Applications of the OCULUS Pentacam for cataract and refractive surgery and general screening. Oculus Pentacam Wet-lab

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Robyn Henderson
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1 Oculus Pentacam Wet-lab Mark Purdy Purdy Consulting, LLC OCULUS head quarter, Wetzlar/Germany Applications of the OCULUS Pentacam for cataract and refractive surgery and general screening 1

2 Pentacam, the comprehensive analyzer Scheimpflug Image + Iris image & Keratometry overlay + 3D Anterior Chamber Analyzer + Pachymetry Map, absolute & relative + Topography Maps (ant. & post.) + Elevation Maps (ant. & post.) + 3D Cataract Analyzer & PNS + 3D piol simulation & aging prediction + Belin/Ambrosio Enhanced Ectasia III + Holladay Report & EKR Detail Report + Tomography & Corneal Optical Density + Cataract Pre-Op-Display & Corneal Wavefront + Indice Report & Help Topic + Corneal Ring Display + various compare displays = Pentacam 100 Scheimpflug images within one scan in less than 2 seconds Scheimpflug Example Schematic course of a scan 2

process 3D model of the anterior segment is calculated via ray-tracing The optical distortions are individually

3 Facts about the imaging and calculation process Center of the cornea is finely measured during the rotating scan Eye motion during imaging process is detected with the pupil camera Detected eye motion is corrected during the calculation process 3D model of the anterior segment is calculated via ray-tracing The optical distortions are individually corrected Overview of all captured Scheimpflug images Stop calculation Help topic Click with the mouse button to the yellow triangle 3

General & Glaucoma screening Glaucoma Screening 36,4 ACA 38,2 Kammervolumen Chamber 2, 68 anterior chamber normal eye

4 parameter value borders classification explantion reasons Quality specifications, QS QS should be checked after every examination! General & Glaucoma screening Glaucoma Screening 36,4 ACA 38,2 Kammervolumen Chamber 2, 68 anterior chamber normal eye 20,1 ACA 19,6 Chamber 1,60 volume mm anterior chamber narrow angle glaucoma Automatic Calculation of: Anterior chamber depth (ACD): internal/external Anterior chamber angle (ACA): in every Scheimpflug image Chamber volume (ACV) 12 4

5 Glaucoma clinical example post-op pre-op difference post-pre Iridectomy Benefit Scheimpflug image overview to detect abnormalities during calculation -> time saving Indices report Objective and automatic calculation of ACD, ACV, ACA in up to 100 locations ACV turns out to be best predictor for narrow angle Glaucoma and post-op iridotomy and is not provided by anterior chamber OCT s Pentacam anterior chamber parameters in young and middle-aged Chinese; Lam AK, Tse JS; Clin Exp Optom Jan;96(1): doi: /j x. Epub 2012 Sep 7. Assessment of the anterior chamber parameters after laser iridotomy in primary angle close suspect using Pentacam and gonioscopy; Alireza et al; Int. journal of Ophthalmology 2013;6(5): Comparison of scheimpflug imaging and spectral domain anterior segment optical coherence tomography for detection of narrow anterior chamber angles; DS Grewal, GS Brar, R Jain and SPS Grewal; Eye (2011), 1 9 & 2011 Macmillan Publishers Limited All rights reserved X/11 Corneal Refractive Surgery - screening for ectasia - Corneal rings/intacs 5

6 What about this case? With courtesy from Renato Ambrosio What about this case? With courtesy from Renato Ambrosio Belin/Ambrosio Display III Now with a database for hyperopic and myopic patients Tomographic Normal values for Corneal Elevation and pachymetry in a Hyperopic Population Joan Kim et all Clinical & Experimental Ophthalmology, 2011, 2:2 Includes a new parameter ARTmax = Tp/PPi(max) Tp = thinnest pachymetry PPi(max) = pachymetry progression index Novel pachymetric Parameters based on Corneal Tomography for diagnosing Keratoconus Renato Ambrosio et all Journal of Refractive Surgery, posted online July 29,

7 What about these cases? Keratoconus? With courtesy from Renato Ambrosio What about these cases? no keratoconus keratoconus With courtesy from Renato Ambrosio Belin/Ambrosio Display III, benefit quick visual inspection, comprehensive but intuitive quick decision for myopic and hyperopic patients for pre/post surgery Keratoconus/Ectasia detection combination of 5 singl, definite parameters into one final overall index minimizes the false negatives and false positives helpful for further diagnosis 7

The diagrams are displaying the max. and avg. values, depending on the selected column or line.

