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USER GUIDE System for measuring and analysing the cornea

1. Fig 7 10 Change system settings screen for the USB port Note The Mode setting is the same as that for the serial interface sect 7 2 7 page 112 Interface settings The keratograph software uses a utility program to communicate with the keratograph via the USB port gt Make sure that the communication takes place by means of a file option File is preselected 7 3 Choose Contact Lens A database is included with the Keratograph software which contains the posterior sur face geometries of the contact lenses sect 4 page 73 For fitting contact lenses you can specify the selection sequence for the manufacturer and lens type in the list User Guide Keratograph 4 UG 70670 0209 en 115 126 7 Settings 116 126 AY GelsjUe gt Press the button Contact lens gt on the Change settings screen The Choose contact lens page appears Choose contact lens Manufacturer CIBA I 8 w cIBAII MPG amp E Miillervvelt Wohlk 1 Wohlk 2 M M v Menicon TECHNO LENS Bausch amp Lomb Ka Pe Used manufacturer SNOT RW Bach Optic 2 10 Bach Optic 3 11 Jenalens 12 Jenalens 2 13 Jenalens 3 14 Johnson amp Johnson Yis 15 Cooper Vision GmbH 16 Conta Optic GmbH 17 WUK Vision 18 No 7 Contact Lenses 19 Sauflon 20 3P Contactlinsen 21 Galifa 22 Falco Lens 23 Conil AG 1 24 Conil AG 2 x 25
2. eee eS a tt 1 Drop Down List Examination 1 6 Difference graph for the meridian plane 2 Position of the main meridians for examination 1 7 Color bar for the difference map 3 Color bar for the topography maps 8 Difference display 4 Drop Down List Examination 1 9 Location of the meridian plane 5 Position of the main meridians for examination 1 10 Patient data Fig 3 39 Refractive Compare display The maps on this comparison screen are ideal for showing changes in the corneal refrac tive power resulting e g from wearing Ortho K lenses or after refractive surgery The following information is displayed for this purpose m Patient data sect 3 1 1 page 22 Two refractive topography maps of the selected examinations sect 3 7 1 page 58 m Map showing the differences between the two topography maps sect 3 70 7 page 69 The following numeric values are shown in the topography maps of the examinations at the bottom left and right m Apex Power at the apex in diopters Astig Astigmatism in diopters In addition the position of the main meridians is shown graphically at the top right of the respective map User Guide Keratograph 4 UG 70670 0209 en AY EHEH 3 Analysis of the Typographic Examinations 3 10 1 Difference display gt Select the examination that is to be used as the basis minuend from the drop down list in the top right topography map 1 gt
3. 16 05 08 12 32 31 Rightideo 16 05 08 12 32 26 RightEinzel 16 05 08 12 11 52 RightVerglei 16 05 08 11 39 44 RightVideo Fullscreen l Details Fig 5 8 Thumbnail view I lt E Back 2 frames The following information is given below each thumbnail for each video or image Date User Guide Keratograph 4 UG 70670 0209 en AY Sewuews 5 Imaging Time m Examined eye left or right a Infomational text if any was entered You can tell from the thumbnail itself whether it is a single image or a video sequence Video sequences have filmstrips at the left and right sides of the thumbnail A zoomed view can also be selected instead of the thumbprint view gt Select the desired image or video by double clicking it in the table The correspond ing image or video is displayed in the top section of the screen gt You can activate the checkbox Zoom at option The thumbprints are then hidden and a table containing the above mentioned information appears instead In addi tion the Type column specifies whether it is an image or a video sequence ergleich mit Spaltlampe 16 05 08 12 40 09 Fight Grab Image FW 13C Vergleichsbild 16 05 08 12 39 59 Right Grab Image Vergleichsbild zu 12 04 56 16 05 08 12 32 41 Right Grab Image Einzelbild 1 16 05 08 12 32 31 Right Grab Image Video Aufnahme 16 05 08 12 32 26 Fight Grab Image Einzelbild 2 16 05 08 12 11 52 Right Grab Image
4. 6 IX Use Hecht fitting software CIBA II MPG amp E Millervelt Wohlk 1 Waohlk 2 Menicon TECHNO LENS Bausch amp Lomb Bach Optic 1 Bach Optic 2 Bach Optic 3 Jenalens Jenalens 2 Jenalens 3 Johnson amp Johnson Cooper Yision GmbH Conta Optic GmbH WUK Vision No 7 Contact Lenses Sauflon 3P Contactlinsen Galifa Falco Lens Conil AG 1 Conil AG 2 5 ue see concer 1 List of all lens types 2 List of contact lenses used 3 Edit lens geometry button 4 Import Export gt button CIBA AIR OPTIX AQUA AIR OPTIX for Astigmatis AIR OPTIX Night Day DAILIES AquaComfort Plt Focus Dailies Focus Dailies Progressi Focus Dailies Toric Focus Monthly Softcolors Focus Progressives Focus Toric Focus Visitint Persecon 92 E Persecon E Persecon HDS E 0 2 Persecon HDS E 0 4 Persecon HDS E 0 6 Persecon Keratokonus S Persecon RPT Persecon RT Weicon 38E Weicon CE VYeicon CE toric S K R A K KA K K R K K K A K KK N K R N K R TK Edit lens data Lens geometry gt Used lens E AIN MTN ANIIA 1 2 AIR OPTIX for Astigmati 3 AIR OPTIX Night Day 4 DAILIES AquaComfort F 5 Focus Dailies 6 Focus Dailies Progress 7 Focus Dailies Toric 8 Focus Monthly Softcola 9 Focus Progressives 10 Focus Toric s 2 11 Focus Yisitint 12 Persecon 92 E 13 Persecon E 14 Persecon HDS E 0 2 15 Persecon HDS E 0 4 16 Persecon HDS E 0 6 17 Persecon Keratokonus 1
5. gt Press the button 1 to the right next to the Folder box gt Inthe dialog that appears select the folder or the file which contains the patient da ta gt Confirm your selection with OK or Savel The patients that are located and the associated examinations are displayed in the lower part of the dialog gt To import the data press the Import button 3 The data is then available in the user interface for Patient Data Management 2 9 Data backup You should carry out a backup of patient and examination data at regular intervals In case of a loss of data you can reconstruct the data from a previously created backup with the help of this function Since data backup takes several minutes depending on the scope of the database and the data to be backed up a backup should be carried out when the PC and the device will not be needed User Guide Keratograph 4 UG 70670 0209 en PMS 2 Patient Data Management AY OCULUS 8 126 The general rules for the creation of backup copies apply to backing up data with the help of the patient data management user interface Storage of backup files should always be done on a separate system e g on a USB stick with adequate capacity 2 9 1 Backup data gt In the upper right part of the patient data management user interface press the Backup button The following dialog appears ES Backup Backup Restore Save all data C Changed and new da
6. 0 000064 Xl izi 0 000028 Xl izi 0 000025 xl Aberrat Coeff 0 0 Fig 3 21 Zernike coefficient display The individual coefficients are displayed below each other gt Activate the checkbox in front of the coefficients which should be considered for the graphical display Fig 3 5 6 page 46 The coefficients can be displayed as individual values or as vectors The vector display Summarizes the coefficients of polynomials which cause the same mapping errors Example Ihe astigmatism is composed of both of the polynomials Z 2 2 and Z 2 2 These differ only in the trigonometric component cosine or sine Instead of both individual values being shown the vector display indicates an amount and the associated angle The amount Is a measurement of the section of the respective polynomial the angle is recognizable in the 3D display Normal values are stored in the program for the Zernike coefficient vector values Any coefficients that deviate from these normal values are shown in red The condition for this is that you have selected the following general settings sect 3 5 4 page 43 m Reference shape Ellipse Ecc 0 75 m Order n 8 Zernike maximum constant 8 0 mm A keratoconus is frequently recognizable already at lower levels of pronouncement in this way Furthermore this functions makes it easier to detect the apex position of the kera toconus The program generally also calculates the so c
