Zeiss IOLMaster 700 User Manual

Starting your workflow with more insights
ZEISS IOLMaster 700 with Central Topography
2Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Agenda
1
2
3
4
ZEISS IOLMaster 700 with Central Topography
EQ Mobile Connectivity
Introduction
5 Key Messages
3Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
EN_32_150_0103I
Starting your workflow with more insights
ZEISS IOLMaster 700 with Central Topography
With no changes in workflow,
the ZEISS IOLMaster 700 now measures
Central Topography
4Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Starting your workflow with more insights
ZEISS IOLMaster 700 with Central Topography
Central Topography provides information on central
corneal shape - right from the start!
It gives central corneal shape information before deciding
on the IOL and consulting the patient
Surgeons have a more comprehensive data at hand right
away …
… without extra hardware
… with no change in workflow
… without additional measurement
… easy and intuitively
Biometry incl.
Central
Topography
Surgery
planning
Surgery
Patient
Talk & decision on
PC or toric IOL-
having information
regarding central
corneal shape
5Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Starting your workflow with more insights
ZEISS IOLMaster 700 with Central Topography
An important part of the preoperative evaluation of the cataract patient is evaluation of corneal topography
Regardless of IOL type but especially for toric & multifocal IOLs
Corneal irregularities in the central optical zone are regarded as visually relevant
With no changes in workflow, the ZEISS IOLMaster 700 now measures central corneal topography.
It provides anterior and total axial power maps, designed to detect visually relevant corneal irregularities.
6Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Getting Central Topography without additional measurements
No change to existing workflow
Central Topography is integrated in the ZEISS IOLMaster 700 standard measurement.
< 45 sec for both eyes
Including Biometry, Total Keratometry,
and Central Topography
7Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Starting your workflow with more insights
ZEISS IOLMaster 700 with Central Topography
Your benefits at a glance
Reading central cornea shape information easily and intuitively
Detecting visually relevant corneal
asymmetries
Integrating topography in your daily biometry
routine without changing your workflow or hardware
8Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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What do surgeons say?
“Scaling and hues of the ZEISS IOLMaster 700
with Central Topography are optimized for
easy and intuitive cornea checks.”
“I am amazed at how much information we get
from Central Topography.”
Douglas D. Koch, Houston, TX, USA
9Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Virtual ASCRS
ZEISS Surgical Symposium
In this presentation, several leading ophthalmic surgeons provide insight on how to nail refractive outcomes in cataract surgery. They detail new surgical technologies and techniques (including Central Topography), and offer guidance on making
treatment decisions.
https://www.healio.com/ophthalmology/education-lab/2020/05_may/zeiss-surgical-symposium/nailing-refractive-outcomes-in-
cataract-surgery
Presenting Faculty
10Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Global Premium Cataract Webinar
ZEISS Ophthalmic Surgery Webinar
11Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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ZEISS IOLMaster 700
IOLCon connectivity
ULIB will no longer be maintained.
ULIB constants have been moved to the IOLCon. (www.IOLCon.org)
IOLCon is a database independent of ZEISS.
IOLCon allows:
manufacturers to provide their IOL constants and specifications,
hosts the ULIB constants, and
offers constant optimization.
With ZEISS IOLMaster 700 SW1.90, IOLCon can now be transferred to the
IOLMaster via an automated export/import function (USB).
12Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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ZEISS IOLMaster 700 with Barrett True-K with TK
Clinical results
“The Barrett True K (TK) provided the lowest mean refractive
prediction error and variance for both prior myopes and hyperopes
undergoing cataract surgery.“
“The Barrett True K (TK) exhibited the highest percentages of eyes
within ±0.50D, ± 0.75D and ± 1.00D of the refractive prediction error compared to other formulae for prior myopic patients.”
“Accuracy of IOL power calculations in post-laser eyes can be improved by the addition of posterior corneal values as measured
by the IOLMaster 700.”
New:
In post-myopic LASIK eyes, Barrett True K with TK improved the outcome prediction
compared to Barrett True K with classic K’s
within ±0.5 D by >12% (p = 0.04)
Lawless M, Jiang JY, Hodge C, Sutton G, Roberts TV, Barrett G. Total keratometry in intraocular lens power calculations in eyes with previous laser refractive surgery [published online ahead of print, 2020 Apr 12]. Clin Exp Ophthalmol. 2020;10.1111/ceo.13760. doi:10.1111/ceo.13760. https://pubmed.ncbi.nlm.nih.gov/32279436/
13Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
EN_32_150_0103I
ZEISS IOLMaster 700 with Central Topography
Feature Overview
1
2
3
4
Starting your workflow with more insights.
ZEISS IOLMaster 700 with Central Topography.
Data access anywhere
ZEISS IOLMaster 700 with ZEISS EQ Mobile.
