Eyeworld

60 | EYEWORLD | SUMMER 2026 C ORNEA Relevant disclosures Rocha: None Venkateswaran: None Weikert: Alcon, Heidelberg Engineering, Zeiss Contact Rocha: karolinnemaia@gmail.com Venkateswaran: nandini.venkat89@gmail.com Weikert: mweikert@bcm.edu one," Dr. Weikert said. They provide high res- olution and you can get detailed images of the cornea, the anterior chamber, the iris, the lens within the pupil, the corneal epithelium. "We can get our typical curvature data. We can get the anatomical dimensions of the front of the eye so we can look at the angle for glaucoma considerations. You can look at epithelial maps of the cornea." The issue with any of these OCT devices, Dr. Weikert said, is they can't penetrate the iris. All the devices have ways to make assumptions and help them size for ICLs based on what they can image, but they're not directly imaging the sulcus. Right now, that can only be done with ultrasound. When considering any gaps in the available technology, that's the biggest, he said. When you have the high-resolution images, it can help you manage corneal pathology, Dr. Weikert said. You can judge the extent of the depth, the density of corneal scars, some foreign bodies, and the intracorneal ring segments. Oculus is coming out with a Pentacam that will include OCT as well. We've had OCT for a while now, Dr. Weikert said, but they were limited to the cornea and not the full anterior segment. "Now that these devices can image the anterior segment, they have become a lot more useful," he said. "We were using corneal OCT to do things like judging scars, looking for irregularities, trying to measure or get a better estimation of what the refractive power of the cornea is be- cause we can image the front and the back sur- face and thickness," he continued. "But again, we were limited to the central 8 mm of the cor- nea. Now, we can get the whole answer. There's potential there that we're not tapping right now, but as these devices are out for longer periods of time and [in] more hands, the applications for them will start expanding." At the present time, in addition to using these devices for biometry and IOL calculations, Dr. Weikert said he's using them after DMEK or DSAEK cases when he wants to check if it's attached or to look for areas of detachment. He also likes to use the imaging to judge if a patient is a good candidate for PTK, adding that this technology has helped him locate entry points to remove a corneal inlay. The technologies are fairly easy to learn and incorporate, but they can be a big investment. You need to look at everything you're getting, he said, adding that it's nice to be able to get combined applications, like a biometer with imaging. Dr. Weikert said these devices are taking many scans and, in the case of ANTERION, taking a bunch of radial scans. "They're taking cross sections of the front of the eye and putting those together to calculate the curvature of the cornea on the front of the eye, the curvature of the back of the cornea. With Placido rings, you're reflecting it off the front surface of the eye, so you're measuring the anterior curva- ture more directly (but you don't get the back surface)." Dr. Weikert mentioned the Eyestar 900 (Haag-Streit), which is also a biometer and OCT device. Whereas the ANTERION is pure OCT for measuring the curvature of the cornea, the Eyestar has some reflective spots to help with that, he said, adding that all these devices are a little different and all have ways of approaching things differently. Often when these devices are first ap- proved, their functionality may not be maxi- mized. Applications are often added as they get into practice and are used more. As time goes on, we'll be able to do more and more, he said. In the future, Dr. Rocha said it will be im- portant to have validation for technologies like this. "We're so used to the IOLMaster [Zeiss] devices for IOL calculation, and we know they work and are precise," she said. When transi- tioning to using a new technology, data and pro- spective studies become important to validate the new technology. "I think physicians may fear a new device a little bit," Dr. Rocha said. In the future, with validation, it will be much easier for patients, for technicians, and the workflow because all the measurements are in one place. continued from page 58 " … as these devices are out for longer periods of time and [in] more hands, the applications for them will start expanding." —Mitchell Weikert, MD

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