Hi everyone, I’m Jessica Sun. I’m the senior marketing manager for myopia and ocular surface disease at Topcon, and we are really excited to introduce the TERA Dry Eye Imager. This is our multimodal platform for corneal analysis, pupillometry, as well as a fully integrated dry eye diagnostic suite. So we’re actually going to run through a test sequence today. I have my patient here. We’re gonna start a new exam and show you all the features of this new device. So go ahead and sit in. To start, we have an optional questionnaire that we can answer for dry eye screening, but I’m actually going to proceed to show you some of the cool automated features that we have. Starting with topography, you want to make sure that your patient is aligned with the canthus lined up to the indicator here. You can go ahead and adjust the chin rest upwards and downwards in order to get a better alignment. And then, for the first test, we’re going to do topography. All you have to do is click on the center of the pupil and you’ll see that the device is driving itself and automatically capturing the topography image. Moving on to the left eye, we’re gonna click the center of the pupil and you’ll see that, again, there’s automated capture of the left eye. We’re gonna save both images and if you wanted to, you could go ahead and zoom in and take a look at that scan. Don’t remember it. We’re gonna move on to pupilometry now. For this, we’re actually going to introduce lights inherent inside the bowl. So again, this is an automated test where I can click on the center of the pupil. We’re going to change the focus to optimize it, and we’re actually going to take dynamic pupilometry where the lights that are integrated within the bowl will turn on and off to simulate different types of lighting, situations. At the end of this capture, you’ll see that the dynamic pupillometry is saved, and then you can also capture scotopic, photopic, and mesopic static pupillometry captures as well. Moving on into the dry eye features, this is where we really have exciting new features I want to show. So starting with the blink analysis, we’re gonna take a look at how this patient naturally blinks. I’m gonna go ahead and get this in focus. You can either click on the joystick here, or you can start the capture with the capture button on the screen. So we’re gonna have the patient go ahead and just naturally blink, and we’re gonna capture how many times the lid actually closes over the pupil. So when we’re ready to calculate how many flings per minute, we can either again stop the capture with a joystick or with the touch panel. Moving on to non-invasive tear breakup testing. This is another automated test. We’re gonna have the patient focus at the green light that they see in the bolt. I’m gonna tap on the center of the pupil. The device is again automatically focusing, and when it’s ready to capture, I’m gonna have the patient blink and then open wide. And then as you can see, the device is going to pick up areas where there is breakup of the tear film, and then when he blinks again, we’re going to stop capture automatically. This is, again, an automated capture sequence, so I can move to the right eye, and we’re gonna complete the same sequence. Go ahead and blink and open, and again, you’re gonna see the tear films break the tear film breaking up over the different sectors. If I wanted to pause the capture here, I could go ahead and click the button, and then we can go ahead and save that image. Moving on to tear meniscus height, this is gonna be capture of the thickness of the tears, so we can actually use the touch panel to get in focus or get in the right area, and then we can move in or out with this focus panel here. And our goal is to really get a nice, high quality in focus image of the lacrimal lake here. The higher the red signal, the better the quality of the scan. When we’re ready to go, we can go ahead and click that capture button. We’re gonna have a little bit of focus optimization as well to ensure that we get the best quality image. You can always take a closer look at any of the images that you capture to ensure that everything is fair and in focus. Moving on into the redness grading. This is going to be the really the wow factor for this device. We have high resolution color imaging integrated into the TERA. And as you can see here, the lashes are visible as well as the iris and the cornea and conjunctiva. So I can take an image here by again tapping on the screen. I can also have the patient look to the right. Go ahead and look to the right and to the left, a little bit higher, and then up into the Lassett. Yep, there we go. And then take a couple images there. And that way, we can take a look in all gazes, and again, you can access any of these photos down the gallery to the left. Now moving on to blepharitis, we’re gonna have the patient look down so we can take a look at the image of the lens, and as you can tell, I’m using my finger to actually drag the image, and I can also use the focusing scale here to scroll in or out to make sure that I capture as much detail as possible. If there’s something that I want to see here, I can go ahead and click the one point five X button, and we can zoom in and take a closer look at any specific area or landmark along the lashes. And again, two x gives me additional magnification. Now I can take images at any of these magnifications, that you see here, and you’ll see it actually saved in the gallery. Moving on to the lipid layer, we’re actually able to take images and videos of the lipid layer of the tear