Published in Retina

iCare USA—Unique Technology Live with Lighthizer

This post is sponsored by ICare USA
14 min read
In this session from Eyes On Glaucoma 2022, Nathan Lighthizer, OD, FAAO discusses how iCare USA's technology is helping establish the next level of eyecare.

Establishing the Next Level of Eye Care

As a trusted partner in ophthalmic technology, iCare understands that sight is one of the most important senses—which is why the company works passionately to protect it. iCare provides eye doctors with the latest solutions for comprehensive screening, diagnostics and monitoring of glaucoma, diabetic retinopathy, and macular degeneration (AMD).
Since 2003, iCare has been known as the company that brought the no drops, no puff handheld rebound tonometer that offers quick and easy intraocular pressure (IOP) measurements. iCare is the original developer of its patented rebound technology for handheld tonometers, which was clinically tested in cooperation with Helsinki University Eye Clinic. Several clinical studies show data obtained by iCare is comparable to measurement results with the Goldmann Applanation Tonometer (GAT).
In addition to tonometers, the company’s product line includes TrueColor imaging devices and perimeters. iCare’s unique confocal TrueColor technology captures ultra-high-quality and detail-rich images—and now includes the ability to integrate Ultra-Widefield imaging technology. Its perimeters offer retinal tracking that compensates eye movements during visual field testing, making the perimetry and microperimetry results more reliable and repeatable.

The iCare Product Line

The following provides additional details about iCare’s product portfolio.

TrueColor Confocal Imaging Systems*

iCare’s range of cutting-edge fundus imaging devices include:
  • iCare EIDON is the first TrueColor confocal system combining SLO and standard fundus imaging to create high-resolution, widefield views in multiple imaging modalities.
  • iCare EIDON AF is a TrueColor confocal scanner with autofluorescence imaging capabilities that acquires high resolution, accurate imaging using multiple modalities.
  • iCare EIDON FA, with automatic Fluorescein Angiography capability, offers a complete suite of imaging modalities to capture ultra-high resolution images and detail-rich, dynamic FA video view.
  • iCare DRSplus, with TrueColor confocal technology, is an easy-to-use and patient-friendly device offering multiple imaging modalities that create high-quality, detail-rich images.
Additionally, the iCare TrueColor Confocal Technology can now be applied to Ultra-Widefield imaging, expanding the iCare EIDON Family’s unsurpassed image quality to increased field of view on the retina.
With the new iCare EIDON Ultra-Widefield Module, it is possible to gain a wider view on the retina and get more information about the signs of pathologies in the periphery, up to 200˚. The high and sharp image quality enables the detection of small details and signs of pathologies from the center to the periphery.
The EIDON Ultra-Widefield Module is available for all iCare EIDON Family models. Besides the TrueColor Confocal images, it enables the acquisition of Ultra-Widefield Infrared, Autofluorescence and FA images with up to 200˚ panoramic view.
*iCare DRS is a traditional fundus camera

Perimetry and Microperimetry with Active Retinal Tracking

Perimetry plays a crucial role in the diagnosis and monitoring of glaucoma, neurological and retinal diseases. Microperimetry is essential in detecting and monitoring macular diseases. iCare’s innovative perimeter and microperimeter, COMPASS and MAIA, combine visual field tests with real-time retinal tracking to compensate eye movement and non-mydriatic confocal fundus imaging.
  • iCare COMPASS—is the first fundus-controlled perimeter that can perform standard visual field tests, while delivering ultra-high-resolution confocal TrueColor fundus images simultaneously.
  • iCare MAIA confocal fundus-controlled microperimetry combines visual field tests, fixation loss correction by real-time retinal tracker and SLO imaging in one exam.

