FORUM GLAUCOMA
WORKPLACE : what is it?
Andika Prahasta
Department of Ophthalmology
Padjadjaran University / Cicendo Eye Hospital Bandung
Introduction
Zeiss Forum and Glaucoma Workplace
• Zeiss Forum (or just Forum from now on) is software designed primarily to connect Zeiss ophthalmic devices together, and increase their functionality (Humphrey Field Analysers (HFAs), Cirrus (and other) Zeiss OCT Scanners and also IOL Master devices
• The software fits into the category on an ophthalmic Picture Archiving and Communication Software (PACS)
• Forum is made of two components, the Forum Viewer and the Forum Server.
• The Viewer is a program that is installed on clinical PCs and is how tests are viewed.
• Forum Server is a program that typically runs on a powerful computer in the IT
department (a server). The Zeiss devices are connected via the network to that central server.
Zeiss Forum and Glaucoma Workplace
• The Zeiss Forum product is a server-based software application for
managing, archiving, and viewing patient examination results that
have been supplied by networked clinical diagnostic devices such as
the HFA, ophthalmic cameras, and optical coherence tomography
instruments such as the Zeiss Cirrus OCT.
ZEISS FORUM Glaucoma Workplace
Information delivery at a glance
What does it offer?
• Centralised storage
• Paperless field reports
• Guided Progression Analysis (GPA)
• Macular OCT progression analysis
• Repository for IOL Master data
• Repository for non-Zeiss data
• Centralised storage
• Zeiss devices connected to the Forum
• Server no longer store their test results locally
• Instead they send them all to the Forum Server
• Data is stored in one place, making backup much easier.
• Failure of an individual device
won’t threaten stored data either.
• Paperless field reports
• Forum supports the drive toward electronic health records
• Allowing visual fields to be viewed without printing
• The same feature can also be used to support virtual clinics
• Guided Progression Analysis (GPA)
• Clinicians can used the Pattern Deviation, Mean Deviation and Glaucoma Hemifield Test values to judge glaucoma progression.
• These can still be viewed in Forum, but the GPA tools provide rich
progression analysis features.
• The data is presented in a number of formats, including a graph of Visual Field Index (VFI) against age and also a progression field image
Structure and Function
The Role of ZEISS in Glaucoma Detection
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Carl Zeiss Meditec, Inc. Mely Medel / Matthias Monhart, Glaucoma 10
Ted Garway-Heath et al published a paper in Opthalmology which documents the structure-function relation between Optic disc angles and the 24-2 visual field pattern1
FORUM® Glaucoma Workplace
RNFL Sectors + 24-2/30-2 Pattern Deviation
1) Garway-Heath, D.F. et al., 2000. Mapping the visual field to the optic disc in normal tension glaucoma eyes.
Ophthalmology, 107(10), pp.1809-15.
2) Hood, D.C., Kardon, R.H. A framework for comparing structural and functional measures of glaucomatous damage. Prog Retin Eye Res. 2007 November; 26(6): 688–
710..
Don Hood and Randy Kardon evaluated this model in a 2007 publication and considered it valid for the application with OCT data.2
FORUM Glaucoma Workplace applies this model to HFA 24-2/30- 2 and CIRRUS HD-OCT RNFL scans to facilitate Glaucoma diagnosis The OCT data is vertically mirrored to match the visual field
orientation.August 3, 2016 / EN_31_150_0055l
Carl Zeiss Meditec, Inc. Mely Medel / Matthias Monhart, Glaucoma 11
• Glaucoma Combined Structure Function Reports
• The central area shows the latest pattern deviation map with the
correlating retinal nerve fibre layer (RNFL) thicknesses overlaid.
• They are very useful in glaucoma suspects, when deciding if field defects correlate with disc damage
• GWP also can produce combined longitudinal analyses of HFA and Cirrus clinical findings
• GWP allows users to add clinical and surgical event markers to the clinical timeline and to append clinical notes.
