Archive for the ‘Devices’ Category

The Original OCT – First OCT Course anno 2003…old but not dusty!

Friday, February 7th, 2014

>English version find below

Es ist unglaublich und wunderschön zu sehen, wie OCT zum Segen der modernen Augenmedizin geworden ist. Die wirklich interessante Geschichte begann circa 2003, wo mit dem ersten kommerziell verfügbaren Time-Domain-OCT Stratus eine neue Epoche in der augenmedizinischen Diagnostik und Therapie eingeläutet wurde. Für den Patienten stand erstmals eine schonende und berührungsfreie Methode bereit, die ohne Nebenwirkungen beliebig oft wiederholt werden konnte.

Follow the first OCT presentation:

Download the first OCT presentation (113MB:  OCT anno 2003 Dr Maloca

OCT Original - the rey first presentation about OCT. Copyright © 2014 GETOCT™ Ltd. All rights reserved.

OCT Original – the very first presentation about OCT. Copyright © 2003-2014 GETOCT™ Ltd. All rights reserved.

Der Augenarzt betrat zuerst einen völlig neuen Mikrokosmos, obwohl aus histo-pathologischen Studien schon sehr viel bekannt war. Dennoch galt es mit Fleiss und Ausdauer, Erfahrungen zu sammeln, um die beste Diagnostik und Therapie zu finden. So haben beide Seiten von der heute etwas angestaubten, aber in den Grundzügen noch stets modernen Time-Domain-Technologie profitiert und viele Augen konnten gerettet werden.

Diabetes mellitus. Copyright © 2014 GETOCT™ Ltd. All rights reserved.

Diabetes mellitus. Copyright © 2003-2014 GETOCT™ Ltd. All rights reserved.

Als Erinnerung an diese “gute alte OCT-Zeit” wird hier der allererste Vortrag zu “OCT und Auge” veröffentlicht. Die Krankheiten haben in all den Jahren nichts an ihrer Aktualität und Gefährdung verloren. Doch gelingt es heute immer besser, die gefährliche Situation schneller und effektiver zu meistern. Schon 2003 zeigte sich eine neue Bildsprache, die mit den OCT-Geräten der neuesten Spectral-Domain-Technologie weiter verfeinert wurde. Dem Augenarzt erschliesst sich diese manchmal eigenwillige Sprache nicht sofort, sodass die “Originale OCT-Präsentation anno 2003″ auch heute Prinzipen zur richtigen Diagnostik aufzeigen kann. Viele interessante Minuten wünscht Dr. med. Peter Maloca, Luzern/University Basel.

Klassische Altersabhängige Makuladegeneration (AMD). Copyright © 2014 GETOCT™ Ltd. All rights reserved.

Klassische Altersabhängige Makuladegeneration (AMD). Copyright © 2003-2014 GETOCT™ Ltd. All rights reserved.

 

It’s amazing and wonderful to see how OCT has become a blessing of modern ophthalmology. The really interesting history began circa 2003, where it was heralded with the first commercially available time-domain OCT Stratus, a new era in eye care diagnostics and therapy. The eye doctor first entered a completely new microcosm, even though it was already very much known from histopathological studies. Nevertheless, it was hard work and perseverance to gain the top-experience to find the best diagnosis and treatment. So both sides have benefited from the “2003 modern time-domain technology” and many eyes were saved.

As a reminder to those “good old OCT-time” , the very first lecture will be published here in its original version. The diseases have lost in all the years none of their risks. But they can be defined today more quickly and effectively. In 2003 there was a new “visual language” introduced , which has been refined with the newer OCT devices as with the latest spectral domain technology. The eye doctor does not understand this sometimes idiosyncratic language immediately, so that the “Original OCT presentation from 2003″ can reveal principles for proper diagnosis even today. Many interesting minutes wishes Dr. Peter Maloca, Lucerne /University Basel.

Retinopathia centralis serosa. Copyright © 2014 GETOCT™ Ltd. All rights reserved.

Retinopathia centralis serosa. Copyright © 2003-2014 GETOCT™ Ltd. All rights reserved.

Diagnostic Atlas of Retinal Diseases offered by Optos (c)

Sunday, September 1st, 2013

A nice gesture from Optos  to realize rapidly which more eye diseases have to be discovered.

Download-> DE_Optos_Diagnostic_Atlas_A4 (PDF).

Diagnostic Atlas of Retinal Diseases. Copyright © 2013 Optos + GETOCT™ Ltd. All rights reserved.

Diagnostic Atlas of Retinal Diseases. Copyright © 2013 Optos + GETOCT™ Ltd. All rights reserved.

NEW ZEISS FORUM data management – Time is a life engine

Sunday, September 1st, 2013

Why do you work?       -> Deutsche Version siehe unten

No time for your patient, no time for a serious exam, no time for a good conversation, no quiet moment for an explanation, no time for a coffee? Why the hell then do you work? Are you already a real slave of your own time? Who made you beeing a slave? You like that?
If yes, forget it, be a slave. Do not read, what I have to report. Maybe you just like to be a slave.

Detect your “dead time zone“!

Analog office GETOCT

Analog office GETOCT

Finally. It is not a question of time. No! It is a question how you waste your time.   Ask yourself, where you can find these little monsters, called “time eaters” or “chronophages”.
In Switzerland we are masters about time and I can show you a way out to make time beeing your friend. Time wasters in an eye doctor’s office are poor organization, untraceable reports, unstructured data, many instruments with their own different formats which do not communicate with each other. I call this “dead time zone”.
No wonder that the office staff get in trouble, too, looses it’s motivation. At this point the game might be over. But there are doors that suddenly donate time – no matter which system you are working. To be ophthalmologist is a wonderful thing. What could be nicer than an eye? A marvel of nature.

Zeiss Data Forum Software

Ophthalmologists take pictures of many details, print it or save it then somewhere where they are no longer to be found. Getting more and more digital, results often in an  analog or digital chaos of data.  This chaos can be structured efficiently. The software “Zeiss Forum” arranges patient data, associates them with each other and allowes their analysis. In addition, data can be imported from devices, either manually or as if by a magic hand – completely automatically. Only when you try you will know it.

Data life zone with Forum:

  • save time for the patient and you
  • more competence
  • more space
  • much more efficiency
  • higer professionalism
  • motivated staff
  • increased networking with collegues and patient
  • more value of the office
  • environmental protection(paper, printer) and finally save money
Digital office GETOCT

Digital office GETOCT

Demo Zeiss Forum (Workshop von Zeiss Schweiz an der Schweizerischen Augenärztegesellschaft Locarno 2013)

-> view Demo “Forum Zeiss” by  GETOCT Blog

Warum arbeiten Sie?

Keine Zeit für Ihre Patienten, keine Zeit für eine seriöse Untersuchung, keine Zeit für ein gutes Gespräch, keine ruhige Minute für eine Erklärung,  keine Zeit für einen Kaffee? Wofür arbeiten Sie dann noch? Sind Sie schon ein richtiger Sklave Ihrer eigenen Zeit? Wenn ja, dann vergessen Sie es und lesen Sie nicht weiter, was ich zu berichten habe. Vielleicht möchten Sie gerne ein Sklave bleiben.

Wo sind die “Todeszonen”?

