THREE OPTIONS TO DIAGNOSE AND MANAGE GLAUCOMA

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The Optopol PTS-1000 Automated Perimeter (distributed by Canon) allows for precise and fast testing with either static or kinetic stimuli.
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Zeiss’ CIRRUS HD OCT incorporates superior visualization and HD maps of the ILM, RPE, retinal thickness, cross sectional, and fundus.
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The Canon CR-2 Digital Non-Mydriatic Retinal Camera combines the latest imaging technology in a small, lightweight design.

A look at the features and benefits of three glaucoma instruments. 

Managing glaucoma suspects and patients has become much more interesting over the last few years as the types of imaging technology has continued to change and evolve. Where intraocular pressure (IOP) and pachymetry””and then photos””used to be enough for a practition-er to manage her glaucoma practice, it’s now imperative to incorporate some sort of imaging tool. With the many choices available (i.e., stereoscopic disc photography, OCT, GDx, HRT, Diopsys), which one works best? As with any profession, if you ask three experts, you tend to get three different opinions. The following examples showcase what your colleagues are using and why.

OPTOPOL PTS-1000
When the time came to upgrade the perimeter  at Carillon Vision Care practice in Glenview, IL, Andrew Neukirch, OD, chose the Optopol PTS-1000 Automated Perimeter (distributed by Canon, USA, Inc.). “As a 2008 graduate used to my school’s Humphrey units, I found the Optopol PTS-1000’s display, interface, and results pages to be quite similar,” he says. “The instrument has a smaller footprint and is run by an external computer, thus decreasing the risks of requiring sending the entire unit in if it ever needs service.”

The software is also very intuitive and can be pulled up on any workstation in the office. The built-in “Advanced Threshold” modes allow 30-2 testing to be completed in about four minutes per eye. Plus, Dr. Neukirch believes the unit “looks much more modern than most other perimeters.” He typically has his staff run the fields, but doesn’t mind running them himself as the unit is relatively fast. He has another workstation next to the machine where he typically catches up on charting or reviews OCTs. “If I’m running the field, I’ll often do the interpretation and report right then and there,” he explains.

The PTS-1000 Automated Perimeter allows for precise and fast testing with either static or kinetic stimuli, using Goldmann standard background illumination, stimulus sizes I”“V, with the operator’s choice of white, blue, red, or green stimuli. This instrument comes with a full library of testing strategies including fast screening, accurate threshold, Intelligent fast threshold, and a quick three-zone, depending on needs and condition. It uses a fast threshold strategy”””Reduced Field” and “Neurological Field Reduction””” to further decrease testing time.

Eyecare professionals (ECPs) can also utilize flickering stimuli for Critical Fusion Frequency (CFF), kinetic tests (helpful for patients with difficulty performing the test), SWAP (“blue on yellow”), red stimuli perimetry, and green stimuli perimetry. The fact that this instrument includes a binocular testing capability and the ability to examine the temporal field up to 80° also makes it a winner.

CIRRUS-HD OCT

Another player in the market is the CIRRUS HD-OCT by Carl Zeiss Meditec, Inc. Rebecca Busier, OD, of Eyecare of VT, in Burlington and Essex Junction, VT, says “the OCT is a fantastic glaucoma diagnostic tool ideal for monitoring progression along with determining initial NFL thinning and cupping.

“We chose the OCT because of its diverse clinical diagnostic ability,” she explains. “Not only can you use it for glaucoma, but for retinal disease, anterior segment disease, choroidal nevi, etc.” Like Dr. Neukirch, she has a technician conduct the test and then she interprets and goes over the results with the patient.

The pluses to the technology are the nerve fiber layer (NFL) analysis and ability to check for progression. It’s also a great teaching tool for educating patients on why they are a glaucoma suspect or glaucoma patient as they can actually see their optic nerves and where NFL thinning has or hasn’t occurred. One of the minuses, however, is irregular optic nerve head (ONH) interpretation variation. “If a patient has a really tilted nerve or lots of peri papillary atrophy (PPA), the machine often miscalculates the nerve structure,” explains Dr. Busier. “Also, if the patient has a dense cataract or anterior segment disease, getting a clear image to the nerve can be difficult.”

Overall, however, the CIRRUS HD OCT incorporates superior visualization and high-definition maps of the internal limiting membrane (ILM) retinal pigment epithelium, (RPE), retinal thickness, cross sectional, and fundus. The smaller design makes this an easy instrument for any practice to incorporate while auto patient recall allows for repeatability by ensuring that patient position and instrument setting are repeated from all previous visits. Advanced optics and mouse driven alignment make this a simple instrument to use with greater patient comfort, while the 90° orientation allows for patient observation during the exam.

CR-DIGITAL NON-MYDRIATIC RETINAL CAMERA
Nicole Ptashkin, OD, Coastal Grand Eye Associates in Columbia, SC, finds the Canon CR-2 Digital Non-Mydriatic Retinal Camera to be a workhorse in her practice. “I use the CR-2 on a daily basis for all retinal conditions and monitoring, but I especially find it useful for monitoring my glaucoma suspects and glaucoma patients over time,” she explains.

“The small design of the instrument allows it to fit seamlessly in my office and not take up much space. Patients find it non-invasive, as the “˜low flash’ is not uncomfortable, and makes it easy to take multiple photos in a short period of time. My techs were able to learn how to use it very quickly, and patients like the improved care we are able to provide them with by using this to monitor any changes that may occur.”

The Canon CR-2 Digital Non-Mydriatic Retinal Camera combines the latest imaging technology with a small, lightweight design, which makes this instrument a great addition to any office, no matter the size. This portable instrument can be used in multiple locations, making it invaluable to a large practice. It also integrates seamlessly with a Canon instrument table and Canon Auto Tonometer.

Furthermore, the white LED flash light saves on energy costs, and minimizes mitosis, improving patient comfort, and allowing for multiple photos to be taken simultaneously. Multiple filters are included, including red-free and cobalt digital, which can both be used for documenting glaucoma, and evaluating the RNFL, among other uses. A trained examiner can easily operate the instrument, and Canon’s ImageSPECTRUM Image Management Software allows images to be stored, viewed, processed, and printed. This instrument is a welcome addition for any office looking to diagnose, monitor, and treat glaucoma.

As these three examples show (and we know there are more out there!), this is a very exciting time in glaucoma diagnosis, management, and patient education. We have so many diagnostic instruments available to us, with noteworthy capabilities. Eyecare professionals can choose what works best for them and their patients, based on financial investment, footprint, and personal preference.

Jennifer L. Stewart is in private practice at Norwalk Eye Care in Norwalk, CT.

WHERE TO FIND IT:

Canon Medical Systems A Division of Canon U.S.A. Inc.
800-970-7227 •usa.canon.com/eye-care

Carl Zeiss Meditec, Inc.
800-342-9821 •meditec.zeiss.com/usa

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