1. Greater Insight to the HRT3 Reports Click to begin

2. Baseline HRT3 Reports OU Initial Moorfield’s Regression Analysis (MRA) GlaucomaProbability Score (GPS) Click for next slide

3. Image Assessment • The importance of evaluating image quality is to determine the reliability of the data • Poor quality images can affect results and data should be interpreted with caution • Image quality is based on focus, illumination, optic disc centering and topography standard deviation (SD) Click for next slide

4. Issues Affecting Image Quality • Dilation recommended • Pupils < 1mm • Dense media opacity • Lubricating drops for • Dry eyes • Other patient factors that determine image quality Click for next slide

5. Normative Database • Determines whether the structure of an examined optic nerve head or the value of a specific stereometric parameter is within or outside a normal range • Uses ethnic specific groups, disc sizes and age to determine the normal range of healthy eyes Click for next slide

6. HRT3 OU Report • Provides a comprehensive analysis of the cup, rim and RNFL. • All parameter values are automatically adjusted for age (in years), optic disc size (mm2), and ethnic specific group for OD and OS • Asymmetry comparisons between the eyes for each parameter are also given Click for next slide

7. HRT3 OU Report • The image quality and disc size are specific to the patient • This information is located at the top of the report Click for next slide

8. HRT3 OU Report • P- values • Statistical values comparing results to the normative database for automatic classification • Parameters are adjusted for optic disc size, age and selected ethnicity • P-values Classification Click for next slide

9. HRT3 OU- cup analysis • The Topography image shown above uses color coding to identify different regions of the optic nerve head • Red identifies the size and shape of the cup • Blue identifies the sloping rim tissue • Green identifies the flat rim tissue Cup Sloping rim tissue Flat/stable rim tissue Click for next slide

10. HRT OU- cup parameters • Linear cup/ disc ratio is the average cup/ disc diameter ratio (square root of cup/ disc area ratio) • Evaluate topography images for the following • Rim thinning, significant rim sloping, cup size asymmetry Click for next slide

11. HRT OU- cup parameters • The Cup Shape Measure summarizes in one number the structure of the cup and takes into account its depth variation and steepness of the cup walls. • This is the patient’s value vs. the median value • Median value = “0” • If the patient’s cup shape is more shallow, the value is (-) which is a preferred result in healthy eyes • If the patient’s cup shape is deeper than normal, the value is (+), which is suspicious • values + values Click for next slide

12. HRT3 OU- rim analysis • The Reflectance image reproduces the reflectance of the retinal surface and is subdivided into six sectors • The green line around the optic disc margin identifies the contour line drawn by the technician • The contour line is only drawn at baseline which keeps the data more objective for progression analysis Click for next slide

13. HRT3 OU- rim analysis • Confidence intervals are computed from the regression which include 95% , 99% , and 99.9% of all normal eyes • Global and sector values are displayed • Additional information can be evaluated on the Regression Analysis Report, which provides a more detailed analysis of the rim tissue within the optic nerve Click for next slide

14. HRT OU- rim parameters • Rim area is the area enclosed by the contour line and located above the reference plane. OS OD Click for next slide

15. HRT OU- rim parameters • Rim volume is the volume enclosed by the contour line and located above the reference plane OS OD Click for next slide

16. HRT OU- RNFL analysis • The black solid or dashed line represent the patient • The shaded areas represent the normative database • The RNFL profile median is the light green line within the green shaded area. • This line represents the midpoint range of all normals Click for next slide

17. HRT OU- RNFL analysis • Starting temporally, superiorly, nasally, inferiorly and back to temporally (TSNIT) • In healthy eyes, double-hump appearance is observed • To aid in evaluation, identify areas where the black line falls outside of normal area • The yellow and red regions indicate likely areas of RNFL loss • If damage is localized, the RNFL profile may dip into the abnormal area only briefly • In glaucoma, as ganglion cells and their axons are lost, the RNFL surface curvature becomes flatter and the height is reduced Click for next slide

18. HRT OU- RNFL analysis • The left and right RNFL profiles are combined so the degree of asymmetry can be evaluated from this graph • Even if both eyes are within normal range, a large asymmetry can indicate early damage • If the correlation between the eyes is good, the values will be near 0% Click for next slide

19. HRT OU- RNFL analysis • Height Variation Contour is the height difference between the most elevated and most depressed point of the contour line Click for next slide

20. HRT OU- RNFL analysis • Mean RNFL Thickness is the mean thickness of the retinal nerve fiber along the contour line (measured relative to the reference plane) Click for next slide

21. Initial Report Initial Report • The Initial Report is a summary of the different tools used to analyze the nerve • The top of the printout has patient information • Second row contains the topography on the left side, the vertical analysis in the middle, and the reflectance image overlaid with Moorfield’s analysis on the right • Third row has the horizontal analysis on the left and the contour height line graph on the right side • On the bottom is the stereometric analysis on the left and Moorfield’s analysis graph on the right Click for next slide