Hand-held Rebound Tonometers

iCare tonometers use iCare’s patented rebound technology for quick and reliable IOP measurements. The ergonomic design and intuitive user interface ensure safe and accurate operation of the instrument. The tonometers are easy-to-use, handheld devices that require minimal training and improve clinic workflow. iCare also provides home tonometers for self-measurement by the patient.
iCare’s tonometers include:
  • iCare IC200 offers 200 degrees of positional freedom measuring. It can measure intraocular pressure when the patient is standing, sitting, elevated or in a supine position.
  • iCare IC100 measures intraocular pressure of patients in a sitting or standing position in a painless and hygienic exam.
  • iCare HOME2 for patient use revolutionizes glaucoma care by enabling the monitoring of IOP variations during normal activities throughout the day.
The iCare CLINIC cloud software stores long-term IOP data from the iCare HOME2 tonometers and provides tools for versatile analysis and reporting of the data.

iCare’s Technology in Practice

Dr. Lighthizer is an optometrist and an Associate Professor and the Associate Dean for Northeastern State University (NSU) Oklahoma College of Optometry. He also is the Director of the Continuing Medical Education Program for the College of Optometry, and the Chief of the Specialty Care Clinics—where they utilize an array of specialized technologies.
When asked to describe the iCare tonometer and rebound technology in general, Lighthizer noted that rebound technology has been around for many years.
“Rebound technology utilizes a probe that is put towards the cornea at a fast pace. It bounces off the cornea and measures the deceleration time off of the cornea and then uses an algorithm that gives you the intraocular pressure,” he explained. “This is all done with a handheld, battery-powered device that is very portable and does it in a very slick way. Generally speaking and very simply speaking, the higher the pressure, the faster the deceleration of that probe and the shorter the contact time. That's how it measures the IOP.”
Saying that there “truly is a subjective component” to GAT, Lighthizer said measurements with GAT can vary based on factors that may include the amount of anesthetic applied, the amount of stain introduced, the manner of reading results, and the skill level of the practitioner.
“I'm at a college of optometry. Second-year optometry students may get a little bit different reading than providers who have been doing it for decades,” he said.
In comparison, Lighthizer said iCare’s tonometers provide more reliable results.
“With the iCare tonometer, it’s more efficient and there’s no need for anesthetic in the eye,” he explained. “Since less-skilled staff can quickly get an accurate reading, it can be delegated to a lot of individuals. Our students love this. We go through so many of these probes because they find it so simple and easy to use—and technicians will feel the same.”
Citing a 2019 study by Chen, Lighthizer also underscored the clinical reliability of iCare tonometers, which he said provide “comparable” results to GAT.

A “Great” Patient Experience

In addition, he said the iCare tonometers provide a “great patient experience.”
“No doubt you’ve had patients saying, ‘Please don't give me the puff of air in the eye.’ And with Goldmann they’ve got a probe coming to their eye and need to have a numbing drop put in,” he said.
But with the positive experience patients get with the iCare tonometers, Lighthizer said patients will be spreading the word.
“They’ll be on social media and talking to their friends, saying, ‘Boy, my doctor has this great way to check pressures.’ Certainly that could benefit the practice,” he said.
Describing the evolution of iCare’s tonometers, he said although the original device is still popular, additional features that have made the devices more “user-friendly” have been added to new versions over the years.
“The latest version, the IC200, was released recently,” Lighthizer said. “It can test in any position, whether the patient is sitting upright, standing, partially reclined, or totally supine. I think that's a great upgrade to be able to measure pressures in a variety of different positions.”
He pointed out that’s true of both the IC200 that providers use in the office, as well as the HOME2, which was recently released for patient use at home.

The Benefits of Home Tonometry

When asked to describe the benefits of home tonometry, Lighthizer underscored the value of measuring over time and within a patient’s real-life routines.
“When we bring patients into the office, we get one snapshot in time,” he explained. “We check their pressure once that day.”
When a colleague recently asked him about how often he used serial tonometry in the office to assess glaucoma progression, Lighthizer said, “I could count on one hand the number of times I've done serial tonometry in my career. It's not convenient for the patient. They don't usually want to be measured multiple times throughout the day. And it's not convenient for the office, either.”
Which underscores the value of home tonometry.
“Progression is happening on the visual field, and yet the IOP [in the office] is stable,” he said. “The IOP is stable, which makes you wonder why progression is happening on the visual field.”
Lighthizer said the home device is easy for patients to use and they can get multiple readings throughout the day without the need to come into the office.
“So I think it offers a great advantage,” he said. “And again, patients can now measure in the supine position, which is often when IOP is elevated. So being able to measure using iCare’s HOME2 is certainly beneficial.”

