Visante omni Basic Operation and Interpretation

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Visante omni System
Comprehensive Topography Basic Operation and
Interpretation
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Visante omni Course Outline

• System Overview
• Basic Operation
• Understanding Comprehensive Topography Maps
• Clinical Examples

Note This e-Learning Course is designed to be
self-paced. To advance the slide, press the
Space Bar or click the mouse button.
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Visante omni Course Outline

• System Overview
• Basic Operation
• Understanding Comprehensive Topography Maps
• Clinical Examples

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What is Visante omni?

• System that links ATLAS Placido disk and Visante
  OCT technologies for enhanced pathology
  detection.
• Visante omni combines ATLAS anterior corneal
  topography with Visante OCT pachymetry to provide
  posterior corneal topography.

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Combining Placido Disk and OCT Technologies
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V-Trac Registration Linking ATLAS and Visante
OCT for Posterior Topography
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Visante omni System Overview

• Visante OCT Software Version 3.0 New Features
• Relative Pachymetry Map
• Auto-alignment feature
• New Optional Features in Software Version 3.0
• Topography Link Software Links ATLAS and
  Visante exams to create posterior topography maps
  (Visante omni)
• DICOM Gateway Import a Modality Worklist and
  export DICOM reports/images to a DICOM compliant
  device (such as ZEISS VISUPAC STAR or FORUM)

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New Feature with Visante OCT 3.0
SoftwareReference Eye Image
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New Feature with Visante OCT 3.0
SoftwareAuto-Alignment
Visante OCT now can automatically track the
cornea to simplify scan acquisition.
x
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New Feature with Visante OCT 3.0 SoftwareReview
ATLAS Exams
ATLAS Review Software now appears on Visante
Select ATLAS Exam.
Select Photokeratoscope.
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Visante omni Course Outline

• System Overview
• Basic Operation
• Understanding Comprehensive Topography Maps
• Clinical Examples

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Always Acquire ATLAS exam first
Network
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1. Select patient on ATLAS and Press Capture
Image
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2. Capture Image on ATLAS and Select Done
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3. Patient Information and Exams are
Automatically Transferred to Visante OCT
Network
ATLAS 993/995/9000
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4. Select the patient from View Todays
Patients tab on Visante OCT and select Scan
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5. Select LVC Comprehensive Protocol
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6. Acquire Global Pachymetry Map Scan using
Auto-Align
Ensure that the corneal vertex is in the green
positioning target
Click on the center of the pupil.
Select Acquire to acquire scan
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7. Comprehensive Topography Maps Automatically
Created
The Comprehensive Topography tab is then
automatically created using the last ATLAS exam
acquired.
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Visante omni Course Outline

• System Overview
• Basic Operation
• Understanding Comprehensive Topography Maps
• Clinical Examples

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There are 3 pre-defined Themes (Standard,
Alternate, Holladay, and 2 Custom Themes) with a
preset selection of maps. The software will
always remember the last Theme selected.
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The maps on the left column are the Anterior
Axial Curvature and Anterior Mean Curvature Maps
from ATLAS.
The maps in the middle column are the Pachymetry
and Relative Pachymetry Maps from Visante OCT.
The map on the top right is the Anterior
Elevation Map from ATLAS. For the STANDARD
Theme, this is expressed relative to a Best-Fit
Sphere.
The map on the bottom right is the Posterior
Elevation Map, from the combination of ATLAS and
Visante. For the STANDARD Theme, this is
expressed relative to a Best-Fit Sphere. Note
the solid band or saddle of elevation across
the cornea in this normal with the rule
astigmatism case. This is due to the use of a
spherical reference object, which results in
posterior elevation values of gt15 µm in this case
in the mid-periphery.
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For the HOLLADAY Theme, the Anterior Elevation
Map is expressed relative to a Best-Fit Toric
Ellipsoid, which factors out the toricity and
asphericity of the normal cornea.
The Posterior Elevation Map is also expressed
relative to a Best-Fit Toric Ellipsoid. Note the
improved fit and smaller residual elevation
values of 4 µm due to the improved fit of the
toric, ellipsoidal reference object.
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Other key corneal data such as minimum
pachymetry, white to white, pupil diameter and
corneal spherical aberration are provided.
These are the simulated keratometry values from
ATLAS.
These are the K values using all the available
corneal data and the Q value for the 4.5 mm Zone.
Corneal Apex
Corneal Vertex
Pupil Boundary
Cursor
Cursor Value
Thinnest Point
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To change any of the map settings (such as
displayed map, colors, overlays), simply
right-click on the map.
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Relative Pachymetry Analysis