7. 7 Settings Toric lens with bevel b1 constant b1 0 25 dr1 drO r1 r0 r2 r0 A B A 1 50 B 0 00 gt Tofinish press the Generate new lens button The lenses will be created using the parameters entered previously 7 3 5 Add soft lenses gt To add a completely new lens generate a new contact lens type sect 7 3 2 page 117 and enter the desired name Alternatively you can insert a new lens into the existing list gt In the top part of the screen select the manufacturer for which you want to add a new contact lens gt Press the Add soft lenses button The following screen appears Add new soft lens geometry Lens type CIBA I AIR OPTIX AQUA Base curve Min Max step romm EX E 8 60 H o 00 E dr fmm 0 00 E oo E 0 00 E omn A e Generate new lenses Quit Fig 7 15 Add new soft lens geometry screen gt Enter all of the parameters Information about the individual parameters Is given in the description of how to generate new rigid contact lenses sect 7 3 4 page 117 gt To finish press the Generate new lens button The lenses will be created using the parameters entered previously User Guide Keratograph 4 UG 70670 0209 en 121 126 7 Settings 122 126 AY COLEUS 7 3 6 Import and Export of Contact Lens Data gt Press the butto
8. Dec Sph added or Irr Sph added then appears in the title bar of the respective presentation accordingly 7 1 16 Communication settings gt Select whether the connection between the PC and the keratograph is established via a serial interface COM port or a USB port The configuration of selected interface is done on the Change system settings screen sect 7 2 page 112 7 2 System settings Different settings must be made depending on the selected interface type Communica tion box gt Press the System gt button 7 2 1 Serial interface port Change system settings x Hode Data transmission Data package size Online O 115 200 Baud 3000 O Demo mode 460 800 Baud 300 00 30 com 4 O Other Device type Bootmode Keratograph 1 Handshake O Keratograph 2 O Synchron NT Clear buffer XP Start Keratograph gt Fig 7 7 Change system settings screen for the serial interface Mode settings gt Select the option Demo mode to be able to use the keratograph software without the unit being connected gt Ifyou want to perform measurements you must select the option Online Device type settings gt Select the keratograph type that is installed User Guide Keratograph 4 UG 70670 0209 en AY BSegeysS 7 Settings Note For the device type Keratograph 2 the inner ring flashes twice after switch on Data transmission settings gt
9. Press the button to the right next to the Backup directory box 3 In the dialog that appears select the folder which contains the backup data Confirm your selection with OK VVUVY To import the data press the Restore button 1 All data in the corresponding fold er will be transferred to the patient data management user Interface 2 9 3 Automatic backup Besides the manually executed backup there is also the option to carry out a backup when the patient data management user interface Is closed The settings required for this can be found in the Settings area sect 2 6 3 page 14 2 6 Settings Basic specifications for working with the patient data management user interface can be made in the Settings area gt Inthe upper right part of the patient data management user Interface press the Settings button The Settings page appears with the Main tab in the foreground User Guide Keratograph 4 UG 70670 0209 en 9 126 2 Patient Data Management AY OCOL US Settings M Language English ha W Autocasing M Optional items for patient Option Comment Option2 Comment2 Options Comment3 Options Comment Options Comment5 3 E e Version 6 0210 1 2 E Save Cancel Li 1 Patient data management user interface program version 3 Cancel button 2 Save button Fig 2 7 Settings screen Main tab The following informati
10. Pupil Camera Image Display or hide the red outline around the pupillary margin in the camera image Slope Display or hide the speed vector in the graph The two relocatable measured values are Interconnected The slope of the connecting line equates to the speed of the change in the pupil Indicator 1 Indicator 2 and Difference box Two white indicators can be placed at any position in the time scale graph of the meas ured pupil diameter sect 6 4 4 page 102 The following information is displayed for each of these two positions Pup Actual pupil diameter in mm Time Time that has elapsed since the start of the measurement In seconds xand y X and Y position of the center of the pupile with respect to the center of the camera The differences for the following values between the two indicators are displayed in the Difference box Time diff Time difference between the positions of the indicators in seconds m Speed Average speed of the pupil change in mm per second This is calcuated by dividing the difference in pupil diameter by the above mentioned time difference 6 4 4 Time Scale of the Pupil Diameter The pupil diameter time scale can be displayed in the bottom section of the screen 2 dur ing the measuring operation A section through the difference map Is shown in a graph below the difference box The time in seconds is plotted on the abscissa X axis of this graph and the pupil diameter
11. gt Press the arrow buttons In the Rotation box The map is rotated in the respective direction gt Press the 0 button to return the map to its original position The map can also be moved automatically using the buttons in the Move box gt Press the Tilt or Turn button After calculation of the animation the map is moved accordingly gt Adjust the movement with the slider control You can make the movement go slower or faster and can perform the animation over a wider or narrower area gt Adjust the exaggeration with the Exaggerate slider control Thanks to the exaggeration the curvature of the cornea is shown more pronounced 3 4 Fourier Analysis 3 4 1 Background Information Named after the french physicist Jean Baptiste Joseph Fourier 1768 1830 the Fourier Analysis is a mathematical process which breaks up decomposes a periodic function into a number of sine and cosine waves User Guide Keratograph 4 UG 70670 0209 en 31 126 3 Analysis of the Typographic Examinations AY OBES Fig 3 12 Wave that is to be analyzed The first basic wave 1st harmonic is thereby a sine wave with the same period as the wave that is to be analyzed The 2nd harmonic has half the wave duration equal to two sine waves the 3rd harmonic has 1 3 of the wave duration equal to three sine waves etc The addition of all these individual wave components the so called Fourier synthesis results in the origina
12. m Lens geometries which are best suited to the measured cornea mathematically are at the start of the list The list of precedence that you generated is also taken into account accordingly sect 7 3 page 115 Soft lenses are placed at the end of the list independent of fitting quality gt Select the desired lens type in the suggestion list 2 gt Alternatively change the parameters for the currently selected lens directly in the data fields found in the Contact lens fitting group box 1 74 126 User Guide Keratograph 4 UG 70670 0209 en AY Seuss 4 Contact lens fitting gt You can also change them using the buttons to the right of the individual fields The buttons increase decrease the value each time they are pressed to the next possible value For example the diameter increases from 9 20 to 9 60 If the selected lens with the changed data is not available a lens that comes as close as possible is selected gt To define contact lenses yourself enter the value Mathematic first field in the field Manufacturer All individual parameters may now be defined independent from the actual availa bility of the lens in the list gt You can change the way in which the cornea data are displayed with the options in the Display 5 box gt Press the Details button to edit additional contact lens parameters The following dialog appears Lens geometry E Base curve 5 rO mm 7 95 Ecc 0 00
13. The Keratograph software includes a list of different models and types of contact lenses sect 7 3 page 115 The program creates a list of suggestions from this complete list based on the corneal geometry data measured Contact lens fitting gt Manufactur MPG amp E MiillerWelt Lens MW compact AS 06 zl rO mm 7 75 Ecc 0 60 r B mm 9 20 Suggestions r0 Ecc 8 MYC AS 06 Wohik1 CFA AS 7 85 0 40 9 30 Wohik1 A90 AS 7 75 0 60 9 35 _ _ 2 Waohik1 100UY AS 7 85 0 40 9 30 Wohlik1 wohlk perfec 7 75 0 60 9 30 Wohlik1 CFA PA PT 7 85 0 40 9 30 Wohlik1 A90 P PT 7 75 0 60 9 35 Wohlk1 A100 YPAVPT 7 85 0 40 9 30 Wohlk1 Wohlk KE 7 55 0 90 9 30 Wohik1 P A U L 7 80 0 50 9 30 TECHN MA N 7 75 0 60 9 20 TECHN MC N 7 75 0 60 9 20 B amp L Quantum 1 7 75 0 60 9 60 B amp L Quantum 2 7 75 0 60 9 60 Jen lens ABOGDT 7 80 0 45 9 30 Jen lens Aspharflex 7 75 0 60 9 30 Jen lens Asph Kera 7 55 0 90 9 30 Jen lens ABOGT pri 7 80 0 45 9 30 Jen lens AsphPri 7 75 0 60 9 30 Jen lens ABOGVTP 7 80 0 45 9 30 i 6 Calc fluo Hecht CL Details 7 3 5 Display Position 4 Eccentricity RuL mm C Sagittal cur UjD mm C Top Test a C Fluo image Incl Ls 1 Selected lens in the suggestion list 4 Display Position 2 Suggestion list 5 Selection Display 3 Details button 6 Calc fluo button Fig 4 2 Detail Contact lens fitting The suggestion list 2 is sorted according to the following criteria
