Digital Imaging Communications in Medicine (DICOM)-compliant equipment is pervasive in radiology, but other domains such as ophthalmology lag in this regard. This is not due to a lack of need. Ophthalmologists create, interpret, store, and retrieve medical images daily. These images are central to any clinician’s decision-making process and are a keystone in diagnosis and treatment. The ability to accurately and effectively incorporate the image and metadata into a workflow depends largely on adherence to the DICOM standard. To determine areas of possible improvement in DICOM adherence, the workflow of various modalities throughout an ophthalmology department was examined. Potential improvements were found. These options are discussed here, and possible solutions are provided.