8 Cataract pre-op screening (includes the general screening) Corneal Optical Density Detailed optical densitometry evaluation in fixed layers and zones. The table chart contains average values only. The diagrams are displaying the max. and avg. values, depending on the selected column or line. Corneal optical densitometry, in a single slice or in a layer defined through 2 slices Corneal, optical density, average or maximum Corneal Optical Density post PKP 8

9 Patients selection for Premium IOL Cataract Pre-Op display It was developed in co-operation with Prof. Naoyuki Maeda Its main clinical use is the pre-op assessment of corneal optical properties for premium IOL selection using a four steps criteria: evaluation of corneal irregularities corneal shape assessment evaluations of corneal spherical aberrations evaluations of the corneal astigmatism An article was published in The Highlights of Ophthalmology Assessment of Corneal Optical Quality for Premium IOLs with Pentacam Cataract Pre-Op display 2nd Step: regular corneal topography, may be suitable for toric IOL 4th 1st Step: Step: Comparison Total HOA < of 0.3µm, corneal 3rd Step: Total Z40 (spherical aberration) therefore astigmatism = 0.105µm, suitable all are equal, therefore for aberration multifocal therefore free IOLs suitable for toric IOL or LRI IOL 9

10 toric IOLs Repeatabillity of corneal astigmatism Repeatabillity of corneal astigmatism COR ΔK IOL Master 500 relative COR LOA range 0.51 D % 1.02 D COR ΔK Pentacam HR sim K relative COR LOA range 0.32 D % 0.64 D 10

11 relative COR [%] Repeatabillity of corneal astigmatism Repeatabillity of corneal astigmatism Scheimpflug imaging derived values showed best repeatability Manual keratometry performed worst In range evaluated, no influence of value of astigmatism on COR Scheimpflug Tomography offers more data combined with more reliable measurements Total corneal astigmatism, important for toric IOL s? Anterior surface only? Is the posterior surface really important? The study Accuracy of Corneal Astigmatism Estimation by Neglecting the Posterior Corneal Surface Measurement showed: 10% of eyes with more than 1 D of astigmatism (candidates to toric IOL) had a difference in magnitude >0.5 D or a difference in angle >10 between anterior and total astigmatism. So considering the posterior surface is useful for these eyes. JAU-DER HO, CHING-YAO TSAI, AND SHIOW-WEN LIOU; 2009 BY ELSEVIER INC. ALL RIGHTS RESERVED /09/$36.00; doi: /j.ajo Conclusion, the posterior surface should be considered in terms of angle and amount of the astigmatism 11

12 Total Corneal Refractive Power The Pentacam calculates the Total Corneal Refractive Power of the cornea, considering: - anterior and posterior corneal shape - corneal thickness - Snell s law of refraction Pentacam provides most accurate and repeatable astigmatic measurements 4 steps to find the best Premium IOL Solution for toric IOL s, incl. posterior corneal surface in terms of: Detection Selection and providing of the best IOL calculation methode Print-out for the OR Benefit IOL power calculation with Pentacam 12

13 Import of the axial length of the human eye The Pentacam software allows the import of the axial length from optical biometers. Currently the axial length from the: AL-Scan from NIDEK Lenstar form Haag Streit OA-1000 from Tomey is supported by the Pentacam software. Phaco Optics and OKULIX are supporting this feature already. Summary: Pentacam for the Cataract surgery 1. pre-op screening using the Indices Display, corneal optical densitometry and Scheimpflug image (PNS) and Belin/Ambrosio Enhanced Ectasia 2. Premium IOL selection using the Cataract pre-op display 3. If necessary use the power distribution display for details 4. IOL power calculation using the: ASCRS or the manufacturers online calculators ray tracing calculators (Phaco Optics, OKULIX), BESSt II, Shammas post hyperopic LASIK, EKR s and Holladay II 5. Keratometry and Topography overlay in the iris image as a printout for the operating theather Imaging 13

14 Pentacam Example: PMD Pentacam example, cornea Descemet s Stripping with Endothelial Keratoplasty With courtesy from Prof. Michael Belin Pentacam example, cornea DLKP (deep lamelar keratoplasty) With courtesy from Dr. T. Neuhann 14

15 Post-op control With courtesy from Renato Ambrosio, MD Thank you for your attention Please visit us under Please visit us under Please visit us under Thank you for your attention Hands On Portion. 15

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