14. gt Azoomed in view of the section of the camera image around the position at which the mouse is located is displayed in a separate window for as long as you hold down the mouse button gt Press the right mouse button to cancel the zoomed in view again 6 4 3 Data field Some information about the measurement are listed in the left hand section of the screen 3 These numeric values relate in part to the graph in the bottom section of the screen sect 6 4 4 page 102 Pupil diameter box Smallest Smallest measured pupil diameter in mm m Mean Mean or average pupil diameter in mm Largest Largest measured pupil diameter in mm Std dev Calculated standard deviation Note These values are only meaningful for measurement of the pupil stability i e for measure ment without glare User Guide Keratograph 4 UG 70670 0209 en 101 126 6 Pupillometer Software Ay Bers 102 126 Display group box You can display or hide additional information in the time scale graph of the measured pupil diameter and in the camera image by activating or deactivating these checkboxes accordingly Pupil curve Display activate or hide deactivate the whole time scale graph of the measured pupil diameter sect 6 4 4 page 102 m X Pos and Y Pos Display or hide the curves of the X and Y position of the center of the pupil in the graph These curves provide an Indication for any eye movements of the patient
15. the curvature of the cornea and the selected contact lens back surface The suggestion is carried over into the Test lens spherical box gt Change the suggested contact lens if necessary Every time the value Sph D is changed the expected remaining power is automatically calculated and is displayed in the Remaining power box at the bottom right of the screen This value corre sponds to the over refraction that would be needed if this contact lens were put onto the eye The test lens selection should therefore minimize the expected remain ing power Note The expected remaining power is not a measured value but a calculated one that takes as many eye and contact lens parameters as possible but not all into account This value should therefore be compared with the measured over refraction after selecting the con tact lens gt Press the Back button to close the power calculation module and to transfer the new values into the power field of the contact lens fitting screen The other parameters on this screen are explained below Test lens spherical group box a rO mm The back surface curvature of the contact lens was previously determined with the fluo image and is therefore only displayed here This value can only be changed in the contact lens fitting screen Fluo image simulation Comments group box gt You can enter any text into this field which is then saved together with the power valu
16. to the periphery The following measured values are shown in the left section of the chart Rh Horizontal radius of curvature in the center shown as a radius value in mm or as a refractive power in diopters m Rv Vertical radius of curvature in the center shown as a radius value in mm or asa refractive power In diopters Note Switching from displaying the information as a radius of curvature or as a refractive pow er and vice versa is done on the Change settings screen sect 7 7 6 page 108 You can also set there whether the horizontal and the vertical or the flat and the steep radius of curvature are to be displayed Ast Astigmatism of cornea in the center m Axis Axis position of the flat meridian m Ecc Mean eccentricity of the cornea cor Cornea or iris diameter Note The fixation point deviation i e the distance between the topographic center and the center of the pupil is also displayed as a numeric value on the Contact lens fitting screen Fig 4 1 page 73 3 1 9 Scaled down camera image The camera image that was captured during the measurement is shown at a reduced size User Guide Keratograph 4 UG 70670 0209 en 25 126 3 Analysis of the Typographic Examinations Ay SCHLUSS Rommentarteld 1 Center of the pupil 4 Edges of the rings 2 Optical axis 5 Corneal margin 3 Pupillary margin 6 Info text field Fig 3 6 Scaled down camera image In addition to the camera image the follow
17. 126 3 Analysis of the Typographic Examinations AY GIGuiLLis gt T3 OCULUS KERA TOGRAPH 3 7 Refractive map gt Inthe Display menu select the menu item Refractive map Patient Examination Display Lens fitting Settings Miscellaneous Print 5 Name Dat 0 B 11 11 22 Demo Patient Exm dat 09 07 96 i Eye Right Exm time 16 24 00 Original EE Ta O 1 Refractive Map 75 0 70 0 in i T j pi al o w E ER EE E FN an Roy coll SP oo a a S i gt gt 58 126 Rh 7 80mm 43 3D 4 6 90 Spectacle power H H 2 Sph o 0 00 cyi D 0 00 axis o cvd m m o wo wo m Aa ond md wm Nm Astig 2 36D Pupil 3 6mm Apex 7 62mm 44 3D mm s3 Sagittal 1 Original topography map 4 Refractive map with color bars 2 Spectacle power 5 Patient and examination data 3 Data fields Fig 3 32 Refractive display display This presentation is especially suited for viewing measurements prior to and after treat ments with an Excimer laser The following information is displayed on the screen for this purpose m Patient and examination data sect 3 7 1 page 22 m Standard topography map sect 3 7 2 page 23 m Refractive topography map sect 3 7 7 page 58 Pupil diameter in mm sect 3 7 2 page 59 The patient s power values at the time of the measurement sect 3 7 3 page 60 3 7 1 Re
18. 4 UG 70670 0209 en AY Beggs 3 Analysis of the Typographic Examinations 3 8 2 Elevation The map at the left hand side of the screen is a graphic presentation of the height data in terms of sagittal height differences between the corneal measurements and the refer ence shape in the map at the left hand side of the screen The following values are dis played at the bottom left of this map Rh Horizontal radius of curvature in the center shown as a radius value In mm or as a refractive power in diopters m Rv Vertical radius of curvature in the center shown as a radius value in mm or asa refractive power in diopters Note Switching from displaying the information as a radius of curvature or as a refractive pow er and vice versa is done on the Change settings screen sect 7 1 6 page 108 In addi tion you can also set there whether the horizontal and the vertical or the flat and the Steep radius of curvature are to be displayed m Axis Axial bearing of flat radius Ecc Mean eccentricity of the cornea at 30 gt Press the Num button to display or hide the height values in polar coordinate form in the height map If you know the apex depth of soheroaspheric or quadrant lenses you can thus assess their fit Color bars Two color bars are shown in the height data map m The right color bar is the same as the color bar that is displayed in the topography map on the overview screen sect 3 7 2 page 23 m Th
19. ARK 9000 Topcon KR7000F 0 Medmont Studio4 NIDEK Magellan f Topcon KR8100F t Oculus Eyetop Topcon CT 100 Oculus Easy Link SHIN NIPPON CT 1000 C Keratron Easygraph C Humphrey i Tomey i Haagstreit Eyetec i Tomey TMS4 t Oculus Pentacam C Tomey RT6000 Abbrechen Fig 7 4 Settings screen of the EyeLite software gt Activate the checkbox Oculus Easy Link User Guide Keratograph 4 UG 70670 0209 en 109 126 7 Settings AY OCULUS gt Finally activate the checkbox EyeLite in the Export box of the keratograph soft ware Change settings Display units Color scale stepping Date format Language Diopter Abs Normal DMY C German mm C Rel Fine C MDY English C Rel Medium CO YMD C French Curvature radius C Rel Coarse C Italian Sagittal Sign of C Spanish step ey Tangential P mm separation C Polish a R t Presentation K Values _ D lmage elease defaul Complete Diopter C Red Green Unlocked C Orginal mm Green Red C Locked Color table l Show sign of astigm C Lens measuring Fourier maps Internal R hor R vert i Dec Sph added External C R flat R steep a Off l In Sph added a Communication X EyeLite Kao Color Serial Ring illumination Yersion 1 4r1 7H normal bright Fig 7 5 EyeLite checkbox activated on the Change settings screen You can now access the EyeLit
