applications of the oculus pentacam® for cataract and ... · densitometry and scheimpflug image...
TRANSCRIPT
1
Oculus Pentacam Wet-lab
Mark Purdy Purdy Consulting LLC
purdyophthalmicsgmailcom
OCULUS head quarter WetzlarGermany
Applications of the OCULUS Pentacamreg for cataract and
refractive surgery and general screening
2
Scheimpflug Image + Iris image amp Keratometry overlay
+ 3D Anterior Chamber Analyzer
+ Pachymetry Map absolute amp relative
+ Topography Maps (ant amp post)
+ Elevation Maps (ant amp post)
+ 3D Cataract Analyzer amp PNS
+ 3D pIOL simulation amp aging prediction
+ BelinAmbrosio Enhanced Ectasia III
+ Holladay Report amp EKR Detail Report
+ Tomography amp Corneal Optical Density
+ Cataract Pre-Op-Display amp Corneal Wavefront
+ Indice Report amp Help Topic
+ Corneal Ring Display
+ various compare displays_______________
= Pentacamreg 100 Scheimpflug images within one scan in less than 2 seconds
Pentacamreg the comprehensive analyzer
Scheimpflug Example
Schematic course of a scan
3
Facts about the imaging and calculation process
bull Center of the cornea is finely measured during the rotating scan
bull Eye motion during imaging process is detected with the pupil camera
bull Detected eye motion is corrected during the calculation process
bull 3D model of the anterior segment is calculated via ray-tracing
bull 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
4
Quality specifications QS
bull parameter bull value bull borders bull classification bull explantion bull reasons
QS should be checked after every examination
General amp Glaucoma screening
Kammervolumen
Glaucoma Screening
anterior chamber bdquonormal ldquo eye
anterior chamber narrow angle glaucoma
2 68 mm
Automatic Calculation of
bull Anterior chamber depth (ACD) internalexternal
bull Anterior chamber angle (ACA) in every Scheimpflug image
bull Chamber volume (ACV)
160 mm
364deg 382deg
201deg
196deg
ACA
ACA
Chamber volume
12
Chamber volume
5
Glaucoma clinical example
post-pre Iridectomy
post-op pre-op difference
bullScheimpflug image overview to detect abnormalities during calculation -gt time saving bullIndices report bullObjective and automatic calculation of ACD ACV ACA in up to 100 locations bull ACV turns out to be best predictor for narrow angle Glaucoma and post-op iridotomy and is not provided by anterior chamber OCTrsquos
bullPentacam anterior chamber parameters in young and middle-aged Chinese Lam AK Tse JS Clin Exp Optom 2013 Jan96(1)85-91 doi 101111j1444-0938201200795x Epub 2012 Sep 7
bullAssessment of the anterior chamber parameters after laser iridotomy in primary angle close suspect using Pentacam and gonioscopy Alireza et al Int journal of Ophthalmology 20136(5)680-684 bullComparison 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) 1ndash9 amp 2011 Macmillan Publishers Limited All rights reserved 0950-222X11
Benefit
Corneal Refractive Surgery
- screening for ectasia - Corneal ringsIntacs
6
What about this case
With courtesy from Renato Ambrosio
What about this case
With courtesy from Renato Ambrosio
BelinAmbrosio 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 amp Experimental Ophthalmology 2011 22
Includes a new parameter ARTmax = TpPPi(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 2011
7
What about these cases
With courtesy from Renato Ambrosio
Keratoconus
What about these cases
With courtesy from Renato Ambrosio
keratoconus
no keratoconus
bullquick visual inspection comprehensive but intuitive
bullquick decision ndash for myopic and hyperopic patients
bullfor prepost surgery KeratoconusEctasia detection
bullcombination of 5 singl definite parameters into one final overall index
bullminimizes the ldquofalse negativesrdquo and ldquofalse positivesrdquo
bullhelpful for further diagnosis
BelinAmbrosio Display III benefit
8
Cataract pre-op screening (includes the general screening)
Corneal Optical Density
Corneal optical density average or maximum
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
post PKP
9
Patients selection for Premium IOL
Cataract Pre-Op display
bull It was developed in co-operation with Prof Naoyuki Maeda bull Its main clinical use is the pre-op assessment of corneal optical
properties for premium IOL selection using a four steps criteria bull evaluation of corneal irregularities bull corneal shape assessment bull evaluations of corneal spherical aberrations bull evaluations of the corneal astigmatism
bull An article was published in bdquoThe Highlights of Ophthalmologyldquo
Assessment of Corneal Optical Quality for Premium IOLs with Pentacamregldquo
Cataract Pre-Op display
1st Step Total HOA lt 03microm therefore suitable for multifocal IOLs
2nd Step regular corneal topography may be suitable for toric IOL
3rd Step Total Z40 (spherical aberration) = 0105microm therefore aberration free IOL
4th Step Comparison of corneal astigmatism ndash all are equal therefore suitable
for toric IOL or LRI
10
toric IOLs
Repeatabillity of corneal astigmatism
Repeatabillity of corneal astigmatism
ΔK IOL Master 500
COR relative
COR LOA range
051 D 5806 102 D
ΔK Pentacam HR sim K
COR relative
COR LOA range
032 D 4016 064 D
11
Repeatabillity of corneal astigmatism
4346
6905
5806
4836
5474
4016
8177
662
5213
4487 4299
33 3027
3604
0
10
20
30
40
50
60
70
80
90
100
rela
tive
CO
R [
]
Repeatabillity of corneal astigmatism
bull Scheimpflug imaging derived values showed best repeatability
bull Manual keratometry performed worst
bull In range evaluated no influence of value of astigmatism on COR
bull Scheimpflug Tomography offers more data combined with more reliable measurements
Total corneal astigmatism important for toric IOLlsquos
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 gt05 D or a difference in angle gt10deg 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 copy 2009 BY ELSEVIER INC ALL RIGHTS
RESERVED 0002-939409$3600 doi101016jajo200812020
Conclusion the posterior surface should be considered in terms of angle and amount of the astigmatism
12
Total Corneal Refractive Power
The Pentacamreg calculates the Total Corneal Refractive Power
of the cornea considering - anterior and posterior corneal shape
- corneal thickness - Snellrsquos law of refraction
bull Pentacam provides most accurate and repeatable astigmatic measurements
bull 4 steps to find the best Premium IOL
bull Solution for toric IOLlsquos incl posterior corneal surface in terms of
bull Detection
bull Selection and providing of the best IOL calculation methode
bull Print-out for the OR
Benefit
IOL power calculation with Pentacamreg
13
Import of the axial length of the human eye
The Pentacamreg software allows the import of the axial
length from optical biometers
Currently the axial length from the
bull AL-Scan from NIDEK
bull Lenstar form Haag Streit
bull OA-1000 from Tomey
is supported by the Pentacamreg 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 BelinAmbrosio 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
bull ASCRS or the manufacturers online calculators
bull ray tracing calculators (Phaco Optics OKULIX) BESSt II Shammas post hyperopic LASIK EKRlsquos and Holladay II
5 Keratometry and Topography overlay in the iris image as a print-out for the operating theather
Imaging
14
Pentacam Example PMD
Pentacam example cornea
Descemetrsquos Stripping with Endothelial
Keratoplasty
With courtesy from Prof Michael Belin
Pentacamreg example cornea
With courtesy from Dr T Neuhann
DLKP (deep lamelar keratoplasty)
