Cynthia Roberts, PhD., Explains the New CLMI.X Index on the Galilei Topographer/Tomographer

This copy below is a transcript (watch video above) of an interview with Cynthia Roberts, professor of ophthalmology at The Ohio State University, ASCRS 2018.


The acronym CLMI.X stands for Cone Location and Magnitude Index, and we actually started out developing it for the anterior surface only, so it was CLMI.X.

And then what we did because the Galilei actually has pachymetry and posterior surface data available as well as anterior surface data was develop CLMI.X.

The idea of the original CLMI was to look for anterior surface curvature asymmetry, which is a hallmark of keratoconus. And other hallmarks of keratoconus are asymmetry in the pachymetry map, or the thickness profile map, as well as asymmetry in the posterior surface. The idea was to combine a very similar analysis of all three surfaces, giving us CLMI.X.


Diagnosing Keratoconus with CLMI.X

The way that it works, essentially, as opposed to looking for the single point curvature maximum, which is subject to lots of error in keratoconus, is that the algorithm actually looks for a 2-millimeter circle region of steepest curvature on the whole map. That was the concept behind CLMI.X.

When we moved to CLMI.X, we extended that to the posterior surface not to just look for the steepest region but also the highest region on the elevation map. So, we take into account the anterior surface steepest curvature area, the anterior surface highest elevation area, the posterior surface steepest curvature area, and the posterior surface highest elevation area, as well as the minimum pachymetry.

Detecting Astigmatism

The other two quantities, curvature and elevation, look for maxima. With the pachymetry, we look for the minimum. And then we look for asymmetry by taking that steepest area on one side of the cornea and comparing it to 180 degrees away, because astigmatism would have a steep area on both sides.

Asymmetry in Keratoconus

But if we’re looking for keratoconus, we want an isolated steep area, so we compare it to a region exactly 180 degrees away and look for the asymmetry in those two regions.

For elevation, we look at a region 180-degrees away and look for asymmetry in the elevation above the best fit sphere. For pachymetry, we find the thinnest area and look for asymmetry again 180 degrees away in the thickness of the cornea.

So, we combine them all into this one index that we call CLMI.X — Cone Location Magnitude Index Extended.

Awesome ASCRS — Wet Labs, Events, Champagne!

We’re pulling out all the corks for ASCRS 2018, three different femtosecond lasers and a dizzying event schedule.

Register for Wet Labs

First things first, if you haven’t registered for our wet labs, this would be a great time to do it. You can register for both wet labs in Cataract Procedures and/or Corneal procedures. We still have openings on April 14, 15 and 16. Each session is 30 minutes long. This is a great way for newbies to learn femtosecond procedures, and more experienced hands to find out what’s new.


Champagne Toast for New Medical Monitor

Introducing Bret Fisher, M.D. at ASCRSZiemer USA is proud to announce that Bret Fisher, M.D. will serve as our new medical monitor. Now it’s high time for a toast.

From 3 to 5 p.m. on Saturday, April 14, Ziemer will host a champagne celebration for Bret Fisher, M.D., at our booth. Dr. Fisher will provide leadership and clinical insight in the use of Ziemer’s product portfolio.

We are very pleased to fill this important role with a surgeon who has the diverse experience offered by Dr. Fisher,” said David Bragg, President of Ziemer USA. “His knowledge and practical expertise will be a great resource for anyone using Ziemer devices.” Learn more about Dr. Fisher.

Ziemer Events at ASCRS 2018: The Whole Enchilada

Ziemer's ASCRS speaker scheduleAdd these presentations to Ziemer’s ASCRS speaking schedule.

Galilei Topographer
Missed Cornea: Description of Peripheral Corneal Curvature Patterns
1:52 to 1:57 p.m.

Arce, Forseto, Pereira, Pfluck •  Level 1, 144C

Diagnostic Ability to Distinguish High Astigmatism from Ectatic Cornea Using 2 Scheimpflug Devices
3:02 p.m. to 3:07 p.m.