Getting 12% more post myopic LASIK patients within 0.5D.
ZEISS IOLMaster 700 with Barrett True K with TK Formula.
Accessing the latest up to date IOL constants
ZEISS IOLMaster 700 with IOLCon import.
14Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Agenda
1
2
3
4
ZEISS IOLMaster 700 with Central Topography
EQ Mobile Connectivity
Introduction
5 Key Messages
15Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Corneal Topography
Overview
A non-invasive medical imaging technique for mapping the surface curvature of the cornea, providing a detailed description of various curvature and shape characteristics of the cornea.
Prior to this technology, the standard of care for measuring corneal curvature was the manual keratometer, which measures
approximately 3mm of the cornea.
The advantage of corneal topography is the ability to measure a wider area of the cornea and is able to quantify irregular
astigmatism, which cannot be done with a manual keratometer.
Source: ZEISS ATLAS 9000 Topographer
Source: Carl Zeiss Media Database
16Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Corneal Topography
Regular cases
80% of all corneas: Standard cases – Keratometry works
Topography
Keratometry
Spheric Toric
Regular Astigmatism
Round
17Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Corneal Topography
Irregular cases
20% of all corneas: Special cases – additional topography
Topography
Keratometry
Toric Toric Toric
Irregular
Astigmatism
Keratoplastic
Keratoconus
Multifocal IOL?
Toric IOL?
18Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Corneal Topography
Detecting irregularities
Corneal topography is most commonly used for the following purposes:
Detect irregularities of the cornea (ie. irregular astigmatism or pathologies).
Important for premium IOLs (ie. toric and multifocal IOLs) Determine if the astigmatism is ‘regular’ or ‘irregular’ to know
if patient is a good candidate (standard keratometers cannot make this determination).
Regular astigmatism: principle meridians are 90 degrees away from each other (eg. WTW, ATR)
Irregular astigmatism: axes not 90 degrees from each other
WTW Astigmatism ATW Astigmatism
Irregular Astigmatism Suspect Keratoconus
19Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Corneal Topography
Corneal patterns – what do they mean?
Symmetric patterns
Asymmetric patterns
Skewed patterns
Special patterns
Abbreviations: SB = symmetric bowtie; SS = superior steep; AB/SS =asymmetric bowtie superior steep; IS = inferior steep; AB/IS = asymmetric bowtie inferior steep;
SB/SRAX = symmetric bowtie with skewed radial axis index; AB/SRAX = asymmetric bowtie with skewed radial axis index
Source: Dr. Han Bor Fam
20Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Corneal Topography
Colored maps – what do they mean?
Corneal topographers measure surface curvatures then presents the information in the form of a colored map.
BLUE - Cool colors = FLATTER curvature or BELOW average height.
GREEN - Medium colors = NORMAL curvature or AVERAGE height.
RED/ORANGE - Hot colors = Steeper curvature or above average height.
BLACK - NO information = Lid, lash, lack of tear film or severe pathology.
Intermediate colors - white, aqua, yellow and orange are transition areas on the cornea
ATLAS
Corneal Topography
IOLMaster 700
Central Topography
NEW
21Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Agenda
1
2
3
4
ZEISS IOLMaster 700 with Central Topography
EQ Mobile Connectivity
Introduction
5 Key Messages
22Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
EN_32_150_0103I
ZEISS IOLMaster 700 with Central Topography
Anterior and Total axial power maps
1. The anterior axial power map represents total corneal power, assuming a fixed ratio of anterior to posterior curvature and normal corneal thickness.
2. The total axial power map represents
total corneal power, replacing
assumptions about the posterior corneal surface and pachymetry with measurements
Generally, axial maps:
Simple way of describing the overall shape of the cornea
Displays astigmatism (regular or irregular)
Most common, intuitive map to understand
23Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Providing central anterior axial power maps
Using 18 telecentric spot locations
18 Spots
Anterior
Surface Model
(curvatures)
Keratometric
Index
n
k
Anterior Axial
Power Map
Measurement of the anterior corneal curvature
or power
The IOLMaster 700 Telecentric Keratometry directly measures surface slopes on 18 spot locations.
This results in high independence from system misalignment.
Every spot is a fully individual and independent measurement (no skew error as Placido!)
The measured curvatures (r) are converted to powers (D) via the chosen keratometric index.
Thus, the anterior axial power map represents total corneal power, assuming a fixed ratio of anterior to posterior curvature and normal corneal thickness.
24Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Providing central total axial power maps
Using 18 telecentric spot locations and SWEPT-Source OCT
18 Spots
Anterior
Surface Model
(curvatures)
„Real“
Refractive
Indices calibration
analog to TK
®
n
cornea
n
aqueous
Total Axial
Power Map
Corneal
Pachymetry
Posterior
Surface Model
(curvatures)
Measurement of the total corneal curvature or power
Additionally to the anterior surface model, pachymetry and posterior surface curvatures are measured by SWEPT-Source OCT in 6 meridians.
