Don’t be Puzzled by Glaucoma – The Comprehensive Solution for Your Practice

Glaucoma is one of the leading causes of blindness. Early glaucoma detection and reliable progression analysis may prevent loss of vision. A serious management of glaucoma is the basis of an individualized therapy and excellent patient care.

The detection and monitoring of glaucoma require a targeted combination of clinical observations and reliable examination results. Clinical expertise is always the key to a accurate glaucoma diagnosis.

Structural and functional examinations from Heidelberg Engineering provide invaluable information to aide in the diagnosis and treatment of glaucoma.

Advanced glaucoma diagnosis demands advanced technology. A complete picture of glaucoma develops only if the diagnostic information fits together like the pieces of a puzzle.

We provide serious diagnostic power for glaucoma!Comprehensive glaucoma solutions from Heidelberg Engineering.

All Pieces of the Puzzle

The Complete Picture of Glaucoma Diagnosis

Flexible Integration – Effi cient Networking

Intelligent Use of Patient Data and Optimized Patient Workfl ow

Effi cient integration of diagnostic equipment in the clinical setting can signifi cantly improve workfl ow and management of an increasing number of patients while delivering a high quality of care.

The HEYEX software platform provides fl exible solutions from a solo practice to a large clinic environment. The integrated patient database facilitates storage and management of image fi les from all existing Heidelberg Engineering devices, such as HRT, HEP and SPECTRALIS.

Network viewing software allows easy and reliable access to patient image fi les on any networked computer supporting seamless consultation and diagnosis.

One software platform for all

Heidelberg Engineering devices

Network integration and viewing stations

Data security

DICOM compatibility

Connectivity to many electronic

health records systems

Import of third party image data

Validated DiagnosticsThe excellent diagnostic performance of the Heidelberg Retina Tomograph (HRT) is well established. The HRT has been used worldwide over 20 years for the detection and management of glaucoma. Advanced algorithms like the Moorfi elds Regression Analysis (MRA) and the Glaucoma Probability Score (GPS) allow an objective assessment of morphometric glaucomatous changes. Objective structural parameters complement the 3D topographic profi le of the optic nerve head and facilitate a comprehensive risk assessment of suspect glaucoma patients.

All relevant anatomic structures at a glance – optic nerve head (ONH) excavation, neuroretinal rim and peripapillary retinal nerve fi ber layer

Weinreb 2010: Baseline GPS, MRA, and stereoparameters alone or when combined with baseline clinical and demographic factors can be used to predict the development of POAG end points in OHTS (Ocular Hypertensive Treatment Study) participants and are as effective as stereo photographs for estimating the risk of developing POAG in ocular hypertensive subjects1

Zangwill 2005: HRT MRA is the top predictive factor for glaucoma and can identify those patients at high risk for developing the disease2

Strouthidis 2010: In clinical practice, patients with both an abnormal MRA and an abnormal GPS classifi cation at presentation should be followed closely as they have an increased risk of future visual fi eld or HRT change3

Weinreb 2010: Baseline GPS, MRA,

Strouthidis 2010: In clinical practice, Strouthidis 2010: In clinical practice,

1 Weinreb RN et al; Ophthamol 2010; 117:1674–1683. 2 Zangwill LM. et al.; Arch Ophthalmol 2005;123:1188-1197.3 Strouthidis NG et al.; Glaucoma 2010; 19(5):304-309.

Zangwill 2005: HRT MRA is the top

Examination Report – HRT Moorfi elds Regression Analysis

Heidelberg Retina TomographOU Report

Software Version: 3.2/0www.HeidelbergEngineering.com

Patient: Glaucoma, Outside DOB: 14.Dez.1951 Examination: 24.Sep.2003Pat-ID: Caucasian Gender: male Ethnicity: (Caucasian)

OD OSInitial ReportQuality: Excellent (SD 8 µm)

Focus: -1.00 dpt Operator: dcp

Quality: Excellent (SD 9 µm)Focus: -1.00 dpt Operator: dcp

CUPDisc Size: 2.13 mm² (average) Disc Size: 2.55 mm² (average)