The markers can highlight medication changes, injections, surgery, and other relevant milestones
ZEISS FORUM Glaucoma Workplace Information delivery at a glance
Woman, 81 y.o., POAG OU
ZEISS FORUM Glaucoma Workplace Information delivery at a glance
VFI or MD Progression
Grayscale or PSD Progression
ZEISS FORUM Glaucoma Workplace
Information delivery at a glance
ZEISS FORUM Glaucoma Workplace Information delivery at a glance
VFI Plot
MD Plot
IOP Plot
This combination of visual field and OCT probability information was suggested by Hood & Raza (2011). For accurate registration, the visual field points must be positioned to take into consideration the
displacement of ganglion cells near the fovea.
The displacement in this presentation corresponds to that in Hood DC, Raza AS, Method for comparing visual field defects to local RNFL and RGC damage seen on frequency domain OCT in patients with glaucoma.
Biomed Opt Express. 2011 Apr 5;2(5):1097–1105- and are based upon a study by Drasdo, Millican, Katholi, and Curcio (2007).
Layer thickness [um] and probability for 6 sectors
FORUM Glaucoma Workplace 2.0
GCA+IPL Layer Thickness + 10-2 Pattern Deviation
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Carl Zeiss Meditec, Inc. Mely Medel / Matthias Monhart, Glaucoma 20
Essential Research is Using Structural Information Includes Perimetry in the Macular Region
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EN_31_150_0055l 21
Carl Zeiss Meditec, Inc. Mely Medel / Matthias Monhart, Glaucoma
Source: Nguyen, Hood et al, ARVO 2012
Source: Hood DC, Raza AS Biomed Opt Express.
2011 Apr 5;2(5):1097–1105
FORUM Glaucoma Workplace 2.0 Combined 10-2 and GCA Report
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Carl Zeiss Meditec, Inc. Mely Medel / Matthias Monhart, Glaucoma 22
ZEISS FORUM Glaucoma Workplace
Always check structure, not only function!
Visual Field OCT ONH&RNFL 4
Fundus Image 2
1 3 OCT ONH&RNFL
Glaucoma needs to be examined completely:
Act faster, and have certainty with combined reports!
View integrated information - certainty in Structure + Function
Conclusion
• For Combining Structural and Functional Information :
• OCT and Perimetry provide complementary information for the diagnosis
• Combining Structure & Function may lead to earlier confirmation of diagnosis
• Combining Structure & Function may help in confirming trends
• There’s not always agreement between Structure & Function
Looking to the Future
• Clear opportunities exist to construct analyses that go well beyond the
colocation of structural and functional findings, seen today in summing point applications such as Glaucoma Workplace.
• By means of artificial intelligence methods, experimental “combo” programs have computationally incorporated both OCT and visual field findings into diagnostic metrics that consider both.
• The same has been done experimentally with combination analyses for
progression, which may suggest that there are opportunities to reduce the time required to identify rapidly progressing glaucoma patients.
• Combo analyses might also add a higher level of standardization to clinical decision-making.
Bizios D, Heijl A, Bengtsson B. Integration and fusion of standard automated perimetry and optical coherence tomography data for improved automated glaucoma diagnostics. BMC Ophthalmol. 2011;11:20.
Shigueoka LS, Vasconcellos JPC, Schimiti RB, et al. Automated algorithms combining structure and function outperform general ophthalmologists in diagnosing glaucoma. PLoS One. 2018;13(12):e0207784.
Medeiros FA, Zangwill LM, Girkin CA, Liebmann JM, Weinreb RN. Combining structural and functional measurements to improve estimates of rates of glaucomatous progression. Am J Ophthalmol. 2012;153(6):1197-1205 e1191.
de Gainza ME, Salazar Vega DC, Mohammadzadeh V, Yu F, Afifi A, Nouri-Mahdavi K. The trajectory of glaucoma progression in two-dimensional space. Ophthamology Glaucoma. 2020;1.
