FORUM—The Way to Integrate Glaucoma Diagnostics

The FORUM Eye Care data management system integrates your instrument data into a single stream for easier, more effective glaucoma diagnosis and management.

Early detection and aggressive treatment of glaucoma are imperative for eyecare practitioners. The stakes are high. Glaucoma is one of the leading causes of blindness, but early detection and effective management can preserve sight for decades.

An array of technologies has helped doctors reduce the vision loss that once seemed inevitable. Visual field testing, fundus photography, scanning laser polarimetry and high-definition optical coherence tomography (HD-OCT) give practitioners the data they need to diagnose glaucoma confidently and early, as well as to analyze progression over time.

FORUM^®, from Carl Zeiss Meditec, takes these technologies that are so important individually and integrates them, so the data are more clinically useful, and the glaucoma workflow becomes paperless.

FORUM: Access and Efficiency

FORUM integrates and manages data from ZEISS instruments, as well as DICOM-compliant devices from other manufacturers. Through the web-based FORUM Viewer, practitioners easily view clinical images and reports from multiple locations inside and outside the office. Instrument data form a single flow, in the exam lane and beyond.

The FORUM Archive provides one central location for storage of reports, images and raw data. FORUM helps provide seamless integration with EMR through its innovative Modality Worklist feature, and patient demographic data is sent from the EMR to connected instruments, which means no more entering data into the instruments for each and every patient. This saves time and helps prevent charting errors.

The FORUM ready HFA^™ II-i

Visual field testing is a basic element in the standard of care for glaucoma management. Validated by decades of research and clinical experience, the Humphrey^® Field Analyzer (HFA II-i) is the accepted standard of care in automated perimetry. With the HFA II-i, practitioners can feel confident that they're providing the best possible patient care. It offers fast, reliable testing with no compromise in accuracy.

For better glaucoma management after diagnosis, Guided Progression Analysis^™ (GPA^™) software provides advanced analysis to help quantify the likelihood of progression and identify high-risk patients. (See “Guided Progression Analysis.”) STATPAC, the language of perimetry, compares results to clinically validated, world class, proprietary age-normative and glaucoma databases. The result is the Visual Field Index^™ (VFI), a new summary measurement of a patient's visual field status expressed as a percent of a normal age-adjusted visual field. Designed as a more intuitive assessment of visual function, VFI is optimized for progression analysis to help practitioners make more efficient and confident therapeutic decisions. It is center-weighted to better correlate with ganglion cell loss and visual function, and less affected by cataract and cataract surgery than other measures,^1,2 making it uniquely able to quantify the rate of visual field progression.

The HFA II-i links directly to the FORUM solution, centralizing its data within the FORUM Archive. Data from the instrument exports automatically to the FORUM Archive after each exam for improved clinic workflow and data security. If practitioners see patients at multiple locations, they can see the GPA data on any HFA instrument that is connected to the FORUM Archive and using the FORUM Viewer, they can review the result wherever they are. The HFA II-i also has the widest range of testing protocols of any perimeter. And the ergonomic design promotes maximum comfort, patient wheelchair access and versatility.

The FORUM ready Cirrus^™ HD-OCT

Using spectral domain technology, Cirrus HD-OCT provides exquisite high density images of ocular structures, with precise registration and intuitive, efficient operation.

For assessment of the optic disc and retinal nerve fiber layer (RNFL), the Optic Disc Cube scan captures a dense volume of data over a 6mm × 6mm area. Cup and disc boundaries are automatically identified, and a proprietary ZEISS algorithm is used to measure the optic nerve head parameters, while accounting for tilted discs, disruptions to the retinal pigment epithelium (RPE) and other challenging pathology.

The unique AutoCenter^™ feature means that the peripapillary RNFL calculation circle is automatically centered around the disc.

Additional glaucoma applications include:

● RNFL thickness measurements for the full 6mm × 6mm area around the optic nerve head
● RNFL Deviation Map showing RNFL thickness for the 6mm × 6mm area compared to normative data
● Optic nerve head analysis
● Assessment of rim area, disc area, cup to disc ratio and disc volume
● All optic disc parameters compared to age and disc-size matched normative data
● 3-D visualization of the optic nerve head

What's more, the Cirrus HD-OCT is designed for efficiency and ease of use. Advanced hardware and software facilitate automated alignment and high patient throughput. The iris viewer provides clear visualization of the pupil for simple mouse-driven alignment. A user-friendly interface and fast processing mean chair time is shortened.

The compact, integrated design also has a small footprint, so the instrument can fit into even a crowded clinic. With the 90-degree orientation, the operator can easily see the patient during setup and scanning.

With the FORUM Data Management System, Cirrus can receive Modality Worklists with patient demographic information from a central system, improving efficiency and eliminating duplicate patient records. From Cirrus, users can send reports to the FORUM System for convenient viewing away from the instrument.

HFA-Cirrus Combined Report

FORUM doesn't just integrate and transfer existing data from an array of instruments—it also adds a groundbreaking new diagnostic assessment feature.