Linear Cup/Disc Ratio [ ]0.76 ❢❢❢❢❢❢❢❢

p = 0.03

Asymmetry0.00

✔✔✔✔✔✔✔✔

p = 0.4

0.76 ✔✔✔✔✔✔✔✔

p = 0.06

Cup Shape Measure [ ]-0.06 ❢❢❢❢❢❢❢❢

p = 0.02

Asymmetry0.00

✔✔✔✔✔✔✔✔

p = 0.45

-0.06 ❢❢❢❢❢❢❢❢

p = 0.04

RIM

MRA: Outside normal limits MRA: Outside normal limits

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Rim Area [mm²]0.91 ✖✖✖✖✖✖✖✖

p < 0.001

Asymmetry-0.17

✔✔✔✔✔✔✔✔

p = 0.24

1.08 ✖✖✖✖✖✖✖✖

p < 0.001

Rim Volume [mm³]0.16 ✖✖✖✖✖✖✖✖

p < 0.001

Asymmetry-0.09

✔✔✔✔✔✔✔✔

p = 0.16

0.25 ❢❢❢❢❢❢❢❢

p = 0.02

RNFL

0.8

0.6

0.4

0.2

0.0

-0.2

-0.4

36031527022518013590450

T TS NS N NI TI T

RNFL Profile0.8

0.6

0.4

0.2

0.0

-0.2

-0.4

36031527022518013590450

T TS NS N NI TI T

RNFL Profile

Height Variation Contour [mm]0.28 ✔✔✔✔✔✔✔✔

p = 0.16

Asymmetry-0.13

❢❢❢❢❢❢❢❢

p = 0.02

0.41 ✔✔✔✔✔✔✔✔

p > 0.5

Mean RNFL Thickness [mm]0.20 ✔✔✔✔✔✔✔✔

p = 0.28

Asymmetry-0.05

✔✔✔✔✔✔✔✔

p = 0.12

0.25 ✔✔✔✔✔✔✔✔

p > 0.5

Inter-Eye Asymmetry 13 %

0.8

0.6

0.4

0.2

0.0

-0.2

-0.4

36031527022518013590450

T TS NS N NI TI T

Combined RNFL Profile

✔✔✔✔✔✔✔✔ Within normal limits p > 0.05

❢❢❢❢❢❢❢❢ Borderline p < 0.05

✖✖✖✖✖✖✖✖ Outside normal limits p < 0.001

OD RNFL profileOS RNFL profileRNFL profile median

Comments:

Signature:Date: 29.10.2010

Early Detection and Reliable Progression AnalysisThe Topographic Change Analysis (TCA) of the HRT is the best known and most evidence-based method for glaucoma management4. The Gold Standard for objective comprehensive structural analysis of the ONH is the key to an individualized approach to glaucoma diagnosis and treatment.

ONH and retinal nerve fi ber layer change at a glance

Early detection of subtle glaucomatous changes i.e. disease progression

Trend analysis – Volume and area changes indicated

Contour-line and reference plane independent

Follow-up examinations and single scans automatically aligned

ONH and retinal nerve fi ber

Early detection of subtle Early detection of subtle

Trend analysis – Volume and Trend analysis – Volume and

Contour-line and reference

Follow-up examinations and Follow-up examinations and

4 Chauhan BC. et al.; Invest Ophthalmol Vis Sci 2000; 41:775-782.

Examination Report – HRT Topographic Change Analysis

Heidelberg Retina TomographTCA Overview

Software Version: 3.2/140Page 1/1

Patient:

Examination:

Glaucoma, Progression

Sex: female DOB: 20.Mai.1964 Pat-ID: TCA Ethnicity: (Caucasian)

Baseline: 17.Jul.2000 Last Follow-Up: 03.Jul.2003 Elapsed: 35 months OS

Baseline: 17.Jul.2000Examination Date

01/01 01/02 01/03 01/04 01/05 01/06 01/07 01/08 01/09 01/10

Total Size Change Total Volume Change

[mm

²]

2.0

1.5

1.0

0.5

0.0

[1/1000 mm

³]

100

75

50

25

0

Follow-Up: #2, 10.Dez.2001 Follow-Up: #3, 22.Aug.2002 Follow-Up: #4, 22.Aug.2002

Follow-Up: #5, 03.Jul.2003

One Perimeter – Two Methods The visual fi eld examination remains an essential part of glaucoma diagnosis and management, despite rapid developments in imaging technologies5. Heidelberg Engineering complements the Gold Standard of structural glaucoma diagnosis, the Heidelberg Retina Tomograph (HRT) with an innovative and reliable partner, the Heidelberg Edge Perimeter (HEP). The HEP offers two perimetric methods in one device.