15
Post-op control
With courtesy from Renato Ambrosio MD
Thank you for your attention
Please visit us under wwwpentacamcom
Please visit us under wwwoculusde
Please visit us under wwwoculustv
Thank you for your attention
Hands On Portion hellip
2
Scheimpflug Image + Iris image amp Keratometry overlay
+ 3D Anterior Chamber Analyzer
+ Pachymetry Map absolute amp relative
+ Topography Maps (ant amp post)
+ Elevation Maps (ant amp post)
+ 3D Cataract Analyzer amp PNS
+ 3D pIOL simulation amp aging prediction
+ BelinAmbrosio Enhanced Ectasia III
+ Holladay Report amp EKR Detail Report
+ Tomography amp Corneal Optical Density
+ Cataract Pre-Op-Display amp Corneal Wavefront
+ Indice Report amp Help Topic
+ Corneal Ring Display
+ various compare displays_______________
= Pentacamreg 100 Scheimpflug images within one scan in less than 2 seconds
Pentacamreg the comprehensive analyzer
Scheimpflug Example
Schematic course of a scan
3
Facts about the imaging and calculation process
bull Center of the cornea is finely measured during the rotating scan
bull Eye motion during imaging process is detected with the pupil camera
bull Detected eye motion is corrected during the calculation process
bull 3D model of the anterior segment is calculated via ray-tracing
bull 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
4
Quality specifications QS
bull parameter bull value bull borders bull classification bull explantion bull reasons
QS should be checked after every examination
General amp Glaucoma screening
Kammervolumen
Glaucoma Screening
anterior chamber bdquonormal ldquo eye
anterior chamber narrow angle glaucoma
2 68 mm
Automatic Calculation of
bull Anterior chamber depth (ACD) internalexternal
bull Anterior chamber angle (ACA) in every Scheimpflug image
bull Chamber volume (ACV)
160 mm
364deg 382deg
201deg
196deg
ACA
ACA
Chamber volume
12
Chamber volume
5
Glaucoma clinical example
post-pre Iridectomy
post-op pre-op difference
bullScheimpflug image overview to detect abnormalities during calculation -gt time saving bullIndices report bullObjective and automatic calculation of ACD ACV ACA in up to 100 locations bull ACV turns out to be best predictor for narrow angle Glaucoma and post-op iridotomy and is not provided by anterior chamber OCTrsquos
bullPentacam anterior chamber parameters in young and middle-aged Chinese Lam AK Tse JS Clin Exp Optom 2013 Jan96(1)85-91 doi 101111j1444-0938201200795x Epub 2012 Sep 7
bullAssessment of the anterior chamber parameters after laser iridotomy in primary angle close suspect using Pentacam and gonioscopy Alireza et al Int journal of Ophthalmology 20136(5)680-684 bullComparison 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) 1ndash9 amp 2011 Macmillan Publishers Limited All rights reserved 0950-222X11
Benefit
Corneal Refractive Surgery
- screening for ectasia - Corneal ringsIntacs
6
What about this case
With courtesy from Renato Ambrosio
What about this case
With courtesy from Renato Ambrosio
BelinAmbrosio 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 amp Experimental Ophthalmology 2011 22
Includes a new parameter ARTmax = TpPPi(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 2011
7
What about these cases
With courtesy from Renato Ambrosio
Keratoconus
What about these cases
With courtesy from Renato Ambrosio
keratoconus
no keratoconus
bullquick visual inspection comprehensive but intuitive
bullquick decision ndash for myopic and hyperopic patients
bullfor prepost surgery KeratoconusEctasia detection
bullcombination of 5 singl definite parameters into one final overall index
bullminimizes the ldquofalse negativesrdquo and ldquofalse positivesrdquo
bullhelpful for further diagnosis
BelinAmbrosio Display III benefit
8
Cataract pre-op screening (includes the general screening)
Corneal Optical Density
Corneal optical density average or maximum
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
post PKP
9
Patients selection for Premium IOL
Cataract Pre-Op display
bull It was developed in co-operation with Prof Naoyuki Maeda bull Its main clinical use is the pre-op assessment of corneal optical
properties for premium IOL selection using a four steps criteria bull evaluation of corneal irregularities bull corneal shape assessment bull evaluations of corneal spherical aberrations bull evaluations of the corneal astigmatism
bull An article was published in bdquoThe Highlights of Ophthalmologyldquo
Assessment of Corneal Optical Quality for Premium IOLs with Pentacamregldquo
Cataract Pre-Op display
1st Step Total HOA lt 03microm therefore suitable for multifocal IOLs
2nd Step regular corneal topography may be suitable for toric IOL
3rd Step Total Z40 (spherical aberration) = 0105microm therefore aberration free IOL
4th Step Comparison of corneal astigmatism ndash all are equal therefore suitable
for toric IOL or LRI
10
toric IOLs
Repeatabillity of corneal astigmatism
Repeatabillity of corneal astigmatism
ΔK IOL Master 500
COR relative
COR LOA range
051 D 5806 102 D
ΔK Pentacam HR sim K
COR relative
COR LOA range
032 D 4016 064 D
11
Repeatabillity of corneal astigmatism
4346
6905
5806
4836
5474
4016
8177
662
5213
4487 4299
33 3027
3604
0
10
20
30
40
50
60
70
80
90
100
rela
tive
CO
R [
]
Repeatabillity of corneal astigmatism
bull Scheimpflug imaging derived values showed best repeatability
bull Manual keratometry performed worst
bull In range evaluated no influence of value of astigmatism on COR
bull Scheimpflug Tomography offers more data combined with more reliable measurements
Total corneal astigmatism important for toric IOLlsquos
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 gt05 D or a difference in angle gt10deg 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 copy 2009 BY ELSEVIER INC ALL RIGHTS
RESERVED 0002-939409$3600 doi101016jajo200812020
Conclusion the posterior surface should be considered in terms of angle and amount of the astigmatism
12
Total Corneal Refractive Power
The Pentacamreg calculates the Total Corneal Refractive Power
of the cornea considering - anterior and posterior corneal shape
- corneal thickness - Snellrsquos law of refraction
bull Pentacam provides most accurate and repeatable astigmatic measurements
bull 4 steps to find the best Premium IOL
bull Solution for toric IOLlsquos incl posterior corneal surface in terms of
bull Detection
bull Selection and providing of the best IOL calculation methode
bull Print-out for the OR
Benefit
IOL power calculation with Pentacamreg
13
Import of the axial length of the human eye
The Pentacamreg software allows the import of the axial
length from optical biometers
Currently the axial length from the
bull AL-Scan from NIDEK
bull Lenstar form Haag Streit
bull OA-1000 from Tomey
is supported by the Pentacamreg 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 BelinAmbrosio 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
bull ASCRS or the manufacturers online calculators
bull ray tracing calculators (Phaco Optics OKULIX) BESSt II Shammas post hyperopic LASIK EKRlsquos and Holladay II
5 Keratometry and Topography overlay in the iris image as a print-out for the operating theather
Imaging
14
Pentacam Example PMD
Pentacam example cornea
Descemetrsquos Stripping with Endothelial
Keratoplasty
With courtesy from Prof Michael Belin
Pentacamreg example cornea
With courtesy from Dr T Neuhann
DLKP (deep lamelar keratoplasty)
15
Post-op control
With courtesy from Renato Ambrosio MD
