Published in Glaucoma

A Closer Look at iCare COMPASS: More Than a Standard Perimeter

This post is sponsored by iCare USA
8 min read

In this session from Eyes on Glaucoma 2023, host Justin Schweitzer, OD, FAAO, is joined by Toby Tyson, MD, to discuss the benefits of using the iCare COMPASS perimeter and what makes it stand apart from other perimeters on the market.

iCare COMPASS is the first fundus perimeter that combines a visual field with a retinal image, all in one device. Using retinal tracking to compensate for fixation losses in real-time and TrueColor high-resolution images – the iCare COMPASS takes visual field analysis to the next level.

The advantage of fundus-controlled perimetry

Fundus-controlled perimetry is a technique that images the retina during visual field testing, enabling a reliable correlation between visual function and retinal structure. Active retinal tracking is at the heart of this function.
Infrared scanning of the retina provides continuous, automated tracking of eye movements by active compensation for fixation losses. The perimetric stimuli automatically repositions prior to and during projection based on the current eye position. This ensures an accurate match between function (i.e. retinal sensitivity values) and structure (i.e. retinal image) reducing motion artifacts.

Automated visual field test with TrueColor Confocal imaging

As a perimeter, iCare COMPASS offers full compatibility with standard 24-2, 30-2 and 10-2 visual field tests containing age-matched databases of retinal sensitivity in normal subjects. The iCare COMPASS fundus perimeter also provides a 60° confocal retinal image in TrueColor, infrared and red-free. The iCare COMPASS is the first perimeter to provide high-resolution stereo viewing for a better assessment of the optic nerve head.

A closer look at iCare COMPASS: More than a standard perimeter

Toby Tyson, MD, is a cataract, refractive, and glaucoma surgeon who is part of a multi-location practice made up of optometrists and ophthalmologists in Southwest Florida.
Dr. Tyson’s practice has been utilizing iCare’s EIDON fundus camera, which they found to be a “wonderful device.” As a result, when it was time to open a satellite office that would also require a visual field machine, they decided to go with the iCare COMPASS, since it provides both.
“We love the EIDON camera, and the ability to merge the two into one made a lot of sense,” Dr. Tyson explained. “It allowed us to have one device that can do multiple things, so the footprint was smaller — plus it’s easy to use.”

How often is the iCare COMPASS utilized in your practice and for which types of patients?

Dr. Tyson said when the iCare COMPASS was added to the satellite office, they decided to use it for all patients—for visual field testing of all glaucoma patients and as a “gateway exam” for all other patients.
“So, every new patient gets a fundus photo on the COMPASS,” he explained. “In addition, all of the cataract consults are getting fundus photos, too.”
Dr. Tyson said they embraced that approach because visualization with the iCare COMPASS is superior to what’s possible using the 90-diopter lens of the slit lamp — especially through a two-millimeter pupil— and results are provided in “real” color.
“One of the side benefits is that the technology actually seems to enhance the visibility of epiretinal membranes,” Dr. Tyson explained. “So, when pathology is present, it’s actually being highlighted, rather than overlooked. That has helped us stay out of trouble, especially with premium cataract patients.”
Use of the iCare COMPASS enables his team to conduct visual field testing for glaucoma patients and has provided an extra layer of flexibility. 
“It’s also nice to be able to use the device for both screening and monitoring of the patient’s disease state,” Dr. Tyson added.
“The imaging quality of this camera rivals anything on the market, and the ease-of-use allows it to be used in a screening capacity. So, we're using it as a screener, but we're also using it to monitor disease progression. I think it's a nice jack-of-all-trades.”

Does the tracking capability provide more accurate results over time?

Dr. Tyson said his practice has limited longitudinal data to share since they’ve been using the iCare COMPASS for less than three years, but he believes results will be more accurate over time.
“We don't have much data to evaluate five- or ten-year progression, but my gut instinct says yes,” he explained. “If the patient is taking the test more reliably, then we're going to be able to see that progression much sooner because it's going to stand out earlier in a fashion that we believe and trust is accurate.”

How does the color imaging capabilities of the iCare COMPASS aid in monitoring the optic nerve head?

Dr. Tyson believes being able to see in “real color” makes a difference on several fronts.
“We're used to seeing in color,” he explained. “Some of the other products like to use four colors, and I think you're missing out. Color adds information. So, when you're looking at optic nerves, it's not just trying to infer three dimensionality by how vessels curve or don't curve — but also having the power to more accurately evaluate the health of the optic nerve. In that context, I think having the color imaging capability makes a really big difference. It was one of our driving decisions in buying this technology over some of the competitors that were only using four colors.”

How would you compare the iCare COMPASS to other perimeters on the market?

Noting that he’s been “doing perimetry” since high school, when he was a certified ophthalmic technician, Dr. Tyson remembers how things used to be.
“In the good old days, you'd put patients in the fishbowl, and then sit there to log all the data points,” he said. “The patient would start snoozing off because it took so long, and you weren't sure exactly where you were getting the information.”
In contrast, Dr. Tyson said the iCare COMPASS provides a registration (retinal tracking) so the device knows which area is being tested.
“I think that reproducibility really aids in both accuracy and assessment of disease progression,” he explained. “When you have a change, you know that it really exists where it is. It's not some artifact of testing. That’s very important.”
Patient ease-of-use, efficiency, and intuitive software are additional factors that sets the iCare COMPASS apart.
“Many providers have started using headsets,” he explained. “With elderly patients, the headsets are hard to balance, and the patients get too fatigued.”
“Patients know whether they saw something or not,” he said. “That’s because the COMPASS is actually highlighting the retina, not a reflective surface they have to then visualize. So, it's a little more direct, and I find that patients have more confidence.”
“The iCare COMPASS is easy for my staff to operate, which means I can utilize a much broader range of technicians to operate the device and work with patients compared to some of the other systems that are on the market,” he said.
In fact, Dr. Tyson said the iCare COMPASS is so easy to use that it’s the starter diagnostic on which new staff are trained.
“When they first come in and don't have any ophthalmic or optometric training, they start by learning how to run the COMPASS,” he said. “That’s because the device is so user-friendly that they’re able to master it very quickly, even with a limited skill set — and we know the results they're getting are reliable.”
Toby Tyson, MD
About Toby Tyson, MD

Dr. Farrell C. Tyson practices among an elite group of eye physicians leading the research and development of new treatments for cataracts and eye diseases. A Johns Hopkins graduate with a degree in Biomedical Engineering, Dr. Tyson’s contributions continue to assist ophthalmologists worldwide in their ability to offer patients new advancements in vision technology.

Dr. Tyson was one of the first in the world to utilize Intraoperative Wavefront Technology during cataract surgery, a technology that has revolutionized cataract surgery. Using sophisticated instruments, Dr. Tyson is able to capture real-time refractive measurements of the patient’s eye during surgery. This advanced approach will allow ophthalmologists to tailor intraoperative lenses immediately, reducing or even eliminating the need for postoperative surgery and/or postoperative eyeglasses.

Toby Tyson, MD