16.03.2016 Presenter: Chris O‘Flaherty 1 -...
Transcript of 16.03.2016 Presenter: Chris O‘Flaherty 1 -...
16.03.2016 Presenter: Chris O‘Flaherty 1
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Tomography vs. Topography
• Topography: The process for generating a “topograph”, a detailed representation or description of the surface characteristics of a structure.
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Tomography vs. Topography
• Tomography: The process for generating a “tomogram”, a two-dimensional image of a slice or section through a three-dimensional object.
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Placido Topography
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Placido Topography, What are the issues?
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Tear Film Dependance
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Optical axis and
visual axis the same
Optical axis and
visual axis different
S I S I
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Anterior Segment Tomography
– Schiempflug
– OCT
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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
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Basic Principles
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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.
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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
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Standard Camera Scheimpflug Technique
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Scheimpflug Imaging
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Scheimpflug Imaging
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Scheimpflug Imaging
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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
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Pentacam® Glaucoma Screening
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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°
ACA
ACA
Chamber volume
Chamber volume
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Fast Screening Report/ Indices Report Display
Distribution of pathological findings (red) and normals
(green)
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Overview Display - IOP Correction
Basic exam data
Click “Enter IOP” button to enter IOP
Enter measured IOP (Uncorrected IOP)
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Normal Patient
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Primary Closed Angle Glaucoma
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Detection of Keratoconus and Screening for Refractive Surgery
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“Keratoconus is a clinical term to describe a condition in which the cornea assumes a conical shape
because of thinning and protrusion”
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Elevation Maps
Spherical Cornea Astigmatism Keratoconus
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Elevation with Best Fit Sphere
Note the central island of elevation back surface elevation in this case
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Enhanced Reference Shape
Courtesy of Dr. Michael Belin
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Pachymetric
Evaluation of
the thickness
progression
on concentric
rings from
thinnest spot
towards
periphery
Thinnest spot
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Pachymetric Progression
Pachymetric Progression: Corneal Thickness Spatial Profile
Pachymetric Progression: Percentage Thickness Increase
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Belin/Ambrosio Display
Front Surface
Back Surface
Pachy Progression
Minimum Thickness
ART Max Summary (Final D)
Select the Appropriate Reference Database
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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.
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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
1.
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Topometric / KC Staging Display
A= Anterior Curvature B= Posterior Curvature
C= Thinnest Pachymetry D= Best Corrected Visual Acuity
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Keratoconus
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Cataract Assessment
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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
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Lens Densitometry (PNS)
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IOL Selection and Calculations
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Axial/Sagittal Curvature
n=1.3375
n=1
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True Net Power
• Anterior and posterior curvature is measured
• No adjustment for spherical aberration
n=1.376
n=1.336
n=1
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True Net Power, 4.0mm Zone, Apex, Keratometric Mean (Km)
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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
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Holladay Report
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Higher Order Abberations
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Spherical Aberration
Ideal Optical System Spherical Aberration
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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
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Holladay Report
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Operating Procedure
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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
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New Measurement
Click Examination Scan
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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
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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
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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
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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
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Evaluating Scan Quality
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Capturing Quality Images
Good Scan Bad Scan
Too Much Ambient Light
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Capturing Quality Images
Good Scan Questionable Scan
Check Track Alignment and Ensure Proper Fixation
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Quality Specifications
Basic exam data
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Discussion &
Hands On!