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COVER FOCUS

GALILEI G6: COMBINING
TOPOGRAPHY, TOMOGRAPHY,
AND OPTICAL BIOMETRY
IN ONE SYSTEM
Access to high-definition pachymetry plus total corneal wavefront, curvature,
and astigmatism data provides surgeons with a complete dataset to plan cataract
or refractive surgery.
BY TIM DONALD, CONSULTING EDITOR

T

64  CATARACT & REFRACTIVE SURGERY TODAY EUROPE | JULY/AUGUST 2015

Figure 1. In one measurement session, the
Galilei G6 Lens Professional provides surgeons with
a complete dataset for comprehensive screening
for cataract and refractive surgery patients.

allows determination of axial length (AL), lens
thickness (LT), and other intraocular distances
for premium IOL planning.
The software of the G6 provides an intuitive
graphical user interface including a live view
image of the eye and a five-step measurement
guide, and the device interfaces with electronic
health record systems for optimal workflow. It
also links to ray-tracing software packages such
as Okulix (Tedics Peric & Jöher), offering precise tools
for toric IOL planning by taking into account
the true anatomic properties of the eye and
total corneal astigmatism.
The software generates a biometry report
including AL, LT, central corneal thickness,
(Continued on page 66)
Figure 2. Placido-disc topography provides
data on anterior corneal curvature,
surface irregularities, and tear-film quality;
Scheimpflug tomography provides corneal
pachymetry and elevation data, plus 3-D
anterior chamber analysis and ray-tracing
capabilities; and optical biometry allows
determination of AL, LT, and other intraocular
distances for premium IOL planning.

(Images courtesy of Ziemer)

he Galilei G6 Lens Professional (Ziemer;
Figure 1) combines Placido-disc–based
topography, Scheimpflug tomography, and optical biometry all in one
unit. This combination allows the device to
provide complete data for comprehensive
screening for cataract or refractive surgery
in one measurement session, according to the
manufacturer.1 With all data gathered and
stored on one device, the practice’s clinical
workflow efficiency can be improved, maintenance costs can be reduced, and office space
utilization can be optimized. With access to
high-definition pachymetry plus total corneal
wavefront, curvature, and astigmatism data,
surgeons have a complete dataset to plan
cataract or refractive surgery. The addition
of optical biometry and a suite of IOL power
calculation formulas empowers the cataract
surgeon to determine the best-suited IOL
for each patient.
According to Ziemer, only the Galilei
G6 combines the three elements
of Placido-disc–based topography, dualScheimpflug tomography, and optical biometry
(Figure 2). Placido-disc topography provides data on
anterior corneal curvature, surface irregularities, and tearfilm quality. Scheimpflug tomography provides
corneal pachymetry and elevation data,
plus 3-D anterior chamber analysis and
ray-tracing capabilities. Optical biometry

and residual stromal bed thickness. In that regard.6% sensitivity and 97. MD How do you use the Galilei G6 in clinical practice? My clinical practice is mostly focused on LASIK procedures and refractive cataract surgery with premium IOLs. The author has reported a significant improvement in astigmatism correction when the total corneal astigmatism is used in place of keratometric astigmatism. The Galilei G6 also offers a more morphologic approach to identifying subclinical keratoconus at its earliest stages. we use it for optical biometry and total corneal power measurements as a means to optimize IOL selection. in cataract surgery. helps us to further strengthen the safety of the decision-making process. The PTA considers the relationship between corneal thickness. COVER FOCUS Commentary from the (Images courtesy of David Smadja.Experts Highlights of the Galilei G6 in Clinical Practice By David Smadja. the ability to perform highly reliable and repeatable measurements on the posterior surface.4 While waiting for the upcoming release of this feature. What is your overall impression of the Galilei G6? The Galilei G6 system (Ziemer) fully meets the expectations of refractive surgery specialists. decisions are often based on personal experience and subjective recognition of patterns or empiric cutoff values that are not necessarily the same between imaging systems. An AAI score of 21. Additionally. two of the greatest advantages of the Galilei G6 are its robust refractive screening program and artificial intelligence tools. we use it to determine who is at risk for ectasia and to monitor keratoconus patients.2 on the Galilei G6 helps me to predict the level of risk a patient has of developing post-LASIK ectasia by taking into account the expected biomechanical alteration due to one’s surgical plan. corneal aberrations. A PTA level of 40% can be considered a robust risk factor for ectasia. patients with a PTA this high are treated with PRK instead of LASIK.3. In refractive surgery. the system is able to identify topographically normal contralateral eyes of patients with frank keratoconus with 93. as long as the cornea does not show any other contraindications for refractive surgery. and.5 is the most discriminant parameter to differentiate between normal corneas and subclinical keratoconus. What makes this system attractive is its ability to combine all the technologies needed to screen patients for LASIK and to obtain optimal outcomes in cataract surgery. tissue alteration through ablation and flap creation. our group has Figure 1. and total corneal power data. and for the system to achieve accurate pachymetry. in our clinical practice. Using an automated decision tree. which help me rule out patients who are at risk for ectasia after surgery. Figure 2.2% specificity (Figure 1). Therefore. The plethora and complexity of data provided by current imaging systems presents a challenge of interpretation for the ophthalmologist. MD) JULY/AUGUST 2015 | CATARACT & REFRACTIVE SURGERY TODAY EUROPE  65 . The Santhiago percentage of tissue altered (PTA) report1.