Henrique, Hadid, Izquierdo, Rincon •  Level 1, 144B

Femtosecond Laser
Visual Outcomes of Wave-Fronted Guided Femtosecond-Assisted LASIK for the Correction of Mixed Astigmatism
4:07 p.m. to 4:12 p.m.

Mushkova, Doga, Karimova • Level 1, 143B

Femtosecond Laser
Femtosecond Laser and other Automated Capsulotomy Technologies
9:30 a.m. to 10:30 a.m. | Industry Spotlight Theatre

Moderated by Robert Weinstock; Ziemer represented on panel by Rocky McAdams, M.D. • 
Exhibit Hall Floor

Comparison of Multiple MHz Femtosecond Laser Platforms for LASIK in Low to Moderate Myopia: One Year Results
1:12 p.m. to 1:17 p.m.

Doga, Mushkova, Karimova, Kechin • Level 1, 144A

Comparison of LASIK Flap Thickness and Complication Rates of 2 Femtosecond Lasers
1:17 p.m. to 1:22 p.m.

Lockwood, Behshad • Level 1, 144A

Determinants of Visual Quality and Stability after DMEK
1:38 p.m. to 1:43 p.m.

Houser, Weikert, Golla, G. de Souza, Montes de Oca, Al-Mohtaseb, Little  • Level 1, 143B

Comparison of Phacoemulsification Patterns for Dense Cataract: Traditional vs Femtosecond Laser Assisted Methods
4:16 p.m. to 4:21 p.m.

Mesa, Pastor-Pascual, Abengozar-Vela, Del-Aguila-Carrasco • Level 1, 143B

Big Bubble Type 1 Formation During DALK Guided by Dual Scheimpflug and 10.0 mm Diameter Placido Topography and Pachymetry Maps
8:07 a.m. to 8:12 a.m.

Arce, Forseto, Pereira, Pfluck  • Level 1, 144C

New Protocol for Custom Corneal Crosslinking in Keratoconus and in Corneas with Radial Keratotomy
3:02 p.m. to 3:07 p.m.

Carlos Arce, M.D. • Level 1, 144C

Femtosecond Laser
Safety and Efficacy Presbyopia Correction by Corneal Inlay Implantation in Femtosecond Laser-Created Pocket
9:23 a.m. to 9:28 a.m.

Jeff Machat, M.D. • Level 1 143C

AuthorResults of a New Surgical Technique Using a Femtosecond Laser in LASIK Enhancements to Reduce the Incidence of Epithelium Ingrowth SPS-317
3:44 to 3:49 p.m.

Mark Lobanoff, M.D. • Level 1, 144A

Accuracy of Total Corneal Topographic Astigmatism Compared with Total Corneal Power Measured Using 3 Tomographers
8:12 a.m. to 8:17 a.m.

Alpins • Level 1, 143B

Toric IOL Alignment Prediction Using a Color LED Topographer, Optical Biometer, and Dual Scheimpflug-Placido Topographer
8:53 p.m. to 8:58 p.m.

Al-Motaseb, Chamberlain, Montes de Oca, Weikert, Khandelwal, Koch, Wang

ASCRS Course ID: 6477
Intraocular Lens Power Calculations: When Biometry Is Not Enough

Carlos Arce, M.D.

Learn more about the Galilei Topgrapher

Femtosecond Laser
Femtosecond Laser-Assisted Pterygium Surgery
8:07 a.m. to 8:12 a.m.

Mehta  •  Level 1, 144A

Posterior Polar Cataract Outcomes Using Femtosecond Laser-Assisted Nucleus Delineation
2:08 p.m. to 2:13 p.m.

