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The Visante OCT has 6 imaging modes:
1. High-Resolution Cornea Single
2. High-Resolution Cornea Quad
4. Anterior Segment Single
5. Anterior Segment Double 6. Anterior Segment Quad
In the Quad mode of both High-Resolution Cornea and Anterior Segment, 4 cross-sectional images are taken at 0 to 180, 45 to 225, 90 to 270, and 135 to 315 degrees, respectively. The Anterior Segment Double takes images at preset angles of 20 to 200 and 160 to 340. In the Single mode, only a single image will be obtained at the desired angle.
In all modes, the angle of image capture can be changed. In the Double and Quad modes, the preset angle separation will remain the same. Therefore, when manually changing the angle of image capture, all angles will rotate together. For example, if an image is being obtained in the Anterior Segment Quad and the operator adjusts the angle by 15 degrees, the new images will be captured at 15 to 195, 60 to 240, 105 to 285, 150 to 330. All images have been rotated by 15 degrees and are still separated by 90 degrees.
There are different tools available for measurement, depending on which mode the image was captured in.
In any of the High-Resolution Cornea modes, you can apply thickness calipers, a flap tool, or annotation. The flap tool is composed of a caliper that automatically places itself on the boundaries delineating anterior/posterior surfaces of the cornea with a movable marker in-between to be placed at the flap/stroma interface by the operator.
The Pachymetry map is generated from multiple cross-sectional scans taken at different angles. Again, the program software calculates or finds the anterior/posterior surface of the tomographs then interpolates the thickness between adjacent tomographs. Images captured in the Anterior Segment mode can be analyzed with thickness calipers, angle tools, and anterior chamber depth/width measurements.
Exporting images for presentation is straightforward and simple. After the image has been analyzed, it can be exported in the following process:
File > Export Examinations > Presentation
The image will be saved in JPEG format. All files can be transferred from the Visante either by CD/DVD burner or USB Key. Alternatively, the Visante can be integrated to a wireless network.
In its clinical application, the Visante is excellent at imaging the anterior segment. Primarily, it provides detailed examination of the structures anterior to the iris, with the following being a list of some of the strengths and clinical applications in which it provides useful information.
1. Non-contact instrumentation
2. Quick– no longer than 2 minutes from when the patient sits down
3. Repeatable and reproducible
4. The ability to use measurement tools such as:
a. Angle tools to measure any angle
b. The Anterior Chamber Depth/Width tool
c. Calipers to measure thickness
d. Flap tools to measure LASIK flaps and residual stromal beds
5. Image through an opaque cornea
a. Useful in graft situations
b. Limited only by pigmented tissues
6. Pachymetry, for example:
b. Fuchs endothelial dystrophy
d. Postoperative monitoring of corneal procedures
7. Anterior chamber intraocular lenses
a. Planning– anterior chamber depth and width can be measured
b. Monitor placement and position postoperatively
8. Corneal refractive surgery
a. Corneal thickness
b. Flap thickness and residual stromal bed
9. Endothelial keratoplasty
a. Attachment of graft
b. Placement of graft
c. Monitor swelling and resolution
10. Narrow angles
a. Accurate measurement of narrow angle
b. Diagnostic images of angle closure
11. Tilted intraocular lens implants
12. Patient education
a. The research that can be performed is only limited by the researcher’s creativity, image resolution, and tool selection
b. Comparative studies of pachymetry, flap thickness of different microkeratomes, and anterior chamber depth measurements were performed during our trial period. In our comparative study of pachymetry, 34 eyes were measured 3 times each with the Visante and an ultrasound pachymeter. The Visante was found to give average pachymetry readings 19.8 microns less than ultrasound pachymetry, with a P < 0.001