One's Findings By Ina Conrad-Hengerer, Md; Case 1: Unilateral High Astigmatism With Suspicion Of Bilateral Keratoconus - OCULUS Pentacam Interpretation Manual

6 The Fast Screening Report
6 The Fast Screening Report as a first
step in examining a patient and evaluating
one's findings
by Ina Conrad-Hengerer, MD
The Fast Screening Report is a very good way of gaining a quick overview when examining patients,
especially when they are presenting for the first time. The Pentacam® analysis is a contactless
examination routine which provides you with all relevant data in a mere two seconds. These are
compared with normative data and converted to index (marker) values using suitable algorithms.
These index values can give helpful indications of possible underlying pathology. How does the
anterior chamber compare with that of a normal eye? Or how about the pachymetry or the elevation
data of the front or back surface of the cornea? Might there be something remarkable about the
patient's corneal densitometry? The black line always indicates the value of the current patient, and
its position in the grey bar chart shows where it comes to lie in a standard normal distribution. In the
red-and-green chart this normal distribution is shown in green so that it can be compared with that
of the relevant pathological patient group, shown in red. The navigation bar at the top of the Fast
Screening Report leads you to other maps. If a suspicious value has been detected, it will indicate the
name of the map with which this can be explored further. Clicking on the name will take you directly
to the relevant map. In the lower part of the Fast Screening Report you can see whether the corneal
elevation data (BAD D) are within the normal range or not, whether there is keratoconus, and if so, of
what degree (TKC), and if there is a cataract, the degree of nuclear opacity (PNS).
6.1 Case 1: Unilateral high astigmatism with suspicion of bilateral
keratoconus
A male patient aged 45 years presented for the first time in 2010 to have his distance spectacles
refitted. He reported having a long history of amblyopia of his left eye with a visual acuity of 20/100
– 20/67 at best and no known strabismus. Lang's stereotest I was positive. Correction with sph 0.00
cyl -5.00 A 14° gave him a visual acuity of 20/25 on his left eye, while sph -0.50 cyl -0.50 A 170°
improved his visual acuity to 20/20 on the right.
Slit lamp microscopy showed clear, refracting media bilaterally with no corneal scarring or other
abnormalities. Fundoscopy revealed 2 chorioatrophic foci in the left eye. All other examinations
(without the Pentacam®) yielded unremarkable results.
It was not until 5 years later that the patient presented again, now suspecting that the refraction of
his right eye had changed. The slit lamp microscopy findings were virtually unchanged.
OD: sph -0.50 cyl -1.25 A 167°
„ „
OS: sph 0.00 cyl -4.75 A 14°
„ „
The Pentacam® Fast Screening Report provides an immediate and clear picture of the unusual
pachymetry and elevation profile of the anterior and posterior corneal surface
the maps appear relatively normal. On following the navigation bar to the Belin/Ambrósio Enhanced
Ectasia Display one finds unmistakable evidence of an advanced keratoconus of both eyes
Figure 17). Here the Pentacam® reveals a disease that the patient could have been made aware of
many years earlier.
The patient was informed about this corneal pathology and its prognosis. To improve his visual acuity
he had a rigid contact lens fitted for his left eye. He is coming for follow-up every six months to
monitor how the disease progresses.
20
visual acuity (VA) 20/20
visual acuity (VA) 20/25
(Figure 14), whereas
(Figure 16,