Andika Prahasta Department of Ophthalmology Padjadjaran University Cicendo Eye Hospital Bandung Introduction Zeiss Forum and Glaucoma Workplace Zeiss Forum or just Forum from now on is ID: 933656
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Slide1
FORUM GLAUCOMA WORKPLACE : what is it?
Andika
Prahasta
Department of Ophthalmology
Padjadjaran
University /
Cicendo
Eye Hospital
Bandung
Slide2Introduction
Slide3Zeiss Forum and Glaucoma Workplace
Zeiss Forum (or just Forum from now on) is
software designed
primarily to connect Zeiss ophthalmic devices together, and increase their functionality (Humphrey Field Analysers (HFAs), Cirrus (and other) Zeiss OCT Scanners and also IOL Master devices
The software fits into the category on an ophthalmic Picture Archiving and Communication Software (PACS) Forum is made of two components, the Forum Viewer and the Forum Server. The Viewer is a program that is installed on clinical PCs and is how tests are viewed.Forum Server is a program that typically runs on a powerful computer in the IT department (a server). The Zeiss devices are connected via the network to that central server.
Slide4Zeiss Forum and Glaucoma Workplace
The Zeiss Forum product is a
server-based software application
for managing, archiving, and viewing patient examination results that have been supplied by networked clinical diagnostic devices such as the HFA, ophthalmic cameras, and optical coherence tomography instruments such as the Zeiss Cirrus OCT.
Slide5ZEISS FORUM Glaucoma WorkplaceInformation delivery at a glance
Slide6What does it offer?
Centralised storage
Paperless field reports
Guided Progression Analysis (GPA)
Macular OCT progression analysis Repository for IOL Master data Repository for non-Zeiss data
Slide7Centralised storage
Zeiss devices connected to the Forum
Server no longer store their test results locally
Instead they send them all to the Forum ServerData is stored in one place, making backup much easier. Failure of an individual device won’t threaten stored data either.
Slide8Paperless field reports
Forum supports the drive toward electronic health records
Allowing visual fields to be viewed without printing
The same feature can also be used to support virtual clinics
Slide9Guided Progression Analysis (GPA)
Clinicians can used the Pattern Deviation, Mean Deviation and Glaucoma Hemifield Test values to judge glaucoma progression.
These can still be viewed in Forum, but
the GPA tools provide rich progression analysis features
. The data is presented in a number of formats, including a graph of Visual Field Index (VFI) against age and also a progression field image
Slide10Structure
and
Function
The
Role
of
ZEISS in
Glaucoma
Detection
August 3, 2016 / EN_31_150_0055l
Carl Zeiss Meditec, Inc. Mely Medel / Matthias Monhart, Glaucoma
10
Slide11Ted Garway-Heath et al published a paper in Opthalmology which documents the structure-function relation between Optic disc angles and the 24-2 visual field pattern1
FORUM
®
Glaucoma
Workplace
RNFL
Sectors
+ 24-2/30-2 Pattern Deviation
1)
Garway
-Heath, D.F. et al., 2000. Mapping the visual field to the optic disc in normal tension glaucoma eyes.
Ophthalmology
, 107(10), pp.1809-15.
2) Hood, D.C.,
Kardon
, R.H. A framework for comparing structural and functional measures of glaucomatous damage.
Prog
Retin
Eye Res. 2007 November; 26(6): 688–710.
.
Don Hood and Randy Kardon evaluated this model in a 2007 publication and considered it valid for the application with OCT data.
2
FORUM Glaucoma Workplace applies this model to HFA 24-2/30-2 and CIRRUS HD-OCT RNFL scans to facilitate Glaucoma diagnosis
The OCT data is vertically mirrored to match the visual field orientation.
August 3, 2016 / EN_31_150_0055l
Carl Zeiss Meditec, Inc. Mely Medel / Matthias Monhart, Glaucoma
11
Slide12Glaucoma Combined Structure Function Reports
The central area shows the latest pattern deviation map with the correlating retinal nerve fibre layer (RNFL) thicknesses overlaid.
