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.
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.
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!
General features – OCT 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 screendesign. 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!
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):
Memory Aid – Glaucoma “Homer Simpson Sign” – “Donut Glaucoma” by GETOCT.COM:
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”.
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).
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.
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.
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.
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.
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 capabilities: OCT 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!
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?
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
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). 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.
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. 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 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, 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.
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
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
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:
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:
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
A fun idea is the eye patch, which is mounted on the headrest and is easily moved.
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
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.
EasyTon by EASYOPHT is a special product of its kind for the ocular pressure measurement by applanation tonometry according to Professor Goldmann, Bern, Switzerland.
It is a disposable tonometer device, is virtually sterile, safe and designed for single use only. Each pack contains a sterile disposable tonometer and two fluorescein strips for a correct diagnosis with a tonometer. The package is easily opened and the tonometer can be used immediately. It is very convenient, since the unit is sterile, no cleaning or disinfection required. Therefore, a contamination by infectious agents and a transfer for example, by highly contagious bacteria or adenovirus from patient to patient or staff is not possible.
In addition, a possible toxic effect of disinfectant solutions on the patient’s eye is prevented. Costs are also saved in time and money as the relatively expensive disinfectants are not used.
After unpacking the tonometer is put to the quite common and far-delivered Goldmann tonometry unit.
Purely external, the two tonometers units are quite similar in form. A groove is at the zero position and is aligned to the corresponding mark on the Goldmann.
EasyTone (top) compared with standard Goldmann tonometer device.
In the side view you can see the transparent bottom and roughened top of EasyTone (left), and the grooves for locating the pressure measurement in highly astigmatic eyes.
More important than the external form is the inner life. This can be seen just yet, that the EasyTone is disposable material. The existing transparency allows the occurrence of disturbing stray lights from the outside. The outer grooves are clearly visible from the inside, which causes additional scattering. Most important is, however, that the internal prism, leading to a splitting of the fluorescein soaked tear-diskus are coming along little sharp edged.
Little sharp edged EasyTone (top) compared to the clearly demarcated prism of Goldman (below)
EasyTon also shows an internal optical overlay zone, which looks like a weld. This is of clinical significance, as in exactly this area the inner-contact of the splitted Goldman-rings is done and the very precise determination of the distance and thus of the measured pressure value is more difficult.
Internal optical overlay zone, which looks like a weld, complicates the precise pressure measurement.
Optical rings with EasyTone are somewhat imprecise and irregular.
Beautifully sharp half-rings at Goldman unit.
Clear rings in EasyTon are only achieved by reducing the intensity of the slit lamp (bottom).
Through the realtive light flooding in EasyTone, optimal illumination is achieved by reducing the intensity of the slit lamp. Otherwise, the contour of the Goldmann-rings is hard to seeand the examination time is prolonged, which can lead to a deterioration of the patient and include problems with the cornea, especially in dry eyes.
View from top: The ideal angle between EasyTone and the light source is about 20 degrees.
In summary, the EasyTone a practical piece for the special use, especially
in infectious situations or for rapid needs. Limitation is that the contours are not exactly to be defined, making it a little bit more difficult for an exacte pressure measurement.
Quick and easy to handle.
For an acurate examination of ordinary eyes disposable materials are little recommended.
A good indication for use of disposable EasyTon are infectious processes that can be associated with an increase in pressure:
Very severe bacterial kerato-uveitis with hypopyon in a hard-to-leading contact lens wearer.
Herpetic keratitis with fluorescein positive dendritica.
