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5/14/2008

In the name of God


the most kind and merciful

Basic of orbscan

H.Movahedan MD

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5/14/2008

What is Topography?

Topographic Technologies
• Placido disk –based topography

• AstraMax : ( three-dimensional topography )

• Elevation-based topography:
– Slit-scanning topography (orbscan)
– Scheimpflug imaging (Pentacam-
(Pentacam-Galilei
Galilei--Precisio)

• Artemis : (ultrasound digital topography)

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Elevation Based Topography


• Orbscan:
– Placido disc & slit scanning
• Pentacam:
– Scheimpflug imaging
• Galilei :
– Dual scheimpflug imaging & placido disc
• Precisio:
– Scheimpflug imaging

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Scheimpflug Principle
Schematic picture of a Camera Schematic picture of the Scheimpflug
Picture / Focus Plane Principle

Film Plane
Objective Plane
Picture / Focus Plane

Point of Intersection

Film Plane

Advantage of the Scheimpflug Camera:


Objective Plane
Problem of a normal Camera: •higher depth of focus,

limited depth of focus •sharp picture, but distorted


The Scheimpflug law says: To get a higher depth of focus, move the three
planes, provided that the picture plane, the objective plane and the film
plane has to cut each other in one line or one point of intersection.

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The ORBSCAN II Concept


• Slit-scan triangulation and perspective
reflection are complementary
technologies: where one is weak the other
is strong.
• ORBSCAN II exploits a synergistic
combination of the two technologies.
• The result is unequaled accuracy in the
elevation and curvature of clinically-
relevant, complex surfaces.
October 1997 Orbscan II Concept 9

Hybrid Technology of ORBSCAN II


1. Measure surface elevation directly by
slit-scan triangulation.
2. Measure surface normal directions
directly using perspective reflection,
supplemented with triangulated
elevation.
3. Unify triangulated and reflective data
to obtain accurate surfaces in
elevation, slope, and curvature.
October 1997 Orbscan II Concept 10

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Slit-Scan Triangulation locates


surface points individually.
Triangulate an edge
point in camera object
complex object space (x, y, z)
by mathematically
intersecting the
diffuse reflected
camera edge ray
with the calibrated
slit-beam surface.

Video
Camera
October 1997 Orbscan II Concept 11

Deriving Elevation
Reflection Triangulation
• Primary
• Requires integration.
measurement.
• Accuracy degrades
• Uniformly accurate
peripherally.
over the measured
• Can not traverse surface.
discontinuities.
• Measures complex
• Placido skew ray surfaces.
error is significant in
clinically relevant
abnormalities (e.g.,
October 1997 Orbscan II Concept 12
keratoconus).

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Reflective and Slit-scan


Technologies

• Multiple images,
• One image, one multiple surfaces.
surface. • Omni-direction
• Angle-dependent diffuse backscatter.
Two specular
prevailing
ORBSHOT
reflection.
employstechnologies have
Placido reflective been used ORBSCAN
•technology. for corneal
Triangulates
topography.
• Measures
employs Bothslope
slit-scan have (as
advantages
a of
technology. and disadvantages.
elevation.
II employs
The overwhelming advantage ORBSCAN
slit-scan systemsaishybrid
that
theyfunction
combination
measure of distance).
encompassing
multiple ocular
the surfaces.
best of both worlds.

How ORBSCAN is Multidimensional


Integrates multiple disparate technologies:
slit-scan, reflective, ultrasound.

Measures multiple ocular surfaces:


anterior cornea, posterior cornea, anterior iris, anterior lens.

Displays multiple and complete mathematical surfaces:


curvature, power, elevation, thickness.

Multidimensionality makes ORBSCAN powerful. The wide


variety
The of purpose
first maps canofmake ORBSCAN
this basic mapbewildering.
reading course is to
introduce, both technically and clinically, the most powerful
ORBSCAN maps and measures.

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Color Problem
• Contours are evenly spaced (the normal band being
exceptional).
• Unfortunately, adjacent colors are NOT perceived as
uniformly equidistant.
• An interpretation should never be based on color.
– Instead perceive the topography behind the
colors, contours, and reference objects.
• The third purpose of this course is to warn you
about numerous interpretation pitfalls:
– contour and color problems
– axial artifacts
– elevation distortion and relativity
– power and curvature confusion

Optical Power
Max Red
(+ +)
• high power
• short focal length

(+)

• low power
• long focal length
Min Blue

A high power lens has a short focal length. Red is high


power, and blue is low power.