Ti, Yang, Chee • Level 1, 143B

Galilei Posters
Comparison of Color Light Emitting Diode Corneal Topographer and Dual Rotating Scheimplug-Placido Topographer

Kim, Lee, Choi

Changes in Toric IOL Power and Alignment Based on Intraoperative Aberrometry

Godin, Kim

Ziemer supports NIIOS’s Cornea Evening at Netherlands Embassy

Ziemer is pleased to support Cornea Evening by the Netherlands Institute for Innovative Ocular Surgery (NIIOS). Hot topics include DMEK for Fuchs endothelial dystrophy, the latest developments in ‘Advanced DMEK’ for complicated cases, and innovations for Bowman layer transplantation for advanced keratoconus. The event takes place April 13, Friday evening, 7 to 11 p.m. at the Netherland’s Embassy. Please register in advance, or email

Image result for Netherlands Institute for Innovative Ocular Surgery 1024 × 256Images may be subject to copyright Amnitrans EyeBank Rotterdam

Amnitrans EyeBank Rotterdam

Femtosecond Wet Labs

Book Femtosecond Wet Labs to Avoid the Rush

At last year’s ASCRS, we had quite a rush on our Femtosecond Laser Wet Labs. For 2018, we’re getting a jump on scheduling. Wet Lab Sessions are available 9:15 a.m. to 4:45 p.m. on April 14, 15 and 16.

We’re encouraging people to book early this year to avoid the last-minute rush, and to have the opportunity to schedule two sessions at convenient times.

We’ve added an extra laser to enable three femtosecond wet labs simultaneously for a grand total of 156 slots.

Learn procedures for cataract and corneal surgery

We’re offering two wet labs, each 30-minutes long. 1. Cataract Procedures, and 2. Corneal procedures. You’ll have the opportunity to learn procedures and experience the femtosecond laser.

Practice making a Flap, Pockets and Rings for inlays; and Corneal Therapeutics with the Femtosecond, such as keratoplasties (DALK, DASEK)

The Cataract track offers training for Capsulotomy, Lens Fragmentation, Corneal and Arcuate Incisions.

Related Check out our full line-up of ASCRS speakers throughout the meeting.

So, avoid the rush and put yourself on our femtosecond wet lab schedule now. You’ll enjoy the ease of the laser’s articulating arm, the slick system software, and the unit’s compact size.

Book now, and you’ll have the opportunity to sign-up for a Corneal and Cataract Session.

Femtosecond Wet Labs are for our current customers, too.

Of course! Stop by and say hello, or refine your knowledge of the docking handpiece, or software settings.

Bret Fisher, M.D., Ziemer Medical Monitor

Dr. Bret Fisher Named Ziemer Medical Monitor

Ziemer USA announces that Bret Fisher, M.D. will serve as medical monitor to oversee the clinical performance of Ziemer medical devices like the Ziemer Z8 femtosecond laser and the Galilei Dual Scheimpflug Topographer and Placido system.


Bret Fisher, M.D., Ziemer Medical Monitor
Bret Fisher, M.D., Ziemer Medical Monitor

We are very pleased to fill this important role with a surgeon who has the diverse experience offered by Dr. Fisher,” said David Bragg, President of Ziemer USA. “His knowledge and practical expertise will be a great resource for anyone using Ziemer devices.”

Florida-based ophthalmology practice

Fisher serves as Medical Director of the Eye Center of North Florida, specializing in refractive and cataract surgery. He is board certified by the American Board of Ophthalmology and certified in Cataract and Implant Surgery and LASIK by the American College of Eye Surgeons, as well as an active member of the American Society of Cataract and Refractive Surgery (ASCRS).

The Eye Center of North Florida is nationally recognized as an ophthalmic center of excellence and frequently hosts visiting surgeons from across the U.S. and the world. Dr. Fisher has served as a clinical investigator for more than 30 refractive surgery studies and frequently speaks at industry conferences.

Dr. Bret Fisher specializes in refractive cataract surgery, including femtosecond laser-assisted surgery and multifocal, toric, and accommodative intraocular lens implants. He was the first surgeon in the state of Florida to perform femtosecond laser-assisted cataract surgery (FLACS). He also performs advanced custom LASIK using a femtosecond laser for flap creation. Dr. Fisher was one of the first five ophthalmologists in the United States to perform these procedures using the Ziemer femtosecond laser.