film. As you can see here, I’m on the photo mode, so I’ll go ahead and capture some images here. And then I can also switch to video mode and have the patient blink naturally. I can also reduce the brightness if the light intensity is too high, or I can change to get a wider view or a wider shot of the images that I’m seeing. So we can either look at superior hemisphere, inferior hemisphere, or a full three sixty degree view of the lipid layer. Moving on into meibomian gland imaging, this is gonna be infrared imaging of the meibomian glands. So I’m gonna get the focus centered on his lower lid here and have him look all the way up. I’m gonna reach over and pull down on the lower lid. You’ll see here that I can improve the focus. Once I’m ready to capture, I can hit the capture button on the side, and the image is gonna be focus optimized and saved. So this is what it’s gonna look like. I’m gonna go ahead and close that image so that we can take a look at the measurement tab. Before I end the acquisition sequence, I do wanna also point out that we do have the ability to do fluorescein imaging as well as Lissamine Green imaging. This is gonna require the addition of essential dyes into the eye. We’re not gonna do that today, but we can show you an example of what fluorescein as well as Lysamine green staining look like in the measurement tab. Now that we’re done with the full spread of tests, we can go and take a look at the images that we were able to take. So starting with the topography test, we have the ability to look at the corneal map here. You’ll see a breakdown of the dioptic values across different zones of the cornea, as well as the ability to look at specific indices that tell us about, any irregularity in the cornea or any abnormalities that we might want to zoom into a little more closely. The AK tab tells us if this topography is compatible or not compatible with keratoconus, and the P tab gives us information about the pupil. Moving across the side here, you can actually see corneal aberrometry values as well, and take a look at the white to white measurements of the cornea. So this is gonna be especially helpful for contact lens fitting. This is the pupilometry video that we took earlier. As you can see, the pupil size will change as we introduce different light levels in front of the eye. So this is a great way for us to track specifically how the pupil size changes and reacts to light over time. This is a map of our noninvasive tear breakup test. As you can see, there are sectors that are pointed out where there were initial areas of tear breakup. If we wanted to play back the video and take a look at the impact on the, placido rings, we can do that as well. Moving on to tear meniscus height, this is the raw image that we took earlier, but can also hit the enhancement button and actually improve the contrast that we see here. I can click on the analysis tab and actually drop in calipers to measure the thickness of the tear film. And then once we generate at least five points, we can actually ask the device to assess the average thickness of the tear volume. These are our wonderful color images that we were able to take in different gazes. This is actually, the post process photos. These are the raw images where you can see the reflection of the four LED lights. If we click process, we’re actually able to remove those so that you have an unobstructed view Yeah. Of the eye. Looking at our blepharitis images, you’ll see here that we have different zooms of the same patient. So we can zoom in or zoom out, and we can also take a closer look with the zoom function on the bottom of those three ears. We also have the ability to grade the severity of blepharitis that we see, and so we can pick and choose and save any score that we would like. Moving right along down to the lipid layer analysis, if you recall, we took both images as well as videos, so we can take a look at both of those. And, again, there is the option on the photos to be able to graze. Last but not least, with my biography, this is the image that we were able to capture. Again, the raw image. We’re also able to enhance the contrast with the sliding scale here. We’re also able to check on the analysis button and go ahead and capture the area that we would like to analyze for gland loss. This will automatically select the area that you would like and show you the area of loss up at the top. In addition, you have the ability to hit grade, select lower lid, and be able to grade the severity of blind loss with the color grading scale. So that’s all of the images that we were able to take together. So we’re gonna go ahead and pause there. So I did wanna show the last two images that we weren’t able to take in real time. So if we’re gonna, head over to a patient who has signs of dry eye, We’re gonna go and show you what it looks like when you capture a fluorescein image on a patient where we instilled fluorescein dye and they have signs of staining. So here you’ll see that this is a more global photo taken with Atara, and we can actually zoom in to see signs of staining and evaluate on a grading scale for severity as well. So since this looks pretty severe, I’m gonna go ahead and save that image, and I’m actually able to show you the next capability, which is Lysamine Green Staining. This is a different dye that we can put in, and we can take a look at any areas of the lid margin where there’s dying or devitalized cells. And that wraps up our overview of the TERA Dry Imager. Please reach out to your local Topcon rep to learn more or visit us on our website.