anterior segment pathology, such as trauma, malignancy, corneal, eyelid, and ocular surface disease, as well as postoperative change. Despite potential benefits, its routine integration into ophthalmic workflows remains inconsistent and poorly characterised.

In this single-centre quality improvement project, we aim to evaluate real-world use of anterior segment slit-lamp imaging in routine practice, identify perceived clinical value and barriers to image acquisition and integration, and assess the impact of targeted workflow and equipment interventions on imaging uptake and perceived clinical utility.

A UK secondary care ophthalmology outpatient department delivering cataract, glaucoma, corneal, oculoplastic, medical retina, paediatric ophthalmology, eye casualty, general ophthalmology, orthoptic and optometry services, using electronic patient records and various ophthalmic imaging platforms. A single mounted slit-lamp imaging module was available in one clinic room, with images saved on a separate computer rather than directly into the electronic patient record.

Baseline data were collected using a clinician questionnaire assessing frequency and indications for anterior segment slit-lamp imaging, confidence in image acquisition, and perceived barriers to routine use. Quantitative data were summarised using descriptive statistics; qualitative data were thematically analysed. Existing imaging workflows, equipment accessibility, and image integration processes were reviewed. Based on these findings, targeted interventions will be introduced, including workflow redesign, optimisation of slit-lamp imaging equipment, and practical guidance on image capture and electronic storage. A second cycle of data collection is planned following implementation.

Baseline data were collected with a high clinician response rate (19/20; 95%). All respondents agreed that anterior segment slit-lamp photography improves documentation, disease monitoring, communication, teaching, and patient understanding. Despite this, 85% rarely or never used the mounted camera; 53% opted for alternative devices and 26% did not take photographs at all. Although 95% knew a camera was available, 42% were unfamiliar with its use and only 16% felt confident. Key barriers include limited access to and familiarity with camera, time pressures, and lack of clear workflow for image storage and retrieval. Post-intervention data assessing changes in imaging uptake, clinician confidence, and perceived usefulness will be presented.

Anterior segment slit-lamp imaging remains underutilised due to modifiable workflow and equipment factors. Quality improvement approaches focusing on clinician perspectives, imaging accessibility, and integration may improve uptake and standardisation of documentation. Addressing the gap between recognised clinical value and practical implementation represents a pragmatic opportunity to enhance patient safety, continuity of care, and education in outpatient ophthalmology.