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Elevation (from a reference


surface)
Max Red
anterior
• high
(+) • anterior to the
reference surface

reference level
• low
(-)
• posterior to the
reference surface
posterior
Min Blue

Elevation can be positive or negative. Red is high and


positive (anterior to the reference surface).

Thickness
Min Red
(+)
• thin

(+ +)

• thick
Max Blue

Corneal thickness equals posterior corneal depth. Red is


thinner (the posterior cornea is higher).

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Global Perspective

12,000 miles
12,000 microns
12,000 mi

The elevation topography of both globes is


small in comparison to the entire surface

Topographical Elevation
is Relative

5.6 mi 5.6 miles


12,000 miles

On a local scale these features are significant

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Removing Global Curvature

Although they appear large up close, terrestrial mountains


are very small
Similarly, local (1000
clinicaltimes smaller)
features whenhigh)
(microns compared
are a to the
size of
thousand
This the
disparityearth.
timesin smaller
scale makes
than the
it IMPOSSIBLE
cornea (millimeters
to in
radius).
simultaneously map both the global curvature and
To see clinically relevant features, corneal global curvature
clinically
must firstsignificant
be removed. local elevation
This is done features of theelevation
by measuring cornea.
relative to some close-fitting reference surface, a process
that inevitably introduces distortion.

Removing Global Curvature

Local clinical features (microns high) are a thousand times


smaller than the cornea (millimeters in radius).
This disparity in scale makes it IMPOSSIBLE to
simultaneously
To see clinicallymap bothfeatures,
relevant the global curvature
corneal globaland clinically
curvature
significant
must local
first be elevation
removed. Thisfeatures
is done of
bythe cornea. elevation
measuring
relative to some close-fitting reference surface, a process
that inevitably introduces distortion.

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Close-Fitting Reference
Surfaces Data surface
Topographic maps of terrestrial landscapes are displayed in
(cornea)
the form of constant-elevation contours, measured from
Corneal topography differs from terrestrial topography inthe
“mean
that thesea-level”
reference of the earth.
surface is not some fixed “mean sea-
level”, but is movable.

Reference surface (sphere)


Fit-zone

For the cornea, a reference surface (typically, a sphere) is


constructed by fittingthe
A best-fit minimizes thesquare
reference surface(always
difference as closea as
possible to the data
positive number) surface.
between the two surfaces, but only within
a specified region known as the fit-zone.

Elevation Relativity
Default settings:
• shape = sphere
• alignment = floating

Changing the shape, size, or alignment of the reference


The default
surface reference
changes surfaceelevation,
the relative is the best-fit
just sphere.
like Other
changing
The sphere
reference sea is especially
surface shapes useful, because
are available it is only
for special reference
the
Twomean
parameters
surface with nolevel would
define
unique thechange
symmetry the
best-fitaxis heights
sphere.
(i.e., of mountains.
Radius
every specifies
diameter
applications.
The default sphere alignment is floating, which means its
size. Center location
is a symmetry axis). specifies alignment.
center location is unconstrained. Other alignments may
force the reference sphere to lie on the map axis.
Click for more on reference surface shapes
Click for more on reference sphere alignments

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Elevation (sphere) Elevation (sphere)


Myopic Pre-Post Elevation
Maps

These are pre-op (left) and post-op (right) elevation maps of


The post-operative
a myopic central
with-the-rule “sea” iseye
astigmatic notcorrected
a concavity but
with a
Lasik.
central
The ringflattening.
of relatively highest terrain is not absolutely higher
(more anterior) than the “sea” bottom near the map center.

Elevation (sphere) Elevation (sphere)


Different Fit-Zone Elevation
10 mm fit-zone 5 mm fit-zone

Maps

These elevation maps are the same exam of a normal eye


having
Both with-the-rule
maps astigmatism.
contain exactly the same They differ only They
information. by thelook
size
For aofnormal
thebecause
different, fit-zone used to the
altering
cornea, construct
a smaller fit-zone the
fit-zone reference
changes
results a sphere.
inthe size and
smaller
alignment
reference of
A small fit-zone the
sphere reference
that outs
bring better sphere.
fits the
small central
central cornea. like
anomalies,
central
A large islands.
fit-zone emphasizes global shape. By default, the
largest 10 mm diameter fit-zone is used.

