Understand the Cornea Understand the Pressure

Ocular Response Analyzer

Corneal Biomechanics, Accurate IOP, and CCT in One Easy-to-Use Instrument

Corneal biomechanical properties influence the results and outcomes of ocular measurements and procedures, and may hold clues to diagnosing and managing ocular diseases. Until now, assessing the biomechanical properties of corneal tissue has not been possible, confining practitioners and researchers to measuring purely geometrical aspects of the cornea, such as thickness and topography. The Ocular Response Analyzer utilizes a rapid air impulse, and an advanced electro-optical system to record two applanation pressure measurements; one while the cornea is moving inward, and the other as the cornea returns. Due to its biomechanical properties, the cornea resists the dynamic air puff causing delays in the inward and outward applanation events, resulting in two different pressure values.
As we learn more about corneal biomechanics, we realize that there is a lot more to understanding the cornea than simple pachymetry Jay Pepose, MD, PhD, Medical Director, Pepose Vision Institute

The average of these two pressure values provides a repeatable, Goldmann-correlated IOP measurement (IOPG). The difference between these two pressure values is Corneal Hysteresis (CH); a new measurement of corneal tissue properties that is a result of viscous damping in the corneal tissue. The ability to measure this effect is the key to understanding the biomechanical properties of the cornea. The CH measurement also provides a basis for two additional new parameters: Corneal-Compensated Intraocular Pressure (IOPCC) and Corneal Resistance Factor (CRF). IOPCC is an Intraocular Pressure measurement that is less affected by corneal properties than other methods of tonometry, such as Goldmann (GAT). CRF appears to be an indicator of the overall resistance of the cornea.
Ocular Response Analyzer Measurement Signal

Understand the Cornea

Corneal Disease
Measuring the biomechanical properties of the cornea with the Ocular Response Analyzer enables researchers and practitioners, for the first time, to quantify various corneal conditions by means of a measurable and repeatable metric. Low Corneal Hysteresis (CH) demonstrates that the cornea is less capable of absorbing (damping) the energy of the air pulse. The differences in CH between normal and compromised corneas are highly evident, and lead some experts to theorize that normal eyes exhibiting significantly lower than average CH may be at risk of developing corneal disorders in the future.

Comparison of Corneal Hysteresis distribution of normal, keratoconic, and Fuchs subjects

There is a major concern for most refractive surgeons about preventing post-LASIK ectasia. Devices that can help us learn more about the signature of the cornea preoperatively may alert us to patients that are at a higher risk of developing ectasia Jay Pepose, MD, PhD, Medical Director, Pepose Vision Institute

Refractive Surgery
Clinical data from several studies show a universal reduction in post-LASIK CH. Some experts hypothesize that this is not primarily a function of corneal thinning, but rather a result of weakening of the structure related to creation of the flap. The Ocular Reponse Analyzers Corneal Hysteresis of 15 eyes pre- and post-LASIK ability to characterize the biomechanical properties of the cornea means that potential refractive surgery candidates can be more effectively evaluated for potential post-surgical complications, such as corneal ectasia, than by using CCT and topography alone.

Glaucoma
The Ocular Hypertension Treatment Study (OHTS), as well as other studies, have brought to light the importance of corneal parameters in diagnosing and managing glaucoma. These studies have shown that low CCT (thin cornea) is an independent risk factor for the development and progression of the disease. Many experts believe that corneal parameters other than CCT may provide clues that will aid in the diagnosis and management of glaucoma. There is evidence to suggest that the cornea may reflect the condition of the lamina cribrosa. Clinical studies utilizing the Ocular Response Analyzer support this hypothesis and have confirmed that low CH is an independent indicator of glaucomatous damage and progression. It has also been demonstrated that lower-than-average CH is observed in subjects who have been identified as Normal Tension Glaucoma (NTG) patients. Currently, individuals who have NTG may be missed during routine IOP screening. If the CH parameter proves to be a reliable indicator of this condition, it would be a significant advance in glaucoma screening.