Flicker-Defi ned-Form (FDF) Perimetry for early glaucoma detection in patients at risk and ocular hypertensive patients

The Gold Standard, White-on-White Perimetry (SAP) for continuous care of patients with manifest glaucoma

Unique Legacy Scale for a direct comparison with HFA examination results

The Gold Standard, White-

5 Terminology and Guidelines for Glaucoma. 3rd Edition (2008). European Glaucoma Society.

Examination Report – HEP – FDF 24-2 ASTA Standard – OU Report

Heidelberg Edge PerimeterOU ReportPatient: HEP, FDFPat-ID:

DOB: 01-01-1962 (46)Gender: HEP, F OU

OD OSStimulus: FDF FDFPattern: 24-2 24-2Strategy: ASTA Standard ASTA StandardTest Date: 26-11-2008 26-11-2008Test Time: 4:41 PM 4:48 PMPresentations: 317 305Pupil Diameter:Target Size: 5.0 5.0Refr. Error: +0.00 +0.00Cylinder: +0.00 +0 +0.00 +0IOP: 0 0Corr. Lens: unknown unknown

OD OSDuration: 05:13 04:59FP Count: 0 / 317 (0%) 0 / 305 (0%) FN Count: 0 / 3 (0%) 0 / 5 (0%) Fixation Losses: 5 / 317 (1%) 7 / 305 (2%)

MD: -4.48 dB -3.47 dBPSD: +4.22 dB +5.31 dBGHT: Outside Normal Limits Outside Normal Limits

OD OSSensitivity (legacy dB)

2124

2828

21 25

21

2428

28

17 20 18

14 111717

232321

332828 28 31 30

27 25 31 27

13

24

30

27

25

28

24

3018

20

3431

30

31 28

27

27

28

31

31

21

20

24

30 302424

2827

24 28

30

2428

24

23 28 21

14 20148

23204

313130 31 31 27

28 28 25 28

23

28

25

28

30

27

7

21 23

23

2731

24

31 31

30

24

23

33

24

28

31

30

30 30

Grayscale

30 30 30 30

0 dB5

101520253035

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Total Deviation

Pattern Deviation

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p < 5%

p < 2%

p < 1%

p < 0.5%

Comments:

Signature:Reliability Parameter Graph

0 1 2 3 4 5 6 min

FP

FN

FL

ODOS

Software Version: 2, 1, 0, 0 Normal DB Version: 2010-03-17 21:52:51.89

Unique Legacy Scale for a

Structure and FunctionThe structural analysis of the ONH and the functional assessment of the visual fi eld form two pillars of a comprehensive glaucoma diagnosis. Based on the correlation between topographic classifi cation of ONH sectors and visual fi eld regions described by Garway-Heath et al.6, special algorithms have been developed to directly link structural and functional data with each other and to display them in a single examination report.

All relevant information on one printout

First real correlation of structural and functional examination results

Reliable clinical diagnosis

Improved patient and time management

All relevant information

First real correlation of

Reliable clinical diagnosisReliable clinical diagnosis

Improved patient and time Improved patient and time

Examination Report – HRT & HEP – Unique Structure-Function Map

6 Garway-Heath DF. et al.; Ophthalmology 2000;107:1809–1815.

HRT + HEPOU Report

Software Version: HRT: 3.2/6133 HEP: 2.1.0.63 HEP NDB Version: 2010-03-17 21:52:51.89

Patient:

Examination:

HRT, HEPSex: female DOB: 01.01.1926 Pat-ID: --- Ethnicity: (Caucasian)

HRT Date: 22.04.2009HEP(OD) Date: 30.04.2009HEP(OS) Date: 30.04.2009

OD OS

MRA: Borderline MRA: Outside normal limits

Disc Size: 2.71 mm² (large)

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Disc Size: 2.30 mm² (average)

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Linear Cup/Disc Ratio✔✔✔✔✔✔✔✔ 0.67 p = 0.24 ✔✔✔✔✔✔✔✔ 0.57 p = 0.42

Cup Shape Measure✔✔✔✔✔✔✔✔ -0.13 p > 0.5 ✔✔✔✔✔✔✔✔-0.23 p > 0.5

Rim Area [mm²]❢❢❢❢❢❢❢❢ 1.48 p = 0.04 ✔✔✔✔✔✔✔✔ 1.56 p > 0.5

Rim Volume [mm³]✔✔✔✔✔✔✔✔ 0.31 p = 0.14 ✔✔✔✔✔✔✔✔ 0.38 p > 0.5

Height Variation Contour [mm]✔✔✔✔✔✔✔✔ 0.40 p > 0.5 ✔✔✔✔✔✔✔✔ 0.55 p > 0.5

Mean RNFL Thickness [mm]✔✔✔✔✔✔✔✔ 0.21 p > 0.5 ✔✔✔✔✔✔✔✔ 0.22 p > 0.5

✔✔✔✔✔✔✔✔ Within normal limits

❢❢❢❢❢❢❢❢ Borderline

✖✖✖✖✖✖✖✖ Outside normal limits

Pattern Deviation

GHT: Outside normal limits

Pattern Deviation

GHT: Outside normal limits

Test:24-2 24-2

Strategy:ASTA Standard ASTA Standard

FP Count:3 3

FN Count:3/3 (100.0%) 3/7 (42.9%)