The Value of High-Quality Images

Referencing iCare’s DRSplus, Lighthizer described the difference such high-quality images can make.
“It allows us to really get a nice image of that retinal nerve fiber layer versus standard imaging,” he explained. “And we all know in that nerve fiber layer in glaucoma patients, we're looking for those little wedge defects. So it certainly is nice to have confocal imaging to give you that sharpness, that clarity, and that fine resolution—which offers a significant advantage.”
He also said the DRSplus provides the ability to capture a variety of images, based on the provider’s preference.
“Do I want to take a picture just centrally in the macula? Do I want to go over to the optic nerve? Do I want to take a picture in the arcade as well? So you can select many points,” Lighthizer explained. “If you want multiple images, you'll have a great big montage of the back of the eye, through the arcades—superior, inferior, nasal, to the nerve, and temporal. Or you may just be interested in a centered view of the optic nerve, and that’s what it will give you.”
“You just hit the start button and it will take those images very quickly and basically on auto mode,” he added. “So it does a tremendous job. And again, it's got the confocal imaging, which gives you the advantage of the best sharpness, the best contrast, and nice resolution.”
Lighthizer said users have been quite impressed.
“It's done a great job. Our students, residents, and technicians think it’s awesome,” he said. “It pretty much takes the photos itself. We’ve even utilized this for anterior segment photos.”

A Toolkit to Tackle Glaucoma

When asked about iCare’s COMPASS perimeter and how he’s using it, Lighthizer described the need to use a variety of tools to tackle glaucoma.
“We don't have a perfect answer in glaucoma, do we? We wish there was one test that could diagnose it,” he said. “Glaucoma is a puzzle and we’re solving it and adding up all these pieces.”
Lighthizer said those pieces include both in-office and at-home tonometry, gonioscopy, assessment of the retinal nerves, imaging, and visual field testing.
He said a major advantage of the COMPASS perimeter is that it assesses both structure and function in one instrument.
“The big benefit of the COMPASS perimeter is that it's a visual field device that has retinal tracking,” he explained. “If the patient moves their eyes, if they blink at all, the machine is going to automatically adjust based on that eye movement to make sure they are testing in the same spot every single time, visit after visit. That repeatable visual field component is going to be very advantageous.”
“And if the patient blinks, it will automatically pause,” Lighthizer added. “There's no trial lens, it will automatically adjust and autofocus. It's going to take a sixty degree photo, and that's your True Color image. So you get a great assessment of both structure and function.”
Nathan Lighthizer, OD, FAAO
About Nathan Lighthizer, OD, FAAO

Born and raised in Bismarck, ND, Nate Lighthizer, OD, FAAO, is a graduate of Pacific University College of Optometry. Upon graduation, he completed a residency in Family Practice Optometry with an emphasis in Ocular Disease through Northeastern State University Oklahoma College of Optometry. Dr. Lighthizer has since joined the faculty at the Oklahoma College of Optometry and serves as the Chief of Specialty Care Clinics and the Chief of Electrodiagnostics Clinic.

In 2014, he founded and now heads the Dry Eye Clinic at the College of Optometry. Also in 2014, he was named the Director of Continuing Education as well as the Assistant Dean for Clinical Care Services at the Oklahoma College of Optometry. He is a founding member, and currently serves as Vice President, of the Intrepid Eye Society which is a group of emerging thought leaders in optometry. He was named a member of PCON 250—a list of the top 250 optometrists in the country who practice progressively, provide innovative patient care, conduct optometric research or excel in academia and share what they have learned with other optometrists to advance the profession.

Dr. Lighthizer lectures nationally on numerous topics, most notably advanced ophthalmic procedures, electrodiagnostics, and ocular disease.

Nathan Lighthizer, OD, FAAO
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