Pentacam BKFST Symposium 4/14/2018 Pentacam HD & AXL Purpose of Holladay Report How to Utilize the Holladay Report To facilitate the presentation of in a Cataract and Refractive Clinic information for the busy cataract and refractive surgeon Jack T. Holladay, MD, MSEE, FACS to provide the highest quality Clinical Professor of Ophthalmology care Baylor College of Medicine Houston, Tx 3/29/2018 JTH 1 3/29/2018 JTH 2 Miscellaneous Settings Display Setting are Fixed Version 1.21r33+ (25.01.2018) Same Exact Exam w User Adjustment 3/29/2018 JTH 3 3/29/2018 JTH 4 Overlays Black & White Dashed 1. Perimeter: Pupil Margin 1. Black & White Plus Sign: Pupil 2. 2. Center 3. 4. Black Brackets: Limbal and 3. Iris Geometric Center 5. White Circle with Black Dot: 4. Vertex Normal (Visual Axis) Small Black Circle: Minimum 5. Pachymetry 3/29/2018 JTH 5 3/29/2018 JTH 6 Jack T. Holladay MD MSEE FACS Page 1 of 5
Pentacam BKFST Symposium 4/14/2018 Upper Right Panel Upper Middle Panel • Pupil Diameter: 3 to 4 mm in photopic conditions • HWTW: Diameter and location of the Chord of Angle Alpha • EKR65: Flat, Steep and Astig – Use for IOL Calcs • Total SA: Match with available Aspheric IOLs – 0.00, -0.18 & -0.27 µm • Pachy Min: Location Temporal, but rarely Inferior more than 0.61 mm • Estimated Pre Prefractive Sx Mean K: For IOL Calc Double K method • RMS HOA WE (6 mm): Mean = 0.370µm, > 0.660µm concern, > 1.000µm • External ACD: For IOL Calcs already has retinal image problems due to cornea • Refractive Change from Refractive Sx: 0.0 in Virgin corneas • Chord µ: normal 0.20 ± 0.11 mm, > 0.42 mm glare & halos multifocal 3/29/2018 JTH 7 3/29/2018 JTH 8 Six Color Maps Column 1: Topography Column 2: Corneal Thickness [ ] Column 3: Elevation Blue and Green = Normal Yellow = Suspicious Red = Abnormal 3/29/2018 JTH 9 3/29/2018 JTH 10 Blue Curve Elevation EKR65 versus Pupil Size Topography Pachymetry EKR65 EKR65 Frequency in Zone EKR65 Power Map Axial Absolute Front Tangential Relative Back 3/29/2018 JTH 11 3/29/2018 JTH 12 Jack T. Holladay MD MSEE FACS Page 2 of 5
Pentacam BKFST Symposium 4/14/2018 EKR65 IOL Power Calculations Reports Keratometry value but adjusts for Back Surface Power from Normal Pentacam can measure FRONT & (Current IOL Formulas) BACK SURFACE POWER If corneal front surface is 7.5 mm (45 D), Can Calculate: but if back surface -0.3 D > normal: Equivalent K-Reading (EKR65) EKR = 45.0 – 0.3 = 44.7 D 65% Mean, Peak & Average Not NET POWER, which is ~1 D less Note: Net Power = 43.3 D 3/29/2018 JTH 13 3/29/2018 JTH 14 For TORIC IOL Note Regularity of Semi Meridians 3/29/2018 JTH 15 3/29/2018 JTH 16 Normal LASIK RK IOL Calcs – Abnormal Cornea (Use 65% MEAN EKR ) 41 to 44 D 36 to 41 D 32 to 45 D 3 D Range 5 D Range 13 D Range Post Refractive Surgery Post PKP Keratoconus Corneal Scar Any Irregular Astigmatism 3/29/2018 JTH 17 3/29/2018 JTH 18 Jack T. Holladay MD MSEE FACS Page 3 of 5
Pentacam BKFST Symposium 4/14/2018 Conclusions Detection of Thinning Disorders EKR – Use EKR65 for all IOL Normal Vertical location of Pachy Min Calcs (Mean = -0.19 ± 0.21 mm), > -0.61 mm Look @ smaller zones than 4.5 Hot spot on Topography Maps mm if pupil very small Hot spot on Relative Pachy Map (< 3.0 mm in dim light) Hot spot on F & B Elevation Maps 3/29/2018 JTH 19 3/29/2018 JTH 20 3/29/2018 JTH 21 3/29/2018 JTH 22 3/29/2018 JTH 23 3/29/2018 JTH 24 Jack T. Holladay MD MSEE FACS Page 4 of 5
Pentacam BKFST Symposium 4/14/2018 3/29/2018 JTH 25 3/29/2018 JTH 26 !Thank You! 3/29/2018 JTH 27 Jack T. Holladay MD MSEE FACS Page 5 of 5
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