1. The Fusion of Imaging Technologies The Fusion of Imaging Technologies
INTRODUCING
The Fusion of Imaging Technologies
The Fusion of Imaging Technologies

2. Spectralis is more than resolution …
Time Domain OCT
SPECTRALIS

3. Spectralis is more than fast …
40 kHz = 100x Faster than time domain OCT

4. Spectralis is more then SD-OCT…
Dual laser scanning system for simultaneous imaging:
Confocal Scanning Laser Ophthalmoscope (cSLO) with up to 5 imaging modes: IR, FA, ICGA, AF, Red-free
Spectral Domain Optical Coherence Tomograph (SD-OCT)
Eye tracking:
cSLO recognizes eye movements and guides SD-OCT scanner to follow
Allows repeat scans at exact same location

5. Spectralis is more than one view …
ICGA
Polypoidal Lesion

6. Spectralis is more than 3D …

7. Spectralis is knowing location
Reference scan
Cross section scan
EYE TRACKING
The reference image tracks eye movement, and the cross section is moved to match
Eye Movement

8. Spectralis Tracks Change Over Time
Reference scan
Cross section scan
Real-time alignment
Accurate change measurement
EYE TRACKING
Cross section scanned at same location
Real-time alignment
Exam 1
Exam 2

9. Heidelberg Noise Reduction Technology
Multiple images are captured at the same location
“Noise” is identified as points not common to the set of images
The noise is filtered from the final image
Image 1
Image 2
Heidelberg Noise Reduction Technology produces high resolution, high contrast images with less “speckle”.

10. Simultaneous Imaging with Eye Tracking

11. What’s wrong with the old OCT?
Hidden artifact – structure may be different than presented
Not simultaneous – B-Scan may be in different location than reference image
No eye tracking – Not good for LASIK, not good for diagnostics
(S)low resolution – Layers hard to identify for computer algorithms

12. Old OCT Does Not Stop Eye Movement
While Time Domain OCT scans, the eye keeps moving
The black line is the camera’s perspective
The white line is the actual scan path
© 2003 IEEE
“Tracking the Optic Nervehead in OCT Video…” Koozekanani, et al, 2003

13. Old OCT Does Not Register Images
As the eye moves, so does the scan location
Software algorithms reconstruct the data
Software assumes the lines are straight and intersecting

14. Increasing Reports of OCT Artifact
Study
% Artifact/Error
UCSD: Bartsch (2004)
42%
Duke: Ray (2005)
43%
USC: Sadda (2006)
92%
Bartsch et al. Optical Coherence Tomography: Interpretation Artifacts and New Algorithm. Proc. of SPIE ;
Ray et al. Evaluation of image artifact produced by optical coherence tomography of retinal pathology. Am J Ophthalmol Jan;139(1):18-29.
Sadda et al. Errors in retinal thickness measurements obtained by optical coherence tomography.
Ophthalmology Feb;113(2):

15. Eye Tracking Stops 3D Motion Artifact
Without Eye Tracker
With Eye Tracker
Artificial ripples due to eye movements
True anatomic structure

16. Spectralis Advantages
Eye Tracking – Every B-scan is simultaneously locked to a reference image
Up to 6 modes – Multiple perspectives of the anatomy from multiple wavelengths
40 kHz scanning – High speed helps overcome eye movement artifact and increases patient comfort
TruTrack™ – Image alignment compares reference location at baseline to follow-up
Heidelberg Noise Reduction Technology – Overcomes the limits of “resolution”

17. AF – Occult CNV

18. IR – Central Serous Chorioretinopathy

19. ICGA – RAP

20. ICGA – CNV with Choroidal Hemangioma

21. AF – Occult CNV

22. AF – Diabetic Retinopathy

23. 6 Billing Codes (example for United States)
92135 Scanning Diagnostic Imaging
92235 Fluorescein Angiography
92240 ICG Angiography
92250 Red Free Fundus Photography
92285 External Ocular Photography
92287 Internal Eye Photography (Iris Angiography)

24. Select From Three Versions
2 modes
SD-OCT
Infrared -
5 modes -
Infrared
Autofluorescence
Fluorescein Angiography
ICG Angiography
Red Free Photography
6 modes
SD-OCT
Infrared
Autofluorescence
Fluorescein Angiography
ICG Angiography
Red Free Photography
HEYEX Database

25. HEYEX Network Solution
Registration Link IR FA IR
OCT
HEYEX

26. Heidelberg Engineering Imaging Suite
Registation Link IR FA
OCT IR
OCT
Fundus
HEYEX

27. Fluorescein Angiography
The Fusion of Imaging Technologies
The Fusion of Imaging Technologies
Red Free
Autofluorescence
ICG Angiography
Infrared
Fluorescein Angiography