Comparing the Corneal Hysteresis distribution of normal and glaucomatous subjects

Understand the Pressure

Accurate Pressure Measurements
Evidence in ophthalmic literature continues to mount, leading experts to question whether the Goldmann tonometer is sensitive and specific enough to be used for the critical purpose of measuring IOP in the diagnosis and management of Glaucoma. The Goldmann tonometer is designed to provide accurate measurements in eyes having average central corneal thickness (CCT). Corneal thickness, though, varies significantly more than previously thought. Furthermore, it is now known that the material properties of the cornea have an even greater influence on tonometry results than CCT alone. The We now recognize Ocular Response Analyzer that the Goldmann measures these complex tonometer is much tissue parameters, providing a less accurate pressure measurement (IOPCC) than previously appreciated that is less influenced by corneal properties.
James Brandt, MD, Director, Glaucoma

IOPCC vs. CCT for a population of normal eyes

IOPCC pre and post LASIK in 14 eyes

Since IOPCC compensates Services, UC Davis for corneal influence, it facilitates post-LASIK pressure measurements that are not artificially lower than pre-LASIK values. Goldmann-measured IOP values are known to drop 2-6 mmHg, or more, post LASIK. IOPCC values for a population of 14 eyes pre and post LASIK exhibit an average post-LASIK IOPCC reduction of less than 1 mmHg. In addition, some investigators believe that Goldmann tonometry underestimates the true pressure in Normal Tension Glaucoma eyes. In a population of 24 NTG eyes, IOPCC is more than 2.25 mmHg higher, on average, than IOPG; a significant difference when diagnosing and managing glaucoma.

IOPCC and IOPG in 24 NTG eyes

Assuming that CCT can be used as a correction factor for GAT is a misinterpretation of the results of OHTS that couldnt be further from the truth. Adjusting IOP based on CCT is attempting to instill a degree of precision into a flawed meaurement. You may actually correct in the wrong direction. The issues related to the most accurate tonometry need to include the material properties of the cornea James Brandt, MD, Director, Glaucoma Services, UC Davis

Features and Benefits

Advanced Technology
Patented dynamic bi-directional applanation process enables the only direct measure of corneal biomechanical properties. Eliminates operator variance by utilizing microprocessor control technology and objective measurement criteria.

Patient and Operator Friendly

No chinrest and a soft, quiet air puff make the Ocular Response Analyzer a comfortable, non-intimidating experience for your patients. Fully automatic alignment and measurement provides fast, repeatable results, allowing any member of your staff to conduct an exam.

Comprehensive Pressure and Cornea Information

IOPCC (Corneal Compensated IOP) - New IOP measurement less affected by corneal properties. CH (Corneal Hysteresis) - Measure of viscous damping in the cornea, providing new indicators for disease diagnosis and management. CRF (Corneal Resistance Factor) - Measure of the overall rigidity of the cornea. IOPG (Goldmann Correlated IOP) - Traditional IOP measurement for historical reference. CCT (Central Corneal Thickness) - Measured by built-in, 20 MHz ultrasound pachymeter.
Instant data review and signal analysis to ensure accurate measurements

Powerful Software Package

Enables automatic data capture of all measurements for analyzing trends, treatment efficacy, and diurnal variations. Comprehensive patient management database simplifies record keeping. Review results for a single patient, or data for an entire group of patients for population statistical analysis. Comprehensive printout for hard-copy results.
Diurnal data review enables you to track your patients measurements over time

Export data for use in other applications.

Measure the cornea...dont eliminate it.

Specifications
System Configuration Instrument, Pachymeter (Straight or Angled Probe), Software, and Computer. 17 in., 43.0 cm 9.5 in., 24.0 cm 13.5 in., 34.0 cm 30 lbs., 13.6 kg 100 - 240V - 50/60 Hz 0 - 60 mmHg 200 - 999 mm 20 MHz 5 mm 1 mm

Height Width Depth Weight (unpacked) Power Supply - Frequency Tonometer Range Pachymeter Range Probe Frequency Accuracy Resolution

Specifications subject to change without notice

Ordering Information

Additional information about the Ocular Response Analyzer, as well as information on how to order, is available online at www.ocularresponseanalyzer.com

Reichert Instruments GmbH Hubertusstrasse 2, D-82229 Seefeld Germany Tel: +49-8152-993530 | Fax: +49-8152-993535 www.reichert.com

Reichert products are designed and manufactured under quality processes meeting ISO 9001 requirements

Reichert, Inc. 3374 Walden Avenue, Depew, NY 14043 Toll Free: 888-849-8955 | Tel: (716) 686-4500 Fax: (716) 686-4545 | www.reichert.com