20. Cataract 06 01 1940 central powdery 7 Demo Cataract Congenital 15 09 1967 Demo Flat Ant Chamber 24 03 1939 Demo Glaucoma Narrow Angle 19 10 1932 Cataract 1 Attribute Comments as entry box 2 Attribute Comments in the patient list Fig 2 9 User defined attribute Comments Note Selection of attributes occurs analogously in the context menu The currently selected at trioutes are marked with a check User Guide Keratograph 4 UG 70670 0209 en AY OCULUS 2 Patient Data Management 2 6 2 Devices tab Settings Database 1 9 v Standard load while rs 2 Database folder CATOPO hp 3 8 ata folder Ic STOPOSTOPO DAT ns Picture folder Ic STOPO TOPO BMP z Devices T WV Active Keratograph ial 4 6 File CATOPO TOPO EXE ie Transter folder C ATOPO STOPO DAT be 5 I Write permission Version 6 0222 Save Cancel 1 Dropdown list for selecting a database 6 Path for the currently selected device 2 load while starting option 7 Checkbox for activating a device 3 Folder selection 8 Path for the database 4 Dropdown list for selecting a device 9 Checkbox for activating a database 5 Write permission checkbox Fig 2 10 Devices tab Database group box Different users can be set up for different databases gt Inthe dropdown list for selecting a database 1 choose the entry Standard or Us er 1 4 that you would like to edit gt
21. Choose the corresponding path for the database data and images via the individual buttons for folder selection 3 Normally two different folders are created and displayed for data and image during installation 8 For data Name of the device plus the DAT identifier For images Name of the device plus the BMP identifier gt For each user activate whether the associated database should be actively switched on or not 9 In case more than one database is active an additional dropdown list appears on the main page of the patient data management user interface You can activate a user or the as signed database in this list The patient list and the associated examinations are updated when the active user Is changed User Guide Keratograph 4 UG 70670 0209 en 13 126 2 Patient Data Management AY OCULUS gt You can also activate the option load while starting 2 for exactly one user The associated database will then normally be loaded at start of the patient data man agement user Interface and is pre selected Devices group box Settings for connected devices can be carried out in the group box gt Inthe dropdown list select the desired device 4 gt If the device is in fact connected then activate the checkbox Active 7 gt Choose the path to the associated device s application file via the folder selection button To save patient and examination data in the database this will initially
22. Color map large The program offers the option of displaying the topography map sect 3 7 2 page 23 in large format on the screen gt Inthe Display menu select the menu item Color Map large The following tab appears User Guide Keratograph 4 UG 70670 0209 en 27 126 3 Analysis of the Typographic Examinations Ay OCHEL E3 OCULUS KERATOGRAPH Patient Examination Display Lens fitting Settings Miscellaneous Print 4 gt 28 126 Last name Demo First name Patent Dat o B 11 11 22 Exm Dat 09 07 936 Eye Right i i CS S Radius Opt Power Zone dia Meridian Color Radius Opt Power Zone dia Meridian Color Radius Opt Power Distance Sagittal Absolut 1 Topography map 3 Numeric values of the measured points 2 Color bars 4 Patient and examination data Fig 3 9 Color Map large display This presentation makes interactive analysis of the color topograhic map possible In gen eral this map is the same as the Individual map in the overview sect 3 7 2 page 23 Here you can also output different numeric values for two measuring points gt Clickin the map with the left mouse button to define measuring point 1 Measuring point 1 is shown as a cross Each additional click with the left mouse button rede fines measuring point 1 gt Click in the map with the right mouse button to define m
23. Data In principle a contact lens data update on the PC takes place in the exactly the same way as the Import gt Press the Compare button in the Mark group box Those contact lens data that are present on the external data medium but not on the PC are marked in the list on the right hand side gt Press the lt Import lt button to import the selected data into the PC gt To apply the changes press the Save Quit button to close the Import Export of contact lens data screen Note The changes when importing data are only applied after the Save Quit button has been pressed to close the Import Export of contact lens data screen gt Todiscard the changes press the Cancel button to close the Import Export of con tact lens data screen 7 4 Video Settings If you purchased and Installed the imaging software after you Initially purchased the unit sect 5 1 page 89 you must set the corresponding codec gt Press the button Video gt on the Change settings screen The Select Code dialog box appears User Guide Keratograph 4 UG 70670 0209 en AY OCULUS 8 Miscellaneous Functions H Select codec Full Frames uncompressed Cinepak Codec by Radius HE4 MPEG 4 CODEC lndeo video 5 10 Intel IndeolA I Wideo Ra 2 Intel Indeo A Wideo A3 2 Intel Indeo Video 4 5 Intel U Codec Fig 7 19 Dialog box Select X Codec gt Select the desired code from the list Note Mess
24. Inthe COM field select the COM port to which the keratograph is connected gt Depending on the PC card that Is installed select the data transmission rate for the communication between the PC and the keratograph Note The default setting for the communication ports COM1 and COM2 is 115 200 Baud Bootmode settings The boot process takes place when the keratograph Is switched on In general authenti cation is awaited after each byte has been transmited You can select one of the following settings Handshake The next byte is transmitted immediately after authentication Synchron NT After authentication the next byte is transmitted after a constant time period has elasped This setting slows down the boot process to 10 seconds as opposed to 6 seconds in Handshake mode Handshake However this provides greater transmission reliability Note The setting Synchron NT must be selected if Windows NT is being used as the operat ing system gt Preselect the desired boot mode for switch on of the keratograph gt Ifyou use Windows XP as your operating system activate the checkbox Clear buffer XP Data package size settings From software version 1 38 on an error correction is performed for the data transmission This is necessary because Pentium 2 PCs do not provide stable data transmission espe cially when Windows 98 is being used as the operating system on the PC For error correction pur
25. OCULUS KERATOGRAPH 3 1 Overview display Multiple analysis presentations are displayed on the overview screen to give you a quick overview of the measured corneal topography gt Inthe Display menu select the menu item Overview Patient Examination Display Lens fitting Settings Miscellaneous Demo Patient Exm dat 09 07 96 Dat 0 B fi 1 11 22 Eye Right Exm time 16 24 00 Sa e 1 pia 2 9 J 98 0 9 Keratometric data major meridians perpendicular d 3mm me ae 184 6 4 6 10 5 Rv 7 40mm Ast 2 4D 28 5 Axs 4 6 Ecc 0 56 Sagittal cor 11 3 Absolut 1 Topography map 4 Scaled down camera image 2 Numeric extremes map 5 Patient and examination data 3 Keratometric data Fig 3 1 Overview display 3 1 1 Patient and examination data Name Demo Patient Exm dat 09 07 96 Dat 0 B fi 1 11 22 Eye Right Exm time fi 6 24 00 22 S Fig 3 2 Patient and examination data This individual display 5 shows the most important patient and examination data m Last name and first name Date of birth m Eye examined Examination date and time User Guide Keratograph 4 UG 70670 0209 en AY Seweuws 3 Analysis of the Typographic Examinations 3 1 2 Topography map The measured corneal topography is output as a color map 2 5 6 6 6 8 TA 2 78 ES Eg 82 8 4 1 Color bars 4 Pupillary margin 2 Map 5 Area not measured 3 Current cursor posi
26. Select the examination the results of which are to be subtracted subtrahend from the drop down list in the bottom right topography map 4 Example If you select Examination A in the top topography map and Examination B in the bottom topography map the difference Examination A Examination B is shown in Difference Refractive map gt Press the Num button to display or hide the numeric values for the differences in refraction power in the various zones of the cornea The numeric values are deter mined from the values measured within each zone and are displayed in the center of that zone Note The displayed numeric value is a mean value for the whole zone and does not relate to an individual measuring point 3 10 2 Adjusting the Meridian Plane A section of the difference map 8 is output in the graph 6 below the difference map The distance in mm around the apex of the cornea is plotted on the abscissa X axis of this graph and the power in diopters at the respective point is plotted on the ordinate Y axis gt Inthe difference map activate the blue line 9 which marks the position of the me ridian with the mouse and press and hold down the left mouse button gt To move the meridian plane move the mouse clockwise or counter clockwise ac cordingly The position of the meridian plane is shown in the graph at the top left and right User Guide Keratograph 4 UG 70670 0209 en 69 126 3 Analysis of