The measured curvatures (r) are converted to powers (D) via the refractive indices of the cornea and the aqueous, including corneal thickness.
Thus, the total axial power map represents total corneal power, replacing assumptions about the posterior corneal surface and pachymetry with measurements.
25Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Extended Color Scale (based on ISO 19880)*
34 D to 54 D range; 0.5 D step s; 41 colors
Default color scale window: 39 .. 49 D (10 D range, 21 colors)
Extreme cases color scale window moved up/down on very steep/flat corneas (>49 D / <39 D)
Color scale window extended on highly aberrated corneas (>10 D range >21 colors)
Green always 44 D and always displayed
Diameter of analysis is displayed
Steep - red Normal
Flat – blue / purple
Scaling and hues of the ZEISS IOLMaster 700 with Central Topography are optimized for easy and intuitive cornea checks
Co-Developed with Douglas D. Koch and Li Wang, Houston
*According to ISO 19980 standard, the hue changes monotonically from green to red and shall change monotonically from green to blue.
26Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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In extreme cases color scale window automatically adjusted
For corneas >49 D / <39 D
27Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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ZEISS IOLMaster 700 with Central Topography
Anterior and Total axial power maps
Extended
Color Scale
Step size (D) Topography diameter (mm)
Toggle between anterior and total
axial power maps
User can set Preferred Central Topography map
Settings menu > Advanced settings > Parameters, units
28Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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ZEISS IOLMaster 700 with Central Topography
Keratometry & Central Topography Overview
Device
ZEISS IOLMaster 700
Keratometry
Anterior,
posterior and Total Keratometry (TK)
Telecentric
Keratometry
Topography
Anterior and total
Method
of topography
3
-zone Keratometry (18 LED) and SS-OCT
Diameter
of Topography
3.4
– 5.4mm for corneal radii of 6 – 11mm
Pupil
diameter
Topography
maps
Anterior and total axial power
map
Color
scale
34D
to 54D range; 0.5D steps; 41 colors; Green always 44D and always displayed; steps
and
colors can‘t be changed
Telecentric
Keratometry +
SS-OCT based
topography
Reals Ks,
not Sim Ks
29Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Starting your cataract workflow with more information
ZEISS IOLMaster 700 with Central Topography
Cases of
Regular Astigmatism
Cases of
Irregular post LVC Astigmatism
Cases of
Irregular Pathological Astigmatism
30Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Comparing Central Topography to a dual-Scheimpflug / Placido device
ZEISS IOLMaster 700 vs. Ziemer Galilei G4
9mm diameter Galilei G4
Approx. 4 mm diameter Galilei G4
Approx. 4 mm diameter
ZEISS IOLMaster 700
DOCTOR’S CONCLUSION: Excellent Comparability
With-the-rule astigmatism: normal range of power, meridians straight
Minimal color differences, low amount of astigmatism
Same decision for toric or multifocal IOL
Data Source and interpretation: Li Wang & Douglas D. Koch, USA
31Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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DOCTOR’S CONCLUSION: Great comparability
Irregular astigmatism, inferior steepening (“lazy-eight“) visible on both devices
Same decision for toric or multifocal IOL
Comparing Central Topography to a dual-Scheimpflug / Placido device
ZEISS IOLMaster 700 vs. Ziemer Galilei G4
9mm Diameter Galilei G4
Approx. 4 mm Diameter Galilei G4
Approx. 4 mm Diameter
ZEISS IOLMaster 700
Data Source and interpretation: Li Wang & Douglas D. Koch, USA
32Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Comparing Central Topography to a dual-Scheimpflug / Placido device
ZEISS IOLMaster 700 vs. Ziemer Galilei G4
9mm Diameter Galilei
DOCTOR’S CONCLUSION: Good comparability
Irregular astigmatism on central topography, shape of Central Topography from ZEISS IOLMaster 700 is
similar to the Galilei map
No straight meridians: irregular
Steep and irregular: Be careful!