Es ist nicht eine Frage der Zeit. Nein! Es ist eine Frage, wie man aus der Zeit und Ihnen zwei Freunde macht. “Zeit-Fresser” lauern in einer Augenarztpraxis überall. Typisch sind schlechte Organisation, unauffindbare Berichte, unstrukturierte Daten, viele Messgeräte mit eigenen Formaten, die miteinander nicht kommunizieren. Kein Wunder, dass auch das Personal irgendwann genug hat. Dann kann es zu spät sein.

Es gibt aber Möglichkeiten, die plötzlich Zeit spenden – egal mit welchem System Sie arbeiten.

Zeiss Data Forum Software

Augenarzt zu sein, ist eine wunderbare Sache. Was gibt es Schöneres als ein Auge? Ein Wunderwerk der Natur. Augenärzte fotografieren viele Details, drucken diese aus oder speichern sie dann irgendwo ab, wo sie dann oft nicht mehr  zu finden sind. Je digitaler, je mehr digitales und analoges Daten-Chaos! Dieses Chaos kann effizient strukturiert werden. Die Software “Zeiss Forum” arrangiert Patientendaten, verknüpft sie untereinander und erlaubt deren Analyse. Zudem können Daten aus Geräten importiert werden, teils manuell, teils wie von Geisterhand – völlig automatisch. Nur wenn man etwas Neues probiert, weiss man, ob es klappt.

“Daten-Lebenszone:”

  • Sparen Sie Zeit für Ihren Patienten und sich selber
  • Mehr Kompetenz
  • Mehr Raum
  • Viel mehr Effizienz
  • Hohe Professionalität
  • Motiviertes Personal
  • Zunehmende Vernetzung mit Kollegen und Patienten
  • Wertsteigerung der Praxis
  • Umweltschutz (Papier, Drucker), Geld sparen

 

 

 

OCT Scan Step by Step – Schritt für Schritt

Wednesday, January 30th, 2013

In diesem kurzen Video wird gezeigt, wie eine OCT-Messung des Auges Schritt für Schritt abläuft: unkompliziert, absolut ohne Schmerzen, ohne Berührung des Auges und ohne den Patienten zu beeinträchtigen. Das ist hochmoderne Augenmedizin auf höchstem technologischen Stand. Der Film ist gedacht, um Patienten die Schritte zu zeigen und ihnen eine sorgenfreie Untersuchung zu ermöglichen.

This short video demonstrates an OCT experience: uncomplicated, without pain, without contact and without affecting the patient. This is state of the art eye care on to the highest technological standards. The film is intended to help patients to illustrate the steps of an OCt scan and give them a worry-free eye exam.

->View video OCT Scan Step by Step:

-> Download: OCT Scan Step by Step by GETOCT

Zeiss Cirrus 5000 OCT – a solid OCT solution – Optical Coherence Tomography (OCT)

Monday, January 14th, 2013
Deutsche Version untenstehend.

First Zeiss Cirrus 5000 HD OCT in Switzerland by

Dr. med. Peter Maloca, Blueye Vision Tech & GETOCT.COM.

Provided by Blueye Vision Tech GmbH

Provided by Blueye Vision Tech GmbH

->visit Blueye Vision Tech

GETOCT.COM was given the opportunity as a first party in Switzerland to test the brand new Cirrus 5000 from Zeiss Switzerland.

 

What is the worth of healthy eyes?

What is the worth of healthy eyes?  GETOCT.COM. Copyright © 2013 GETOCT™ Ltd. All rights reserved.

Already the Cirrus 4000 showed its intuitive, compact dimensions, a nice designed user interface and a great robustness. Thus, the Cirrus 4000 had 7 years worked daily without any fail! This is a very nice performance for a computer, for a highly complex optical coherence (OCT) scanner it is almost a miracle. The new Cirrus 5000 system features a modernized system based on a fast Windows 7 computer with much more faster processing and OCT camera system, a larger viewing monitor and a wireless mouse and keyboard. You will experience an increased speed, more comfort and and a better reliability.

->View first Swiss Impression of the brandnew ZeissCirrus5000 Optical Coherence OCT. Copyright © 2013 GETOCT™ Ltd. All rights reserved.

->Download Swiss Impressions Zeiss Cirrus5000HDOCT: Impressions Cirrus5000 GETOCT

Hard Core test NEW FastTrac™ retinal tracking system – full video without a cut.

This video shows the latest OCT technology in full length- without a cut.

-> View Tracker Test by GETOCT. Copyright © 2013 GETOCT™ Ltd. All rights reserved.

This demo film is shown in “real life”, without a cut or ​​any corrections. A young gentleman was measured to test the functionality of the newly introduced Fast Tracker. In the middle of the measurement, the person moves away from the scanner, sits down again, and very surprisingly, the scanner automatically finds the last position and finishes the scanning procedure as if nothing has happened. Surprise, suprise!

Download Video -> Hard Core Test Eyetracker Cirrus5000HD GETOCT

General featuresOCT Tools offered by Zeiss Cirrus 5000HDOCT.

Macula OCT Tools:

  • Precision FoveaFinder™
  • NEW FastTrac™ retinal tracking system
  • NEW Macular Thickness OU Analysis
  • Advanced RPE analysis
  • Macular Thickness and Change Analysis
  • Macular Thickness Normative Data

Glaucoma OCT Tools:

  • Retinal Nerv Fiber Analysis (RNFL)
  • Retinal Nerv Fiber Analysis (RNFL) Normative Data
  • Ganglion Cell Analysis
  • Guided Progression Analysis (GPA™)

Cornea Tools:

  • Axial Corneal Tghickness Analysis
  • Corneal 3D Imaging

 

First encounter- Cirrus 5000 HD OCT – a solid big brother.

Zeiss offered a wide range of tools to for the diagnosis of glaucoma, maculopathies and anterior segment conditions without an additional lens to be installed. At the first touch with the Cirrus 5000  you find your way very quickly. The setup has been consistently adapted from Cirrus 4000 and expanded:

The mouse and keyboard are now wireless and elegant to use. The mouse fits well in the hand, for larger hands it might be a little too small. The keyboard shows a need of getting used, because the keys are close together and the keyboard is arched. The arrow keys are placed into only one piece. The screen is much larger which facilitates the survey.

Professional OCT simplicity. “Reduce to the max “, was chosen as maxime and successfully implemented. A visual tour of the software is intuitive and pleasant as the controls are reduced to the most necessary and were placed very clear. The technical adaptation to the examiner of such a highly complex OCT technology is exemplary. In an OCT aquisition test – carried out by a 65 year old woman who had no knowledge of computers or even strange things like OCT – the data collection lasted under professional guidance only 2 minutes and 42 seconds.

Patient data. The input of the patient data go as previously very fast and easy.

Acquisition of the OCT data. The positioning of the head, focusing on the desired location to go quickly as before – perfect for OCt beginners. The generous protocols consist of anterior segment analysis (corneal thickness and mapping), macular thickness and cross scan regular or high definition (HD-OCT), Enhanced Depth Imaging (EDI) , ganglion-cell analysis, retinal nerve fiber layer analysis (RNFL), optic nerve head analysis (OHD).

New Tools Zeiss Cirrus 500 HD OCT.

Modernized system. Nice handling with wireless mouse and keyboard. Much larger display for relaxing computer work und data representation. Exacter, faster and reproducible data aquisition, and above all very fast data processing.

