COVER FOCUS

GALILEI G6: COMBINING

TOPOGRAPHY, TOMOGRAPHY,
AND OPTICAL BIOMETRY
IN ONE SYSTEM
Access to high-definition pachymetry plus total corneal wavefront, curvature,
and astigmatism data provides surgeons with a complete dataset to plan cataract
or refractive surgery.
BY TIM DONALD, CONSULTING EDITOR

64 CATARACT & REFRACTIVE SURGERY TODAY EUROPE | JULY/AUGUST 2015

Figure 1. In one measurement session, the

Galilei G6 Lens Professional provides surgeons with
a complete dataset for comprehensive screening
for cataract and refractive surgery patients.

allows determination of axial length (AL), lens

thickness (LT), and other intraocular distances
for premium IOL planning.
The software of the G6 provides an intuitive
graphical user interface including a live view
image of the eye and a five-step measurement
guide, and the device interfaces with electronic
health record systems for optimal workflow. It
also links to ray-tracing software packages such
as Okulix (Tedics Peric & Jher), offering precise tools
for toric IOL planning by taking into account
the true anatomic properties of the eye and
total corneal astigmatism.
The software generates a biometry report
including AL, LT, central corneal thickness,
(Continued on page 66)
Figure 2. Placido-disc topography provides
data on anterior corneal curvature,
surface irregularities, and tear-film quality;
Scheimpflug tomography provides corneal
pachymetry and elevation data, plus 3-D
anterior chamber analysis and ray-tracing
capabilities; and optical biometry allows
determination of AL, LT, and other intraocular
distances for premium IOL planning.

(Images courtesy of Ziemer)

he Galilei G6 Lens Professional (Ziemer;

Figure 1) combines Placido-discbased
topography, Scheimpflug tomography, and optical biometry all in one
unit. This combination allows the device to
provide complete data for comprehensive
screening for cataract or refractive surgery
in one measurement session, according to the
manufacturer.1 With all data gathered and
stored on one device, the practices clinical
workflow efficiency can be improved, maintenance costs can be reduced, and office space
utilization can be optimized. With access to
high-definition pachymetry plus total corneal
wavefront, curvature, and astigmatism data,
surgeons have a complete dataset to plan
cataract or refractive surgery. The addition
of optical biometry and a suite of IOL power
calculation formulas empowers the cataract
surgeon to determine the best-suited IOL
for each patient.
According to Ziemer, only the Galilei
G6 combines the three elements
of Placido-discbased topography, dualScheimpflug tomography, and optical biometry
(Figure 2). Placido-disc topography provides data on
anterior corneal curvature, surface irregularities, and tearfilm quality. Scheimpflug tomography provides
corneal pachymetry and elevation data,
plus 3-D anterior chamber analysis and
ray-tracing capabilities. Optical biometry

Experts

Highlights of the Galilei G6

in Clinical Practice
By David Smadja, MD

How do you use theGalilei G6in clinical practice?

My clinical practice is mostly focused on LASIK procedures and
refractive cataract surgery with premium IOLs. In that regard, two
of the greatest advantages of the Galilei G6 are its robust refractive screening program and artificial intelligence tools, which help

me rule out patients who are at risk for ectasia after surgery. The
plethora and complexity of data provided by current imaging systems presents a challenge of interpretation for the ophthalmologist. Therefore, decisions are often based on personal experience
and subjective recognition of patterns or empiric cutoff values
that are not necessarily the same between imaging systems.
The Santhiago percentage of tissue altered (PTA) report1,2 on
the Galilei G6 helps me to predict the level of risk a patient has of
developing post-LASIK ectasia by taking into account the expected biomechanical alteration due to ones surgical plan. The PTA
considers the relationship between corneal thickness, tissue alteration through ablation and flap creation, and residual stromal bed
thickness. A PTA level of 40% can be considered a robust risk factor for ectasia, and, in our clinical practice, patients with a PTA this
high are treated with PRK instead of LASIK, as long as the cornea
does not show any other contraindications for refractive surgery.
The Galilei G6 also offers a more morphologic approach to
identifying subclinical keratoconus at its earliest stages. Using an
automated decision tree, the system is able to identify topographically normal contralateral eyes of patients with frank keratoconus
with 93.6% sensitivity and 97.2% specificity (Figure 1).3,4 While
waiting for the upcoming release of this feature, our group has

Figure 1. An AAI score of 21.5 is the most discriminant

parameter to differentiate between normal corneas and
subclinical keratoconus.

Figure 2. The author has reported a significant improvement

in astigmatism correction when the total corneal
astigmatism is used in place of keratometric astigmatism.

What is your overall impression of

theGalilei G6?
The Galilei G6 system (Ziemer) fully meets
the expectations of refractive surgery specialists.
What makes this system attractive is its ability to
combine all the technologies needed to screen
patients for LASIK and to obtain optimal outcomes in cataract surgery. In refractive surgery,
we use it to determine who is at risk for ectasia and to monitor
keratoconus patients; in cataract surgery, we use it for optical
biometry and total corneal power measurements as a means to
optimize IOL selection. Additionally, the ability to perform highly
reliable and repeatable measurements on the posterior surface,
and for the system to achieve accurate pachymetry, corneal aberrations, and total corneal power data, helps us to further strengthen the safety of the decision-making process.