Thank you for your attention
Please visit us under wwwpentacamcom
Please visit us under wwwoculusde
Please visit us under wwwoculustv
Thank you for your attention
Hands On Portion hellip
3
Facts about the imaging and calculation process
bull Center of the cornea is finely measured during the rotating scan
bull Eye motion during imaging process is detected with the pupil camera
bull Detected eye motion is corrected during the calculation process
bull 3D model of the anterior segment is calculated via ray-tracing
bull 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
4
Quality specifications QS
bull parameter bull value bull borders bull classification bull explantion bull reasons
QS should be checked after every examination
General amp Glaucoma screening
Kammervolumen
Glaucoma Screening
anterior chamber bdquonormal ldquo eye
anterior chamber narrow angle glaucoma
2 68 mm
Automatic Calculation of
bull Anterior chamber depth (ACD) internalexternal
bull Anterior chamber angle (ACA) in every Scheimpflug image
bull Chamber volume (ACV)
160 mm
364deg 382deg
201deg
196deg
ACA
ACA
Chamber volume
12
Chamber volume
5
Glaucoma clinical example
post-pre Iridectomy
post-op pre-op difference
bullScheimpflug image overview to detect abnormalities during calculation -gt time saving bullIndices report bullObjective and automatic calculation of ACD ACV ACA in up to 100 locations bull ACV turns out to be best predictor for narrow angle Glaucoma and post-op iridotomy and is not provided by anterior chamber OCTrsquos
bullPentacam anterior chamber parameters in young and middle-aged Chinese Lam AK Tse JS Clin Exp Optom 2013 Jan96(1)85-91 doi 101111j1444-0938201200795x Epub 2012 Sep 7
bullAssessment of the anterior chamber parameters after laser iridotomy in primary angle close suspect using Pentacam and gonioscopy Alireza et al Int journal of Ophthalmology 20136(5)680-684 bullComparison 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) 1ndash9 amp 2011 Macmillan Publishers Limited All rights reserved 0950-222X11
Benefit
Corneal Refractive Surgery
- screening for ectasia - Corneal ringsIntacs
6
What about this case
With courtesy from Renato Ambrosio
What about this case
With courtesy from Renato Ambrosio
BelinAmbrosio 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 amp Experimental Ophthalmology 2011 22
Includes a new parameter ARTmax = TpPPi(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 2011
7
What about these cases
With courtesy from Renato Ambrosio
Keratoconus
What about these cases
With courtesy from Renato Ambrosio
keratoconus
no keratoconus
bullquick visual inspection comprehensive but intuitive
bullquick decision ndash for myopic and hyperopic patients
bullfor prepost surgery KeratoconusEctasia detection
bullcombination of 5 singl definite parameters into one final overall index
bullminimizes the ldquofalse negativesrdquo and ldquofalse positivesrdquo
bullhelpful for further diagnosis
BelinAmbrosio Display III benefit
8
Cataract pre-op screening (includes the general screening)
Corneal Optical Density
Corneal optical density average or maximum
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
post PKP
9
Patients selection for Premium IOL
Cataract Pre-Op display
bull It was developed in co-operation with Prof Naoyuki Maeda bull Its main clinical use is the pre-op assessment of corneal optical
properties for premium IOL selection using a four steps criteria bull evaluation of corneal irregularities bull corneal shape assessment bull evaluations of corneal spherical aberrations bull evaluations of the corneal astigmatism
bull An article was published in bdquoThe Highlights of Ophthalmologyldquo
Assessment of Corneal Optical Quality for Premium IOLs with Pentacamregldquo
Cataract Pre-Op display
1st Step Total HOA lt 03microm therefore suitable for multifocal IOLs
2nd Step regular corneal topography may be suitable for toric IOL
3rd Step Total Z40 (spherical aberration) = 0105microm therefore aberration free IOL
4th Step Comparison of corneal astigmatism ndash all are equal therefore suitable
for toric IOL or LRI
10
toric IOLs
Repeatabillity of corneal astigmatism
Repeatabillity of corneal astigmatism
ΔK IOL Master 500
COR relative
COR LOA range
051 D 5806 102 D
ΔK Pentacam HR sim K
COR relative
COR LOA range
032 D 4016 064 D
11
Repeatabillity of corneal astigmatism
4346
6905
5806
4836
5474
4016
8177
662
5213
4487 4299
33 3027
3604
0
10
20
30
40
50
60
70
80
90
100
rela
tive
CO
R [
]
Repeatabillity of corneal astigmatism
bull Scheimpflug imaging derived values showed best repeatability
bull Manual keratometry performed worst
bull In range evaluated no influence of value of astigmatism on COR
bull Scheimpflug Tomography offers more data combined with more reliable measurements
Total corneal astigmatism important for toric IOLlsquos
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 gt05 D or a difference in angle gt10deg 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 copy 2009 BY ELSEVIER INC ALL RIGHTS
RESERVED 0002-939409$3600 doi101016jajo200812020
Conclusion the posterior surface should be considered in terms of angle and amount of the astigmatism
12
Total Corneal Refractive Power
The Pentacamreg calculates the Total Corneal Refractive Power
of the cornea considering - anterior and posterior corneal shape
- corneal thickness - Snellrsquos law of refraction
bull Pentacam provides most accurate and repeatable astigmatic measurements
bull 4 steps to find the best Premium IOL
bull Solution for toric IOLlsquos incl posterior corneal surface in terms of
bull Detection
bull Selection and providing of the best IOL calculation methode
bull Print-out for the OR
Benefit
IOL power calculation with Pentacamreg
13
Import of the axial length of the human eye
The Pentacamreg software allows the import of the axial
length from optical biometers
Currently the axial length from the
bull AL-Scan from NIDEK
bull Lenstar form Haag Streit
bull OA-1000 from Tomey
is supported by the Pentacamreg 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 BelinAmbrosio 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
bull ASCRS or the manufacturers online calculators
bull ray tracing calculators (Phaco Optics OKULIX) BESSt II Shammas post hyperopic LASIK EKRlsquos and Holladay II
5 Keratometry and Topography overlay in the iris image as a print-out for the operating theather
Imaging
14
Pentacam Example PMD
Pentacam example cornea
Descemetrsquos Stripping with Endothelial
Keratoplasty
With courtesy from Prof Michael Belin
Pentacamreg example cornea
With courtesy from Dr T Neuhann
DLKP (deep lamelar keratoplasty)
15
Post-op control
With courtesy from Renato Ambrosio MD
Thank you for your attention
Please visit us under wwwpentacamcom
Please visit us under wwwoculusde
Please visit us under wwwoculustv
Thank you for your attention
Hands On Portion hellip
4
Quality specifications QS
bull parameter bull value bull borders bull classification bull explantion bull reasons
QS should be checked after every examination
General amp Glaucoma screening
Kammervolumen
Glaucoma Screening
anterior chamber bdquonormal ldquo eye
anterior chamber narrow angle glaucoma
2 68 mm
Automatic Calculation of
bull Anterior chamber depth (ACD) internalexternal
bull Anterior chamber angle (ACA) in every Scheimpflug image
bull Chamber volume (ACV)
160 mm
364deg 382deg
201deg
196deg
ACA
ACA
Chamber volume
12
Chamber volume
5
