DICOM, the standard that imaging devices speak to each other in, carries separate object definitions for ophthalmic photography in 8 bit and 16 bit, ophthalmic tomography, ophthalmic thickness maps, static perimetry measurements, and a whole family of refractive measurements: lensometry, autorefraction, keratometry, subjective refraction, visual acuity, axial measurements and intraocular lens calculations. That list, from Part 3 of the current standard, is a fair summary of why general clinic software runs out of road in an eye clinic. Almost everything you record is a measurement with a side, a device and a date, and most of it wants to sit next to a picture.
Here is what separates ophthalmology EMR software built for eyes from a general system with a "specialty template" bolted on.
The consultation record, field by field
Visual acuity. Unaided, aided, pinhole and near, each eye separately, in the notation your optometrist uses. A free-text box fails here, because the point of recording acuity is putting today against six months ago in one column.
Refraction. Sphere, cylinder, axis and add for each eye, and usually more than one set per visit: autorefraction, retinoscopy, subjective acceptance, final prescription. A system that stores one refraction per visit loses the distinction between what the machine measured and what the patient accepted.
Intraocular pressure. Value, method (applanation, non-contact, tonopen), time of day, and central corneal thickness when you have it. A glaucoma patient's chart is a time series, so the system has to plot it, not list it.
Anterior and posterior segment. Lids, conjunctiva, cornea, anterior chamber depth, iris, pupil and lens status with cataract grading (nuclear sclerosis, posterior subcapsular, cortical); then disc with cup-to-disc ratio, macula, vessels and periphery.
Every one of those fields needs a right and a left, stored separately and shown side by side. Laterality is the fastest test of whether a system was designed for eyes: ask the salesperson to open the vitals screen and count the columns.
Drawings are part of the record
Fundus charts, retinal detachment diagrams and slit lamp sketches are how eye findings get communicated, and they do not survive as a scanned photo of a paper sheet. Check three things in a demo: can you draw over a standard template, does the drawing print on the referral letter, and can you copy last visit's drawing forward and edit it.
Imaging: what DICOM gives you and what it does not
DICOM does two separate jobs and vendors blur them. The Storage Service Class is the part everyone demonstrates: the OCT, fundus camera and topographer send images somewhere and the EMR shows them. The second job saves your technician's afternoon. DICOM's Basic Worklist Management Service Class, specifically the Modality Worklist SOP Class, lets the EMR push the patient's details and the order out to the machine, so the technician picks a name from a list on the device instead of typing it. Typed names are where mismatched scans come from. Ask for worklist by name, and see it working on one of your own machines.
On the Indian side, the EHR Standards for India, notified by the Ministry of Health and Family Welfare in September 2013 and revised in 2016, name DICOM PS3.0-2015 for image, waveform and audio or video data, and say a health record implementation is required to implement the relevant DICOM Information Object Definitions for the data types it supports. Whether anyone inspects a private eye clinic against those standards is a separate question, and one I could not find an answer to, so treat DICOM as an interoperability decision you make for your own benefit, not a licensing hurdle. Our ABDM and electronic medical records checklist covers the rest of the standards picture.
Spectacles and the optical counter
DICOM has a Spectacle Prescription Report, which tells you the industry treats the spectacle prescription as a document of record, not a scribbled note. Check that the system prints a prescription an optician can dispense from, carrying pupillary distance, segment height and lens type, and that it keeps the prescribing history.
If the clinic sells frames, the requirements change shape. You need frame and lens stock by brand, model, size and colour, job orders out to the grinding lab with a promised date, and a bill that carries an exempt consultation and a taxable pair of spectacles on the same sheet. Health care services by a clinical establishment sit at Nil under Sl. No. 74 of Notification 12/2017-Central Tax (Rate); frames and lenses sold across the counter are goods. Show your accountant a sample bill from the demo.
The cataract list
Surgical work needs booking lists by surgeon and theatre day, biometry attached to the correct eye (axial length, keratometry, IOL power and the formula used), consent, an operation note, and the IOL model with its batch number against the patient. If the software cannot tell you which patients received a given IOL batch, it cannot help you when the manufacturer issues a notice.
Prices, and who publishes them
Of the ophthalmology-specific systems whose own websites I opened in September 2026, none published a price. Ezovion's ophthalmology page lists visual acuity, intraocular pressure and optical prescription storage, then asks you to book a demo; EyeMD EMR, Nextech, Compulink and Medixcel had no live pricing page. Expect a quotation, not a price list.
You can still anchor the number. General Indian clinic software does publish prices, and our medical software buyer's guide walks through how to read them. Treat the published general-purpose figure as your floor and make the ophthalmology vendor justify the gap in specific fields, not adjectives.
Where ExaHealth fits, and where it does not
ExaHealth is general clinic software, not an ophthalmology system. Its published feature list covers appointments and a live queue with WhatsApp wait-time alerts, e-prescriptions typed or dictated with medicines picked from a drug list and interaction alerts before sending, prescriptions and lab reports on WhatsApp, one-tap invoicing, role-based staff access, ABDM certification as a PHR and health locker with ABHA linking, an audit trail and data hosted in India. It does not list eye-specific fields, fundus drawing, DICOM device integration or optical stock, so if those are the reason you are buying, ask before shortlisting. Where it fits is the patient-facing half of an eye clinic: booking on your own domain, the waiting room, and getting reports out without phone calls.
A demo script for your optometrist
Run this with your own staff on every shortlisted system:
Register a patient and record acuity both eyes unaided and with pinhole, a refraction, an IOP with method, anterior segment findings and a fundus drawing.
Open the same patient a month later and put the two IOP readings side by side on one screen.
Send a worklist entry to your OCT, scan, and bring the images back into the visit.
Print a spectacle prescription and an operation note.
Export one patient's full record and open the file without the vendor's help.
Time each step. The system your optometrist finishes fastest is usually the right answer, whatever the feature grid says.
To see what a general Indian clinic platform covers before you decide how much eye-specific software you need, the ExaHealth features for doctors page lists it plainly.
Sources
DICOM defines Ophthalmic Photography 8 Bit / 16 Bit Image IODs (A.41, A.42), Ophthalmic…
DICOM defines both a Storage Service Class (Annex B) and a Basic Worklist Management…
EHR Standards for India (Ministry of Health & Family Welfare; first notified September…
GST: health care services by a clinical establishment are exempt, Sl. No. 74, Heading 9993,…
Ezovion's ophthalmology page lists "Log visual acuity, intraocular pressure, ocular…
Frequently Asked Questions
Is DICOM support mandatory for an eye clinic in India?
The EHR Standards for India name DICOM PS3.0-2015 as the standard for imaging data and say conforming systems must implement the relevant object definitions. I could not find evidence that any state registration authority inspects private clinics against those standards, so buy DICOM for interoperability and future portability, not because someone will fine you.
Can general clinic software handle an eye clinic if I keep imaging separate?
For booking, billing, queue and patient messaging, yes. For the clinical record, the sticking point is laterality and measurement history: acuity, refraction and IOP have to be per eye and comparable across visits. If a general system stores those as free text, your optometrist will keep a parallel paper register, which defeats the purpose.
What should I ask a vendor about my existing OCT and fundus camera?
Three questions. Does your system receive DICOM Storage from this exact model? Does it send a Modality Worklist to it? And is the DICOM option already licensed on my machine, or do I pay the device vendor extra? Get all three answered in writing, by model number, before you sign.