Fast Tracis an active eye-tracker allows repeatable measurements of identical sites. The tracker is optional, which means that it can be turned off in patients with a perfect fixation. If fixation is impaired, for example in cases of maculopathies, the tracker supports the OCT measurement. The method compensates blinking and eye movements, which otherwise often lead to artifacts and a poor image quality and leads to a wastage of precious time. The patient can now even stand-up and leave the room during the measurement, later sit down and The Cirrus 5000 HD OCT continues with the measurement at the predetermined location accurately. In a test this feature worked perfectly: a surprisingly positive result. This may be important in patients who need a break because theybecome tired very quickly or unexpectedly need to use the lavatory.

Synopsis of the macular dataset both eyes. It is encouraging that now the data of macular measurements in a synopsis can be represented. This makes comparison and pathological changes easier to explain to the patient.

New Zeiss Forum Software Suite (network based and very fast data transfer and data analysis).  For the digital data transfer,  Zeiss provides an interesting way offering a central software solution (Zeiss Forum) so that the patient data have to be typed in only once at the reception and investigative requests to the inthe network existing Zeiss machines are sent instantly. Save time. Save paper. Save money. Go digital. It works and nearly all kind of data output from different manufacturers, even videos can be imported. The so-called “Turnschuh-Laufwerk” or  “sneaker-drive” is now a thing of the past.

Not enough about OCT? What is still missing?

Data analysis. Various analytical protocols process the acquired OCT data. If several identical scansets were performed in one patient, it happens quickly, that a wrong data set is clicked to be analyzed. The analytical protocol “crunshes” then all the data to a visual representation, but “the dog cannot be stopped”. A small “Cancel button” would save time.

Patient data. Best enter first the day and month of birth, then choose the dropdown menu to complete the year of birth very quickly. The represntation of the months is now relatively dynamically as the past or future months appears a little smoother. This is a matter of taste. However,  displaying like “one click, one month” would be prefered and zack you are done.

Analysis screen design. Fortunately, the number of analysis options has increased, which leads to safer diagnosis and treatments of eye diseases. Because of the abundance, not all protocols appear at the same time, therefore time-consuming scrolling is needed. To change this, it should not be a computer science major effort. Only enlarge the “analysis protcolls window” down and efficiency is improved by a simple step.

Black-On-White versus White-On-Black mode. What’s missing is a small switch button to quickly change the color coding of the OCT images, ideally black-on-white, since the layers are better visible, printer ink can be saved to reduce costs and to protect the environment . This desire was expressed many years ago.

Security. Currently there is a good security setup of the device with password protection and separate selection of the OCT operator. This is especially useful in large and busy eye centers. In smaller offices  ethe first steps are rather cumbersome and make no real sense, because often only one or two investigators are involved.

Corneal thickness measurement (Corneal Thickness). Zeiss treats the cornea to neglected. It would be beautiful to have a survey of the entire corneal cube in micrometers (OCT pachymetry), not only a  few and small sized sections. It would also be helpful if the compartments (epithelium, stroma) are measured in Thickness and volume, especially for refractive surgery or keratoconus. Moreover: measurements should not only be possible vertically along the laser optical axis, but also obliquely, for example, in corneal scars or corneal wounds. A longer corneal scan length would be very desirable, why not at last 14 millimeters?

Chamber angle (Anterior Segment). In certain situation the numeric definition of the anterior chamber angle is helpful.

Children and Teen: normative database for macula and glaucoma. Why is the “OCT-life” beginning at 18 years? In practice, there are many children and young people by the way. Therefore, a normative database for the under-18s is important. Ths is missing nearly by all OCT manufacturers.

Noise-fan. The new Cirrus 5000 system is very quiet, almost “OCT-whispering” only. Cirrus 4000 produces much more noise, so the existing aerators can be replace, especially OCT operators who sit all day near the OCT scanner would be veryy happy. By the way: it is possible to replace the fans of the Cirrus 4000, to reduce the noise impact. Ask the Zeiss representant!
What are you missing? Please write your comment below! Please enter your comments in the comment section below, thank you!

Cirrus 5000_GETOCT.COM 1

Brand new OCT Cirrus 5000 GETOCT.COM. Copyright © 2013 GETOCT™ Ltd. All rights reserved.

Erstes Zeiss Cirrus 5000 HD OCT in der Schweiz,

von Dr. med. Peter Maloca, Luzern, Blueye Vision Tech GETOCT.

GETOCT.COM hatte als erste in der Schweiz die Chance  erhalten, das brandneue Cirrus 5000 OCT (Optical Coherence Tomography oder Optische Kohärenztomography, kurz OCT) zu testen. Bereits das Cirrus 4000 zeigte seine intuitive Bedienbarkeit, kompakte Masse, ein schönes und praktisches Design und eine grosse Robustheit. So hat das Cirrus 4000 HD OCT seit 7 Jahren täglich funktioniert – ohne einen Ausfall. Das ist eine ausserordentliche Leistung für einen Computer, für einen hochkomplexen OCT-Scanner ist es fast ein Wunder.

Das neue modernisierte Cirrus 5000 HD OCT-System verfügt über eine zeitgemässe Hard- und Software, basierend auf einem schnellen Computer mit Windows 7 mit 64 bit, einem deutlich beschleunigten OCT-Kamera-System, einem angenehm größeren 19 Zoll Monitor und einer drahtlosen Maus und Tastatur. Dies führt zu einer schnelleren Verarbeitung mit kürzeren Zeiten für den Patienten und den Augenarzt. Die OCT-Scangeschwindigkeit liegt zwischen 27,000 bis 68,000 pro Sekunde.

Cirrus 5000 OCT – der grosse Bruder
Nicht zuletzt fand sich eine ausserordenltiche breite Palette an Tools zur Diagnose von Glaukom, Maculopathien und Vordersegment, ohne dass eine Zusatzlinse installiert werden muss.

Erste Berührung.

Schon bei der ersten Berührung findet man sich sehr schnell zurecht. Das Setup wurde konsequent vom bewährten und weit verbreiteten Cirrus 4000 HD OCT adaptiert und erweitert:

Die Maus und das Keyboard sind jetzt kabellos und elegant zu bedienen. Die Maus sitzt gut in der Hand, kann für grössere Hände aber etwas zu klein daherkommen. Die Tastatur ist gewöhnungsbedürftig, da die Tasten eng beieinander sind und die Tastatur gewölbt ist. Die Tastatur ist auf Englisch, sodass das x und y gesucht werden müssen. Daran gewöhnt man sich aber sehr rasch. Die Pfeiltaste besteht nun aus einem Guss und wirkt zu sperrig. Ein grosser, aufgeräumter Bildschirm erleichtert die Arbeit sehr.

Professionelle OCT-Schlichtheit. “Reduce to the max”, wurde als Maxime gewählt und erfolgreich verwirklicht. Die visuelle Führung durch die Software ist intuitiv und angenehm, da die Bedienelemente auf das Allernötigste reuziert und sehr übersichtlich platziert wurden. Die technische Adaptation an den Untersucher einer so hochkomplexen OCT-Technologie ist vorbildhaft. Bei einem OCT-Aufnahmetest – ausgeführt durch eine 65 jährige Frau, die keine Ahnung von Computern oder geschweige OCT hatte – dauerte die Daten Erfassung unter professioneller Anleitung nur 2 Minuten und 42 Sekunden.

Patientendaten: die Eingabe der Patientendaten und des Geburtsdatums gehen wie bis anhin sehr flüssig und zeitsparend. Am besten erfolgt zuerst die Eingabe das Tages und der Monats der Geburt, danach soll das DropDownmenu angeklickt werden, um das Geburtsjahr rasch zu vervollständigen. Am Bildschirm huscht nun relativ dynamisch bei der Wahl des Monats die Anzeige vorbei und erscheint etwas flüssiger. Bevorzugt wird aber die Darstellung “ein Klick, ein Monat”, zack und fertig.