Glaucoma clinical example
post-pre Iridectomy
post-op pre-op difference
bullScheimpflug image overview to detect abnormalities during calculation -gt time saving bullIndices report bullObjective and automatic calculation of ACD ACV ACA in up to 100 locations bull ACV turns out to be best predictor for narrow angle Glaucoma and post-op iridotomy and is not provided by anterior chamber OCTrsquos
bullPentacam anterior chamber parameters in young and middle-aged Chinese Lam AK Tse JS Clin Exp Optom 2013 Jan96(1)85-91 doi 101111j1444-0938201200795x Epub 2012 Sep 7
bullAssessment of the anterior chamber parameters after laser iridotomy in primary angle close suspect using Pentacam and gonioscopy Alireza et al Int journal of Ophthalmology 20136(5)680-684 bullComparison 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) 1ndash9 amp 2011 Macmillan Publishers Limited All rights reserved 0950-222X11
Benefit
Corneal Refractive Surgery
- screening for ectasia - Corneal ringsIntacs
6
What about this case
With courtesy from Renato Ambrosio
What about this case
With courtesy from Renato Ambrosio
BelinAmbrosio 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 amp Experimental Ophthalmology 2011 22
Includes a new parameter ARTmax = TpPPi(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 2011
7
What about these cases
With courtesy from Renato Ambrosio
Keratoconus
What about these cases
With courtesy from Renato Ambrosio
keratoconus
no keratoconus
bullquick visual inspection comprehensive but intuitive
bullquick decision ndash for myopic and hyperopic patients
bullfor prepost surgery KeratoconusEctasia detection
bullcombination of 5 singl definite parameters into one final overall index
bullminimizes the ldquofalse negativesrdquo and ldquofalse positivesrdquo
bullhelpful for further diagnosis
BelinAmbrosio Display III benefit
8
Cataract pre-op screening (includes the general screening)
Corneal Optical Density
Corneal optical density average or maximum
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
post PKP
9
Patients selection for Premium IOL
Cataract Pre-Op display
bull It was developed in co-operation with Prof Naoyuki Maeda bull Its main clinical use is the pre-op assessment of corneal optical
properties for premium IOL selection using a four steps criteria bull evaluation of corneal irregularities bull corneal shape assessment bull evaluations of corneal spherical aberrations bull evaluations of the corneal astigmatism
bull An article was published in bdquoThe Highlights of Ophthalmologyldquo
Assessment of Corneal Optical Quality for Premium IOLs with Pentacamregldquo
Cataract Pre-Op display
1st Step Total HOA lt 03microm therefore suitable for multifocal IOLs
2nd Step regular corneal topography may be suitable for toric IOL
3rd Step Total Z40 (spherical aberration) = 0105microm therefore aberration free IOL
4th Step Comparison of corneal astigmatism ndash all are equal therefore suitable
for toric IOL or LRI
10
toric IOLs
Repeatabillity of corneal astigmatism
Repeatabillity of corneal astigmatism
ΔK IOL Master 500
COR relative
COR LOA range
051 D 5806 102 D
ΔK Pentacam HR sim K
COR relative
COR LOA range
032 D 4016 064 D
11
Repeatabillity of corneal astigmatism
4346
6905
5806
4836
5474
4016
8177
662
5213
4487 4299
33 3027
3604
0
10
20
30
40
50
60
70
80
90
100
rela
tive
CO
R [
]
Repeatabillity of corneal astigmatism
bull Scheimpflug imaging derived values showed best repeatability
bull Manual keratometry performed worst
bull In range evaluated no influence of value of astigmatism on COR
bull Scheimpflug Tomography offers more data combined with more reliable measurements
Total corneal astigmatism important for toric IOLlsquos
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 gt05 D or a difference in angle gt10deg 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 copy 2009 BY ELSEVIER INC ALL RIGHTS
RESERVED 0002-939409$3600 doi101016jajo200812020
Conclusion the posterior surface should be considered in terms of angle and amount of the astigmatism
12
Total Corneal Refractive Power
The Pentacamreg calculates the Total Corneal Refractive Power
of the cornea considering - anterior and posterior corneal shape
- corneal thickness - Snellrsquos law of refraction
bull Pentacam provides most accurate and repeatable astigmatic measurements
bull 4 steps to find the best Premium IOL
bull Solution for toric IOLlsquos incl posterior corneal surface in terms of
bull Detection
bull Selection and providing of the best IOL calculation methode
bull Print-out for the OR
Benefit
IOL power calculation with Pentacamreg
13
Import of the axial length of the human eye
The Pentacamreg software allows the import of the axial
length from optical biometers
Currently the axial length from the
bull AL-Scan from NIDEK
bull Lenstar form Haag Streit
bull OA-1000 from Tomey
is supported by the Pentacamreg 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 BelinAmbrosio 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
bull ASCRS or the manufacturers online calculators
bull ray tracing calculators (Phaco Optics OKULIX) BESSt II Shammas post hyperopic LASIK EKRlsquos and Holladay II
5 Keratometry and Topography overlay in the iris image as a print-out for the operating theather
Imaging
14
Pentacam Example PMD
Pentacam example cornea
Descemetrsquos Stripping with Endothelial
Keratoplasty
With courtesy from Prof Michael Belin
Pentacamreg example cornea
With courtesy from Dr T Neuhann
DLKP (deep lamelar keratoplasty)
15
Post-op control
With courtesy from Renato Ambrosio MD
Thank you for your attention
Please visit us under wwwpentacamcom
Please visit us under wwwoculusde
Please visit us under wwwoculustv
Thank you for your attention
Hands On Portion hellip
5
Glaucoma clinical example
post-pre Iridectomy
post-op pre-op difference
bullScheimpflug image overview to detect abnormalities during calculation -gt time saving bullIndices report bullObjective and automatic calculation of ACD ACV ACA in up to 100 locations bull ACV turns out to be best predictor for narrow angle Glaucoma and post-op iridotomy and is not provided by anterior chamber OCTrsquos
bullPentacam anterior chamber parameters in young and middle-aged Chinese Lam AK Tse JS Clin Exp Optom 2013 Jan96(1)85-91 doi 101111j1444-0938201200795x Epub 2012 Sep 7
bullAssessment of the anterior chamber parameters after laser iridotomy in primary angle close suspect using Pentacam and gonioscopy Alireza et al Int journal of Ophthalmology 20136(5)680-684 bullComparison 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) 1ndash9 amp 2011 Macmillan Publishers Limited All rights reserved 0950-222X11
Benefit
Corneal Refractive Surgery
- screening for ectasia - Corneal ringsIntacs
6
What about this case
With courtesy from Renato Ambrosio
What about this case
With courtesy from Renato Ambrosio
BelinAmbrosio 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 amp Experimental Ophthalmology 2011 22
Includes a new parameter ARTmax = TpPPi(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 2011
7
What about these cases
With courtesy from Renato Ambrosio
Keratoconus
What about these cases
With courtesy from Renato Ambrosio
keratoconus
no keratoconus
bullquick visual inspection comprehensive but intuitive
bullquick decision ndash for myopic and hyperopic patients
bullfor prepost surgery KeratoconusEctasia detection
bullcombination of 5 singl definite parameters into one final overall index
