Partners to progress

The 1960s-style office block on the busy Moseley Road into central Birmingham houses some of the latest instruments to be produced by Japanese instrument manufacturer Nidek. Birmingham Optical Group is the sole UK distributor of Nidek Instruments and so optician was keen to get a sneak preview of some of the latest developments likely to hit the market next year.
The company has been supplying instruments to the optical profession for over 50 years, from cross-cylinders and trials lenses to autorefractors, but in recent years it has concentrated almost exclusively on the more high-tech instrument market so that its name has become almost synonymous with that of Nidek.
Nidek was established in July 1971 and has over 1,200 employees at its headquarters in Japan. Chris Tyler, current CEO and business development director of Birmingham Optical Group, was heavily involved in the original discussions that led in 1987 to Birmingham being granted the official UK distribution rights for Nidek. Nidek also has outlets across the US, France and Italy.
Birmingham has a UK-wide distribution and annual turnover in excess of 10m. It supplies instrumentation to optical practices as well as academic and hospital departments. Although it concentrates on the ophthalmic instrument market, Tyler points out there is also a significant need for edging equipment also supplied by the Birmingham/Nidek partnership.
ANM-3000
There is already a buzz of excitement about the ANM-3000 auto alignment digital non-mydriatic fundus camera (figure 1), particularly after its appearance at the American Academy of Ophthalmology meeting earlier this autumn. This instrument contains two posterior fixation points and six peripheral points which, once viewed, allow the instrument to automatically focus on the fundus, removing the need for the sometimes frentic joystick adjustments often needed for obtaining an in-focus image. There is a need to correct for patient ametropia and the unit will contain 'dioptric compensation' for the patient ranging from -32.00D to +40.00D. Tyler revealed that the company aims to unveil the first UK instrument at Optrafair.

'30 Second Refraction'
A cynic might suggest that the profession has developed accurate and clinically practicable aberrometers at around the time that some are questioning the long-term viability of involvement in refractive surgery. Any other use of these high-tech instruments would be useful at justifying the initial investment. A less cynical approach would note that the ability to marry accurate assessment of higher-order aberrations with lower-order aberrations (or refractive errors) could allow an improvement in accuracy of objective refraction. If this objectively obtained refractive data could then easily be loaded into the refractor head, the refraction itself might be sufficiently speeded up to allow more time for the optometrist to assess ocular health and discuss management options with the patient.
The Nidek OPD-Scan has been used as part of the pre- and post-refractive surgery assessment for some time now. It is able to assess topography of the cornea (figure 2) and so may be useful, not just for refractive surgical purposes, but also for contact lens fitting, and the diagnosis and monitoring of a variety of corneal diseases.
This topography is linked within the same unit with 'dynamic skiascopy' (autorefraction) which is able to assess both lower- and higher-order aberrations. Primarily this was used by the refractive surgery teams, but increasingly papers have appeared suggesting its usefulness in more accurate objective refraction in general optometric practice. Eminent optometrists such as Catania and Mendoza, both based in the US, are using the technology to support routine refraction and have suggested it as the basis of the so-called '30 second refraction'. Of the various studies to come from the US so far, most suggest a good (though expected) correlation between subjective and objective results. But a significant proportion found a preference for the aberration-adapted autorefraction result compared with the normal objective result and, importantly, needed little subjective adjustment to arrive at a satisfactory end result.
Next year will show if the concept of seeing such a specialised autorefractor in general practice becomes familiar, though it is likely that some play will be made of the '30 second refraction' phrase.

RKT- 7700
Another industry first that Nidek is looking to promote next year is another instrument combining functions previously requiring a sequence of instruments. The RKT-7700 (figure 3) is a combined autorefractor, keratometer and non-contact tonometer.
The ability to take base-line data of refractive power for subsequent refraction, 'k' readings for corneal monitoring and possible contact lens fitting, and tonometry readings as part of a pre-screening approach, will make this an attractive and space-saving instrument for busy practices. The ease of use and adjustability of the instrument (figure 4) should prove popular with ancillary staff.

Pachymetry
Much has been written in recent months about the increasing use of pachymetry in optometry, particularly when putting a tonometry reading into context. The majority of such instruments reported upon have been ultrasound based. Birmingham has been promoting an Oculus Instrument, the Pachycam, which is an optical-based system for assessing corneal thickness (figure 5).
Using a Scheimpflug image system, the system allows visualisation of the corneal section on screen from which various parameters, including corneal thickness and then subsequent correction values
for IOP readings, may be established (Figure 6).

MP 1
One instrument still undergoing trials but bound to make a big impact next year is the Nidek MP1 (figure 7). This has been in development for some while and has undergone several reappraisals of its software. It is now available in a version which has considerable potential in optometry. In essence, the instrument is a combination of perimeter and fundus camera (the MP stands for microperimeter). The value of such an instrument is that, first of all, it allows one machine to carry out the work of two. A high-resolution fundus camera produces high quality retinal images (figure 8).
The image may then be used as the basis of tracking to maintain constant fixation while a perimetry programme is run. This may be specified in many ways, from a simple mapping of the blind spot to a full-threshold static assessment of central field or a kinetic plot.
The instrument may then assess retinal sensitivity at specific points and then superimpose them over an image of the fundus. As such, the potential for the instrument in mapping scotoma progression (as with glaucoma or AMD), for monitoring sensitivity changes in glaucoma, for looking at pre- and postoperative function and for predicting disease, such as maculopathy and tapetoretinal degenerative influences, is great.
There may also be potential for vision therapy, such as eccentric viewing training related to accurate appraisal of central vision loss. As a progression from the now unavailable Rodenstock SLO, the MP1 shows impressive potential.

<25C6> A future article in optician will give more detail on the instrument.