Detecting Glaucoma

and Risks

Oculus Centerfield 2 Oculus Twinfield 2

Oculus Easyfield Oculus Pentacam

We focus on progress
What does Glaucoma mean to y  
You don’t see your own Scotoma !

The normal driver‘s view

Common textbook illustration of

a glaucomatous field defect

The patient‘s view:

no apparent scotoma

Perimetry reveals an arcuate

1 2
nerve fiber bundle defect OS and
blind spot enlargement OD
Monocular field defects are compensated by the fellow
eye. Overlapping zones of right and left eye scotomas
are masked by fitting in surrounding visual information.
The patient remains unaware even of the binocular sco-
3
1) Left eye
toma – and of the pedestrian! Scotomas (excepting cen-
2) Right eye
tral ones) are clandestine threats which do not show up
3) Binocular
in consciousness. Perimetry is the unique and essential
tool to detect scotomas – and to prevent hazards from
patients and increase traffic safety.
  ou?
A look ahead

By the year 2020, an estimated 80 million people world- There are several known risk factors for glaucoma, which
wide will have glaucoma, and 11 million of them will be include increasing age, family history of glaucoma, Af-
blind in both eyes. rican and Chinese ancestry, nearsightedness, high blood
pressure and elevated eye pressure (also known as el-
Patients are at risk for significant damage to the optic evated intraocular pressure or IOP)2). Of these, IOP is
nerve before noticing problems with their eyesight. As currently recognized as the only modifiable risk factor
such, prevention becomes key and practitioners are be- for glaucoma. Lowering IOP in glaucoma’s early stages
ing urged to encourage patients to ‘know their risks’ and offers the best chance of preserving vision.
be screened for glaucoma.  
  “Accurate diagnosis and appropriate treatment of glau-
Known as the “sneak thief of sight,” glaucoma is a dis- coma can prevent damage to the optic nerve and pre-
ease characterized by a gradual loss of vision resulting serve healthy vision, which is why comprehensive check-
from the death of the cells in the eye – the optic nerve ups that include eye pressure measurements and careful
cells – which transmit visual images through the optic evaluation of the optic nerve are so important,” said Dr.
nerve to the brain. Ivan Goldberg (Sydney, Australia), Immediate Past WGA
  President and Co-Chair of the WGA/WGPA Physician
As the optic nerve becomes increasingly damaged, pro- Liaison Committee. “Since vision loss from glaucoma is
gressive vision loss and eventually blindness can occur. permanent, glaucoma needs to be diagnosed and treated
Early detection is the key to treating and halting the ef- as early as possible,” said Dr. George Lambrou (Athens,
fects of glaucoma, but current worldwide estimates re- Greece), Global Project Leader for the World Glaucoma
veal that more than half of glaucoma sufferers do not Day and Executive Vice-Chair of the WGA/WGPA Physi-
even realize they have the disease.1) cian Liaison Committee.
 
“When glaucoma is detected early and appropriate treat-
ment is instituted, 90% of the blindness from glaucoma
could be eliminated,” said Dr. Robert Ritch, Professor and
Chief of Glaucoma Services New York Eye and Ear Infir-
mary and Co-Chair of the World Glaucoma Association
(WGA) and World Glaucoma Patient Association (WGPA)
Physician Liaison Committee.
 

 Increased intraocular pressure can lead to

optic nerve damage and visual field loss.

Oculus is a sponsor of World Glaucoma Association, www.worldglaucoma.org

1) Tielsch JM, Sonimer A, Katz J, Royall RM, Quigley HA, Javitt J. Racial variations in the prevalence of primary open-angle glaucoma:
The Baltimore Eye Survey. JAMA 1991;266:369-74.
2) The Glaucoma Foundation. Who’s at Risk? Available at: http://www.glaucomafoundation.org/risk.htm. Accessed on August 24. 2007.
We have it all!
From early glaucoma detection to long-term management

The Pentacam
The Pentacam is a Scheimpflug camera which captures
Scheimpflug images during a rotating scan and calcu-
lates a 3D model of the anterior eye segment.
Important parameters such like chamber depth, 360°
chamber angle, pachymetry and lens densitometry
are calculated automatically. It’s automatic alignment
systems accounts for easy operation and repeatable
results.

The Twinfield 2
The Twinfield 2 combines all measurement principles
(static and kinetic) in one device. It tests the whole vi-
sual field up to 90°. This perimeter is optimized for daily
use in clinical routine and medical practices, performing
screening and threshold examinations, follow-up pro-
grams and statistical analysis of the results.