27. Vergleich mit Spaltlampe 16 05 08 11 39 44 Fight Movie Video Sequenz Fullscreen V Details 2 frames Back Fig 5 9 Zoom view Note The assignment of an informational text is done is the same way as for camera images sect 3 1 5 page 25 0 4 2 Adjusting the display gt Press the button Full screen to get a full screen display of the individual image User Guide Keratograph 4 UG 70670 0209 en 95 126 5 Imaging AY SGuLls Note This function does not apply to video recordings gt To play the video sequences press the _ button or press the _II_ button to pause gt Press the button Zoom in to compare two video sequences or two individual im ages with each other gt Select the first image or first video sequence in the thumbprint or in the zoom view This is then shown in the bottom section gt Select the second image or the second video sequence This is now shown in the bot tom section and the previously selected image or video sequence moves to the top section ergleichsbild zu 12 04 56 Fw 13C Yergleichsbild Fullscreen l Details 1 frame Back Fig 5 10 Comparison of two individual images Note The image or video sequence that was loaded last Is always displayed in the bottom sec tion of the screen 96 126 User Guide Keratograph 4 UG 70670 0209 en AY OCULUS 6 Pupillometer Software 6 Pupillometer Software The pupillometer software enables you to condut pull
28. WaATE socsnrsssinnninn tetne terete nee tn omnnere 97 6 2 Activation and Setup of the Pupillometer Software ou eecssesssseseeseeesneessneeeesnees 98 6 3 Setting the Camera Brightne ss cccsssssssesssesssscsssesssessecssecssscsssesssecsssesssessessseesseesseeesses 99 64 Pupilome ty Overview Sre iesen ne ante cence nee ore 100 6 4 1 Patientand examinatorn datassa 100 6 4 2 Scaled down camera IMa0 ssssssssssssssssssrsrrinririririrrssssssssssssssssrnrnrerrrrrrrrrrrrnne 101 6 4 3 Da ee E EN 101 6 44 Time Scale of the Pupil Diametr arsissrssissistissresserisasinsssiinissaiiss 102 65 Comparison View of the Pupillornieti ysies 103 Sec mmm gO 101 6 a a S T G eA nooner 104 Do SMI ccc clench ceca pec tatcnoutdcbch ne tcec sche zoecdpette kde nial ueedosae sect 105 PN CES VA NSS a E E cece E E 106 7 1 1 DISPO UNIS SENO Suinae aeaa E a E tastes 106 7 1 2 OUR VE TOPE tadis SEWING S sinipi ai 106 7 1 3 Settings Presentati soes E E EEEE E 107 7 1 4 CONC FAS SEU I e yee cteomec uence cteneeeiecngess 107 7 1 5 Color scale stepping settings sirissiiisussisiiseiiisrissnisriisisssi rnas 107 7 1 6 Settings K Value Presentation sssssssssssssssssssssssesrsnnnrrnrnnnnrnrnnnnnnnnnnsss 108 7 1 7 C Lens measuring STUNG Sn siccstscnnsosessnsetedalvesicsreashitedelinstzselasdeheneliastaceteana 108 7 1 8 NS EO ar EE EEES 108 7 1 9 POS IM caveat etc esac eal ese veal cleaves Gade eeboceednos 110 AAO SE SUM AOe scacmua
29. be created in the so called Transfer folder This folder is always created locally on the PC gt Choose the transfer folder via the folder selection button This should correspond with the name of the device and the DAT extension You can also specify settings for devices which are not connected to the PC gt Activate the checkbox Write permission for the devices that are in fact connected to the PC 2 6 3 Import Export tab Settings Automatic backup Folder F dataSbackup 3 1 1 5 j i Including Bitmaps 4 Enable Import Export Folder F data export H 2 3 n Foma u12 control unit ad Version 6 0210 Save Cancel 1 Automatic backup folder 4 Enable checkbox 2 Select import export folder 5 Including Bitmaps chechbox 3 Standard format for import and export Fig 2 11 Import Export tab 14 126 User Guide Keratograph 4 UG 70670 0209 en AY OCULUS 2 Patient Data Management Automatic backup group box Besides the manually executed backup sect 2 5 1 page 8 there is also the option to car ry out a backup when the patient data management user interface is closed The settings required for this can be specified in the group box gt Select the folder via the folder selection button 1 where the data should be saved during an automatic backup gt Selected the checkbox Including Bitmaps 5 if the camera images should also be backed up gt Activate the chec
30. data 5 select an individual lens and press the Delete but ton 3 to delete the data or press Change 4 to change it 7 3 4 Adding Rigid Contact Lenses gt To add a completely new lens generate a new contact lens type sect 7 3 2 page 117 and enter the desired name Alternatively you can insert a new lens into the existing list gt In the top part of the screen select the manufacturer and lens type for which you want to add a new contact lens gt Click the button Add lenses The following screen appears User Guide Keratograph 4 UG 70670 0209 en 7 Settings 117 126 7 Settings AY cgr Lens type 3P Contactlinsen 3P AS Sonder Base curve 4 Min Max Step Generate new lenses rO mm 7 20 7 20 H 0 00 E drO mm 0 00 0 00 4 0 00 E Ecc 0 20 0 20 0 00 E 9 00 9 00 0 00 3 mm m e 3 Periphery Width b1 mm ri mm dri mm b1 0 35 r1 1 00 bl constant ri constant C drl constant Crl r0 A B dri drO r1 frO Width b2 mm r2 mm dr2 mm b2 0 00 r2 1 00 b2 constant r2 constant dr2 constant Cr2 r0 A B dr2 drO r2 r0 1 Generate new lens button 3 Settings Periphery 2 Back button 4 Settings Base curve Fig 7 13 Add new lens geometry screen The following parameters have to be entered for every contact lens rO Curvature radius of contact lens at center steep meridian for contact lenses
31. fiactc sansa cadaascnatstaace uatececeattada 19 3 Analysis of the ypographic EXammiita WOMS iescccssssessescossecesse taccestattaccesteicesnpcesroeenactziensPichiuendaast 21 A EWN O ae EEA AENT A E E E E 22 3 1 1 Patientand a IT eG Osea ete dacesctsszcescensocesestenessssnessncsactuesceszcosseumccuereianeles 22 3 1 2 WO OG TNO ee e E 23 333 Numeric extremes Maj seisein i e 24 3 1 4 E eeenrrnvne ener ret rmrer tere ORT eT ENC ST estrone SOO 24 3 1 5 Scaled down camera IMAQE sssesssssssessssssssesssecssscssscsssessuecssecesscsssesssecesecessecsses 25 ey saan a E a E E T E A E eee 27 F AD 6 eee e ee E EAEE ere ee 29 3 4 Fourier FINA 51S a vovesscnsexcreeosseycisrutstanianneovcinonlereuspsieysbaestansacaputesnaaesaynenssesavsnmnievernteesinenlsevtion 31 3 4 1 Backgrouna ATONA ONE sissies 31 3 4 2 Color Maps ol ihe Componei Sossarna 33 3 4 3 Display of the Fourier ICI CCS sessies aiaa inai 36 3 4 4 ION Sh o ena e oc scez nae da eda csvazccuseeveasisadelenesecasecnssesttecnaecaaets 37 3 4 5 Application Example for KeratOCOnub csscsssssssssssssssesssessssesssessssessssessess 37 39 LANKE ANSSI caataasctccstaomencsscascecaniannganneadesap EnE TEENE ONN EEAR ANNAAS ENADE NNE E 39 3 5 1 G a E E E S J9 User Guide Keratograph 4 UG 70670 0209 en ii iv lil iv AY GS S52 Summary of the Most Important Zernike Polynomials 41 35 3 Definitions of the First Zernike Polynomials eseesssessesssecseesseestesseesteeees 42 3 5 4 General Etr
32. left mouse button again to set the end point of the 2nd line and to per manently display the angle Note gt Activate the menu item Camera Image again in the Display menu to delete the display of all angles and distances 3 9 3 Determination of a Distance gt Press the fi button at the top left of the camera image Note The distance between two points can then be determined in the camera image in the same way as in the zoomed out view sect 3 1 5 page 25 Note gt Activate the menu item Camera Image again in the Display menu to delete the display of all angles and distances User Guide Keratograph 4 UG 70670 0209 en 3 Analysis of the Typographic Examinations 67 126 3 Analysis of the Typographic Examinations Ay aCe 3 10 Refractive Compare gt Inthe Display menu select the menu item Refractive Compare EY OCULUS KERATOGRAPH 10 9 68 126 Patient Examination Lens Check Display Lens fitting Settings Miscellaneous Print 3 50 Name Demo Imaging Dat 0 B 11 11 11 90 0 1 AE 80 0 2 Difference Refractive D 1 minus _ a J uU0 SS prai ie 75 2 75 re 42 1D 0 1D le 5 _ Apex Astig cn a J S t eleliecls J He 4 as 2 06 05 08 14 09 21 R Video Aufnahme B T T T X T T T T pra ee 5 35 0 34 0 J Ww wi w o gt 288 4 Diopter Refr Absolut Ww
