SPOTLIGHT ON TECHNOLOGY & TECHNIQUE

Imaging device maps new terrain

The Insight 100 can perform epithelial mapping and provide images and data beyond inlays

By Robert Stoneback, associate editor

If a little information can go a long way, then ArcScan’s Insight 100 can go far indeed.

The ophthalmic imaging device is used to visualize the eye’s anterior segment, including the area behind the iris, using high-frequency ultrasound. This allows it to take images that could not be previously obtained from other methods, such as OCT scans, according to Shamik Bafna, MD, cornea services director at the Cleveland Eye Clinic.

The Insight 100, which is indicated for refractive surgical planning and evaluation of anterior segment pathology, is also one of the few devices that can perform epithelial mapping, according to Dr. Bafna. This mapping is ideal for detecting pathologies such as keratoconus, says William Wiley, MD, medical director of the Cleveland Eye Clinic. This is especially valuable for potential LASIK patients, to see whether the procedure is appropriate. The Insight 100 is great for determining a patient’s corneal strength, a necessary factor in determining if corneal refractive surgery is safe. “It’s a good deciding factor for that decision tree,” Dr. Wiley says.

The epithelial mapping provided by the Insight 100 can help physicians detect pathologies.

If the patient is ineligible for LASIK, a better procedure can be suggested. This results in better treatment for everyone who comes to the clinic, which also helps to increase revenue as the clinic can use that information to provide the patient with more care options, rather than turning them away, says Dr. Wiley.

SIGHT BEYOND SIGHT

Unlike OCT, the Insight 100’s high-frequency ultrasound is not obstructed by objects that block light, such as a corneal inlay, says Dr. Bafna. This feature will be especially useful in an upcoming clinical trial to determine how corneal inlays affect wound healing. Before the Insight 100, Dr. Bafna says it was difficult to tell if there was swelling or other changes to the cornea behind such implants.

Also, with the Insight 100, doctors can easily monitor how the cornea accepts the foreign body, says Dr. Wiley. If they detect an inflammatory response, they can change the postoperative regimen to accommodate.

The Insight 100 can also visualize the eye’s line of sight in relation to the inlay to determine if it is properly centered.

Dr. Bafna has also found the Insight 100 more useful for measuring implantable contact lenses. He had previously used a Sonomed ultrasound for such lenses, to measure white-to-white distance, but he prefers the Insight’s ability to gauge sulcus width.

Scans using the Insight 100 are reimbursable using existing UBM codes, according to ArcScan.

BETTER FOR PATIENTS

The Insight 100’s epithelial mapping helps with patient education. Seeing an accurate visual helps when explaining to the patient what is irregular in the eye and why vision is affected.

“It is much easier to explain to a patient what exactly is going on,” Dr. Bafna says. “I think they’re more able to appreciate what I’m describing to them.”

In patients who need to regularly use artificial tears, using these images as a demonstration helps reinforce the importance of their drops, resulting in increased compliance, Dr. Bafna says.

Dr. Wiley also finds that patients are more comfortable being measured with the Insight 100’s “EyeSeal Disposable” system. Patients lean forward onto a headrest and place their eye into the soft-rimmed EyeSeal, which rests above a saline-filled scanning chamber. The EyeSeal can then be removed and replaced for the next patient, preventing cross-contamination.

MORE ACCURATE RESULTS

Both Dr. Bafna and Dr. Wiley found the Insight 100 to have more reproducible results than handheld ultrasound devices, as the more automated Insight 100 offers less chance for user error.

The Insight 100 was also easy for Dr. Bafna’s technicians to learn; they were comfortable with the device after the first day of use, he says. He’s been using it at his clinic for the past 6 months, on an average of 10 to 15 patients each week.

When interviewed in the early summer, Dr. Wiley said he had used the Insight on about 50 patients so far.

Along with its other advantages, the Insight 100 can capture images behind the iris and measure the full lens diameter, which could improve effective lens positioning for IOLs, says Dr. Wiley. While that research is still being conducted, “we feel confident this is a piece of information no other tool has been able to easily give us in the past,” he says. Determining effective lens position would result in a more accurate IOL calculation and more predictable results for cataract surgery.

LOOKING TO THE FUTURE

ArcScan has partnered with the Cornea, External Disease, and Refractive Society/American Society of Progressive Enterprising Surgeons (CEDARS/ASPENS) to develop applications for the Insight 100. This research will be used to improve patient care, treatment and outcomes when using the Insight 100.

“By partnering with ArcScan, CEDARS/ASPENS surgeons will work with their team to refine and perfect this novel technology,” said Robert J. Weinstock, MD, vice president of CEDARS/ASPENS, via the press release. OM

Dr. Wiley does consulting work and research for ArcScan.
Dr. Bafna has no relevant financial disclosures.