The Centerfield 2
The Centerfield 2 is the only compact perimeter able
to perform examinations up to 70°. The self-contained
measurement system warrants examinations largely
independent of ambient illumination. Therefore, peri­
metry no longer needs to be carried out in an absolutely
dark room.

The Easyfield
The Oculus Easyfield is an exciting compact perimeter to
carry out static perimetry up to 30°. It has been designed
for the combined use as a visual field screener and pe-
rimeter, offering many features usually available only in
large units.
Your office network
Practice efficiency and more time for patient care

Connect your Oculus device directly to your office net- System integration enables an easy synchronizing of
work. All Oculus devices use their own common patient your instruments, eliminates manual data entry and
management system by default. But if you prefer to data retrieval, while minimizing paper handling.
continue using your familiar management system, inte-
gration of Oculus software can be easily performed.

External
Workstation

Workstation Patient Data Transfer

Management transfer via email
System

Reception

Workstation

Oculus Easyfield

Oculus Centerfield 2

Oculus Twinfield 2

Oculus Pentacam
THE PEntacam
The Gold Standard in Anterior Segment Tomography

The Pentacam provides automatic evaluation of the an- corneal topography including anterior and posterior
terior eye segment, from the anterior corneal surface to corneal surface,
the posterior lens surface using a rotating Scheimpflug unique Keratoconus detection based on topography
camera. The non-contact measuring process takes only and pachymetry.
2 seconds and performs up to 50 single captures. In to-
tal, up to 138.000 true elevation points are detected and The Pentacam is an ideal instrument for quick glaucoma
processed to a 3D model of the anterior eye segment. screening with automatic evaluation software and is the
perfect analyzer for corneal refractive surgeons.
The key advantages of the rotating imaging process are:
precise measurement of the whole cornea,
correction for eye movements,
easy fixation for the patient,
easy and intuitive operation,
extremely short examination and processing time.

There are several evaluation modules available, such as:

Scheimpflug tomography,
3D chamber analysis (chamber depth, angle and
volume),
pachymetry (including correction of the intraocular
eye pressure [IOP] ),
densitometry of the crystalline lens and IOL,

How may a Glaucoma screening look in practice?

Imagine you see a 45 year old patient. You do a routine

refraction and measure the IOP. The patient is mildly
myopic. IOP raw reading is 19 mmHg by applanation to-
nometry. You also perform a Pentacam exam and obtain
the following information, which are automatically dis-
played on the Pentacam screen in your office:
Scheimpflug image with an obvious shallow chamber
corneal thickness of 487μm
ACD of 2.72 mm
anterior chamber volume (ACV) of 105 mm³
anterior chamber angle (ACA) of 23.6°.

You know immediately the true IOP is most probably What does it mean
higher than measured with the tonometer. The Pentacam to your patients?
IOP correction table based on pachmetry confirms this
and displays a corrected IOP of 23.1mmHg. Patients who often do not have a medical background,
Considering the patient’s age of 45 years with, a family experience the Pentacam as very educational and infor-
history of narrow angle glaucoma, you may want to ob- mative. For example, it makes narrow-angle glaucoma
tain further information about the condition of the optic easy to understand and not only shows corneal thick-
nerve using the Oculus Twinfield perimeter to perform a ness clearly, but also presents a three-dimensional view
pre-programmed Glaucoma screening test. of the anterior eye segment.
Easy and Quick Glaucoma Screening

Pachymetry

The corneal thickness is displayed as a colored map over

its entire area from limbus to limbus.
Each single location can be individually evaluated by a
mouse click. Additionally the measured IOP can be cor-
rected with regard to corneal thickness.

Furthermore important points are displayed in values

and locations, such as:
pupil center thickness
corneal apex thickness
thinnest location
corneal volume

3D Chamber Analyzer

The Scheimpflug image itself gives an initial impression chamber are visible immediately after surgery and can
about the anterior chamber conditions. One can imme- be measured manually:
diately notice a shallow chamber. Moreover the software in the Scheimpflug images,
automatically calculates and displays important param- in the ACV and ACD value,
eters, such as: This allows an easy documentation as well.
chamber angle
chamber volume The Pentacam Tomographer displays a virtual
chamber depth model of any individual anterior eye segment which can
be easily used for patient’s education.
You may want to check biometric parameters after
iridotomy or iridectomy. The changes in the anterior
Perimetry
Visual field and Glaucoma

Even with an increasing number of various advanced gression control of glaucoma. In the hand of an experi-
imaging methods, perimetry remains the only method at enced practitioner, a perimeter is more than just a device
hand for direct and comprehensive measurement of the for final confirmation of suspicions raised by previous
visual function. Visual field tests continue to represent diagnistic procedures; it can provide by itself precise and
an important tool in early detection, staging and pro- reliable information necessary for a diagnosis.