22. Initial Report Initial Report • Patient’s measurements • Normal Range is used to compare the patient’s results • Additional stereometric parameters provided on this printout • Cup Area • Cup Volume • Cup/ Disc Area Ratio • Mean Cup Depth • Maximum Cup Depth • RNFL Cross Sectional Area Click for next slide

23. Initial Report Initial Report • Illustrates a horizontal and vertical cross section of the ONH • Displays the profile of the disc allowing the analysis of the width, slope, walls and depth of the cup Click for next slide

24. Initial Report • Gray line within the cross section graphs represents the mean height of the retinal surface • Red line represents the reference plane • Cup appearance is displayed below line • Black lines mark the edges of the disc as defined by the contour line Click for next slide

25. Initial Report • Reference Plane is located 50 microns below the mean height of the retinal surface along the contour line, between 350o to 356o (papillo-macular bundle) Click for next slide

26. Initial Report • Green line is a profile of the contour line • More height displayed represents thicker RNFL • Lower the green line is to the reference plane suggests RNFL thinning Click for next slide

27. Moorfield RegressionAnalysis (MRA) • MRA is a statistical analysis that measures rim area and compares rim area to a predicted value derived from a normative database • MRA compares local and global rim area values to disc size to determine if normal using a regression analysis • MRA enables a visual inspection of where the neuroretinal rim area lies in relation to normal ranges Click for next slide

28. Moorfield RegressionAnalysis (MRA) z • MRA : The neuroretinal rim area and optic cup area are displayed as a series of bars for the whole disc (far left) and each predefined segment (left to right: temporal, supero-temporal, infero-temporal, nasal, supero-nasal, and infero-nasal) • Cup area is designated in red • Rim area is designated in green Click for next slide

29. Moorfield RegressionAnalysis (MRA) z • The black lines represent values of eyes in the normative database • Predicted- 50% of all optic nerve heads in the normal database have a percentage share of the rim area that is greater than this limit • Low 95.0% / Low 99.0% / Low 99.9%- of all optic nerve heads in the normal database have a percentage share of the rim area that is greater than this limit Click for next slide

30. Moorfield RegressionAnalysis (MRA) • Patient ‘s rim area is represented at the top of the green bar where the red (cup) and green (rim) meet • Predicted classification is the average (marked “50%”) of the normal range • If the rim is above Low 95.0%, classified with a • 95% of the normal eyes would be expected to have rim area above this interval line • If the rim is between Low 95.0 % and Low 99.9%, the classification is borderline and designated with a • If the rim falls under Low 99.9%, then the classification is outside normal limits and designated with a Click for next slide

31. Moorfield RegressionAnalysis (MRA) • Actual (mm2) row identifies the patient’s rim measurements globally and for each local sector • Global is the sum of all predefined local sectors • Evaluate the rim area of the patient and compare to the measurements of the displayed classification interval lines • The closer the rim area get to the lower prediction intervals, the greater the probablity that the rim area is abnormal Click for next slide

32. Glaucoma ProbabilityScore (GPS) • GPS is a computer analysis program that is “taught” to identify patterns of structural change consistent with glaucoma • This “global shaped base analysis” utilizes the entire surface topography of the image all at once deriving the probability of damage consistent with glaucoma Click for next slide

33. Glaucoma ProbabilityScore (GPS) • 3 parameters are used to characterize the optic disc: • Cup Size (Width) • Cup Depth • Rim Steepness (Slope) • 2 parameters are used to characterize the RNFL • Vertical RNFL curvature • Superior to inferior curvature • Horizontal RNFL curvature • Nasal to Temporal curvature Width Depth Slope V H Click for next slide

34. Glaucoma ProbabilityScore (GPS) • The shape of the cupping and the contour of the retina surrounding the optic disc undergoes specific changes in glaucoma • The RNFL surface becomes flatter as retinal ganglion cells and their axons are lost • The optic disc changes are such that the cup becomes larger, the rim slope steeper, and the cup depth greater Normal Glaucomatous Click for next slide

35. Glaucoma ProbabilityScore (GPS) • The classification is made based on probability values that the shape of the eye belongs to the glaucomatous nerve group • If greater than 64%, then the result is outside normal limits • If between 63% and 29%, then the result is borderline • If less than 28%, then the classification is within normal limits Click for next slide

36. MRA and GPS Differences • GPS is combining shape-based information from cup, rim and RNFL into a single analysis • GPS uses a machine learning classifier to combine shape parameters in optimum way • GPS identifies diffuse damage and early disease • MRA is evaluating single structure • MRA uses regression analysis to detect abnormality • MRA identifies focal defects, diffuse rim thinning especially in patients with average and large optic discs Click for next slide

37. Disclaimer • The information provided by Total Vision Care in this powerpoint came from several resources and was intended for educational purposes and in no way was intended to replaces the advice and diagnosis of a licensed eye care professional. • Total Vision Care disclaims any and all liability that may result from the use of the provided information • Always use HRT results in combination with other clinical findings Click for next slide

38. Table of Contents OU Report Cup analysis Rim analysis RNFL analysis Initial Report Moorfields Regression Analysis (MRA) Glaucoma Probability Score (GPS) (click on any of the links to jump to a report)