Neuestes  Zeiss Forum Datensuite (blitzschneller Datentrasfer und Datenanalyse im Netzerk): für den Datentransfer bietet Zeiss eine interessante Möglichkeit durch eine zentrale Software-Lösung (Zeiss Forum), sodass die Patientendaten am Empfang nur einmal eingetippt werden müssen und dann Untersuchungs-Aufträge über das Netzwerk an vorhandene Zeiss- Maschinen blitzschnell geschickt werden. Spare Zeit, Papier und Geld. Das sogenannte “Turnschuh-Laufwerk” gehört ab jetzt der Vergangenheit an. Erfreulicherweise und für den klinischen Alltag sehr wichtig können in die Forum Suite Daten von fast allen anderen Firmen über einen separaten Kanal importiert werden, sogar Videos.

Aquisition der OCT-Daten. Die Positionierung des Kopfes, die Fokussierung auf die gewünschte Lokalisation des vorderen oder hinteren AUgensegments gehen sehr rasch wie bisher. Gerade OCT-Beginner werden Freude daran haben und sich rasch eingewöhnen. Die grosszügigen Protokolle bestehen aus Vordersegment-Analyse (Cornea-Dicke und Mapping), Makula-Dicke und Querschnitt, Enhanced Depth Imaging (EDI) , Ganglien-Zell-Analyse, retinale Nerven-Faser-Schicht Analyse (RNFL), Opticus.

Neue Funktionen Zeiss Cirrus 5000 HD OCT.

Modernisiertes System. Haptisch ist die Benutzung der kabellosen Maus und der Tastatur sehr angenehm. Ein deutlich größerer Monitor sorgt für entspannte Arbeit am Computer und Darstellung der OCT-Daten, was auch bei der Erklärung der Pathologien für den Patienten hilfreich ist. Das führt zu einer genaueren, merklich schnelleren und reproduzierbareren Datenaufnahme und vor allem sehr schnellen Datenverarbeitung.

Fast Trac ist ein aktiver Augen-Tracker erlaubt die wiederholbare Messung identischer Lokalisationen. Der Tracker ist optional, das heisst, dass man bei Patienten mit perfekter Fixation, der Tracker ausgeschaltet werden kann. Ist die Fixation beeinträchtigt, zum Beispiel bei Makulopathien, unterstützt der Tracker die Messung. Die Methode kompensiert Blinzeln und Augenbewegungen, was sonst häufig zu Artefakten und schlechten Bildern führt und Zeit kostet. Der Patient kann nun sogar während der Messung vom Scanner weggehen, sich hinsetzen und Cirrus fährt mit der Messung an der genau vorgegebenen Stelle weiter. Beim Selbstversuch zeiget sich ein erstaunlich positives Resultat. Das kann wichtig sein bei Patienten, die rasch ermüden, eine Pause benötigen oder unerwartet auf das WC müssen.

Makula-Synopsis. Erfreulich ist, dass nun die Daten einer Makula-Messung in einer Synopsis beider Augen darstellbar sind. Das erleichtert den Vergleich und krankhafte Veränderungen sind dem Patienten einfacher erklärbar.

Nicht genug von OCT? Was fehlt noch?

Datenanalyse.  Diverse Analyseprotokolle verarbeiten die erhaltenen OCT-Daten. Wurden bei einem Patienten mehrere gleiche Scans durchgeführt, passiert es rasch, dass ein falsches Datenset angeklickt wird. Das Analyseprotokoll “zermalmt” dann sämtliche Daten zu einer bildlcihen Darstellung und ist nicht zu stoppen. Ein kleiner “Abbrechen-Knopf” spart Zeit.

Analyse-Bildschirm. Erfreulicherweise wuchs die Zahl der Analysemöglichkeiten an, was zu einer sicheren Diagnose und Therapie bei Augenkrankheiten führt. Aufgrund der Fülle werden aktuell nicht sämtliche Protokolle angezeigt, sodass geblättert werden muss. Hier sollte nur das “Protokoll-Fenster” etwas nach unten verbreitertert werden und schon ist die Effizienz gesteigert. Das sollte kein grosser Informatik-Aufwand sein.

Schwarz-Auf-Weiss versus Weiss-Auf-Schwarz Darstellung. Was noch fehlt ist ein kleiner Schaltknopf, um schnell die Farbkodierung der OCT-Bilder zu wechseln, idealerweise Schwarz-Auf-Weiss, da somit die Schichten besser erkennbar sind, Drucker-Tinte gespart werden kann, sich die Kosten reduzieren und die Umwelt geschützt wird. Dieser kleine Wunsch wurde schon vor Jahren geäussert.

Sicherheit.  Aktuell besteht eine gute Zugangssicherheit des Gerätes mit Passwortschutz und separater Auswahl des OCT-Operateurs. Das ist vor allem sinnvoll in grösseren und stark frequentierten Augenzentren. In kleineren Augenarztpraxen sind die ersten Schritte eher umständlich und machen keinen richtigen Sinn, da oft nur ein oder höchstens zwei Untersucher die Messungen durchführen und der ZUgang zum OCT-Scanner mir seinen Patientendaten eingeschränkt ist. Darum sollte hier die Option angeboten werden, dass nach dem Druck des Startknopfes direkt die Analyse/Aquisitionsmaske gezeigt wird oder das bisherige Regime gewählt werden kann.

Hornhaut-Dickenmessung (Corneal Thickness).  Zeiss behandelt die Hornhaut etwas stiefmütterlich, dabei ist die Hornhaut die zentrale Struktur für gutes Sehen und auch für gute OCT-Bilder. Hier besteht Entwicklungspotential. Schön wäre eine Vermessung des ganzen Hornhautkubus in Mikrometern, nicht nur weniger Querschnitte. Zudem wäre es hilfreich, wenn die cornealen Kompartimente (Epithel, Stroma) ausgemessen werden in Dicke und Volumen, gerade für die refraktive Chirurgie mit Laser, wo aktuell meist nur Durchschnittswerte verwendet werden,  oder bei Keratokonus mit seiner unregelmässig dicken Epithelschicht. Zudem sollte eine Messung einer Läsion in Mikrometern nicht nur vertikal entlang der optischen Laserachse möglich sein, sondern auch schräg, zum Beispiel bei Hornhautnarben, Hornhautwunden. Wünschenswert wäre auch ein längere bzw. selbst einstellbarere Scanlänge und -richtung. Erweiterungen folgen wahrscheinlich mit den nächsten Versionen.
Kammerwinkel  (Anterior Segment).  In gewissen Situation ist eine Winkeldarstellung der Vorderkammer in Grad hilfreich.

Kinder und Jugendliche normative Datenbank für Makula und Glaukom. Warum beginnt das “OCT-Leben” erst ab 18 Jahren? In der Praxis gibt es übrigens viele Kinder und Jugendliche. Darum ist eine normative Datenbank für die unter 18jährigen wichtig. Das fehlt bei fast allen OCT-Herstellern.