The first step: Scanning the visual field

Typically, a patient comes in contact with perimetry by

undergoing a screening-type examination. Most often
this is a consequence of high value IOP measurements,
but it can be recommended also after routine examina- blind spot
tion of the anterior segment with the Pentacam (like in
case of contact lens adjustment), or can follow other
ophthalmologic investigations (like OCT). Belonging to the
glaucoma risk groups (advanced age, family history, etc)
can also represent a valid reason.

Most common screening-type examinations are supra­

threshold tests. Although often considered having a lesser
sensitivity, supra-threshold tests offer the considerable
advantage of reduced duration (can be as short as 1-2
minutes) and lowered patient stress. A wise choice of the
examination pattern can further improve the final results
of the tests. Therefore, patterns adapted to the physiology  Area 4 of Oculus Twinfield 2 (53 test points
of the eye might be more useful than old-style rectangu- between 0°- 30°) The specific test patterns of all
lar patterns. Oculus perimeters can always find and display the
blind spot, using it as a reference scotoma.

When numbers matter: Measuring the visual field

In order to get a comprehensive picture of the visual

field, there is no way around measuring luminance in-
crement sensitivity. Performed accurately, threshold
tests not only offer information about the existence of
defects in the visual field, but also provide a quantitative
description of their shape, pattern and severity.

A drawback of precise threshold tests is their relatively

long duration. The reliability of the tests is influenced by
patient fatigue, from which in particular elderly patients
suffer. Reducing the number of test points is not the
best option (although for stable patients by all means
adoptable). Consequently efforts are directed towards
developing test strategies partially based on statistical fovea centralis
models and interpolation.

 Color 3D representation of a threshold measure-

ment on Oculus Twinfield 2, with noticeably glau-
comatous visual field defects. (Area 4, CLIP)
Threshold Strategies: From staircase to elevator

4/2 Bracketing CLIP

2
4
2 fovea centralis

4/2 Strategy satisfaction level is kept high. This unique real threshold
test that outperforms most interpolation based algo-
The classical approach to threshold measurement is the
rithms is now available in all Oculus perimeters.
so-called 4/2 strategy. Its name points to the fact that
the measurement starts by presenting light stimuli in 4 dB
In the case of CLIP, the test stimulus is always “on”,
steps in the direction towards the threshold (with in-
its luminance being increased in time in smaller steps
creasing luminance for sub-threshold, and with decreas-
(usually 1 dB), until the patient gives a positive answer.
ing luminance for supra-threshold stimuli), followed by
By measuring the average reaction time of the patient
2 dB steps in the opposite direction after crossing the
and choosing the appropriate incremental rate of the
threshold. This way the measurement can be conclud-
luminance, a significant reduction of the examination
ed after the second crossing of the threshold. But, this
time can be achieved, without losing precision or repro-
method can lead to an increased number of sub-thres­
ducibility. The fact that a stimulus with increasing lumi-
hold stimuli in the presence ot defects. This might cause
nance in the end is always observed generates elevated
frustration of the patients.
patient comfort.
Interpolating Braketing Strategies
Using various statistical models and interpolation meth-
ods, the bracketing procedure may be abbreviated using
larger steps and requiring a smaller number of stimuli.
The inherent loss in precision due to the larger dB steps
should be at least partially compensated by modeling
and interpolation.

