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Pentacam BKFST Symposium 9/3/2016

Jack T. Holladay MD MSEE FACS of 8

9/3/2016 JTH 1

Pentacam Breakfast Symposium

How to apply the Holladay Report in

a Cataract and Refractive Clinic

Jack T. Holladay, MD, MSEE, FACSClinical Professor of Ophthalmology

Baylor College of MedicineHouston, Tx WWW.AAO.ORG

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AMERICAN ACADEMY OF OPHTHALMOLOGY

Financial Disclosure I have the following financial interests or relationships to disclose: Abbott Medical Optics: C;

AcuFocus, Inc.: C,O;

Alcon Laboratories, Inc.: C;

ArcScan: C,O;

Carl Zeiss Inc: C;

Elenza: C,O;

Oculus, Inc.: C;

Visiometrics: C,O;

Wavetec: C

WWW.DOCHOLLADAY.COMHandouts

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Version 1.20b76+

1.20b91+

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Main Color Bar Setting

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Miscellaneous Settings

x

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Corneal Thickness Other

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Parameter x y locations& Chord µ

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Normative Data TablesTable 1. Q-value (Front)*

Lower Limit Upper Limit Q-value Q-value Q-value

Min Max Mean -0.23 -- -- ± SD 0.11 -0.12 -0.34 ±2 SD 0.22 -0.01 -0.47 ±3 SD 0.33 +0.10 -0.56

Table 2. Q-value (Back)* Lower Limit Upper Limit Q-value Q-value Q-value Min Max Mean -0.18 -- -- ± SD 0.17 -0.01 -0.35±2 SD 0.34 +0.16 -0.52 ±3 SD 0.51 +0.33 -0.69

Table 3. Pupil Diameter Lower Limit Upper Limit

Pupil

Diameter Pupil

Diameter Pupil

Diameter Min Max Mean 2.86 -- -- ± SD 0.60 2.26 3.46 ±2 SD 1.20 1.66 4.06±3 SD 1.80 1.06 4.66

Table 4. Corneal Diameter (HWTW)

Lower Limit Upper Limit

Corneal

Diameter Corneal

Diameter Corneal

Diameter Min Max Mean 11.77 -- -- ± SD 0.42 11.35 12.19 ±2 SD 0.84 10.93 12.61 ±3 SD 1.26 10.51 13.03



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Normative Data TablesTable 5. Pachymetry Minimum

Lower Limit Upper Limit Pachymetry Pachymetry Pachymetry Min Max Mean 543 -- -- ± SD 33 510 576 ±2 SD 66 477 609 ±3 SD 99 444 642

Table 6. Central Keratometry (Front)* Lower Limit Upper Limit Central K Central K Min Central K Max (diopters) (diopters) (diopters) Mean 43.82 -- -- ± SD 1.51 42.31 45.33 ±2 SD 3.02 40.80 46.84 ±3 SD 4.53 39.29 48.35

Table 7. Maximum Tangential K (Front)*

Lower Limit Upper Limit Central K Central K Min Central K Max (diopters) (diopters) (diopters) Mean 45.55 -- -- ± SD 1.84 43.71 47.40 ±2 SD 3.69 41.87 49.24 ±3 SD 5.53 40.02 51.08

Table 9. Minimum Relative Pachymetry*

Thinnest Lower Limit Pach Thinnest Pach (microns) (microns)

Mean -2.5 -- -SD -2.6 -5.1

-2 SD -5.1 -7.7 -3 SD -7.7 -10.2

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Normative Data TablesTable 10. Front Elevation near Min RP*

Elevation Upper Limit (microns) (microns)

Mean +1.0 -- +SD +2.1 +3.1

+2 SD +4.2 +5.2 +3 SD +6.2 +7.2

Table 11. Maximum Front Elevation* Elevation Upper Limit (microns) (microns)

Mean +1.0 -- +SD +1.3 +4.3

+2 SD +2.6 +5.5 +3 SD +3.8 +6.8

Table 12. Back Elevation near Min RP*

Elevation Upper Limit (microns) (microns)