Same decision for toric or multifocal IOL
Approx. 4 mm Diameter Galilei G4
Approx. 4 mm Diameter
ZEISS IOLMaster 700
Data Source and interpretation: Li Wang & Douglas D. Koch, USA
33Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Comparing Central Topography to a dual-Scheimpflug / Placido device
ZEISS IOLMaster 700 vs. Ziemer Galilei G4 – Case report: previous myopic LASIK/PRK
9mm Diameter Galilei
DOCTOR’S CONCLUSION: Good comparability
Flat cornea, irregular and against-the-rule astigmatism
(Blue color, meridians not straight, “lying eight“)
Flat, ATR and meridians not straight both are a warning in itself to check further
Same decision for toric or multifocal IOL
Approx. 4 mm Diameter Galilei G4
Approx. 4 mm Diameter
ZEISS IOLMaster 700
Data Source and interpretation: Li Wang & Douglas D. Koch, USA
34Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Comparing Central Topography to a dual-Scheimpflug / Placido device
ZEISS IOLMaster 700 vs. Ziemer Galilei G4 – Case report: previous hyperopic LASIK/PRK
DOCTOR’S CONCLUSION: Good comparability
Central steep cornea on central topography
Overall shape similar to the Galilei map
Galilei shows peripheral flattening
IOLM K astigmatism: 0.38 D @ 15° | Galilei SimK astigmatism: 0.29 D @ 28°
ZEISS IOLMaster 700
Galilei G4
Data Source and interpretation: Li Wang & Douglas D. Koch, USA
35Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Corneal information you can trust
ZEISS IOLMaster 700 with Central Topography
Subject 2
IOLMaster
700
Subject
1
IOLMaster
700
Measurement 1
Measurement 2
Measurement 3
Data Source: ZEISS
36Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Corneal information you can trust
ZEISS IOLMaster 700 with Central Topography vs. Pentacam AXL
Pentacam
AXL
9 mm
(approx. 4 mm black circle)
IOLMaster
700
4.2 mm
Measurement 1
Measurement 2
Measurement 3
Data Source: ZEISS
37Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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Disclaimer
The ZEISS IOLMaster 700 is indicated to aid clinicians with IOL selection. While clinicians may find Central Topography
feature to be helpful in their decision-making process, topographers should be used as primary devices for topographical decisions. The information presented in this presentation was an opinion of Dr. Douglas D. Koch (clinician). Douglas D. Koch has a contractual or other financial relationship with Carl Zeiss Meditec AG and its affiliates and has received financial support for consulting activities.
38Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
EN_32_150_0103I
Agenda
1
2
3
4
ZEISS IOLMaster 700 with Central Topography
EQ Mobile Connectivity
Introduction
5 Key Messages
39Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
EN_32_150_0103I
ZEISS EQ Mobile
A FORUM and cloud based software solution including a mobile app for iPhone and iPad
Features
1. Flexible and secure data access on iPad and iPhone – anywhere, anytime,
independent of the location of surgery
2. Easy wireless data transfer to/from ZEISS CALLISTO eye in the OR
via ZEISS EQ Mobile cloud
3. Digital IOL confirmation via QR/barcode scan for ZEISS IOLS or photo
documentation for non-ZEISS IOLs
4. Surgery report from ZEISS CALLISTO eye, transferred back to ZEISS FORUM
Benefits
1. Secure astigmatism management workflow via cloud connectivity
2. Peace of mind and increased safety. Surgical data becomes automatically
available where and when needed
3. Avoid critical workflow events during the surgery by automatic inclusion
of comprehensive surgical planning via the cloud and allowing digital IOL confirmation in the OR
4. Facilitated surgical documentation by automated surgery reports
What is ZEISS EQ Mobile:
ZEISS EQ Mobile provides a flexible and secure data transfer to ZEISS CALLISTO eye via the cloud-based ZEISS EQ Mobile app
Replace paper and USB sticks
Streamline your cataract refractive workflow
40Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
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ZEISS EQ Mobile Connectivity
Supporting different use cases within the ZEISS Cataract Suite with/without ZEISS FORUM
Surgery center
VERACITY* cloud
(*only in USA)
ZEISS EQ Mobile cloud
Surgery report
IOLMaster Report +
Reference Images
Ophthalmology Practice
*NEW in 1.7
Surgery planning +
Reference images
Coming
soon
*EQ Mobile 1.7 is still in development and not yet released.
41Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
EN_32_150_0103I
Agenda
1
2
3
4
ZEISS IOLMaster 700 with Central Topography
EQ Mobile Connectivity
Introduction
5 Key Messages
42Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
EN_32_150_0103I
Starting your workflow with more insights
ZEISS IOLMaster 700 with Central Topography
Your benefits at a glance
Reading central cornea shape information easily and intuitively
Detecting visually relevant corneal
asymmetries
Integrating topography in your daily biometry
routine without changing your workflow or hardware
43Carl Zeiss Meditec AG, ZEISS IOLMaster 700 with Central Topography
EN_32_150_0103I
ZEISS IOLMaster 700 with Central Topography
Feature Overview
1
2
3
4
Starting your workflow with more insights.
ZEISS IOLMaster 700 with Central Topography.
Data access anywhere
ZEISS IOLMaster 700 with ZEISS EQ Mobile.
Getting 12% more post myopic LASIK patients within 0.5D.
ZEISS IOLMaster 700 with Barrett True K with TK Formula.
Accessing the latest up to date IOL constants
ZEISS IOLMaster 700 with IOLCon import.
EN_32_150_0103I
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