Lärmentwicklung-Lüfter. Das neue Cirrus 5000 System ist sehr leise, es verbreitet fast nur ein “OCT-Geflüster”. Der Computer des Cirrus 4000 produziert im direkten Vergleich etwas mehr Lärm. Übrigens: beim Cirrus 4000 können die Ventilatoren durch geräuscharme Modelle ersetzt werden! Darüber freuen sich vor allem die OCT-Operateure, die den ganzen Tag an der Kiste sitzen müssen.

Teilen Sie uns mit, was Ihnen fehlt (Comments unten).

 

OCT Optical Coherence Tomography (OCT)

High Definition Gallery Zeiss Cirrus 5000 HD OCT

The potential of the new Zeiss Cirrus 5000 (optical coherence tomography, OCT) are represtend by following images.
Folgende Bilder zeigen das Potential von Zeiss Cirrus 5000 HD OCT (Optische Kohärenztomographie, OCT):

OCT Angle Closure Glaucoma GETOCT.

Angle closure glaucoma

OCT Angle Closure Glaucoma. Nicer details, better insight into deeper layers. Note the very narrow anterior chamber angle, iris in too close in contact with the corneal endothelium. Trabecular meshwork is pictured.  Copyright © 2013 GETOCT™ Ltd. All rights reserved.

 

Anterior Segment HD OCT, 3D Corneal OCT GETOCT.

Anterior segment HD OCT GETOCT

Anterior segment HD OCT GETOCT. The very nice thing with the Cirrus is that you must not buy for the anterior segment an additional anterior segment lens. The lens is embedded in the device and thus by a mishap does not get destroyed or contaminated. It is still worth with time to clean the main front lens again with adequate aids. Aggressive cleaning agents are prohibited, handkerchiefs, cloths, lint-free cotton swab and especially to hard pressure, too. The video image shows a rectangle measuring cube (1) which provides a nice corneal cross-section (2). Along the vertical scan beam the thickness measurement is possible (3, thin cornea with 509 microns.  In certain diseases, for example, scars, even an oblique length measurement would be desirable (4). The red inset (4) shows a nice 3D representation of the cornea, which can be cut and rotated to look at a particular lesion. A corneal thickness- mapping – similar to the macular thickness map or like a corneal topography – is, however, still not offered. Probably because the measured data points allow only a minor interpolation and offer only a very relative thickness of the cornea. Attention: be careful with corneal thickness measurements obtained with other scanners. These images show only an interpolation from a few hundred data points, not the reality. Even with good positioning of the eye, artifacts occur (5, red arrow). This should be switched off, through a optional software adjustment, as the localization is not plausible for a general pathology. Copyright © 2013 GETOCT™ Ltd. All rights reserved.

 

Bilateral Macular Thickness OCT analysis GETOCT.

Macular thickness OU analysis GETOCT

Macular thickness OU analysis GETOCT. Macular Thickness analysis allows now a very nice representation of the data aquired with Macular Cube Scan imaging. The SLO image looks much sharper due to the faster camera system. The plot of retinal thickness with false color is softer and looks more detailed. Although many data are shown, the arrangement is simple and does not overload the print out. Copyright © 2013 GETOCT™ Ltd. All rights reserved.

 

OCT Enhanced Depth Imaging (EDI) GETOCT.

Enhanced Depth Imaging (EDI)

OCT Enhanced Depth Imaging (EDI). With the  EDI mode the deeper choroidal structures are much better seen. Copyright © 2013 GETOCT™ Ltd. All rights reserved.

 

OCT Advanced RPE Change GETOCT in Dry Age Related Maculopathy (dry AMD OCT) GETOCT.

Advanced RPE change

OCT Advanced RPE Change. A progression of retinal pigment layer lesion (RPE) is demonstrated with the red dots on the right, showing a worsening of the maculopathy and a poor prognosis in dry age reated maculopathy (AMD). Copyright © 2013 GETOCT™ Ltd. All rights reserved.

 

OCT Macular Change Analysis Coss Section OCT GETOCT.

Macular change analysis cross section OCT

OCT Macular Change Analysis Coss Section OCT. Copyright © 2013 GETOCT™ Ltd. All rights reserved.

 

Normal OCT Optic Nerve Head (ONH) RNFL Analysis GETOCT.

ONH (Optic nerve head) RNFL Analysis

OCT ONH (Optic Nerve Head) RNFL Analysis in a healthy subject. Copyright © 2013 GETOCT™ Ltd. All rights reserved.

 

Guided Progression (GPA) Retinal Nerve Fiber (RNFL) Analysis in Progressing Glaucoma GETOCT.

Guided Progression Analysis (GPA) GETOCT

Guided Progression Analysis (GPA) GETOCT. With the Guided Progression Analysis the retinal nerve fiber layer (RNFL) is tracked over time. A significant change of the RNFL area around the optic disc will be discovered and beautifully illustrated. The image shows three consequent RNFL data sets (top left). After two years a wedge-shaped RNFL defect temoral-inferiorly emerges (brown area, red arrow), so the therapy must be re-evaluated in order to prevent further damage. Red inset: detailed view of the nerve fiber lesion in the RNFL mapping/SLO image and a corresponding circular RNFL cross section around the nerve head. Very nice and of clinical importance: this analysis is unique (double RNFL information): RNFL maping around the optic disc plus standard circular RNFL analysis, including the change over time. Copyright © 2013 GETOCT™ Ltd. All rights reserved.

 OCT Ganglion Cell Analysis (GCL) in Advanced Glaucoma GETOCT.

Ganglion cell analysis in galucoma

OCT Ganglion Cell Analysis (GCL) in advanced glaucoma on the right eye. The normal thickness of the ganglion cell layer is reduced (“eaten doughnut sign or Homer Simpson sign”) , normal dounut like configuration of the retinal ganlion cell layer in the left eye. Copyright © 2013 GETOCT™ Ltd. All rights reserved.

Memory Aid  – Glaucoma “Homer Simpson Sign” – “Donut Glaucoma” by GETOCT.COM:

Glaucoma Homer Simpson Sign GETOCT

Glaucoma Homer Simpson Sign GETOCT. Glaucoma “Homer Simpson Sign” by GETOCT (“donut glaucoma”), normal ganglion cell layer (GCL), left image below,  devastated ganglion cell layer (right image).  The ganglion cells are essential in signal transmition, for example, to assess glaucoma. Normally, their frequency is centrally greatest where they are located in a shape of a ring. In progressing glaucoma these cells die, so that this ring is slowly disappearing. A memory aid for ganglion cell layer (GCL): In keeping with the famous “Januar Loch” in Switzerland (a uncomfortable situation without money and at the limit tipically ocuring in the first month of a new year), a masterful baker in Lucerne is offering a “January hole pastries”. In Anglo-Saxon area it is referred to a “donut”. The cartoon character “Homer Simpson” eats mainly donuts, there “”Homer Simpson donut sign” in cases with reduced ganglion cell desity.     Die Gangienzellen sind essentiell zum Beispiel zur Beurteilung eines Glaukoms. Normalerweise ist ihre Häufigkeit zentral am grössten, wo sie ringförmig angeordnet sind. Bei einem Glaukom zeigt sich ein Verlust dieser wichtigen Zellen, sodass der Ring langsam verschwindet. Gedächtnisstütze: in Anlehnung an das “berüchtigte Januarloch” gibt es einen Meisterbäcker in Luzern, der ein “Januarloch-Gebäck” anbietet (siehe Foto). Im angelsächsischen Gebiet wird von einem Donut gesprochen. Die Comic Figur Homer Simpson ernährt sich vor allem von Donuts, daher als Gedächtnisstütze “Homer Simpson donut sign”.