Mean +6.8 --+SD +4.2 +11.0

+2 SD +8.4 +15.2 +3 SD +12.6 +19.4

Table 13. Maximum Back Elevation* Elevation Upper Limit (microns) (microns)

Mean +8.5 -- +SD +3.3 +11.8

+2 SD +6.5 +15.0 +3 SD +9.8 +18.3

9 10

11 12

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Normative Data Tables

Table 14. Longitudinal Marginal Spherical Aberration (LMSA) in diopters for typical Apical K‐value and Asphericity Quotient (Q‐value) of anterior cornea assuming surface is an aspheric conic.1

Apical Ant. K‐value Q‐value

‐0.53 (prolate)

Q‐value

‐0.26 (prolate)

Q‐value

0.00 (sphere)

Q‐value

+0.26 (oblate)

36.00 0.00 0.57 1.14 1.74

40.00 0.00 0.78 1.58 2.43

44.00 0.00 1.05 2.13 3.29

48.00 0.00 1.37 2.81 4.37

52.00 0.00 1.76 3.64 5.70

LMSA (D) is determined using corneal stromal index of refraction of 1.376 and a perfect aspheric conic surface

with a Q‐value for a corneal zone diameter of 6 mm.

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Detection of Thinning Disorders

Vertical location of Pachy Min

(0.11 ± 0.08 mm)

Hot spot on Topography Maps

Hot spot on Relative Pachy Map

Hot spot on F & B Elevation Maps



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IOL Power Calculations Pentacam can measure FRONT &

BACK SURFACE POWER

Can Calculate: Equivalent K-Reading (EKR65)

65% Mean, Peak & Average

NET POWER9/3/2016 JTH 28

EKR65 Reports Keratometry value but adjusts

for Back Surface Power from Normal (Current IOL Formulas)

If corneal front surface is 7.5 mm (45 D), but if back surface -0.3 D > normal:

EKR = 45.0 – 0.3 = 44.7 D

Note: Net Power = 43.3 D

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IOL Calcs – Abnormal Cornea(Use 65% MEAN EKR) Post Refractive Surgery

Post PKP

Keratoconus

Corneal Scar

Any Irregular Astigmatism



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Normal LASIK RK41 to 44 D3 D Range

36 to 41 D5 D Range

32 to 45 D13 D Range

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Post LASIK CALC Kmean = 40.2 D

Used 40.2 D => SEQ = +1.10 D

(+1.00 + 0.25 X 155 = 20/20)

EKR65 = 39.1 D => +0.00 D

Use EKR65

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Conclusions EKR – Use EKR65 for all IOL

Calcs

Look @ smaller zones than 4.5 mm if pupil very small

(< 3.0 mm in dim light)

Axial length measurement & 3D Scan in one routine

+ IOL power calculator (sph, toric, post refractive)

+ Scheimpflug Image + Iris image & Keratometry overlay

+ 3D Anterior Chamber Analyzer

+ Pachymetry Map, absolute & relative

+ Elevation & Topography Maps (ant. & post.)

+ 3D Cataract Analyzer & PNS

+ 3D pIOL simulation & aging prediction

+ Belin/Ambrosio Enhanced Ectasia III

+ Holladay Report & EKR Detail Report

+ Tomography & Corneal Optical Density

+ Cataract Pre‐Op‐Display & Corneal Wavefront

+ Indice Report & Help Topic

+ Corneal Ring Display

+ various compare displays

= Pentacam®AXL

100 Scheimpflug images within one scan in less than 2 seconds

Pentacam®AXL; Two Devices in One!



Optical: Partial Coherence Interferometry

• Laser diode generates infrared light• Mirrors reflect the light into eye• Time for light to travel to retina measured• Light interference methodology used to measure time and

determine axial length

Advantages• No corneal indentation

artifacts• Measurement along the visual

axis

Disadvantage• Difficult to obtain

measurement with dense cataract

Axial length, optical biometry

light source

detector

reference arm

beam splittermirrow

measurement arm

IOL Calculator, documentation IOL Calculator, post‐op refraction



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!Thank You!

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