7 What are the advantages of the Galilei G6 compared with other ocular biometry technologies?  For a refractive. higher-order aberration detection. Role of percent tissue altered on ectasia after LASIK in eyes with suspicious topography. In addition to its roles in cataract surgery. Repeatability of automatic measurements performed by a dual Scheimpflug analyzer in unoperated and post-refractive surgery eyes. David Smadja. We recently reported a significant improvement in astigmatism correction when the total corneal astigmatism is used in place of keratometric astigmatism (Figure 2).com/key-features-g6. MD Anterior Segment Unit. Bar Ilan University. Smadja D. Influence of the reference surface shape for discriminating between normal corneas. and especially the synergistic combination of morphologic and biomechanical approaches.8 mm3 are not recommended for LASIK. Wilson SE. and optical biometry for optimal IOL selection. SRK/T. Ziemer Ophthalmic Systems AG website. 3. Bordeaux Hospital University. Galilei G6 Lens Professional. Surgeons can use the refractive data from both anterior and posterior corneal surfaces.5 is the most discriminant parameter to differentiate between normal corneas and subclinical keratoconus.  n 1.36(3):425-430. France n davidsmadj@hotmail. Alcon) n .fr n Financial disclosure: Consultant (Ziemer. to calculate IOL powers for eyes after corneal refractive surgery. according to Ziemer. and corneal surgery specialist. et al. the Galilei G6 diagnostic system allows the most extensive analysis of corneal features that exists today in a single device. the combination of highdefinition pachymetry.6. and keratoconus.5 or a corneal volume lower than 30. the development and introduction of artificial-intelligence–based 66  CATARACT & REFRACTIVE SURGERY TODAY EUROPE | JULY/AUGUST 2015 programs for screening ectasia-susceptible corneas. Smadja D.158(1):87-95. Cohen A. Furthermore. The other key feature that we routinely use is the ability to measure posterior astigmatism and total corneal astigmatism in the calculation of toric IOL power. densitometry. Barboni P. et al. 2010. 2015. 2014. total corneal power measurements. http://galilei. corneal aberrations analysis. Am J Ophthalmol.29(4):274-281.COVER FOCUS (Continued from page 64) and anterior chamber depth. pachymetry report including corneal volume. Hoffer Q. Touboul D. posterior corneal surface analysis. Smadja D. Israel n Institute of Nanotechnology and Advanced Materials.156(2):237-246. Koch DD. Santhiago MR. technically speaking.ziemergroup. Holladay I. Santhiago MR. Savini G. This index measures the asymmetry of the posterior corneal surface. including keratoconus screening. Association between the percent tissue altered and post-laser in situ keratomileusis ectasia in eyes with normal preoperative topography. Boston. J Refract Surg. 2015. Influence of posterior astigmatism on toric intraocular lenses calculation. 5. html. Tel Aviv Sourasky Medical Center. Presented at: the 40th ASCRS Annual Symposium & Congress. 4. et al.37(2):302-309. These data are also help- Commentary from the Experts ful for IOL calculations in unusually long or short eyes. helps surgeons to comfortably rely on these measurements. Highlights of the Galilei G6 in Clinical Practice (Continued) pointed out that an Asphericity Asymmetry Index (AAI) of 21. which have been demonstrated in the literature. In eyes with astigmatism. 2013. Smadja D. Gomes BAF. can assist refractive surgeons in their decision-making process without relying only on subjective interpretation and personal expertise. 7. Accessed June 12. cataract. 6. Carbonelli M. Mello GR. It combines Placido-disc–based corneal topography. Santhiago MR. Hoffer KJ. Repeatability of corneal power and wavefront aberration measurements with a dual-Scheimpflug Placido corneal topographer. and total corneal astigmatism measurement allows the surgeon to determine incision placement for cylinder correction in conjunction with cataract surgery. Israel n National Reference Center for Keratoconus. Am J Ophthalmol. 2014. as generated by Scheimpflug imaging. et al. the device can also perform complete topographic screening of refractive surgery candidates. Wang L. and the Shammas no-history method for eyes after refractive surgery. Shirayama M.5 Like us. subclinical keratoconus. The combination of Scheimpflug imaging with optical biometry data makes the Galilei G6 especially helpful for IOL selection in postrefractive surgery eyes. It also includes an IOL calculator with formulas including Haigis. April 25-29. Ophthalmology Department. others have also noted the reliability and repeatability of posterior astigmatism and total corneal power measurements in toric IOL calculation. plus the AL and other intraocular distances as determined by optical biometry. 2011. 2013. 2. J Cataract Refract Surg. and it is helpful in planning for corneal implants and in planning and follow-up of keratoplasty patients. Detection of subclinical keratoconus using an automated decision tree classification. the level of accuracy and repeatability of the parameters measured with the Galilei G6. Additionally. J Cataract Refract Surg.31(4):258-265. The combination of a morphologic approach (decision tree) and a biomechanical approach (PTA report) is a unique feature in ocular biometry that can increase the sensitivity of detection of corneas at risk for ectasia. Smadja D. 1. Tel Aviv. J Refract Surg. we have found that patients with an AAI greater than 21.