bullminimizes the ldquofalse negativesrdquo and ldquofalse positivesrdquo
bullhelpful for further diagnosis
BelinAmbrosio Display III benefit
8
Cataract pre-op screening (includes the general screening)
Corneal Optical Density
Corneal optical density average or maximum
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
post PKP
9
Patients selection for Premium IOL
Cataract Pre-Op display
bull It was developed in co-operation with Prof Naoyuki Maeda bull Its main clinical use is the pre-op assessment of corneal optical
properties for premium IOL selection using a four steps criteria bull evaluation of corneal irregularities bull corneal shape assessment bull evaluations of corneal spherical aberrations bull evaluations of the corneal astigmatism
bull An article was published in bdquoThe Highlights of Ophthalmologyldquo
Assessment of Corneal Optical Quality for Premium IOLs with Pentacamregldquo
Cataract Pre-Op display
1st Step Total HOA lt 03microm therefore suitable for multifocal IOLs
2nd Step regular corneal topography may be suitable for toric IOL
3rd Step Total Z40 (spherical aberration) = 0105microm therefore aberration free IOL
4th Step Comparison of corneal astigmatism ndash all are equal therefore suitable
for toric IOL or LRI
10
toric IOLs
Repeatabillity of corneal astigmatism
Repeatabillity of corneal astigmatism
ΔK IOL Master 500
COR relative
COR LOA range
051 D 5806 102 D
ΔK Pentacam HR sim K
COR relative
COR LOA range
032 D 4016 064 D
11
Repeatabillity of corneal astigmatism
4346
6905
5806
4836
5474
4016
8177
662
5213
4487 4299
33 3027
3604
0
10
20
30
40
50
60
70
80
90
100
rela
tive
CO
R [
]
Repeatabillity of corneal astigmatism
bull Scheimpflug imaging derived values showed best repeatability
bull Manual keratometry performed worst
bull In range evaluated no influence of value of astigmatism on COR
bull Scheimpflug Tomography offers more data combined with more reliable measurements
Total corneal astigmatism important for toric IOLlsquos
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 gt05 D or a difference in angle gt10deg 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 copy 2009 BY ELSEVIER INC ALL RIGHTS
RESERVED 0002-939409$3600 doi101016jajo200812020
Conclusion the posterior surface should be considered in terms of angle and amount of the astigmatism
12
Total Corneal Refractive Power
The Pentacamreg calculates the Total Corneal Refractive Power
of the cornea considering - anterior and posterior corneal shape
- corneal thickness - Snellrsquos law of refraction
bull Pentacam provides most accurate and repeatable astigmatic measurements
bull 4 steps to find the best Premium IOL
bull Solution for toric IOLlsquos incl posterior corneal surface in terms of
bull Detection
bull Selection and providing of the best IOL calculation methode
bull Print-out for the OR
Benefit
IOL power calculation with Pentacamreg
13
Import of the axial length of the human eye
The Pentacamreg software allows the import of the axial
length from optical biometers
Currently the axial length from the
bull AL-Scan from NIDEK
bull Lenstar form Haag Streit
bull OA-1000 from Tomey
is supported by the Pentacamreg 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 BelinAmbrosio 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
bull ASCRS or the manufacturers online calculators
bull ray tracing calculators (Phaco Optics OKULIX) BESSt II Shammas post hyperopic LASIK EKRlsquos and Holladay II
5 Keratometry and Topography overlay in the iris image as a print-out for the operating theather
Imaging
14
Pentacam Example PMD
Pentacam example cornea
Descemetrsquos Stripping with Endothelial
Keratoplasty
With courtesy from Prof Michael Belin
Pentacamreg example cornea
With courtesy from Dr T Neuhann
DLKP (deep lamelar keratoplasty)
15
Post-op control
With courtesy from Renato Ambrosio MD
Thank you for your attention
Please visit us under wwwpentacamcom
Please visit us under wwwoculusde
Please visit us under wwwoculustv
Thank you for your attention
Hands On Portion hellip
6
What about this case
With courtesy from Renato Ambrosio
What about this case
With courtesy from Renato Ambrosio
BelinAmbrosio 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 amp Experimental Ophthalmology 2011 22
Includes a new parameter ARTmax = TpPPi(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 2011
7
What about these cases
With courtesy from Renato Ambrosio
Keratoconus
What about these cases
With courtesy from Renato Ambrosio
keratoconus
no keratoconus
bullquick visual inspection comprehensive but intuitive
bullquick decision ndash for myopic and hyperopic patients
bullfor prepost surgery KeratoconusEctasia detection
bullcombination of 5 singl definite parameters into one final overall index
bullminimizes the ldquofalse negativesrdquo and ldquofalse positivesrdquo
bullhelpful for further diagnosis
BelinAmbrosio Display III benefit
8
Cataract pre-op screening (includes the general screening)
Corneal Optical Density
Corneal optical density average or maximum
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
post PKP
9
Patients selection for Premium IOL
Cataract Pre-Op display
bull It was developed in co-operation with Prof Naoyuki Maeda bull Its main clinical use is the pre-op assessment of corneal optical
properties for premium IOL selection using a four steps criteria bull evaluation of corneal irregularities bull corneal shape assessment bull evaluations of corneal spherical aberrations bull evaluations of the corneal astigmatism
bull An article was published in bdquoThe Highlights of Ophthalmologyldquo
Assessment of Corneal Optical Quality for Premium IOLs with Pentacamregldquo
Cataract Pre-Op display
1st Step Total HOA lt 03microm therefore suitable for multifocal IOLs
2nd Step regular corneal topography may be suitable for toric IOL
3rd Step Total Z40 (spherical aberration) = 0105microm therefore aberration free IOL
4th Step Comparison of corneal astigmatism ndash all are equal therefore suitable
for toric IOL or LRI
10
toric IOLs
Repeatabillity of corneal astigmatism
Repeatabillity of corneal astigmatism
ΔK IOL Master 500
COR relative
COR LOA range
051 D 5806 102 D
ΔK Pentacam HR sim K
COR relative
COR LOA range
032 D 4016 064 D
11
Repeatabillity of corneal astigmatism
4346
6905
5806
4836
5474
4016
8177
662
5213
4487 4299
33 3027
3604
0
10
20
30
40
50
60
70
80
90
100
rela
tive
CO
R [
]
Repeatabillity of corneal astigmatism
bull Scheimpflug imaging derived values showed best repeatability
bull Manual keratometry performed worst
bull In range evaluated no influence of value of astigmatism on COR
bull Scheimpflug Tomography offers more data combined with more reliable measurements
Total corneal astigmatism important for toric IOLlsquos
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 gt05 D or a difference in angle gt10deg 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 copy 2009 BY ELSEVIER INC ALL RIGHTS
RESERVED 0002-939409$3600 doi101016jajo200812020
Conclusion the posterior surface should be considered in terms of angle and amount of the astigmatism
12
Total Corneal Refractive Power
The Pentacamreg calculates the Total Corneal Refractive Power
of the cornea considering - anterior and posterior corneal shape
- corneal thickness - Snellrsquos law of refraction
bull Pentacam provides most accurate and repeatable astigmatic measurements
bull 4 steps to find the best Premium IOL