The HFA-Cirrus Combined Report, available exclusively with the FORUM data management solution, is the industry's first integration of OCT and visual field diagnostic analysis. (See “HFA-Cirrus Combined Report.”) By combining data from the gold standard Humphrey Field Analyzer (HFA) and market-leading Cirrus HD-OCT, this FORUM HFA-Cirrus Combined Report provides structure and function status at-a-glance to help practitioners save time making clinical assessments. This automatically generated one-page digital snapshot delivers key patient exam information at the point of care for both right and left eyes, including analyses of visual function, RNFL and the optic nerve.

For clinical assessment of glaucoma suspects and patients already diagnosed with the disease, practitioners need to look at visual function testing alongside structural measures to compare the results for both modalities. The HFA-Cirrus Combined Report automatically puts structural OCT data and visual field data into a single on-screen report, making comparison for routine glaucoma care faster and clearer. Its efficiency is beneficial for workflow, while side-by-side comparison, data integration and interpretive data like normative database numbers support accurate clinical decision-making. Practitioners spend less time pulling information together and more time making clinical decisions. And with a quick turn of the computer monitor, practitioners can use the report to show patients exactly the pathology that they are seeing in the patient's eyes.

Added to the single data stream of the FORUM Data Management System, practitioners can view the HFA-Cirrus Combined report, images, GPA and other metrics quickly and easily on a single computer. State-of-the-art tools seamlessly merge with a cutting-edge data management system. The patients and the practice both reap the benefits.

The FORUM ready GDxPRO^™

The GDxPRO, a tool dedicated to RNFL assessment, is easily integrated with FORUM. As the world's only scanning laser polarimeter, the instrument uniquely characterizes RNFL Integrity^™ (RNFL-I^™), structural information that goes beyond RNFL thickness to incorporate the cumulative level of organization of its micro-structures. Recent studies suggest that RNFL micro-structures undergo changes in orientation and density before RNFL anatomical thickness changes become apparent.^3,4 To detect and follow early RNFL changes, the additional information offered by the RNFL-I report may be beneficial to early diagnosis and treatment planning over time.

HFA-Cirrus Combined Report

The Automatic Image Alignment offered with the GDxPRO ensures exceptional registration between the reference image and subsequent measurements, even across multiple visits. It uses retinal blood vessels as landmarks to align all images with one reference image.

Practitioners and technicians find the GDxPRO easy to use effectively. The instrument has proven high repeatability, independent of operator expertise, and simple operation, which allows staff members to operate the device easily with minimal training.

Users acquire high-quality scans with minimal training through touch screen, mouse or keyboard navigation. AutoFocus ensures that the scan is performed at the optimal imaging position. And because the test is simple, smooth and intuitive to perform, it is also fast.

The FORUM ready VISUCAM^{PRO NM}

The VISUCAM non-mydriatic fundus camera system from Zeiss increases the quality and simplicity of fundus imaging. Compact, yet big enough to set the standard in ophthalmic photography, it features a unique combination of functions to enhance fundus visualization and documentation.

The VISUCAM takes an all-in-one approach, incorporating highly corrected ZEISS optics with an advanced professional grade digital sensor. It has an integrated patient database, including multiple options for image comparison, review and transfer, as well as full readiness for the FORUM data management solution.

VISUCAM optimizes practice efficiency and outcomes. The instrument is designed for both routine clinical use and screening. It integrates all elements of clinical retinal photography—from image capture through documentation to disease monitoring—in a single, state-of-the-art system. Operation is easy to ensure a smooth, rapid workflow with the help of its positioning aid, auto-focus, auto-flash and internal fixation in an ergonomic design.

Visual overview and assessment are possible at all times in every phase of the exam. When the image is captured, it automatically is stored and can be reviewed immediately on the 19" flat-screen monitor, without interruption of the capture workflow. With its specialized stereo capture mode for 3-D visualization and 45° and 30° field angles, the excellent image quality of the VISUCAM makes it the perfect solution for glaucoma case documentation. Image display, editing, printing and data export are managed by software, and a variety of image export formats are available. Finally, practitioners can access VISUCAM data alongside other testing and reports integrated into the FORUM system.

References

1. Bengtsson B, Heijl A. A visual field index for calculation of glaucoma rate of progression. Am J Ophthalmol 2008;145(2):343-353.
2. Leung CK, Cheung CY, Weinreb RN, et al. Evaluation of retinal nerve fiber layer progression in glaucoma: a study on optical coherence tomography guided progression analysis. Invest Ophthalmol Vis Sci. 2010;51(1):217-222.
3. Huang XR, Knighton RW. Microtubules contribute to the birefringence of the retinal nerve fiber layer. Invest Ophthalmol Vis Sci. 2005;46(12):4588-4593.
4. Fortune B, Cull GA, Burgoyne CF. Relative course of retinal nerve fiber layer (RNFL) birefringence, RNFL thickness and retinal function changes after optic nerve transection. Invest Ophthalmol Vis Sci. 2008;49(10):4444-4452.