Fixation Losses:3 (0.7%) 0 (0.0%)

MD:-7.24 dB p<0.05% -6.50 dB p<1%

PSD:+5.66 dB p<0.05% +4.86 dB

p > 5% p < 5% p < 2% p < 1% p < 0.5%

HEP

HRT

Within normal limitsBorderlineOutside normal limits

Comments:

Date: 05.11.2010 Signature:

PrecisionThe SPECTRALIS enables the precise measurement of the nerve fi ber layer thickness around the optic nerve head. Comparing the measurement to a normative database allows a fast and reliable detection of local nerve fi ber defects. The examination results are comprehensively documentedand summarized.

Precise measurement of retinal nerve fi ber layer thickness

Evaluation of more than 1,500 data points on a single circle scan around the optic nerve head

Automatic comparison to an age-adjusted normativedatabase to classify a patient as being within or outside normal limits

High sensitivity and specifi city with TruTrackTM Active Eye Tracking and Fovea-to-Disc (FoDiTM) alignment

High-quality fundus images even under challenging conditions (e.g. cataract)

Evaluation of more than 1,500 Evaluation of more than 1,500

High sensitivity and specifi city High sensitivity and specifi city

Automatic comparison to an

High-quality fundus images even High-quality fundus images even

Examination Report – RNFL Single Exam Report OU

ReproducibilityThe reliable detection of change is critical and defi nes glaucoma in suspect patients. With the SPECTRALIS changes in nerve fi ber layer and retinal thickness as small as 1 µm can be identifi ed.7,8 Structured reports enable a comprehensive documentation of change over time.

Reliable identifi cation of changes as small as 1µm

AutoRescanTM function for follow-up exams

Color-coding of local changes

Visualization of disease progression for easy interpretation

Comprehensive documentation of change over time

Fast localization of nerve fi ber layer changes

Reliable identifi cation of

AutoRescan

Color-coding of local

Visualization of disease

Comprehensive

7 Wolf-Schnurrbusch et al. Macular thickness measurements in healthy eyes using six different optical coherence tomography instruments. Invest Ophthalmol Vis Sci. 2009; 50:3432-3437.8 Wu et al. Reproducibility of retinal nerve fi ber layer thickness measure- ments using spectral domain optical coherence tomography. J Glaucoma. 2010 (Published online ahead of print).

Fast localization of nerve

Examination Report – RNFL progression

Innovative ConceptsThe Posterior Pole Asymmetry Analysis combines mapping of retinal thickness over the entireposterior pole with an innovative asymmetry analysis. The full geographic extend of nerve fi ber and ganglion cell layer defects can be visualized. The combination of nerve fi ber layer thickness and retinal thickness provides an even more robust parameter for glaucoma detection and monitoring of change over time.

Examination Report – RNFL & Asymmetry Analysis

Evaluation of nerve fi ber layer and retinal thickness in a single visit

Targeted combination of multiple parameters

High-resolution thickness maps with fi nely graded color scale

Asymmetry Analysis for early detection of glaucomatous abnormalities

Detailed reports

Excellent Image QualityAnterior Chamber Angle assessment is typically used in a comprehensive glaucoma diagnosis to identify Angle Closure Glaucoma. The SPECTRALIS Anterior Segment Module offers image acquisition of the Cornea and the Sclera. Moreover, both anterior chamber angles can be visualized in a single SD-OCT scan for an effi cient glaucoma diagnosis.

16 mm White-to-White SD-OCT scan

High-resolution images acquired with TruTrackTM Active Eye Tracking and Heidelberg Noise Reduction

Manual measurement tools for Anterior Chamber Angle assessment

16 mm White-to-White

High-resolution images

Manual measurement tools

Examination Report – Anterior Segment Module

Corporate Headquarters Heidelberg Engineering GmbH · Tiergartenstr. 15 · 69121 Heidelberg · Germany

phone +49-62 21-64 63 0 · fax +49-62 21-64 63 62 · www.HeidelbergEngineering.com 9918

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