bull Solution for toric IOLlsquos incl posterior corneal surface in terms of
bull Detection
bull Selection and providing of the best IOL calculation methode
bull Print-out for the OR
Benefit
IOL power calculation with Pentacamreg
13
Import of the axial length of the human eye
The Pentacamreg software allows the import of the axial
length from optical biometers
Currently the axial length from the
bull AL-Scan from NIDEK
bull Lenstar form Haag Streit
bull OA-1000 from Tomey
is supported by the Pentacamreg 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 BelinAmbrosio 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
bull ASCRS or the manufacturers online calculators
bull ray tracing calculators (Phaco Optics OKULIX) BESSt II Shammas post hyperopic LASIK EKRlsquos and Holladay II
5 Keratometry and Topography overlay in the iris image as a print-out for the operating theather
Imaging
14
Pentacam Example PMD
Pentacam example cornea
Descemetrsquos Stripping with Endothelial
Keratoplasty
With courtesy from Prof Michael Belin
Pentacamreg example cornea
With courtesy from Dr T Neuhann
DLKP (deep lamelar keratoplasty)
15
Post-op control
With courtesy from Renato Ambrosio MD
Thank you for your attention
Please visit us under wwwpentacamcom
Please visit us under wwwoculusde
Please visit us under wwwoculustv
Thank you for your attention
Hands On Portion hellip
7
What about these cases
With courtesy from Renato Ambrosio
Keratoconus
What about these cases
With courtesy from Renato Ambrosio
keratoconus
no keratoconus
bullquick visual inspection comprehensive but intuitive
bullquick decision ndash for myopic and hyperopic patients
bullfor prepost surgery KeratoconusEctasia detection
bullcombination of 5 singl definite parameters into one final overall index
bullminimizes the ldquofalse negativesrdquo and ldquofalse positivesrdquo
bullhelpful for further diagnosis
BelinAmbrosio Display III benefit
8
Cataract pre-op screening (includes the general screening)
Corneal Optical Density
Corneal optical density average or maximum
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
post PKP
9
Patients selection for Premium IOL
Cataract Pre-Op display
bull It was developed in co-operation with Prof Naoyuki Maeda bull Its main clinical use is the pre-op assessment of corneal optical
properties for premium IOL selection using a four steps criteria bull evaluation of corneal irregularities bull corneal shape assessment bull evaluations of corneal spherical aberrations bull evaluations of the corneal astigmatism
bull An article was published in bdquoThe Highlights of Ophthalmologyldquo
Assessment of Corneal Optical Quality for Premium IOLs with Pentacamregldquo
Cataract Pre-Op display
1st Step Total HOA lt 03microm therefore suitable for multifocal IOLs
2nd Step regular corneal topography may be suitable for toric IOL
3rd Step Total Z40 (spherical aberration) = 0105microm therefore aberration free IOL
4th Step Comparison of corneal astigmatism ndash all are equal therefore suitable
for toric IOL or LRI
10
toric IOLs
Repeatabillity of corneal astigmatism
Repeatabillity of corneal astigmatism
ΔK IOL Master 500
COR relative
COR LOA range
051 D 5806 102 D
ΔK Pentacam HR sim K
COR relative
COR LOA range
032 D 4016 064 D
11
Repeatabillity of corneal astigmatism
4346
6905
5806
4836
5474
4016
8177
662
5213
4487 4299
33 3027
3604
0
10
20
30
40
50
60
70
80
90
100
rela
tive
CO
R [
]
Repeatabillity of corneal astigmatism
bull Scheimpflug imaging derived values showed best repeatability
bull Manual keratometry performed worst
bull In range evaluated no influence of value of astigmatism on COR
bull Scheimpflug Tomography offers more data combined with more reliable measurements
Total corneal astigmatism important for toric IOLlsquos
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 gt05 D or a difference in angle gt10deg 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 copy 2009 BY ELSEVIER INC ALL RIGHTS
RESERVED 0002-939409$3600 doi101016jajo200812020
Conclusion the posterior surface should be considered in terms of angle and amount of the astigmatism
12
Total Corneal Refractive Power
The Pentacamreg calculates the Total Corneal Refractive Power
of the cornea considering - anterior and posterior corneal shape
- corneal thickness - Snellrsquos law of refraction
bull Pentacam provides most accurate and repeatable astigmatic measurements
bull 4 steps to find the best Premium IOL
bull Solution for toric IOLlsquos incl posterior corneal surface in terms of
bull Detection
bull Selection and providing of the best IOL calculation methode
bull Print-out for the OR
Benefit
IOL power calculation with Pentacamreg
13
Import of the axial length of the human eye
The Pentacamreg software allows the import of the axial
length from optical biometers
Currently the axial length from the
bull AL-Scan from NIDEK
bull Lenstar form Haag Streit
bull OA-1000 from Tomey
is supported by the Pentacamreg 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 BelinAmbrosio 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
bull ASCRS or the manufacturers online calculators
bull ray tracing calculators (Phaco Optics OKULIX) BESSt II Shammas post hyperopic LASIK EKRlsquos and Holladay II
5 Keratometry and Topography overlay in the iris image as a print-out for the operating theather
Imaging
14
Pentacam Example PMD
Pentacam example cornea
Descemetrsquos Stripping with Endothelial
Keratoplasty
With courtesy from Prof Michael Belin
Pentacamreg example cornea
With courtesy from Dr T Neuhann
DLKP (deep lamelar keratoplasty)
15
Post-op control
With courtesy from Renato Ambrosio MD
Thank you for your attention
Please visit us under wwwpentacamcom
Please visit us under wwwoculusde
Please visit us under wwwoculustv
Thank you for your attention
Hands On Portion hellip
8
Cataract pre-op screening (includes the general screening)
Corneal Optical Density
Corneal optical density average or maximum
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
post PKP
9
Patients selection for Premium IOL
Cataract Pre-Op display
bull It was developed in co-operation with Prof Naoyuki Maeda bull Its main clinical use is the pre-op assessment of corneal optical
properties for premium IOL selection using a four steps criteria bull evaluation of corneal irregularities bull corneal shape assessment bull evaluations of corneal spherical aberrations bull evaluations of the corneal astigmatism
bull An article was published in bdquoThe Highlights of Ophthalmologyldquo
Assessment of Corneal Optical Quality for Premium IOLs with Pentacamregldquo
Cataract Pre-Op display
1st Step Total HOA lt 03microm therefore suitable for multifocal IOLs
2nd Step regular corneal topography may be suitable for toric IOL
3rd Step Total Z40 (spherical aberration) = 0105microm therefore aberration free IOL
4th Step Comparison of corneal astigmatism ndash all are equal therefore suitable
for toric IOL or LRI
10
toric IOLs
Repeatabillity of corneal astigmatism
Repeatabillity of corneal astigmatism
ΔK IOL Master 500
COR relative
COR LOA range
051 D 5806 102 D
ΔK Pentacam HR sim K
COR relative
COR LOA range
032 D 4016 064 D
11
Repeatabillity of corneal astigmatism
4346
6905
5806
4836
5474
4016
8177
662
5213
4487 4299
33 3027
3604
0
10
20
30
40
50
60
70
80
90
100
rela
tive
CO
R [
]
Repeatabillity of corneal astigmatism
bull Scheimpflug imaging derived values showed best repeatability
bull Manual keratometry performed worst
