CR
Overview
What sets it apart?
Reicherts 7CR Auto Tonometer + Corneal Response Technology takes corneal biomechanical properties into consideration, providing Corneal Compensated IOP (IOPcc) a pressure measurement that is significantly less affected by the cornea than other methods of tonometry. The 7CR is based on Reicherts patented dynamic bi-directional applanation technology, which is the foundation of the revolutionary Reichert Ocular Response Analyzer (ORA). The ORA is the first instrument capable of measuring corneal bio-mechanical properties and is supported by over 100 peer-reviewed publications in the medical literature. Corneal properties such as elasticity, viscosity, and thickness can affect the accuracy of Goldmann IOP values by as much as 17 mmHg in normal eyes and more than 20 mmHg in eyes with corneal pathology. The ORA, and now 7CR, are the only devices in the world that can account for these properties. IOPcc is patented technology (US 7, 481, 767 B2)
Overview
What sets it apart?
The 7CR presents you with a tremendous opportunity to sell a unique product that has strong clinical utility and essentially NO COMPETITION. 7CR is THE Glaucoma tonometer. This is not a screening device, as NCTs were perceived to be in the past. 7CR should be positioned as the tonometer of choice for the management of glaucoma for ODs and MDs alike. The 7CR is superior to Goldmann or any other IOP measurement. Reichert 7CR Provides more clinically relevant tonometry measurements in:
Normal Tension Glaucoma patients (subjects who have glaucoma but measure low on Goldmann) Primary Open Angle Glaucoma patients (typical high-pressure glaucoma subjects) Post-LASIK and refractive surgery patients (subjects with biomechanically altered corneas) Patients with Fuchs or Edema (very spongy corneas that measure inaccurately on Goldmann) Keratoconus patients (biomechanically weak corneas that measure inaccurately on Goldmann) Patients with thick, thin, or otherwise biomechanically atypical corneas
Tonometry
Tonometry is used to measure the Introcular Pressure (IOP), which is a risk factor for Glaucoma. Higher IOP increases the risk for glaucoma.
IOP is the ONLY modifiable risk factor for glaucoma. This means that once a patient has been diagnosed with glaucoma, the only thing doctors can do is try to lower the pressure. Regular monitoring of IOP is essential to determining efficacy of treatment in glaucoma patients.
As such, accurate measurement of IOP is CRITICAL for the proper diagnosis and management of glaucoma.
Tonometry
The Goldmann Tonometer has long been considered the gold standard for measuring pressure, but its accuracy is widely questioned today.
Goldmann Design Assumptions - Cornea is infinitely thin and perfectly flexible - Tear-film and corneal thickness effect cancel each other out Flaws - Experimentation done on cadaver eyes (not representative of live eyes) - Variations in corneal thickness is significantly greater than assumed - Variations in corneal biomechanical properties unaccounted for Accordingly, Goldmann cannot compensate for differences in thickness, elasticity, and other biomechanical parameters that influence accuracy
Thicker corneas tend to measure higher on GAT and Thinner corneas tend to measure lower.
However, the relationship between CCT and measured IOP is only valid when observing large data sets. When applied to individual patients, corneal thickness IOP correction formulas present a 40% chance of adjusting the IOP in the WRONG DIRECTION!
But SCATTER in the data makes accurate mathematical adjustment of IOP impossible for individuals!
The 7CR IOPcc measurement is not based on the overly-simplistic Corneal Thickness correction approach.
7CR quantifies the corneas biomechanical properties, and then reduces the effect of these on the IOP measurement process
CR
Air-Jet
Applanated Cornea
Air-Jet
Corneal Concavity
Air-Jet
Applanated Cornea
Inward Applanation
Corneal Hysteresis
Outward Applanation
Hysteresis
Hysteresis
A property of materials or systems that do not instantly follow forces applied to them, but react slowly, or do not return completely to their original state. The phenomenon was identified by Sir James Alfred Ewing in 1890. This term is commonly used to describe material properties in engineering and architecture.
Hysteresis
Many common visco-elastic materials and systems exhibit hysteresis. - Automotive struts - Foam mattresses - Viscous fluids like honey and oil - Door dampers (closers)
IOPcc
Corneal-Compensated Intraocular Pressure
7CR utilizes the information provided in the Corneal Hysteresis measurement to determine IOPcc, which is less affected by corneal properties than other methods of tonometery, such as Goldmann (GAT). 7CR also provides IOPg which is similar to an actual Goldmann measurement. Seeing these values simultaneously gives clinicians a better understanding of patient tonometry values.
IOPcc is patented technology (US 7, 481, 767 B2)
IOPcc
Corneal-Compensated Intraocular Pressure
IOPcc is still a Goldmann correlated IOP measurement. It agrees with Goldmann on average, but is not influenced by the cornea in the same way as Goldmann and other tonometers are.
Therefore IOPcc has the same scale as a Goldmann measurement, but is more clinically relevant because it is not contaminated by corneal artifacts.
Note: The PASCAL DCT, which claims independence from corneal properties is NOT Goldmann correlated. As such, the clinical relevance of the DCT IOP measurement is questionable.
IOPcc ignores the change in corneal properties cause by LASIK and provides similar IOP measurements in pre and post refractive surgery subjects
Data courtesy Dr. David Castellano, MD / Dr. Jay Pepose, MD
Clinical Publications
IOPg, IOPcc correlation with Goldmann and CCT
GAT
Conclusions: IOPg agrees with Goldmann very well. IOPcc seems to provide an estimate of IOP that is less influenced by corneal properties than those provided by GAT
Evaluation of the Influence of Corneal Biomechanical Properties on Intraocular Pressure Measurements Using the Ocular Response Analyzer. Felipe A. Medeiros, MD and Robert N. Weinreb, MD J Glaucoma 2006;15:364370.
IOPcc
Clinical Publications
IOPcc differentiates Glaucomatous Eyes
In Glaucomatous eyes IOPcc was significantly higher than GAT. This relationship was also true in Glaucoma suspects. However, in normal eyes and OHT eyes, IOPcc, IOPg, and GAT were all similar. This indicates that IOPcc is a better indicator of glaucoma presence
Ocular Response Analyzer in Subjects with and without Glaucoma. Sullivan-Mee M, Billingsley SC, Patel AD, Halverson KD, Alldredge BR, Qualls C. J Optom Vis Sci. 2008 Jun;85(6):463-70.
Clinical Publications
IOPcc can differentiate NTG eyes from normal eyes
True normal eyes and eyes with NTG (normal tension glaucoma) were measured with GAT, DCT, IOPg, and IOPcc
Conclusions: Only IOPcc was able to distinguish the NTG eyes from the true normal eyes.
Intraocular pressure measured by dynamic contour tonometer and ocular response analyzer in normal tension glaucoma Tetsuya Morita & Nobuyuki Shoji & Kazutaka Kamiya & Mana Hagishima & Fusako Fujimura & Kimiya Shimizu Graefes Arch Clin Exp Ophthalmol DOI 10.1007/s00417-009-1169-4