• Typical corneal thickness
• 550 ?m centrally
• 700 ?m peripherally
• Relative pachymetry shows the percent deviation
  from typical corneal thickness
• GREEN is equal to typical thickness profile
• RED is thinner than typical
• BLUE is thicker than typical
• Localized hot spots may indicate pathology
• Changes in relative pachymetry greater than 9
  across the cornea (as seen in this Suspect
  Keratoconus case) may suggest an abnormal cornea
• 4 in periphery
• -8 at thinnest point
• 12 total change across cornea

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-8
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Relative Pachymetry Examples
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Relative Pachymetry Examples
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Guideline for Analyzing Visante omni
Comprehensive Topography Maps
Note The following are general guidelines that
may be used to assist with interpreting
Comprehensive Topography Maps, including Anterior
Mean Curvature, Relative Pachymetry, and Toric
Ellipsoid Posterior Elevation. These are
empirical guidelines based on early experience
with Visante omni and should not be considered
definitive thresholds for clinical diagnosis.
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Visante omni Course Outline

• System Overview
• Basic Operation
• Understanding Comprehensive Topography Maps
• Clinical Examples

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Case 1 Normal Cornea
The maximum Anterior Elevation (Toric Ellipsoid)
is less than 2 µm.
Mean Curvature eliminates corneal astigmatism to
reveal the local average corneal curvature. In
this case, the Anterior Mean Curvature Map is
symmetrical and normal, with a maxmum curvature
of 44.5 Diopters.
The maximum Posterior Elevation (Toric Ellipsoid)
is also less than 2 µm.
Relative Pachymetry reveals a cornea that is 8
thinner than typical, but generally uniform and
symmetrical.
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Case 2 Irregular Astigmatism or Suspect
Keratoconus?
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Case 2 is Irregular Astigmatism, due to Normal
Posterior Elevation and Relative Pachymetry
The maximum Anterior Elevation is less than 2 µm.
The maximum curvature on the Anterior Mean
Curvature Map is slightly decentered, with a
value of 47.5 Diopters.
The maximum Posterior Elevation is less than 4
µm, consistent with a normal cornea.
Relative Pachymetry reveals a thinner than
typical, but otherwise normal cornea.
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Case 3 Normal or Suspect Keratoconus?
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Case 3 is Suspect Keratoconus, due to Noticeable
Posterior Elevation and Localized Thinning
The maximum Anterior Elevation is only 4 µm.
The Anterior Mean Curvature Map is slightly
decentered, but is still generally symmetrical.
However, the maximum curvature is high (greater
than 48 Diopters).
But the maximum Posterior Elevation is over 11 µm
at the same point of localized thinning. This is
consistent with Suspect Keratoconus.
Relative Pachymetry reveals localized thinning of
12 across the cornea.
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Case 4 Suspect Keratoconus due to Prominent
Posterior Elevation and Localized Thinning
The maximum Anterior Elevation is 7 µm.
The Anterior Mean Curvature Map is decentered
with a maximum curvature in excess of 49 Diopters.
And the maximum Posterior Elevation is over 21 µm
at the same point of localized thinning,
consistent with Suspect Keratoconus.
Relative Pachymetry reveals localized thinning of
9 across the cornea.
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Case 5 Suspect Keratoconus
The maximum Anterior Elevation is over 21 µm.
The Anterior Mean Curvature Map clearly
highlights the localized maxmum curvature in
excess of 48 Diopters.
Relative Pachymetry reveals localized thinning of
10 across the cornea.
The maximum Posterior Elevation is over 45 µm,
which is clearly abnormal
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Case 6 Clinical Keratoconus
The maximum Anterior Elevation is over 41 µm.
The Anterior Mean Curvature Map clearly
highlights the 70 Diopter cone.
Relative Pachymetry reveals significant localized
thinning across the cornea.
The maximum Posterior Elevation is over 91 µm
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Case 7 Pellucid Marginal Degeneration
The maximum Anterior Elevation is over 41 µm.
The Anterior Mean Curvature Map clearly
highlights the decentered area of high local
average curvature greater than 50 Diopters.
Relative Pachymetry reveals localized thinning of
11 across the cornea.
The maximum Posterior Elevation is over 70 µm
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