OCT Extraordinary Diabetic Retinal Edema GETOCT.

Huge diabetic  edema

OCT Extraordinary Diabetic Edema. Eleveted retina with intraretinal cystoid spaces and subretinal fluid as a sign of a uncontrolled diabetes mellitus. The eye is only affected as an organ of a systemic disease. Copyright © 2013 GETOCT™ Ltd. All rights reserved.

OCT Extraordinary Diabetic Edema Cross Section GETOCT.

Huge diabetic  edema

OCT Extraordinary Diabetic Edema. Intraretinal cystoid spaces and subretinal fluid as a complication of an uncontrolled diabetes mellitus.  Copyright © 2013 GETOCT™ Ltd. All rights reserved.

OCT Retinal Plaquenil Toxicity (Retinal Atrophy) GETOCT.

Plaquenil toxicity, bilateral synopsis view

Plaquenil Toxicity, bilateral synopsis view. Copyright © 2013 GETOCT™ Ltd. All rights reserved.

Plaquenil Toxicity OCT (Retinal Atrophy) GETOCT.

Plaquenil OCT

Plaquenil Toxicity OCT, Scanning-Laser-Image SLO superposed with retinal thickness mapping. Note the massive atrophy of retinal tissue (blue area). Copyright © 2013 GETOCT™ Ltd. All rights reserved.

 

OCT 3D OCT and SLO Retinal Imaging GETOCT.

3D OCT.

3D OCT and SLO Retinal Imaging. Copyright © 2013 GETOCT™ Ltd. All rights reserved.

 

3D and Cross Sectional OCT Resolution Cirrus 5000 GETOCT.

3D resolution GETOCT

3D resolution Cirrus 5000 GETOCT. Actually no OCT scanner offers a real good 3D representation of OCT data providing real clinical significance . In this case the image in 3D seems very nice, but in 3D the real insertion of a tractional maculopathy may not be pictured (1,2). The basic data for the 3D imaging is based on cross sectional images with a lower resolution (2, macula cross scan with vitreous insertion leading to a full thickness hole. This is clinically not to detect). Using higher computer power, so called high density cross scan images are shown (4). These scans are improved in quality by superposition and summation of many single cross scan. Copyright © 2013 GETOCT™ Ltd. All rights reserved.

OCT Comparision CIRRUS 4000 HD versus 5000 HD OCT (Optical Coherence Tomography).

Comparision CIRRUS 4000 HD versus 5000 HD.

Comparision CIRRUS 4000 HD versus 5000 HD OCT (Optical Coherence Tomography). They seem the same but the details make the difference. Scanner control with Cirrus 5000 HD is wireless (on the right), the display is enhanced (Cirrus 4000 with 15″ and 1024×768 versus Cirrus 5000 with 19″ and 1280×1024 pixel).  Copyright © 2013 GETOCT™ Ltd. All rights reserved.

And now a congratulation makes sense. Dr. med. Peter Maloca for his detailed work about the OCT maschines and you as my interested blog reader, who persevered to the end of this post.

CONGRATULATIONS! You have OCT power!

I hope, I could offer you some inspiration!
And please, enter a few comments below and sign up for our GETOCT community here.

yours Peter Maloca, MD

You will find more in th free GETOCT iTunes Store (search for Podcast, GETOCT).

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-> Play Video First Swiss Impressions Zeiss Cirrus 5000 HD OCT:

OptosOCT SLO: Swiss Army Knife OCT?!

Friday, March 23rd, 2012

Optical Coherence Tomography (Optische Kohärenztomographie, OCT): Time ist so short to do only routine work, you can be sure that there must be something more to be discovered. What should you say? There are sufficiently OCT scanner and the market is saturated. The poor ophthalmologists should not be plagued with all with the machines. Are you still waiting for the right OCT scanner to buy or to work with? Are you waiting for the 100 procent machine? This device doesn’t exist!

View user video about OptosOCT SLO:

Yet! Optos has dared, and it is amazing what their brand new OCT scanner is capable. As a world first blog we are reporting about a new all-in-one device suitable for nearly every purpose: OptosOCT SLO.

 

OptosOCT SLO GETOCT

OptosOCT SLO (view through anterior chamber lens). Copyright © 2012 getoct™ Ltd. All rights reserved.

Components of the System
The device is comparable to the other OCT scanner with a dual setup: a scanner unit and a separate aquisition/analysis standard PC system (a screen and keyboard with mouse).
As a separate part a frontlens is included for anterior segment imaging which must be screwed to the anterior part of the optical head.

OptosOCTSLO GETOCT 03

OptosOCT SLO with its dual system setup: OCT scanner (left) and aquisition/analysis PC system (right). Copyright © 2012 getoct™ Ltd. All rights reserved.

Start the OCT Engines
Compared with other OCT’s the launch of the system is very simple, very smooth and user friendly. One must press only two buttons on the main power switch/PC, the system starts by itself and is ready, no separate configuration is needed.

OptosOCT Optical head (patients view) GETOCT 04

OptosOCT Optical head (patients view). Copyright © 2012 getoct™ Ltd. All rights reserved.

Patient Screen
The input of patient data is a bit a cumbersome solution. In particular, the birth date is inconvenient to enter. The patient screen has a bit a confusing design, because it is mixed up with different tabs of patient data, acquisition protocols and analysis.

A standard manually adjustable head rest is offered to ensure a good positioning of the patient. Once the alignment is carried out correctly the OCT scanner is guided by using the operator’s controls.
A special feature is that the live image of the CCD camera on the screen is to be find unobtrusively at the right bottom corner. For beginners, this may be somewhat confusing, because the fast exact focusing  is regarded as the primary key setting. The workflow would be more intuitive if the eye of the examiner is guided in a serial way on the screen.

Once the three presented white dots are displayed sharp, clear and at a minimum size the measurement can begin. On the screen  a relative nice infrared image of the fundus is projected. Fine adjustment of lateral and axial movements are corrected using the joystick.
For larger corrections the chinrest is moved by using the up / down buttons. A little disadvantage is that the patient’s head behind the scanning unit virtually disappears so  that one has not always a direct visual control on the positioning and the patient’s condition.

Potpurry of Scan Protocols

The OptosOCT SLO system shows its strengths: a whole potpurry of acquisitions protocols is disclosed. The tomographic imaging contains all standard protocols by means of Line Scanning, Raster Scanning, Radial Scanning, 3D Retinal Topography, RNFL Scannning, Optic nerve Topography.
Those who still want more can use the Cornea-Lens-Module: a separate lens has to be screwed on the optical head of the scanner. It takes a little finesse, because the grooves of the anterior chamber lens are a little too fine shot, but it goes pretty fast.

OptosOCT . Copyright © 2012 getoct™ Ltd. All rights reserved.

OptosOCT SLO Cornea-Lens-Module. Copyright © 2012 getoct™ Ltd. All rights reserved.

This extension includes a relative detailed imaging of the cornea, the anterior chamber and even the angle. The quality of no current OCT system at 800nm is outstanding  in relation to the cross sectional imaging. But the OptosOCT SLO is moving in the medium quality range. Therefore, it is still a gift without being asked for: corneal pachymetry may be performed as well. That might be a very nice additional bonus in patients with corneal pathologies or glaucoma.