Ziemer Femtosecond Lasers

Meet Ziemer Femtosecond Experts in Cancun and Aspen

Ziemer Pops a Wheelie for Femto Efficiency

“We just wheel it up to the bed; I don’t have to take patients to a laser room and then move to the OR. No one has to cut surgical volume to add this Ziemer Femtosecond Laser. And I think this technology will extend the longevity of our surgical careers as well.” Bret L. Fisher, M.D., is the medical director of the Eye Center of North Florida in Panama City

Mellow out with a Femto

Join your ophthalmologist colleagues thirsty for knowledge about our Femtosecond Laser with OCT. Your friends from Ziemer will answer all your questions, while you sip a Mai Tai in Cancun or a hot chocolate in Aspen.

Hot and Spicy in Cancun

Caribbean Eye February 2 to February 6

Cancun, Mexico

The Freezer Section in Aspen

The American-European Congress of Ophthalmic Surgery®
(AECOS) Winter Symposium February 25 to February 28
Aspen, CO

Z8 Femtosecond Laser with OCT unveiled at AAO

Just weeks ago, Ziemer introduced the Z8 Femtosecond laser with Optical Coherence Tomography (OCT) in wet labs at this year’s American Academy of Ophthalmology Meeting in New Orleans.

“The Z8 with OCT offers new corneal therapeutic solutions, DALK with OCT-guided tunnels for the big bubble technique, and a liquid patient interface for penetrating keratoplasties,” said David Bragg, President of Ziemer USA. “Our commitment is to the advancement of femtosecond technology with innovations that anticipate a physician’s needs and creating solutions that add value and efficiency to a practice.”

The Ziemer Femtosecond features overlapping micro-pulses that create precise incisions without “tissue bridges.” The low energy pulses protect tissue and shorten recovery time.

Wet Labs AAO 2017

During AAO, November 11-14, Ziemer will offer two wet lab options for Femto newbies, or salty veterans, to experience our Z8 Laser with OCT.

Experience the benefits of Ziemer Femtosecond for yourself

  • Overlapping micro pulses create precise incisions without “tissue bridges”
  • Low energy pulses protect tissue and shorten recovery
  • One laser that assists in up to 10 procedures
  • A compact unit brings the laser to your side
  • Mobility increases usage with effortless moves between ORs and multiple locations
  • Exceptional economy

Join Ziemer for Drinks and Support Hurricane Relief

A trip to the Ziemer booth at AAO might be more gratifying than usual. Enjoy a hurricane* from the Ziemer bar and Ziemer will donate to the AAO Hurricane Relief fund. One hundred percent of the proceeds go to Americares to help the communities affected by Hurricanes Harvey, Irma and Maria.

The Ziemer bar is in the Ziemer Booth #4213 and will be serving cocktails from 3-5 pm, Saturday, November 11, and Sunday, November 12, during the academy meeting at the Ernest N. Morial Convention Center, New Orleans

“With so many people in need in the aftermath of Hurricanes Harvey, Irma and Maria, we’re eager to help by donating proceeds to Americares, to help those in the affected communities,” said David Bragg, Ziemer USA President. “Americares is a great organization with emergency response teams that provide supplies, medicine and health care to those affected by this year’s devastating hurricane season.”

The hurricane cocktail is the signature drink of New Orleans created by the legendary Crescent City tavern owner, Pat O’Brien. The libation contains rum and a variety of fruit juices and is often served in hurricane lamp-shaped glasses.

Donations for hurricane relief may also be made directly to Americares through the AAO Emergency Relief webpage.
*one per attendee.

What if I can’t wait until AAO for a Hurricane?

Whip up one of your own with our secret Swiss Hurricane recipe.


  • 2 Parts Dark Rum of Jamaican Type
  • 2 Parts Light Rum
  • 2 Parts Lime Juice
  • 3 Parts Orange Juice
  • 1 Part Passionfruit Syrup
  • 3 Parts Pineapple Juice
  • 5 Parts Passionfruit Juice
  • 1 Whole Maraschino Berry

Toss all the ingredients in you a shaker and fill with ice. Shake and strain into your designated Hurricane glass. Garnish with an orange wheel and a cherry. Drink.

The Femto LDV Z8’s innovative nanojoule technology gives me consistent, excellent flaps.


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