bull In range evaluated no influence of value of astigmatism on COR
bull Scheimpflug Tomography offers more data combined with more reliable measurements
Total corneal astigmatism important for toric IOLlsquos
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 gt05 D or a difference in angle gt10deg 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 copy 2009 BY ELSEVIER INC ALL RIGHTS
RESERVED 0002-939409$3600 doi101016jajo200812020
Conclusion the posterior surface should be considered in terms of angle and amount of the astigmatism
12
Total Corneal Refractive Power
The Pentacamreg calculates the Total Corneal Refractive Power
of the cornea considering - anterior and posterior corneal shape
- corneal thickness - Snellrsquos law of refraction
bull Pentacam provides most accurate and repeatable astigmatic measurements
bull 4 steps to find the best Premium IOL
bull Solution for toric IOLlsquos incl posterior corneal surface in terms of
bull Detection
bull Selection and providing of the best IOL calculation methode
bull Print-out for the OR
Benefit
IOL power calculation with Pentacamreg
13
Import of the axial length of the human eye
The Pentacamreg software allows the import of the axial
length from optical biometers
Currently the axial length from the
bull AL-Scan from NIDEK
bull Lenstar form Haag Streit
bull OA-1000 from Tomey
is supported by the Pentacamreg 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 BelinAmbrosio 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
bull ASCRS or the manufacturers online calculators
bull ray tracing calculators (Phaco Optics OKULIX) BESSt II Shammas post hyperopic LASIK EKRlsquos and Holladay II
5 Keratometry and Topography overlay in the iris image as a print-out for the operating theather
Imaging
14
Pentacam Example PMD
Pentacam example cornea
Descemetrsquos Stripping with Endothelial
Keratoplasty
With courtesy from Prof Michael Belin
Pentacamreg example cornea
With courtesy from Dr T Neuhann
DLKP (deep lamelar keratoplasty)
15
Post-op control
With courtesy from Renato Ambrosio MD
Thank you for your attention
Please visit us under wwwpentacamcom
Please visit us under wwwoculusde
Please visit us under wwwoculustv
Thank you for your attention
Hands On Portion hellip
9
Patients selection for Premium IOL
Cataract Pre-Op display
bull It was developed in co-operation with Prof Naoyuki Maeda bull Its main clinical use is the pre-op assessment of corneal optical
properties for premium IOL selection using a four steps criteria bull evaluation of corneal irregularities bull corneal shape assessment bull evaluations of corneal spherical aberrations bull evaluations of the corneal astigmatism
bull An article was published in bdquoThe Highlights of Ophthalmologyldquo
Assessment of Corneal Optical Quality for Premium IOLs with Pentacamregldquo
Cataract Pre-Op display
1st Step Total HOA lt 03microm therefore suitable for multifocal IOLs
2nd Step regular corneal topography may be suitable for toric IOL
3rd Step Total Z40 (spherical aberration) = 0105microm therefore aberration free IOL
4th Step Comparison of corneal astigmatism ndash all are equal therefore suitable
for toric IOL or LRI
10
toric IOLs
Repeatabillity of corneal astigmatism
Repeatabillity of corneal astigmatism
ΔK IOL Master 500
COR relative
COR LOA range
051 D 5806 102 D
ΔK Pentacam HR sim K
COR relative
COR LOA range
032 D 4016 064 D
11
Repeatabillity of corneal astigmatism
4346
6905
5806
4836
5474
4016
8177
662
5213
4487 4299
33 3027
3604
0
10
20
30
40
50
60
70
80
90
100
rela
tive
CO
R [
]
Repeatabillity of corneal astigmatism
bull Scheimpflug imaging derived values showed best repeatability
bull Manual keratometry performed worst
bull In range evaluated no influence of value of astigmatism on COR
bull Scheimpflug Tomography offers more data combined with more reliable measurements
Total corneal astigmatism important for toric IOLlsquos
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 gt05 D or a difference in angle gt10deg 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 copy 2009 BY ELSEVIER INC ALL RIGHTS
RESERVED 0002-939409$3600 doi101016jajo200812020
Conclusion the posterior surface should be considered in terms of angle and amount of the astigmatism
12
Total Corneal Refractive Power
The Pentacamreg calculates the Total Corneal Refractive Power
of the cornea considering - anterior and posterior corneal shape
- corneal thickness - Snellrsquos law of refraction
bull Pentacam provides most accurate and repeatable astigmatic measurements
bull 4 steps to find the best Premium IOL
bull Solution for toric IOLlsquos incl posterior corneal surface in terms of
bull Detection
bull Selection and providing of the best IOL calculation methode
bull Print-out for the OR
Benefit
IOL power calculation with Pentacamreg
13
Import of the axial length of the human eye
The Pentacamreg software allows the import of the axial
length from optical biometers
Currently the axial length from the
bull AL-Scan from NIDEK
bull Lenstar form Haag Streit
bull OA-1000 from Tomey
is supported by the Pentacamreg 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 BelinAmbrosio 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
bull ASCRS or the manufacturers online calculators
bull ray tracing calculators (Phaco Optics OKULIX) BESSt II Shammas post hyperopic LASIK EKRlsquos and Holladay II
5 Keratometry and Topography overlay in the iris image as a print-out for the operating theather
Imaging
14
Pentacam Example PMD
Pentacam example cornea
Descemetrsquos Stripping with Endothelial
Keratoplasty
With courtesy from Prof Michael Belin
Pentacamreg example cornea
With courtesy from Dr T Neuhann
DLKP (deep lamelar keratoplasty)
15
Post-op control
With courtesy from Renato Ambrosio MD
Thank you for your attention
Please visit us under wwwpentacamcom
Please visit us under wwwoculusde
Please visit us under wwwoculustv
Thank you for your attention
Hands On Portion hellip
10
toric IOLs
Repeatabillity of corneal astigmatism
Repeatabillity of corneal astigmatism
ΔK IOL Master 500
COR relative
COR LOA range
051 D 5806 102 D
ΔK Pentacam HR sim K
COR relative
COR LOA range
032 D 4016 064 D
11
Repeatabillity of corneal astigmatism
4346
6905
5806
4836
5474
4016
8177
662
5213
4487 4299
33 3027
3604
0
10
20
30
40
50
60
70
80
90
100
rela
tive
CO
R [
]
Repeatabillity of corneal astigmatism
bull Scheimpflug imaging derived values showed best repeatability
bull Manual keratometry performed worst
bull In range evaluated no influence of value of astigmatism on COR
bull Scheimpflug Tomography offers more data combined with more reliable measurements
Total corneal astigmatism important for toric IOLlsquos
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 gt05 D or a difference in angle gt10deg 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 copy 2009 BY ELSEVIER INC ALL RIGHTS
RESERVED 0002-939409$3600 doi101016jajo200812020
Conclusion the posterior surface should be considered in terms of angle and amount of the astigmatism
12
Total Corneal Refractive Power
The Pentacamreg calculates the Total Corneal Refractive Power
of the cornea considering - anterior and posterior corneal shape
- corneal thickness - Snellrsquos law of refraction
bull Pentacam provides most accurate and repeatable astigmatic measurements
bull 4 steps to find the best Premium IOL
bull Solution for toric IOLlsquos incl posterior corneal surface in terms of