Fast and easy Signal Centration
An ideal solution is to center the OCT signal. In other OCT devices with buttons, the signal must be moved gradually into the lower third of the scanning window. Some OCT machines have an auto adjust button which sometimes fires beyond the objective. With OptosOCT SLO a cross-sectional image on the screen is simply packed with the mouse and brought out where you want it. Very comfortable. Then comes the ready for take off: aquistion of the OCT signal! For this you press the button “AUTO” next to the joystick or on the screen.

Then something strange happenes. Nothing happens! Because the OptosOCT SLO , uses only one light source it has a “break”, which is uncommon when compared with other devices that have a permanent live SLO scan. On the screen it is shown that the system has to run a “warm-up”.
This auto reference is found in other scanners, too, and is called calibration for example, but it interferes less, because the live-SLO image always allowes to control the patient’s eye. This is a pure matter of habit and of no further importance.

Additional capabilitiesOCT viewer

There is a primarily viewer software on the PCand it is easy to use. But there is a very comfortable, additional support from Optos: an external OCT data viewer software is available, you just have to unzip it , double click only, and voilà, all your recorded OCT data can be imported to any PC and be considered whenever you have time and desire.
In comparison with other OCT viewer installations, it is solved in an very elegant way and even inexperienced PC user will enjoy it. It just works!

OptosOCT SLO Viewer

OptosOCT SLO Viewer. Copyright © 2012 getoct™ Ltd. All rights reserved.

Summary
The OptosOCT SLO is an eye catcher, is beautifully designed and very well made. It leaves a good impression,  is relatively easy to use and to delegate. The presentation of the OCT scans is good compared to other standard OCT systems and is certainly sufficient for everyday clinical practice, but it is not enough to the absolute top of OCT quality. On the technical side the user interface may be simplificated to improve the workflow, but one gets along well. Very surprising are the many possibilities: cornea, anterior chamber, retina, glaucoma. As only OCT device, it provides a built-in micro-perimeter with many simulations. This can be helpful in the combined analysis of morphology and function in case of glaucoma, macular degeneration or in central serous retinopathy (CSR).

What is extremely encouraging is the price! For about 62 000 Swiss Francs as an  introduction package in Switzerland one can get an exceptionally good equipped OCT system, even including the cornea module and micro-perimetry and possibly even the external viewer software and one-year-full range service.
Of course that’s a lot of money. But for this you nearly get a “Swiss Army Knife OCT” with lots of possibilities and one may ask:  healthy vision, what is it really worth?

Images OptosOCT SLO

 

OptosOCT SLO Cross sectional image B Scan (inactive CNV after Lucentis, click to enlarge). Copyright © 2012 getoct™ Ltd. All rights reserved.

OptosOCT SLO Cross sectional image B Scan with a very good cross scan quality (inactive CNV after Lucentis, click to enlarge). Copyright © 2012 getoct™ Ltd. All rights reserved.

 

Optos OCT SLO very nice combined  OCT SLO

Very nice combined OptosOCT SLO (click to enlarge). Copyright © 2012 getoct™ Ltd. All rights reserved.

OptosOCT SLO Retinal Mapping

OptosOCT SLO Retinal Mapping of healthy macula. Copyright © 2012 getoct™ Ltd. All rights reserved.

 

Optos OCT SLO pathological microperimetry in CNV

OptosOCT SLO pathological microperimetry in CNV. Copyright © 2012 getoct™ Ltd. All rights reserved.

OptosOCT SLO 3D

OptosOCT SLO 3D. No current OCT device provides a real good 3D representation of data. Therefore, Optos has made his basic 3D-OCT work, still, there is a lot of hidden potential. Copyright © 2012 getoct™ Ltd. All rights reserved.

 

Optos OCT SLO Cornea Cross Scan

OptosOCT SLO Cornea Cross Scan. Copyright © 2012 getoct™ Ltd. All rights reserved.

OptosOCT SLO Corneal Topography Pachymetry

OptosOCT SLO Corneal Topography Pachymetry. Copyright © 2012 getoct™ Ltd. All rights reserved.

 

Optos OCT SLO Angle imaging.

OptosOCT SLO angle imaging. Copyright © 2012 getoct™ Ltd. All rights reserved.

 

Download Video of OptosOCT SLO: Swiss Army Knife OCT OptosOCT GETOCT

View Swiss Army Knife OCT OptosOCT SLO video now:

Newsletter about OCT

Thursday, December 22nd, 2011

We are very pleased if you subscribe to our professional newsletter about ophthalmology and OCT. Take the opportunity to get exciting  informations:

OCT Newsletter by getoct.com

OCT Newsletter provided by GETOCT.COM. Copyright © 2013 GETOCT™ Ltd. All rights reserved.

 

 

 

 

 

 

 

 

 

 

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OCT news Download all GETOCT Newsletters and interact with the professional GETOCT Community
1 01 GETOCT Newsletter Dec 2011 (Christmas cataract, iTunes, OCT Blog, register getoct)
2 02 GETOCT Newsletter an 2012 (Best OCT scanner, pitfalls with OCT part 1, register getoct)
3 03 GETOCT Newsletter Feb 2012 (Interpretation, pitfalls with OCT part 2, high myopia, algorithm, login)
4 04 GETOCT Newsletter Mar 2012 (Myopic schisis, pitfalls with OCT part 3, high myopia, Big Apple Test vitamins)
5 05 GETOCT Newsletter Apr 2012 (About, Strategies in Diabetes part 1, Eye Acrobatics 1, iTunes)
6 06 GETOCT Newsletter May 2012 (New Swiss Amry Knife OptosOCT SLO, Calibrating your brain library online, summary on diabetes)
7 07 GETOCT Newsletter Jun 2012  (Diabetes between life and death, strategies in diabetes 2, quiz 1 on diabetes)
8 08 GETOCT Newsletter Jul 2012 (Diabetes from 3th to 4th dimension, laser or anti-VEGF, quiz 2 on diabetes)
9 09 GETOCT Newsletter Sep 2012 (You are the sun – stored energy, Einladung 7.GETOCT Kongress, Diabetes part 5)
10 10 GETOCT Nerwsletter Jan 2013 (First Swiss Basic Science OCT Course 2013, Test your OCT knowledge quiz on OCT Basics, diabetes, glaucoma)
11 11 GETOCT Newsletter Mar 2013 (Steps to the perfect OCT scan, evaluation new Cirrus 5000, tracker demo test)
12 12 GETOCT Newsletter Sep 2013 (Professional data management Zeiss Forum software, Retina atlas by Optos, Einladung 8. GETOCT Kongress Luzern)
13 13 GETOCT Newsletter Oct 2013 (8. GETOCT praxisnaher OCT Kongress, Keratoconus)
14 14 GETOCT Newsletter Feb 2014 (OCT Olympics, OCT training, Einladung 9.GETOCT 6.12.2014, Original OCT-Vortrag 2003: Makuladegeneration, Diabetes, RCS, Flaoters, Glaukom, Morbus Stargardt!)
15 15 GETOCT Newsletter  April 2014 (Invitation 9. GETOCT praxisnaher OCT Kongress, interactive quiz retinal zones, quiz compolications of diabetes, phenomenal results 2nd Swiss OCT Basic Science Course 2014)
16 16 GETOCT Newsletter 2014_9 (Peripheral retinal tuft- thus nolaser therapy, normal incomplete posterior vitreous detachment, 9.GETOCT 6.12.2014, Thank you to Prof. Georg Eisner, Bern/Switzerland): 04 Tutorial vitreous retinales interface_Dr Peter Maloca_GETOCT
17 17 GETOCT Newsletter 2014_10 (Tutorial vitreous, posterior vitreous detachment, traction, vitreomacular adhesion, sMVT, hole, pseudo-hole, Einladung praxisnaher 9.GETOCT Kongress)

 

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TearLab – New Reference for Dry Eye Diagnosis

Sunday, June 27th, 2010

The normal human tear film lubricates and protects the anterior surface of the eye (the cornea and conjunctiva). It consits of three layers. Patients with dry eye may feel: foreign body sensation, stinging, itching, burning, sensitivity to light, redness, blurry vision, a stringy discharge from the eyes and a generalized eye fatigue. Dry eye syndrome has many causes.