They are very useful in glaucoma suspects, when deciding if field defects correlate with disc damage
Slide13Slide14GWP also can produce combined longitudinal analyses of HFA and Cirrus clinical findings
Slide15GWP allows users
to add clinical and surgical event markers
to the clinical timeline and to append clinical notes. The markers can highlight medication changes, injections, surgery, and other relevant milestones
Slide16ZEISS FORUM Glaucoma Workplace
Information delivery at a glance
Woman, 81
y.o
., POAG OU
Slide17ZEISS FORUM Glaucoma WorkplaceInformation delivery at a glance
VFI or MD
Progression
Grayscale or PSD
Progression
Slide18ZEISS FORUM Glaucoma WorkplaceInformation delivery at a glance
Slide19ZEISS FORUM Glaucoma WorkplaceInformation delivery at a glance
VFI Plot
MD Plot
IOP Plot
Slide20This combination of visual field and OCT probability information was suggested by Hood & Raza (2011). For accurate registration, the visual field points must be positioned to take into consideration the displacement of ganglion cells near the fovea.
The displacement in this presentation corresponds to that in Hood DC,
Raza
AS, Method for comparing visual field defects to local RNFL and RGC damage seen on frequency domain OCT in patients with glaucoma. Biomed Opt Express. 2011 Apr 5;2(5):1097–1105- and are based upon a study by
Drasdo
,
Millican
,
Katholi
, and
Curcio
(2007).
Layer thickness [um] and
probability for 6 sectors
FORUM
Glaucoma
Workplace
2.0
GCA+IPL Layer
Thickness
+ 10-2 Pattern Deviation
August 3, 2016 / EN_31_150_0055l
Carl Zeiss Meditec, Inc. Mely Medel / Matthias Monhart, Glaucoma
20
Slide21Essential Research is Using Structural Information Includes Perimetry
in the Macular Region
August 3, 2016 / EN_31_150_0055l
21
Carl Zeiss Meditec, Inc. Mely Medel / Matthias Monhart, Glaucoma
Source: Nguyen, Hood et al,
ARVO 2012
Source: Hood DC,
Raza
AS
Biomed Opt Express.
2011 Apr 5;2(5):1097–1105
Slide22FORUM Glaucoma Workplace 2.0
Combined 10-2 and GCA Report
August 3, 2016 / EN_31_150_0055l
Carl Zeiss Meditec, Inc. Mely Medel / Matthias Monhart, Glaucoma
22
Slide23Slide24Slide25Slide26Slide27Slide28Slide29ZEISS FORUM Glaucoma WorkplaceAlways check structure, not only function!
Visual Field
4
OCT ONH&RNFL
2
Fundus Image
1
OCT ONH&RNFL
3
Glaucoma needs to be examined completely:
Act faster, and have certainty with combined reports!
Slide30View integrated information - certainty in Structure + Function
Slide31Conclusion
For
Combining
Structural
and Functional Information :OCT and
Perimetry
provide
complementary
information for the
diagnosis
Combining
Structure
& Function may lead to earlier confirmation of diagnosis Combining
Structure
&
Function
may
help
in
confirming
trends
There’s
not
always agreement between Structure & Function
Slide32Looking to the Future
Clear opportunities exist to construct analyses that go well beyond the colocation of structural and functional findings, seen today in summing point applications such as Glaucoma Workplace.
By means of artificial intelligence methods, experimental “combo” programs have computationally incorporated both OCT and visual field findings into diagnostic metrics that consider both.
The same has been done experimentally with combination analyses for progression, which may suggest that there are opportunities to reduce the time required to identify rapidly progressing glaucoma patients.
Combo analyses might also add a higher level of standardization to clinical decision-making.
Bizios
D,
Heijl
A, Bengtsson B. Integration and fusion of standard automated perimetry and optical coherence tomography data for improved automated glaucoma diagnostics.
BMC
Ophthalmol
.
2011;11:20.
Shigueoka
LS, Vasconcellos JPC,
Schimiti
RB, et al. Automated algorithms combining structure and function outperform general ophthalmologists in diagnosing glaucoma. PLoS One. 2018;13(12):e0207784. Medeiros FA, Zangwill LM, Girkin CA, Liebmann JM, Weinreb RN. Combining structural and functional measurements to improve estimates of rates of glaucomatous progression.
Am J
Ophthalmol
.
2012;153(6):1197-1205 e1191.
de
Gainza
ME, Salazar Vega DC,
Mohammadzadeh
V, Yu F, Afifi A, Nouri-Mahdavi K. The trajectory of glaucoma progression in two-dimensional space.
Ophthamology
Glaucoma.
2020;1.
Slide33Thank you