33. m drO Curvature difference of main section at center for toric lenses this value is O for rotation symmetrical lenses Ecc The eccentricity of the contact lens for aspherical lenses this value is 0 for spherical lenses Total diameter of contact lens A minimal value maximum value and a step length can be entered for every value More lenses will be created later for which the data results from the individual values Example Min Max Step Min Max Step Min Max Step drO 0 00 0 00 0 00 0 30 1 00 0 10 0 00 0 00 0 00 9 30 10 30 0 50 90 10 30 0 50 9 30 10 30 0 50 118 126 User Guide Keratograph 4 UG 70670 0209 en AY BIB Eee Fig 7 14 Definition of the periphery Besides the basic parameters the peripheral values must also be entered In order to define multi curve lenses and bevels You can define up to two peripheral zones with the fol lowing three individual values b1 or b2 Width of Zone 1 or Zone 2 r1 or r2 Curvature of Zone 1 or Zone 2 If the curvature is constant select the op tion r1 constant or r2 constant and enter the curvature If this is not the case select the option r1 rO A B or r2 rO A B and enter the respective values A and B Example 1 If the curvature in an edge zone is always 0 8 mm larger than the central radius rO enter 1 for A and 0 8 for B Example 2 If the curvature in an edge zone always amounts to 1 5 times the central
34. mm 7 75 F Toric 10 Suggestions r Ece fa Ece 0 60 B mm 9 20 Wohlk1 CFA AS Wohlk1 A90 AS Wohlk1 100UY AS Wohlk1 wohlk perfec Wohlk1 CFA P PT Wohlk1 A90 YP PT Wohlk1 A100 YP PT Wohik1 Wohlk KE Wohlk1 P A U L TECHN MA N TECHN MC N B amp L Quantum 1 B amp L Quantum 2 Jen lens ABOGDT Jen lens Aspharflex Jen lens Asph Kera Jen lens ABOGTpri Jen lens AsphPri Jen lens ABOGVTP Display Eccentricity Sagittal cur Top Test Fluo image Fig 4 7 Calling up the Hecht basic module 7 85 7 75 7 85 7 75 7 85 7 75 7 85 7 55 7 80 7 75 7 75 7 75 7 75 7 80 7 75 7 55 7 80 7 75 7 80 Hecht CL 0 40 0 60 0 40 0 60 0 40 0 60 0 40 0 90 0 50 0 60 0 60 0 60 0 60 0 45 0 60 0 90 0 45 0 60 Position RyL mm U D mm Incl _ 5 Quit gt First select the desired lens type rigid or soft contact lens by pressing the appropri ate button User Guide Keratograph 4 UG 70670 0209 en 81 126 4 Contact lens fitting AY Seeks HECHT ANPASSUNG Linsenart wahlen Weiche Linse Fig 4 8 Selection of the lens type If the APEX r software is not installed the following screen appears HECHT ANPASSUNG S Info Hecht Yorschlag Bestelldaten gt gt Fluobild gt gt if BIAS y KA1 KA4 KERATOKONUS WEICHELINSE E 7 70 36 HS ASB ANPASSEN OK PAE asph rische Multifokal Linse Fig 4 9 Hecht basi
35. signs The diagnosis of the pre stage of Keratoconus is always based on clinical criteria such as a change in power and the axis of the astigmatism fluctuating refraction values conspicuous changes in retinoscopy and corneal shadows during observation with the direct ophthalmoskope Videokeratometry provides supplementary information but a diagnosis can not be based solely on the results Corneal tear film irregularities and fixation problems can yield similar images without the presence of a true Keratoconus This classification was adapted from the classical Amsler and Muckenhirn standards It is a topography based graduation and not a clinical one ISV Index of surface variance Fig 3 31 Levels of keratoconus Note Sole diagnosis of a keratoconus above all for incipient cases without including all clinical facts can lead to a misdiagnosis since Irregularities of the mucus layer Irregularities of KI Keratoconus index Rmin minimum value of the curvature of the cornea Eccentricity in 30 refers to the four measuring values nasal temporal superior and inferior If visual acuity of 20 25 to 20 20 is achieved with a spectacle correction contact lenses are not necessarily indicated Munson sign The cornea bulges forward The conical shape is easily recognized in profile particularly by the acute the cornea or fixation problems can also provide similar images User Guide Keratograph 4 UG 70670 0209 en 57
36. the Typographic Examinations AY OCULUS 3 11 Compare examinations gt Inthe Display menu select the menu item Compare Examinations The following tab appears E3 OCULUS KERATOGRAPH Patient Examination Lens Check Display Lens fitting Settings Miscellaneous Last name Demo First name Imaging gt Dat o B MII Exm Dat 06 0508 Right Difference mm i Map s0000 E 000D 1 minus 2 fee ma ad a d vlololn a on ES 1 Drop Down List Examination 2 6 Difference display 2 Topography map 2 7 Color bar for the difference map 3 Color bar for the topography map 8 Examination selection 4 Drop Down List Examination 4 9 Patient and examination data 5 Topography map 4 Fig 3 40 Display Compare examinations In addition to the patient and examination data sect 3 1 1 page 22 the topography maps of up to four examinations can be displayed here Selection of the individual exam inations occurs analogously to that of display Refractive Compare sect 3 70 7 page 69 In the Difference box 8 at the left hand side of the screen you can also select the ex aminations for which the difference map is to be calculated gt Select the examination with the upper options button which should be used as the basis Minuend gt Select the examination with the lower options button from which the results should be taken Su
37. the diameter for which the Zernike analysis is to be done You can select from the following options constant Enter the desired diameter as a numeric value here Typically a value of 8 0 mm Is used Topography The Zernike analysis is done for the total measured corneal area gt Enter the maximum order number of the Zernike polynomial that is to be calculated into the field n in the Order box gt Press the button Calculate new to make the analysis with the new parameters Saving and Loading the Settings gt To save the present settings press the button Save settings on the Zernike Analy sis screen These settings are then automatically loaded and used for the analysis the next time the Zernike Analysis screen is opened gt If you have changed the settings for another analysis in the meantime press the button Load settings to manually reload the settings that were last saved 3 9 9 Zernike coefficient display The coefficients are displayed as a simple list in the right hand section of the screen 3 44 126 User Guide Keratograph 4 UG 70670 0209 en Ay Seg 3 Analysis of the Typographic Examinations Reference Shape Diff 0 000048 IZ 0 002353 Z 0 001177 izi 0 002058 IZ 0 003493 Es m m O Z 0 000566 IZ 0 000379 x izi 0 000512 Xl xl izi 0 000219 IZ 0 000065 xl Z 0 000106 xl izi 0 000022 Xl izi
38. the user interface for Patient Data Management Fi OCULUS Patient Data Management Patient r Functions 8 Last name Demo New Keratograph First name fmgng Change Dat o B Maa aa Search a ID Number Patient list Date of birth 11 11 1922 Date gt Time Device ype E moea Rent exam 16 05 2108 12 40 09 16 05 2108 12 39 59 Keratograph Keratograph i Image only FWX 13C Image only Vergleich 16 05 2108 12 32 41 16 05 2108 12 32 31 Keratograph Keratograph Image only Einzelbild 1 t t Image only Video Aut 16 05 2108 12 32 26 Keratograph Image only Einzelbild 2 16 05 2108 1211 52 16 05 2108 11 39 44 Keratograph Keratograph Image only Vergleich Movie Video Se o 06 05 2108 14 09 21 06 05 2108 14 08 52 Keratograph Keratograph i i Standard Video Aut Standard oo t iF N Wl Sf ain N 06 05 2108 14 08 35 1 Functions group box 5 Import button 2 Previous examinations 6 Delete Patient button 3 Delete exam button 7 Patient list 4 Export button 8 Patient group box Fig 2 1 Patient Data Management Note Keratograph Standard Einzelbild 2 To enter the Keratograph software you must either enter a new patient into the Patient group box 8 or select an existing patient from the list 2 2 2 Entering new patie
39. 0 D 9 2 0mm New TECHN MAN r 7 75mm Ecc 0 60 D 9 20mm Keep old data Store new data Back Fig 4 15 Confirmation dialog box that appears after the contact lens data have been changed 88 126 User Guide Keratograph 4 UG 70670 0209 en AY OCULUS 5 Imaging D Imaging The imaging software is used to record videos and capture images You can thus compare video recordings and images with the fluo image simulation of the measured eye 9 1 Ordering the Imaging Software Note If you purchased the imaging software when you bought the keratograph you do not need to order the software again Then simply set up the imaging software accordingly sect 5 2 page 90 In the appendix of the Operating Manual you will find a fax order form for ordering the optional imaging software if you didn t already purchase it when you bought your kera tograph To order the software you will need the serial number and the so called Device Code of the keratograph gt Take your keratograph s eight digit serial number SN that is printed on the OCULUS label on the power pack or on the head of the keratograph and write it on the fax order form gt Open start the Keratograph software sect 3 7 page 22 gt Click on the blue menu bar OCULUS KERATOGRAPH to activate it ca OCULUS KERATOGRAPH Patient Examination Lens Check Display Lens Fitting Settings Miscellaneous Fig 5 1 Menu bar of the keratograph software gt En