Tear Film Osmolarity: that can be controlled using TearLab. A new basic test that may help to determine the balance of the tear film quality measures “osmolarity”. The osmolarity of lacrimal fluid is an important part and changes with eye pathologies.

TearLab is a small monitoring station to determine the osmolarity of the tear film.

TearLab

TearLab

The unit can easily be placed on a table. The manufacturer recommends the device to be always turned on because the electronics is protected and the power consumption was minimized (about 10 Swiss francs per year). Whether that makes sense is another question.

After calibration with the blue check card the osmolarity is to determine with the white measurement card. The benchmark for the calibration is 335 (+/- 3). In the U.S., in addition the control with a special solution is mandatory. The check cards is individually packaged sterile and there is a need to open it carefully, as the packaging is realtive tight.

Calibration check card (blue).

Calibration check card (blue). The electronic check with the blue card must be carried out once per month.

Probe check card (white) with a semi-transparent protective cover, which must be removed.

Probe check card (white) with a semi-transparent protective cover, which must be removed.

You have two minutes available for measurement, which is indicated by a green light. Important: the patient may previously have received no eye drops, do not wear contact lenses. The test is carried best before the ophthalmological examination by the practice staff. The patient looks slightly to the nose and blinks quietly, the sample is led slowly from the top down to the lower eyelid. “Stalking, not attacking your patient!”

Led slowly from the top down to the lower eyelid.

Led slowly from the top down to the lower eyelid. Only 50 nanoL are collected (As a tip of a pen)!

Once placed on the edge of the lid to stay there and move only parallel to the lid, if necessary. Never withdraw the tip of the sample, otherwise air bubbles are sucked and the measurement is distorted.

The tip has a tiny opening at the base below, therefore don't move away from the eye.

The tip has a tiny opening at the base below, therefore don't move away from the eye.

The probe tip has a tiny opening at the base, which passes into a small canal.

The probe tip has a tiny opening at the base, which passes into a small canal.

Do not pull on the lid, so that no reflex tears are raised. The measurement will be acknowledged with a beep tone and the green light goes out. Wait ten seconds before analysis. If the two minutes is exceeded, the green light turns off and the sample measurement is unfortunately useless.

    The cutoff of the intercept between the distribution curves of the normal and dry eyes in the studies was found to be 315.6 mOsmol/L.

The cutoff of the intercept between the distribution curves of the normal and dry eyes in the studies was found to be 315.6 mOsmol/L, actually a cutoff about 308 is used in daily work.

Results Tear Film Osmolarity:
-Less than 308 mOsmol/L & patient has Problems: test other eye
-Early stage of dry eye: more than 308 mOsmol/L
-Cutoff about 308  mOsmol/L is generally used.

A disadvantage of the TearLab device is low: the hand pieces have to be placed quite vertical on the measuring station to avoid a damage to the connection. The approximation of the number of the measuring probe and the measurement station is a bit tedious, because the panel menu is not so intuitive. On the panel you can see white arrows and curved arrows, which confuses. The deep docking station is a dust catcher and can not be cleaned in practice. The rubber coasters on the bottom can be lost what lets shake the device when touching the unit.

It should be noted that the device after disconnecting from the current (for example, during the holidays), about 25 minutes can not be used because a security charge must be carried out, before a new test can be performed.

The determination of the osmolarity is a further step in the diagnosis of dry eye, protect   and monitor the therapy carried out.
The measured values can be included in a personal logbook of patients. This may improve compliance in the often difficult and arduous treatment.

LENSTAR LS 900 – 9 working animals in one

Tuesday, June 22nd, 2010

Haag-Streit has made with its 900 Lensstar a wonderful and fast machine for biometry, this is a measurement prior to surgery, such as a cataract operation or a corneal laser treatment.

Piece of work

Piece of work

Experience an OCT measurement in the video stream:

It can be used as a stand-alone version or as a separate module.

Nine in one optical biometer

Nine in one optical biometer

The core is a non-invasive, non-contact OLCR (optical low-coherence reflectometry) Biometer with a huge specification found nowhere else:

• Axial eye length
• Corneal thickness
• Anterior chamber depth
• Aqueous depth
• Lens thickness
• Radii of corneal curvature of flat and steep meridian
• Axis of the flat meridian
• White-to-white distance
• Pupil diameter

The results are highly reproducible on all parameters and can be controlled in detail very quick, very fast. The personalised IOL constants are imported very easy and the user is led by a well illustrated menu on a huge screen:

User control unit

In the stand-alone device, the input of patient data is done with a small computer. The user is guidedvia picture and text to perform a quick measurement.

Core element is the OLCR (optical low-coherence reflectometry) Biometer, which has won a design competition in 2009:

OLCR (optical low-coherence reflectometry) Biometer

OLCR (optical low-coherence reflectometry) Biometer

OLCR (optical low-coherence reflectometry) Biometer

OLCR (optical low-coherence reflectometry) Biometer

A little awkward is the release button for the measurement. The button is not the top centered on the joystick as usual, and could be activated with a light touch. No, it is a small plastic lever that lies ahead and is somewhat cumbersome to operate.

The time for a measurement varies. Thus, with the Lenstar one needs more than 3 minutes, until both eyes were measured, compared with the faster IOL Master from Zeiss about 55 seconds. Some patients experienced the flickering and playful light with the Lenstar somewhat unpleasant, while the yellow light at the IOL Master was felt slightly more comfortable.

Release button for the measurement

Release button for the measurement

A fun idea is the eye patch, which is mounted on the headrest and is easily moved.

A fun idea is the eye patch, which is mounted on the headrest and is easily moved.

3D capture LS 900.

3D capture LS 900.

3D capture LS 900.

3D capture LS 900.

Goldmann applanation tonometry – ancient and modern

Thursday, May 27th, 2010

Goldmann tonometry is the “Gold Standard” by which all other tonometry is compared. The applanation area of the central cornea is in a circular zone of 3.06 mm and a suspect intraocular pressure (IOP) is equal to or greater than 21 mmHg. Pathologic tonometry findings are not diagnostic of glaucoma, but one of several signs to be considered.

“blue light glaucoma test”

Goldmann's classic tonometer

Goldmann's classic tonometer

The applanation of the cornea is very light. Topical anesthetics and Fluorescein are used first to prevent an unpleasant feeling during the time, when the probe is in contact with the eye. Due to the slightly distortion of  the cornea, blurred vision can be caused  for a short period. The test is very well tolerated. Patients shouldn’t wear soft lenses because Fluorescein will be absorbed into the lens turning them yellow. Of course, use no rigid lenses, too, and give about one hour for clearance from Fluorescein.

Correct alignment of Goldmann semicircles - inner touch.Correct alignment of Goldmann semicircles – inner touch.

Goldmann measurement (physicians view):