16.03.2016 Presenter: Chris O‘Flaherty 1

Tomography vs. Topography

• Topography: The process for generating a “topograph”, a detailed representation or description of the surface characteristics of a structure.

Tomography vs. Topography

• Tomography: The process for generating a “tomogram”, a two-dimensional image of a slice or section through a three-dimensional object.

Placido Topography

Placido Topography, What are the issues?

Tear Film Dependance

Optical axis and

visual axis the same

Optical axis and

visual axis different

S I S I

Anterior Segment Tomography

– Schiempflug

– OCT

Pentacam® Comprehensive Analyzer

• High resolution anterior segment images

• Corneal thickness

• Curvature

• Total corneal refractive power

• Elevation

• Corneal Optical Densitometry

• Lens Densitometry and Pentacam Nucleus Staging (PNS) 3D cataract analysis

• Anterior chamber angles, depth, and volume

• Corneal aberrometry – Zernike wavefront analysis

Basic Principles

Rotating Scheimpflug Camera

• The Pentacam® uses a slit beam and Scheimpflug camera to take several cross-sectional images of the anterior segment of the eye.

3D Model

• The individual images are used to construct a 3D model of the eye

• All images go through the central cornea

• Coverage is nearly limbus to limbus

• Measurements are not tear film dependent

Standard Camera Scheimpflug Technique

Scheimpflug Imaging

Applications of Anterior Segment Tomography

• Angle Closure Glaucoma Screening and IOP Correction

• Detection of Keratoconus

• Screening Refractive Surgery Candidates

• Cataract Assessment

• IOL Selection and Calculations

• Anterior Segment Imaging

Pentacam® Glaucoma Screening

Glaucoma Screening

anterior chamber „normal “ eye

anterior chamber narrow angle glaucoma

2, 68 mm •Anterior chamber depth

•Anterior chamber angle

•Anterior Chamber Volume

1,60 mm

36,4° 38,2°

20,1°

19,6°

Chamber volume

Fast Screening Report/ Indices Report Display

Distribution of pathological findings (red) and normals

(green)

Overview Display - IOP Correction

Basic exam data

Click “Enter IOP” button to enter IOP

Enter measured IOP (Uncorrected IOP)

Normal Patient

Primary Closed Angle Glaucoma

Detection of Keratoconus and Screening for Refractive Surgery

“Keratoconus is a clinical term to describe a condition in which the cornea assumes a conical shape

because of thinning and protrusion”

Elevation Maps

Spherical Cornea Astigmatism Keratoconus

Elevation with Best Fit Sphere

Note the central island of elevation back surface elevation in this case

Enhanced Reference Shape

Courtesy of Dr. Michael Belin

Pachymetric

Evaluation of

the thickness

progression

on concentric

rings from

thinnest spot

towards

periphery

Thinnest spot

Pachymetric Progression

Pachymetric Progression: Corneal Thickness Spatial Profile

Pachymetric Progression: Percentage Thickness Increase

Belin/Ambrosio Display

Front Surface

Back Surface

Pachy Progression

Minimum Thickness

ART Max Summary (Final D)

Select the Appropriate Reference Database

Belin/Ambrosio Enhanced Ectasia

1. Ambrósio R Jr, Caiado AL, Guerra FP, Louzada R, Roy AS, Luz A, Dupps WJ, Belin MW. Novel Pachymetric Parameters Based on Corneal Tomography for Diagnosing Keratoconus. J Refract Surg. 2011 Oct;27(10):753-8. doi: 10.3928/1081597X-20110721-01. Epub 2011 Jul 29.

Belin/Ambrosio Enhanced Ectasia

1. Renato Ambrósio, Fernando Faria-Correia, Isaac Ramos, Bruno F. Valbon,Bernardo Lopes, Daniela Jardim & Allan Luz. Enhanced Screening for Ectasia Susceptibility Among Refractive Candidates: The Role of Corneal Tomography and Biomechanics. IOVS June 2013, Vol.54, 3715. doi: 10.1007/s40135-012-0003-z

Topometric / KC Staging Display

A= Anterior Curvature B= Posterior Curvature

C= Thinnest Pachymetry D= Best Corrected Visual Acuity

Keratoconus

Cataract Assessment

Lens Densitometry (PNS)

PNS Button: Pentacam Nucleus Staging

Value from 0 to 5 is displayed based on lens opacity Field will turn yellow if pupil is not dilated to 4mm as a quality warning

Lens Densitometry (PNS)

IOL Selection and Calculations

Axial/Sagittal Curvature

n=1.3375

True Net Power

• Anterior and posterior curvature is measured

• No adjustment for spherical aberration

n=1.376

n=1.336

True Net Power, 4.0mm Zone, Apex, Keratometric Mean (Km)

Total Corneal Refractive Power

• Ray Tracing is used to determine corneal power

• The anterior cornea, posterior cornea, and the refractive effect (i.e. spherical aberration) are considered

Holladay Report

Higher Order Abberations

Spherical Aberration

Ideal Optical System Spherical Aberration

Cataract Pre-Op Display

Detection of abnormal corneal shape (Keratoconus, Post LASIK, etc.)

Evaluation of corneal spherical aberration (Spheric or Aspheric IOL?)

Evaluation of corneal Higher order aberrations

Holladay Report

Operating Procedure

Patient Data Management

Add New Patient or Search for Existing Patients

You Must Click New to Enter Patient

Click Save After Entering Patient Info

Click Pentacam Button To Enter Exam Software

New Measurement

Click Examination Scan

New Measurement

• Sanitize the chinrest and forehead rest

• Seat the patient and explain what to expect during the scan

• Have the patient remove their glasses

New Measurement

• Adjust the table height

• Have the patient put chin in rest and forehead against strap

• Adjust the height of the chinrest so eyes are level with black ring

New Measurement • Turn out lights in room or cloak the patient

• Instruct the patient to focus on the fixation target and blink normally • Move the Pentacam so the crosshairs are in the center of the pupil and the red dot

(corneal apex) is on the red line • Guides will appear to assist with fine adjustments

New Measurement

• Make fine adjustments as directed

• When alignment is close instruct the patient to open eye wide • Proper alignment is a black cross in the center of the circle

with four black bars surrounding it.

• Instruct the patient not to blink and to remain still

• Let the patient know when the scan is complete

Evaluating Scan Quality

Capturing Quality Images

Good Scan Bad Scan

Too Much Ambient Light

Capturing Quality Images

Good Scan Questionable Scan

Check Track Alignment and Ensure Proper Fixation

Quality Specifications

Basic exam data

Discussion &

Hands On!

16.03.2016 Presenter: Chris O‘Flaherty 1 -...

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