bull Detection
bull Selection and providing of the best IOL calculation methode
bull Print-out for the OR
Benefit
IOL power calculation with Pentacamreg
13
Import of the axial length of the human eye
The Pentacamreg software allows the import of the axial
length from optical biometers
Currently the axial length from the
bull AL-Scan from NIDEK
bull Lenstar form Haag Streit
bull OA-1000 from Tomey
is supported by the Pentacamreg 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 BelinAmbrosio 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
bull ASCRS or the manufacturers online calculators
bull ray tracing calculators (Phaco Optics OKULIX) BESSt II Shammas post hyperopic LASIK EKRlsquos and Holladay II
5 Keratometry and Topography overlay in the iris image as a print-out for the operating theather
Imaging
14
Pentacam Example PMD
Pentacam example cornea
Descemetrsquos Stripping with Endothelial
Keratoplasty
With courtesy from Prof Michael Belin
Pentacamreg example cornea
With courtesy from Dr T Neuhann
DLKP (deep lamelar keratoplasty)
15
Post-op control
With courtesy from Renato Ambrosio MD
Thank you for your attention
Please visit us under wwwpentacamcom
Please visit us under wwwoculusde
Please visit us under wwwoculustv
Thank you for your attention
Hands On Portion hellip
11
Repeatabillity of corneal astigmatism
4346
6905
5806
4836
5474
4016
8177
662
5213
4487 4299
33 3027
3604
0
10
20
30
40
50
60
70
80
90
100
rela
tive
CO
R [
]
Repeatabillity of corneal astigmatism
bull Scheimpflug imaging derived values showed best repeatability
bull Manual keratometry performed worst
bull In range evaluated no influence of value of astigmatism on COR
bull Scheimpflug Tomography offers more data combined with more reliable measurements
Total corneal astigmatism important for toric IOLlsquos
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 gt05 D or a difference in angle gt10deg 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 copy 2009 BY ELSEVIER INC ALL RIGHTS
RESERVED 0002-939409$3600 doi101016jajo200812020
Conclusion the posterior surface should be considered in terms of angle and amount of the astigmatism
12
Total Corneal Refractive Power
The Pentacamreg calculates the Total Corneal Refractive Power
of the cornea considering - anterior and posterior corneal shape
- corneal thickness - Snellrsquos law of refraction
bull Pentacam provides most accurate and repeatable astigmatic measurements
bull 4 steps to find the best Premium IOL
bull Solution for toric IOLlsquos incl posterior corneal surface in terms of
bull Detection
bull Selection and providing of the best IOL calculation methode
bull Print-out for the OR
Benefit
IOL power calculation with Pentacamreg
13
Import of the axial length of the human eye
The Pentacamreg software allows the import of the axial
length from optical biometers
Currently the axial length from the
bull AL-Scan from NIDEK
bull Lenstar form Haag Streit
bull OA-1000 from Tomey
is supported by the Pentacamreg 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 BelinAmbrosio 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
bull ASCRS or the manufacturers online calculators
bull ray tracing calculators (Phaco Optics OKULIX) BESSt II Shammas post hyperopic LASIK EKRlsquos and Holladay II
5 Keratometry and Topography overlay in the iris image as a print-out for the operating theather
Imaging
14
Pentacam Example PMD
Pentacam example cornea
Descemetrsquos Stripping with Endothelial
Keratoplasty
With courtesy from Prof Michael Belin
Pentacamreg example cornea
With courtesy from Dr T Neuhann
DLKP (deep lamelar keratoplasty)
15
Post-op control
With courtesy from Renato Ambrosio MD
Thank you for your attention
Please visit us under wwwpentacamcom
Please visit us under wwwoculusde
Please visit us under wwwoculustv
Thank you for your attention
Hands On Portion hellip
12
Total Corneal Refractive Power
The Pentacamreg calculates the Total Corneal Refractive Power
of the cornea considering - anterior and posterior corneal shape
- corneal thickness - Snellrsquos law of refraction
bull Pentacam provides most accurate and repeatable astigmatic measurements
bull 4 steps to find the best Premium IOL
bull Solution for toric IOLlsquos incl posterior corneal surface in terms of
bull Detection
bull Selection and providing of the best IOL calculation methode
bull Print-out for the OR
Benefit
IOL power calculation with Pentacamreg
13
Import of the axial length of the human eye
The Pentacamreg software allows the import of the axial
length from optical biometers
Currently the axial length from the
bull AL-Scan from NIDEK
bull Lenstar form Haag Streit
bull OA-1000 from Tomey
is supported by the Pentacamreg 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 BelinAmbrosio 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
bull ASCRS or the manufacturers online calculators
bull ray tracing calculators (Phaco Optics OKULIX) BESSt II Shammas post hyperopic LASIK EKRlsquos and Holladay II
5 Keratometry and Topography overlay in the iris image as a print-out for the operating theather
Imaging
14
Pentacam Example PMD
Pentacam example cornea
Descemetrsquos Stripping with Endothelial
Keratoplasty
With courtesy from Prof Michael Belin
Pentacamreg example cornea
With courtesy from Dr T Neuhann
DLKP (deep lamelar keratoplasty)
15
Post-op control
With courtesy from Renato Ambrosio MD
Thank you for your attention
Please visit us under wwwpentacamcom
Please visit us under wwwoculusde
Please visit us under wwwoculustv
Thank you for your attention
Hands On Portion hellip
13
Import of the axial length of the human eye
The Pentacamreg software allows the import of the axial
length from optical biometers
Currently the axial length from the
bull AL-Scan from NIDEK
bull Lenstar form Haag Streit
bull OA-1000 from Tomey
is supported by the Pentacamreg 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 BelinAmbrosio 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
bull ASCRS or the manufacturers online calculators
bull ray tracing calculators (Phaco Optics OKULIX) BESSt II Shammas post hyperopic LASIK EKRlsquos and Holladay II
5 Keratometry and Topography overlay in the iris image as a print-out for the operating theather
Imaging
14
Pentacam Example PMD
Pentacam example cornea
Descemetrsquos Stripping with Endothelial
Keratoplasty
With courtesy from Prof Michael Belin
Pentacamreg example cornea
With courtesy from Dr T Neuhann
DLKP (deep lamelar keratoplasty)
15
Post-op control
With courtesy from Renato Ambrosio MD
Thank you for your attention
Please visit us under wwwpentacamcom
Please visit us under wwwoculusde
Please visit us under wwwoculustv
Thank you for your attention
Hands On Portion hellip
14
Pentacam Example PMD
Pentacam example cornea
Descemetrsquos Stripping with Endothelial
Keratoplasty
With courtesy from Prof Michael Belin
Pentacamreg example cornea
With courtesy from Dr T Neuhann
DLKP (deep lamelar keratoplasty)
15
Post-op control
With courtesy from Renato Ambrosio MD
Thank you for your attention
Please visit us under wwwpentacamcom
Please visit us under wwwoculusde
Please visit us under wwwoculustv
Thank you for your attention
Hands On Portion hellip
15
Post-op control
With courtesy from Renato Ambrosio MD
Thank you for your attention
Please visit us under wwwpentacamcom
Please visit us under wwwoculusde
Please visit us under wwwoculustv
Thank you for your attention
Hands On Portion hellip