COVER FOCUS

Commentary
from the

(Images courtesy of David Smadja, MD)

JULY/AUGUST 2015 | CATARACT & REFRACTIVE SURGERY TODAY EUROPE 65

COVER FOCUS

(Continued from page 64)

and anterior chamber depth. It also includes an IOL calculator with formulas including Haigis, Holladay I, Hoffer Q,
SRK/T, and the Shammas no-history method for eyes after
refractive surgery.
The combination of Scheimpflug imaging with optical
biometry data makes the Galilei G6 especially helpful for IOL
selection in postrefractive surgery eyes, according to Ziemer.
Surgeons can use the refractive data from both anterior
and posterior corneal surfaces, as generated by Scheimpflug
imaging, plus the AL and other intraocular distances as
determined by optical biometry, to calculate IOL powers for
eyes after corneal refractive surgery. These data are also help-

Commentary
from the

Experts

ful for IOL calculations in unusually long or short eyes.

In eyes with astigmatism, the combination of highdefinition pachymetry, higher-order aberration detection,
and total corneal astigmatism measurement allows the
surgeon to determine incision placement for cylinder correction in conjunction with cataract surgery.
In addition to its roles in cataract surgery, the device can
also perform complete topographic screening of refractive
surgery candidates, including keratoconus screening, and it
is helpful in planning for corneal implants and in planning
and follow-up of keratoplasty patients. n
1. Galilei G6 Lens Professional. Ziemer Ophthalmic Systems AG website. http://galilei.ziemergroup.com/key-features-g6.
html. Accessed June 12, 2015.

Highlights of the Galilei G6

in Clinical Practice
(Continued)

pointed out that an Asphericity Asymmetry Index (AAI) of 21.5 is

the most discriminant parameter to differentiate between normal
corneas and subclinical keratoconus. This index measures the
asymmetry of the posterior corneal surface; we have found that
patients with an AAI greater than 21.5 or a corneal volume lower
than 30.8 mm3 are not recommended for LASIK.
The combination of a morphologic approach (decision tree)
and a biomechanical approach (PTA report) is a unique feature
in ocular biometry that can increase the sensitivity of detection of
corneas at risk for ectasia.
The other key feature that we routinely use is the ability to
measure posterior astigmatism and total corneal astigmatism in
the calculation of toric IOL power. We recently reported a significant improvement in astigmatism correction when the total
corneal astigmatism is used in place of keratometric astigmatism
(Figure 2).5 Like us, others have also noted the reliability and
repeatability of posterior astigmatism and total corneal power
measurements in toric IOL calculation.6,7
What are the advantages of theGalilei G6compared
with other ocular biometry technologies?
For a refractive, cataract, and corneal surgery specialist, the
Galilei G6 diagnostic system allows the most extensive analysis of
corneal features that exists today in a single device. It combines
Placido-discbased corneal topography, posterior corneal surface
analysis, pachymetry report including corneal volume, corneal
aberrations analysis, total corneal power measurements, densitometry, and optical biometry for optimal IOL selection. Additionally,
the development and introduction of artificial-intelligencebased

66 CATARACT & REFRACTIVE SURGERY TODAY EUROPE | JULY/AUGUST 2015

programs for screening ectasia-susceptible corneas, and especially

the synergistic combination of morphologic and biomechanical
approaches, can assist refractive surgeons in their decision-making
process without relying only on subjective interpretation and
personal expertise. Furthermore, technically speaking, the level of
accuracy and repeatability of the parameters measured with the
Galilei G6, which have been demonstrated in the literature, helps
surgeons to comfortably rely on these measurements.
1. Santhiago MR, Smadja D, Gomes BAF, et al. Association between the percent tissue altered and post-laser in situ
keratomileusis ectasia in eyes with normal preoperative topography. Am J Ophthalmol. 2014;158(1):87-95.
2. Santhiago MR, Smadja D, Wilson SE, et al. Role of percent tissue altered on ectasia after LASIK in eyes with suspicious
topography. J Refract Surg. 2015;31(4):258-265.
3. Smadja D, Santhiago MR, Mello GR, et al. Influence of the reference surface shape for discriminating between normal
corneas, subclinical keratoconus, and keratoconus. J Refract Surg. 2013;29(4):274-281.
4. Smadja D, Touboul D, Cohen A, et al. Detection of subclinical keratoconus using an automated decision tree classification. Am J Ophthalmol. 2013;156(2):237-246.
5. Smadja D. Influence of posterior astigmatism on toric intraocular lenses calculation. Presented at: the 40th ASCRS
Annual Symposium & Congress; April 25-29, 2014; Boston.
6. Wang L, Shirayama M, Koch DD. Repeatability of corneal power and wavefront aberration measurements with a
dual-Scheimpflug Placido corneal topographer. J Cataract Refract Surg. 2010;36(3):425-430.
7. Savini G, Carbonelli M, Barboni P, Hoffer KJ. Repeatability of automatic measurements performed by a dual Scheimpflug analyzer in unoperated and post-refractive surgery eyes. J Cataract Refract Surg. 2011;37(2):302-309.

David Smadja, MD
Anterior Segment Unit, Ophthalmology Department, Tel Aviv
Sourasky Medical Center, Israel
n Institute of Nanotechnology and Advanced Materials, Bar Ilan
University, Tel Aviv, Israel
n National Reference Center for Keratoconus, Bordeaux Hospital
University, France
n davidsmadj@hotmail.fr
n Financial disclosure: Consultant (Ziemer, Alcon)
n