11/10/2015. Haag Streit Topcon Zeiss Kowa Add On Systems- OIS/Escalon and Others. The Original Design. Photo Slit lamp Systems. Who Makes Them?

Transcription

1 The Original Design Photo Slit lamp Systems Who Makes Them? Alvar Gullstrand Inventor of the Slit lamp illuminator Swedish ophthalmologist, recipient of the 1911 Nobel Prize for Physiology of Medicine for his research on the eye as a light-refracting apparatus. Current slit lamp biomicroscopes are based on the design of Gullstrand, Czapski, Comberg and Goldmann developed over a 30 year period. Haag Streit Topcon Zeiss Kowa Add On Systems- OIS/Escalon and Others Topcon D Series Digital Slit Lamps SL-D7 Offers magnifications of 6X to 40X The FD-21 power supply to add a Topcon DC-1 camera back Accepts a variety of CCD cameras for video Maximum slit beam size of 14 mm SL-D8Z Offers zoom magnifications 6X to 32X The FD-21 power supply to allow addition Of a Topcon DC-1 camera Accepts a variety of CCD cameras for video capture Zeiss Photo Slit Lamps- SL 130 Magnification 6x, 10x, 16x, 25x, 40x with 12.5x eyepieces Field of view diameter 31-5 mm with 12.5x eyepieces Width of slit image Continuous from 0 to 14 mm Haag-Streit Photo Slit Lamps The Haag-Streit BX 900 Slit lamp The 900 Series The workhorse-bx 900 The newest generation: The BM and BP 900 offer advances of LED illumination and more photo-video options 6 Versions are available 900 Series CM 900 Imaging Module 1

2 Canon and Nikon camera bodies The Canon 20D thru 50D are compatible The Haag-Streit BX 900 Slit lamp The Illumination Tower Top to bottom- Lamp Housing Flash tube Background Light Control Slit Height Scale The Background Light control has 6 settings + Cobalt Blue The Haag-Streit BX 900 Slit lamp Filter Control Lever Slit Height Control Knob Mirror and Diffuser Slit Orientation Guide The Haag-Streit BX 900 Slit lamp Lightsource Decentration (Centering Knob) Head Inclination Lever Slit Width Control Knob Centering Knob Shutter Release Bar Slit Width Adjustment 2

3 The Biomicroscope and Camera Assembly Magnification Control Knob Camera body and relay lens Stereo Ocular Aperture Selection Knob Magnification Control Flash Power Supply The flash has a Regular Setting and a Power Boost setting Basic Slit lamp Maintenance Replace bulb: Halogen bulb is located in the head- Unscrew two set screws and remove housing to replace bulb. Replace fuses: Fuses are located in the back of the power supply box. Clean slit lamp and table with anti-bacterial cloths. Use lens cleaner for the binocular optics. Do not use wipes on the mirror. The flash tube plugs into the back of the head of the illumination tower. Magnification The Basic Exam H-S Changer Setting Magnification on The Chip Plane 6.3x.63x 2.6 mm 10x 1.0x 1.0 mm 16x 1.6x 0.4 mm Depth of Field w/ # 3 Aperture 25x 2.5x 0.15 mm 40x 4.0x 0.05 mm Set your accommodation Clean the chinrest and headband Make the patient comfortable Start with a 10X magnification establishing shot Shoot Two overall views with diffuse illumination Note the Ocular Adnexae/ Sclera Move to 16X If Pathology Dictates Magnification= Image size over Object Size 3

4 The Basic Exam Special Technique- Everting the Lid Ask the patient to look down Place the stem of a q-tip along the center of the top lid Grasp the lashes- pull out and up against the stem The lid will flip up exposing the palpebral conjunctiva of the upper lid Quickly move in a shoot the needed photos Diffuse 10X The Basic Exam Direct Illumination Diffuse Illumination Optical Sectioning Tangential Illumination Diffuse Illumination Diffuse Illumination Scleritis The Controls Flip the diffusion filter in place Maximize beam width and beam height Angle the head to move the light reflex off the pupil Adjust the Fill light to pull it off the pupil Flash Setting LOW For diffuse Illumination of Background Light ½ the sclera increase the Magnification 10X aperture to 3 or reduce the Aperture 2 beam width 4

