1. They feel the need for speed. With an average test time of less than three seconds, Galilei’s dual Scheimpflug cameras gather data faster, which helps maintain patient attention and reduces the time for the eye to dry and distort data. Faster speed equals more accuracy!
2. Precision! Placido Topography provides highly accurate anterior corneal curvature with precise detection of anterior surface irregularities and tear film quality.
3. And even more precision! Dual Scheimpflug Tomography provides posterior corneal curvature and precise pachymetry and elevation plus 3D anterior chamber analysis. Plus ray-traced posterior corneal surface data can detect bulging and asymmetry in the early stages
4. Combined data is accurate data. Ziemer’s own proprietary algorithm sorts through and combines data to provide a precise surgical roadmap.
5. It’s fun to pronounce! Gal-ee-lay, Gal-ee-lay!
Find even more reasons to switch to the Galilei here.
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.
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.
Seth Pantanelli, M.D. is a cornea specialist and an Galilei topographer expert at the Penn State Hershey Medical Center’s Department of Ophthalmology, and he lives in Hershey, Pennsylvania, the city that chocolate built.
His clinical interests include medical and surgical management of corneal infections, keratoconus, Fuch’s endothelial dystrophy, and ocular surface diseases like graft-versus-host disease and neurotrophic keratopathy.
He also has clinical and research interests in intraocular lens power calculations for cataract surgery.
One of his most important instruments for fitting premium IOLs is the Galilei Topographer, which helps him evaluate which patients are candidates for premium IOLs. He measures angle kappa, inspects the regularity of astigmatism, and evaluates the posterior cornea information. He finds the latter most useful because it helps him identify patients that are exceptions to the rule.
“In most patients, the steep meridian of the posterior corneal curvature is oriented vertically,” he explains, “but 10-15% have it oriented horizontally. Identifying these patients is difficult and astigmatism correction in these patients is challenging. You can’t just plug their information into the Barrett Toric Calculator and expect to get a good result. But, with the Galilei, I can identify them and compensate for the unexpected finding.”
Pantanelli tracks keratoconus with the Galilei topographer
Pantanelli also uses the Galilei Topographer for diagnosing and monitoring the progression of keratoconus. “The metrics we have in the literature now for tracking progression are varied and not easy to remember,” says Pantanelli. “We are currently working on a study to better define what progression of keratoconus means on the Galilei, with the ultimate goal of simplifying its diagnosis.”
Another promising Galilei analysis that Pantanelli is keen on is the CLMI.X. “It’s great for helping to identify keratoconus, and we are evaluating the value of CLMI.X indices as they pertain to progression.”
Quantifying Irregular Astigmatism
Another report he finds valuable is Wavefront, which he uses to quantify patients’ level of irregular astigmatism. It helps him to evaluate which patients are likely to do well if he refers them to an optometrist for a scleral lens. Says Pantanelli, “We have an extremely large scleral lens practice that does a lot of good for a lot of patients, and I’m proud ‘and I’m proud to be able to provide this service through our department by way of our outstanding optometrists!”
“The best Trick or Treat ever”
For fun, Pantanelli travels with his wife and kids. They love skiing in the winter and thawing out in Florida. He lives in Hershey, PA, which is a playground for his children, and not just because of the chocolate. Halloween is the biggest holiday, and the whole family enjoys its small-town feel.
Learn more about Dr. Pantanelli on LinkedIn.