40. 3D for the 3D display Fig 3 23 Zernike display in 3D gt Press the Scale button for an optimal color map User Guide Keratograph 4 UG 70670 0209 en 47 126 3 Analysis of the Typographic Examinations AY OCULUS Notes about 2D display gt Click with the left mouse button in the 2D display to show the current elevation at the relative location Notes about 3D display gt Move the slider Exaggerate to the right to exaggerate the 3D display Press the Scale button again to rescale the graphic to the optimum gt Just like with the 3D topography map by clicking on the arrow buttons you can ro tate the 3D Zernike polynomial map and then return it to Its original position by pressing the 0 button sect 3 3 page 29 gt The 3D map provides a clear overall picture but the height values at certain corneal positions cannot be determined very well It is better to use the 2D map for this pur pose Diagnosing a Keratoconus gt Select the following settings for early detection of a less pronounced keratoconus m Reference shape Ellipse Ecc 0 75 Zernike coefficients Activate all polynomials with the exception of the lower or ders Z 0 0 Z 1 1 Z 2 0 and Z 2 2 and display them as vector values The apex position of the keratoconus can this be identified more easily Experience has shown that the normal map of the sagittal radii left can be misleading when it comes to the actual position of th
41. 70670 0209 en AY DCHEUS Edit contact lenses x Lens type Manufact e AA Ee a gt Short 6 Lens 3P AS Sonder Short New lens type Delete lens type r Ecc bi ri b2 r2 Add lenses 5 1 7 20 0 20 9 30 0 35 10 70 0 00 10 70 7 20 0 20 9 40 0 35 10 70 0 00 10 70 e ia da 7 20 0 20 9 50 0 35 10 70 0 00 10 70 7 20 0 20 9 60 0 35 10 70 0 00 10 70 7 20 0 20 9 70 0 35 10 70 0 00 10 70 7 20 0 20 9 80 0 35 10 70 0 00 10 70 7 20 0 20 9 90 0 35 10 70 0 00 10 70 7 20 0 20 10 00 0 35 10 70 0 00 10 70 7 20 0 20 10 10 0 35 10 70 0 00 10 70 7 20 0 20 10 20 0 35 10 70 0 00 10 70 7 20 0 30 9 00 0 35 10 70 0 00 10 70 7 20 0 30 9 10 0 35 10 70 0 00 10 70 saves 7 20 0 30 9 20 0 35 10 70 0 00 10 70 2 7 20 0 30 9 30 0 35 10 70 0 00 10 70 7 20 0 30 9 40 0 35 10 70 0 00 10 70 Lens fi of Change 4 3 1 Add lenses soft lenses 4 Change button 2 Save Quit and Cancel buttons 5 List of lenses ofa particular type 3 Delete button 6 Settings Lens type Fig 7 12 Edit contact lenses screen gt Afterall settings have been made press the Save Quit button to apply the chang es or Cancel to discard the changes 7 3 2 Editing manufacturer data and lens types gt Inthe upper area 6 select if you would like to add a new lens type delete the cur rent lens type or change the name and then enter the corresponding information 7 3 3 Editing individual contact lens data gt Inthe list of contact lens
42. 75 CFA YPVPT 7 85 A90 YP VPT 7 75 A100 VPVPT 7 85 Wohik KE 7 55 P A ULL 7 80 MA N 7 75 MC N 7 75 Quantum 1 7 75 Quantum 2 7 75 ABOGDT 7 80 Aspharflex 7 75 Asph Kera 7 55 ABOGTpri 7 80 AsphPri 7 75 A ABOGYTP 7 80 Display Eccentricity Sagittal cur C Top Test Fluo image Keratometer 5 Distance of major meridian and contact lens pm CL power Spect Sph 0 00 Cyl 0 00 0 cvd 0mm C lens Rh 7 80mm 184 6 94 6 274 6 Rv 7 40mm 100 Ecc 0 56 3 80 90 0 SSSSnece 2 4 6 8 Manufactur PREET z g Ecc o0 E fmm 9 20 PuL mm U D mm ma 5 Position 1 Contact lens fitting 2 Refraction display 3 Keratometric data 4 Distance display 5 Fluorescent image simulation 6 Patient and examination data Fig 4 5 Display Fluo image Below center 4 is a display of both main sections of the contact lens For a flat fitting the curve Is bent upwards for steep fittings the curve is bent downwards and for a par allel fitting the curve runs horizontally After the first fluo image simulation the field CL power 2 is activated at the bottom right of the screen The refractive powers of the contact lens can be calculated here based on the patient s spectacle lens power and the lens type sect 4 2 5 page 83 through sect 4 2 7 page 87 The main part of the screen 5 shows a calculation of the corneal distance values for
43. 8 Persecon RPT 19 Persecon RT 20 Persecon RPVT 21 Persecon YT 22 S75 23 Weicon 38E 24 Weicon CE 25 Yreicon CE toric 3 Import Export gt _ _ 5 Use Save and Cancel buttons 6 Checkbox Use Hecht fitting software 7 List of used manufacturers 8 List of all manufacturers Fig 7 11 Choose contact lens screen In order to create a Ranked list proceed as follows gt Deactivate all manufacturers in the complete list 8 The list of manufacturers is now empty gt Switch on the manufacturer in the desired row The suggestion list displays pre ferred lenses with a similar geometry from a particular manufacturer at the top gt Now gradually select the applicable manufacturer 7 and deactivate all lens types from the corresponding manufacturer in the complete list 1 gt Now gradually switch on the desired lens types 2 Note The buttons Use Save and Cancel have the same function as those on the Change settings screen Fig 7 1 page 105 You can also add new manufacturers lens types and lens data to the database and im port export the entire database The procedure for this is explained in the following sub chapters 7 3 1 Editing lens geometry gt Select the manufacturer for which you want to edit or add contact lens data gt Press the Lens geometry gt button The following screen appears User Guide Keratograph 4 UG
44. A AS A90 AS A R 100UV AS 7 85 0 40 9 30 wihlk perfec 7 75 0 60 9 30 CFA VPVPT 7 85 0 40 9 30 A90 YP VPT 7 75 0 60 9 35 A100 VP VPT 7 85 0 40 9 30 Wihlk KE 7 55 0 90 9 30 P A ULL 7 80 0 50 9 30 MA N 7 75 0 60 9 20 MC N 7 75 0 60 9 20 Quantum 1 7 75 0 60 9 60 Quantum 2 7 75 0 60 9 60 ABOGDT 7 80 0 45 9 30 2 eratumo at Asph rflex 7 75 0 60 9 30 Rh 7 80 Axi 4 6 Asph Kera 7 55 0 90 9 30 eta e 30 ABOGTpri 7 80 0 45 9 30 Ry 7 40 11 3 ela AsphPri 7 75 0 60 9 30 zamm eel tamm ef eo ABOGYTP 7 80 0 45 9 30 Am 760mm Ecc 0 56 an ae Hecht CL 270 i Astigm 2 36 D Fix dif 0 23 mm ee une Sagittal cur C Top Test Fluo image 1 Contact lens fitting 3 Eccentricity chart 2 Keratometric data 4 Patient and examination data Fig 4 1 Display Contact lens fitting 4 1 Cornea data In the left part of the screen the following is displayed m Patient and examination data sect 3 1 1 page 22 m Eccentricities of the major meridians or sagittal radii sect 4 2 3 page 79 m Keratometric data sect 3 7 4 page 24 User Guide Keratograph 4 UG 70670 0209 en 73 126 4 Contact lens fitting Ay Bers This data helps provide the contact lens fitter with a good impression of the shape of the cornea from the center to the periphery 4 2 Contact lens data The actual selection of the lens to be fitted is made in the right side of the screen 1 4 2 1 Selecting the Contact Lenses
45. E X Tori r0 7 65 B mm 9 30 Periphery l r1 mm 9 85 a 4 am 0 50 b1 mm E x Tori rt 9 50 r2 mm 9 85 wie J 0 00 b2 mm El X Tori r2 9 50 Tilt Position PIL 70 00 PAL nn 70 00 2 3 UDP U D mm Incl 5 1 Flat meridian alignment 4 Periphery 2 Position 5 Base curve 3 Tilt Fig 4 3 Lens geometry gt Enter the desired parameters for the base curve 5 and the periphery 4 into the re spective entry fields User Guide Keratograph 4 UG 70670 0209 en 75 126 4 Contact lens fitting 76 126 AY Geiser Note Changing the parameters in the group box Periphery is only sensible if you have selected the entry Mathematic in the field Manufacturer beforehand Additional notes on pe riohery parameters can be found in the contact lens settings description sect 7 3 3 page 117 The calculated tilt of the lens can be viewed in the group box Tilt 3 the movement and rotation Inclination can be viewed in the group box Position 2 The align ment of the flat meridian 1 is also displayed Confirm your entries with the OK button Press the Calc fluo button to simulate a fluorescent image sect 4 2 2 page 77 However this is only possible for rigid contact lenses for soft contact lenses the option Soft is active in the Ecc field this button is disabled The individual fields in the group box Position 4 display the offset and rotation of t