5 Diffuse Illumination Terrien s Disease Optical Sectioning Broad Beam (parallelpiped)- At times helpful for cornea pathology or to directly light structures such as a dense cataract. A neutral density filter should be introduced Narrow Beam- Used to define small structures in the endothelium or to view the lens sulcus Flash Setting High Magnification 16X Aperture 1 or 2 Optical Sectioning Corneal Erosion Optical Sectioning Keratic Precipitates Optical Sectioning Palpebral Cyst Anterior Chamber Depth Van Herick s Technique: Allows estimation of the nasal and temporal anterior chamber depth. Angle= Grade 1 Angle Grades Risk of Angle Closure Cornea to Angle Ratio WIDE OPEN ANGLE; INCAPABLE OF CLOSURE. DEPTH (SHADOW) IS 4 IRIS TO CORNEA ANGULAR EQUAL TO OR GREATER SEPARATION EQUALS 35- THAN CORNEAL THICKNESS MODERATELY OPEN Place an optic section of light ANGLE; at the INCAPABLE limbus OF CLOSURE. IRIS TO angled at 60 degrees. 3 CORNEAL ANGULAR SEPARATION EQUALS The section of light will illuminate the 0 cornea MODERATELY NARROW and then pass through to light up ANGLE; the CLOSURE iris. 2 POSSIBLE. IRIS TO CORNEAL ANGULAR SEPARATION EQUALS 20 0 The shadow between these two is the anterior chamber depth indicator EXTREMELY NARROW ANGLE; CLOSURE 1 PROBABLE. IRIS TO CORNEAL ANGULAR SEPARATION EQUALS 10 0 DEPTH (SHADOW) IS BETWEEN 1/4 AND 1/2 THE CORNEAL THICKNESS DEPTH (SHADOW) IS EQUAL TO 1/4 THE CORNEAL THICKNESS DEPTH (SHADOW) IS EQUAL TO LESS THAN 1/4 THE CORNEAL THICKNESS The grading system BASICALLY is 0 through CLOSED 4 with 0 being ANGLE; CLOSURE IS MOST a very 0 narrow angle EMANATE. and 4 IRIS being TO a wide, deep CORNEAL ANGULAR angle. SEPARATION EQUALS 0 0 DEPTH (SHADOW) IS ONLY A VERY NARROW SLIT; OR NO ANGLE 5

6 Tangential Illumination This can be helpful when highlighting an elevated Area or to show a large area with a light that has a harder edge. Use a neutral density filter and A higher aperture setting as needed. Exposure can Also be controlled by decreasing the beam width. Tangential Illumination Flash Setting LOW Magnification 10X-40X Aperture 2 Maximize beam width and height Indirect Illumination Proximal Illumination Sclerotic Scatter Retroillumination Iris Transillumination Proximal Illumination This form of lighting uses tissue adjacent to an area to be captured as a reflector or bounce panel of sorts This allows the photographer to avoid overlying tissue that is anterior to the subject and diffusing the light Flash Setting LOW Magnification 10 to 40X Aperture 1 or 2 Proximal Illumination Sclerotic Scatter Sclerotic scatter is best done on a dilated pupil for a dark background. The slit beam adjustment Knob is fully loosened and the beam is offset temporally. This allows the subject to be centered The slit beam should be placed at the corneo-scleral border and the width adjusted for best illumination of the subject Flash Setting HIGH Magnification 10 to 16 Aperture 1 6

7 Sclerotic Scatter Vortex Keratopathy Retroillumination This technique is achieved by bouncing a half moon or mediumsized, shortened optical section off the retina or the iris to backlight a subject in silhouette Flash Setting HIGH Magnification 10 to 16 Aperture 1 Retroillumination Cataract Iris Transillumination Done on an undilated eye Use a small disc of light that is smaller than the patient s pupil size- 2 or 3 mm Move the illuminator head until it is almost coaxial with the biomicroscope. Perfect alignment is achieved when a bright, red reflex is noted off of the fundus Flash Setting HIGH Magnification 10 to 16 Aperture 1 Types of Filtration Goniophotography Cobalt Blue to highlight.fluorescein Green to highlight..rose Bengal Gonioscopic lenses come in a variety of styles for exam of the angle, peripheral fundus and, centrally, the posterior pole Common Mirror angles: and 73 - To observe the iris, the angle, trabecular meshwork and peripheral retina Goniophotography should be done on an undilated eye. The middle mirror allows the best view of the iris body and angle of the eye 7

8 Thank You! A special thanks to: Rachel Bishop, MD Denise Cunningham, F.O.P.S. Manuel Datiles, MD Pascal Gartman of Haag-Streit Instruments 8