7.16 mm radius 6.88 mm radius

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Elevation Distortion
Data surface
Spherical
profile
reference surface

Relative
elevation
profile

As an example of distortion, consider the corneal surface


To see
(i.e., surface
data features
surface) (which
following are highly
refractive exaggerated
surgery in
for myopic
When
this relative
drawing),
correction. elevation
elevation
It is is mapped,
centrallymust the
be measured
flattened reference
with respect to is
by the surgery. surface
effectively
This
somerelativeflattened.
elevation
reference This
peak
surface. distorts
is NOTthetherelative
highestelevation
point on the
This apparent central "concavity" does NOT exist.
profile.
cornea.

Elevation Topology: Central Hill

Sharp center

Flat periphery

The normal cornea is prolate, meaning that meridional


curvature decreases
Prolateness from center
of the normal corneatocauses
periphery.
it to rise centrally
above the reference
Immediately sphere.
surrounding The result
the central a central
hill is an annular hill.
sea
where the cornea dips below the reference surface.
In the far periphery, the prolate cornea again rises above
the reference surface, producing peripheral highlands.

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Elevation Topology: Central


Saddle

The regular astigmatic cornea is toric, meaning that


The sharp curvature
meridional (or steep)hasprofile falls and
maxima below the reference
minima in different
surface.
The flat profile rises above
directions, 90 degrees apart. the reference surface.
The resulting elevation topology is a central saddle.
A saddle is shaped like a riding saddle, rising peripherally
in one direction, and falling peripherally in a mutually
perpendicular direction.

Prolateness and Toricity


E, Prolate
Balance T, Toric
Shape Factor Amplitude

Corneal radius Fit-zone size

Central Hill Central Saddle

Central elevation topology is determined by the balance of


corneal prolateness and toricity.

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Prolate Patterns

Central Hill

When prolateness dominates, a


central hill will appear.

Toric Patterns

Central Saddle

When toricity dominates, a central


saddle will appear.

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Prolateness-Toricity Fulcrum
E, Prolate T, Toric
Shape Factor Amplitude

Corneal radius Fit-zone size

Central Hill Central Saddle


Small fit-zones favor Large fit-zones favor
toric shapes, of the prolateness-toricity
The position prolate shapes,
fulcrum is
preferentially
determined byproducing preferentially
the size of the fit-zone producing
with respect to the
central saddles.
mean corneal radius. central hills.

Elevation topology is only invariant when fit-zone size


and reference sphere alignment are both fixed.

Basic Map Reading


10:
Optical Diagnosis
Point spread function
Image convolution
Raytrace analyses
Case report: Lasik OD
Case report: Bilateral Lasik

29 points

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Point Spread Function

Raytrace analysis through one or both corneal surfaces can


The maintofocus
be used (pinkthe
calculate andPoint
red) is spreadFunction
Spread horizontally and
(PSF),
A lower is the retinal image of a single point of light. Thisfar
intensity
irregularly.
which blur pattern (green and blue) spreads
beyond
Extra
PSF isfoci
theappear
main focus.
aberrated. at the vertices of the blur pattern.

Image Convolution

Simulated
Original Picture Retinal Image

The easiest way to interpret a PSF is to directly see how is


The original picture is disassembled into points, each point
affects the simulated retinal image.
is spread out into the PSF pattern, and the patterns are
reassembled to form the simulated image.

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Lasik OD: Raytrace OD

Simulated
Original Picture Retinal Image

This is the aberrated total corneal PSF of a patient that


underwent Lasik
The simulated OD. image
retinal The procedure didwhat
lets us see not correct the
the patient
original
sees. myopia and resulted in severe subjective symptoms
(blurred vision, glare, etc.).

Summary
• Corneal Elevation Topography is viewed
relative to a reference surface
• Standardization of the reference surface is
necessary to allow meaningful
comparisons

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Thank you for your attention

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