CLIP Strategy
CLIP (Continuous Light Increment Perimetry) follows a
radically different path. In contrast to the regular brack-
eting methods, CLIP makes use of test points with lumi-
 Choosing CLIP on Oculus perimeters
nance increased at a steady rate. As a result, test dura-
tion is drastically shortened. Also, reproducibility of the
results is increased. In addition, convenient side effect,
The Oculus Solutions

The Easyfield
Full-fledged, compact automated perimeter for static
visual field examinations up to 30° – more than just
a screener!
Versatile hand control unit with built-in printer of-
fers complete independence from usual computer
systems, facilitating screening examinations even in
locations not solely dedicated to this purpose
Reliable and comparable results through standard
perimetry – no need for additional perimeter to
verify screening results
GSS 2 (Glaucoma Staging System) following Brusini
CLIP (Continuous Light Increment Perimetry) strategy
offers the unique real threshold test that outper-
forms most interpolation based algorithms

The Centerfield 2
The most compact projection perimeter for static
and kinetic perimetry up to 70° eccentricity
Total flexibility in choosing predefined test patterns
and in creating individual ones
Blue on yellow perimetry (SWAP - Short Wavelength
Automated Perimetry ) for early glaucoma recognition
New ways of displaying results using color map and
color 3D animation
Increased reliability through easy re-check of test
points

The Twinfield 2
Projection perimeter according to Goldmann-Stan-
dard, for static and kinetic perimetry of the whole
visual field
Unique rear-surface projection system ensures pre-
cise reproducibility of test point locations and offers
complete freedom in creating suitable examination
patterns
Manual perimetry available for various certification
procedures
Efficient follow-up comparing with previous exami-
nations and intuitive graphical overlapping
Color perimetry: SWAP and red on white perimetry
Perimeter Features
All features at a glance

Easyfield Centerfield 2 Twinfield 2

Optical System
Stimulus generation LED grid Back-surface projection
Eccentricity 30° 36° / 70° 90°
Background illumination 10 cd/m2 (31.4 asb)
Stimulus size (Goldmann) III III I / III / V
Stimulus duration (ms) 200 200 / 500 / 800 / user defined
Stimulus interval (s) 0.6 / 0.9 / 1.2 / 0.6 / 0.9 / 1.2 /
adaptive user defined / adaptive
Stimulus luminance range 0.1 – 3180 cd/m2 0.1 – 318 cd/m2 0.1 – 318 cd/m2
Stimulus luminance increment 0.1 log steps 0.1 log steps 0.1 log steps
Methods
Static perimetry   
SWAP (Blue on Yellow perimetry) —  
Red on White perimetry — — 
Automated kinetic perimetry —  
Manual kinetic perimetry — — 
Examination strategies
CLIP (Continuous Light Increment Perimetry)   
Classic Threshold (4/2)   
Fast Threshold   
Threshold oriented class strategy   
Suprathreshold strategies (2-zone, 3-zone)   
Freely selectable meridians, sectors and speeds (kinetic) —  
Semi-automated scotoma boundary mapping — — 
Static and kinetic combinations —  
Areas
30-2, 24-2, 10-2 (orthogonal patterns)   
Central physiological patterns (Area 1-4, Area 7-8) —  
Peripheral physiological patterns (Area 5-6) — — 
Estermann grid —  
Sectors   
Profile —  
Custom test patterns   
Re-check points —  
Quality
Eye monitoring   
Central threshold fixation control   
Heijl-Krakau fixation control   
Pupil diameter measurement   
Motorized chinrest —  
Adjustable headrest   
Ergonomic armrest — — 
Remote monitoring —  
Result display
Sensitivity values (dB)   
Greyscale map   
Probability map   
3D animation   
Profile   
Symbols   
GSS2 (Glaucoma Staging System)  — —
Glaucoma Asymmetry Test (GAT)   
Isopter representation —  
Technical data – Perimeters

Easyfield Centerfield 2 Twinfield 2

Operating voltage 100 – 240 V AC
Perimeter bowl radius 30 cm
Weight 4.6 kg 13.0 kg 42.0 kg
Interface RS 232 USB USB
PC compatibility All Windows systems (Win98 or higher)

Technical data – Pentacam

Feature Pentacam®
Camera Custom designed digital CCD camera with synchronous pixel sampling
Light source Custom designed blue LED’s (475 nm, UV free)
Processor Ultra fast DSP with 400 million operations per second
Speed 50 scans in two seconds with approx. 500 true elevation points
per scan and surface
Measurement range

Specification, accessories and design are subject to change without notification and may vary depending on region.
 Curvature 3 to 38 mm
9 to 99 dpt
 Accuracy ± 0.2 dpt
 Reproducibility ± 0.2 dpt
 Working distance 80 mm

Dimensions max. (HxDxW) 21.1 x 14.2 x 11 inches

(535 x 280 x 360 mm)
Weight 19.5 pounds (9 kg)
PC minimum requirements Pentium III 1.5 GHz, Windows XP,
512 MB RAM, special graphic card, USB interface,
for further details please contact your authorized distributor

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