Article Date: 6/1/2010

Espy Endotheliopathies
instrumental focus

Espy Endotheliopathies

Specular microscope enables accurate and early detection.

MARC BLOOMENSTEIN, O.D., F.A.A.O.

Corneal endotheliopathies, such as Fuchs endothelial dystrophy, can result in edema and possibly affect corneal transparency. Therefore, to ensure early diagnosis and the most appropriate treatment, we must have a device that enables us to accurately monitor and detect abnormal variation in endothelial cell size (polymegathism) and shape (pleomorphism). Add easy to use, efficient and a pachymeter component, and this describes the EM-3000 specular microscope, from Tomey.

Overview

The EM-3000, which employs an LED light source, includes a color touch screen, auto alignment and auto image functions to facilitate your ability to diagnose corneal endotheliopathies, such as iatrogenic-caused endotheliopathy.

Also, it includes a pachymeter, which measures corneal thickness with +/− 10 μm accuracy. Having the corneal thickness measurement helps determine glaucoma status, the presence of corneal edema and refractive surgery candidacy.

In addition, the specular microscope enables you to provide your patients with a color printout of their endothelium through its USBH connector. I personally go over the color printout image with the patient to show him areas of concern. For my asymptomatic patients, for instance, the image helps to emphasize what I'd like to avoid, or it demonstrates disease progression. As the saying goes, "A picture is worth a thousand words," and much like a visual field, the EM-3000 provides a representation of the cornea structure's inside.

Should you wish to store the images electronically, the device includes "Data Transfer" software, which you can connect to your PC and electronic health record software via LAN connection.

EM-3000

HEIGHT: 17.8 inches
WIDTH: 12.1 inches
DEPTH: 17.8 inches
WEIGHT: 39.6 lbs
COST: $24,750.00

Image acquisition

The EM-3000 provides an image size of 0.25mm x 0.54mm and can acquire images at seven points: the center of the pupil and the peripheral points of 2, 4, 6, 8, 10 and 12 0'clock on a f 6mm arc. These various image points enable you to accurately examine a patient who has an irregular corneal surface. Often times, patients may have scarring or significant dryness that affects the measurement in one area. Having the ability to move the image point allows the flexibility for better measurements. Moreover, since guttata may not be seen in all the endothelium, you can pinpoint areas of concern with this feature.

To acquire an image, just touch the center of the patient's pupil — seen on the color touch screen. This enables the device to center the image via its auto-alignment function, which moves the EM-3000's measuring head toward the patient's eye. (Incidentally, once you touch the eye display button, the instrument automatically moves its measuring head to the patient's other eye, so he doesn't have to turn his face. (Patient comfort is always a major plus with any device.)

Then, the EM-3000's auto shot begins taking 15 serial images to decrease image errors. Once the device has acquired all 15 images, it automatically chooses the best one of the bunch and displays it for you via the color touch screen.

To further facilitate an accurate diagnosis, the device enables you to select from four image display functions: a regular image of the patient's endothelial cells, a traced cell shape image, an image that shows different areas of the endothelium and an image that reveals differing polygonal cell shapes. Analysis values include the number of analyzed cells ("number"), cell density ("CD"), average cell area ("AVG"), coefficient of variation of cell area ("CV"), maximum cell size ("Max") and minimum cell size ("Min").

Ideal diagnostic devices are those that provide not only accurate data to guide patient management, but also ease of use and efficiency. Because the EM-3000 specular microscope provides accurate data on the endothelium, and it's comprised of easy-to-use and efficient features, I feel it's a musthave device in the diagnosis and management of corneal endotheliopathies. OM


DR. BLOOMENSTEIN IS DIRECTOR OF OPTOMETRIC SERVICES AT SCHWARTZ LASER EYE CENTER IN SCOTTSDALE, ARIZ. E-MAIL HIM AT DRBLOOMENSTEIN@SCHWARTZLASER.COM.

Optometric Management, Issue: June 2010