46. KKS En AA 1 Corneal eccentricity 5 Color bar for the vertical decentration 2 Curvature display 6 Color map Vertical decentration 3 Color bar for the curvature map 7 Indices 4 Progress of indices 8 Patient and examination data Fig 3 25 Indices display The keratograph used the following data for index calculation Curvature data Elevation Data from the Fourier analysis Data from the Zernike analysis The comprehensive use of all relevant corneal data enables different abnormalities to be detected at an early stage The patient and examination data sect 3 1 1 page 22 are displayed in the top section of the screen 8 The following are also displayed there Pat ID Patient ID as entered in the patient data management system User Guide Keratograph 4 UG 70670 0209 en 49 126 3 Analysis of the Typographic Examinations AY OBwawsS 50 126 Infotext Infotext as entered in the scaled down camera image in the overview screen sect 3 1 5 page 25 The vertical decentration based on the Fourier analysis of the height data is output at the top left 6 below the patient and examination data sect 3 4 2 page 33 For normal and astigmatic eyes and for very central keratoconi still fully closed rings are visible in this map which open up more and more as the transition to keratoconus due to decentration progresses until they ultimately take on the shape of an inverted omega in the center E
47. Pa a OCULUS KERATOGRAPH 4 USER GUIDE System for measuring and analysing the cornea topography AY CELUS Information about this User Guide Thank you for your purchase and the trust you have placed in this OCULUS product The Keratograph 4 has been manufactured and tested according to strict quality criteria You have selected a modern and well engineered product To ensure safe operation it is essential that you use the device correctly It is also intend ed that you make yourself familiar with the instructions manual which were also deliv ered with the device This User Guide provides you with detailed information about the topographic examina tion analyses and how the examination results are presented in particular Due to ongoing development the diagrams shown may depict minor changes to the ac tual device delivered If you have any queries or would like additional information about your device do not hesitate to call or send us a fax Qur service team will gladly assist OCULUS Optikger te GmbH Management and workers 7 a OCULUS is certified according to DIN EN ISO 9001 2000 and 13485 2003 setting high standards of quality where development manufacture quality assurance and service re garding the entire range of products are concerned 9 A SUD lt 2 0 O aks i fiv User Guide Keratograph 4 UG 70670 0209 en AY OCULUS Table of Contents t General NOE e A de edaatdce
48. Save button on the Change settings screen The imaging software is now ready for use gt Open the menu Examination The new menu item New examination Imaging is now present here User Guide Keratograph 4 UG 70670 0209 en 91 126 0 Imaging 92 126 AY CHLIS Loading of Videos or Individual Images You can load videos or individual images as well as other examinations sect 3 2 page 27 For each examination it is shown whether it is a standard topographic meas urement no entry a captured image grab image or a video sequence The text that was entered in the info text field appears after that Load old examination x Examinations 12 40 09 Right Grab Image 16 05 08 12 39 59 Right Grab Image 16 05 08 12 32 41 Right Grab Image 16 05 08 12 11 52 Right Grab Image 16 05 08 11 41 26 Right 16 05 08 11 39 44 Right Movie KL nach 1 Std Tragezeit Fig 5 5 Load old examination dialog gt Select an examination with image data or a video sequence gt Press the OK button The following screen displaying the overview of the selected examination appears User Guide Keratograph 4 UG 70670 0209 en AY Sew Lys 5 Imaging E3 OCULUS KERATOGRAPH Pri Patient Examination Lens Check Display Lens fitting Settings Miscellaneous int Name Demo Imaging Exm dat 16 05 08 Dat 0 B fi 1 11 11 Eye Right Exm time fi 2 32 31 ideo Aufnahme Fig 5 6 Overview of a ca
49. Select the menu Settings sect 7 page 105 90 126 User Guide Keratograph 4 UG 70670 0209 en AY Begs 5 Imaging Change settings x Display units Color scale stepping Date format Language C Diopter Abs Normal DMY O German mm Rel Fine O MDY English C Rel Medium O YMD C French Curvature radius C Rel Coarse C Italian Sagittal Sign of Spanish Step ver all C Tangential P mm separation e C Polish Presentation K Values 3D Image Release default Complete C Diopter Red Green Unlocked Orginal mm Green Red Locked Color table B Shine sign ay asym C Lens measuring Fourier maps Internal R hor R vert C On Dec Sph added C External C R flat R steep Off Irr Sph added Export Print Communication EyeLite Kao C Color C Serial Ring illumination Yersion 1 4r1 H normal bright Fig 5 3 Change settings screen gt Press the button Video gt on the Change settings screen The Select Code dialog box appears H Select codec Full Frames uncompressed Cinepak Codec by Aadius HE4 MPEG 4 CODEC lndeo video 5 10 Intel IndeolA Video Ra 2 Intel Indeo Ai Video A3 2 Intel lndeo Video 4 5 Intel PUY Codec Fig 5 4 Select Code dialog box gt Select the desired code from the list Note Messrs OCULUS recommends the code HDX4 MPEG 4 CODEC gt Close the Select Code dialog box gt Apply the setting by pressing the
50. active power of the contact lens based on the spectacle lens power and the lens type gt Conclude the selection of the contact lens back surface i e the fluo image simula tion before you start the power calculation module For rigid contact lenses a change in the curvature of the back surface also requires other corrective powers of the contact lens gt Press the CL power 2 button in the CL power display Fig 4 5 page 77 The fol lowing screen appears CL power calculation spectacle power Test lens spherical cvd 0 Sph 0 EE H Sph D 5 25 E cyi D 2 25 E Axis g cwd mm w H rO mm Comment Cornea Remaining power r fmm oph Cor Ast Cyl Axis Rf eS Axis ps Fig 4 11 Power calculation module for rotationally symmetric lenses gt First enter the patient s values in the Spectacle Power field Note Bear in mind that the cylinder must always be entered as a negative value User Guide Keratograph 4 UG 70670 0209 en 83 126 4 Contact lens fitting Ay OCULUS 84 126 m If spectacle power values have already been entered previously these are taken over and do not have to be entered again sect 3 7 3 page 60 The spectacle power Is converted into the optical refraction using the corneal vertex dis tance cvd and is displayed in the cvd 0 column gt Press the Suggestion button A contact lens suggestion is generated taking into ac count the power values
51. alled aberration coefficient using the Zernike coefficients In case a coefficient does not deviate from the normal value then the aberration coefficient has a value of 0 If the aberration coefficient has a value greater than 1 then there are oscillation components on the corneal surface which are atypical and are possibly the cause of reduced optical quality User Guide Keratograph 4 UG 70670 0209 en 45 126 3 Analysis of the Typographic Examinations AY BCwrws 46 126 3 5 6 Graphical display The polynomials are also displayed graphically in the form of height data in the left hand section of the screen 6 To display the height data a rotationally symmetrical elliose with an eccentricity of 0 75 should preferably be used as the reference shape as this comes very close to the actual Shape of the cornea The graphical display of individual polynomials and coefficients can be interpreted as a deviation from this ellipsoid Basically the selected polynomials can be output in a 2D display or a 3D display First se lect the Zernike polynomials which should be displayed gt Press the All an or All off button to activate deactivate all polynomials gt After preselection in this way or in general the individual polynomials can be select ed deselected via the associated checkbox in front of the coefficient Note The graphical display is updated immediately by selecting deselecting polynomials but not scaled automat
52. ally hor izontal or horizontally sloped 38 126 User Guide Keratograph 4 UG 70670 0209 en AY BSeggesS 3 Analysis of the Typographic Examinations Regular astigmatism Regular astigmatism While with astigmatism the axis runs in a straight line with a keratoconus it often turns from the center towards the periphery and thus takes on a spiral appearance Irregularity or Irregularity and Spherical Component With a keratoconus three or four leaf shapes can often be seen more or less pronounced in the map These correspond to higher order corneal aberrations which in Zernike poly nomials sect 3 5 page 39 are known as three wave trefoil or four wave quadrafoil The combination with the spherical component often makes the shapes even more pro nounced 3 9 Zernike Analysis 3 5 1 General Zernike polynomials are generally used to describe wavefronts The following figure shows the passage of a parallel wavefront through a refracting surface L User Guide Keratograph 4 UG 70670 0209 en 39 126 3 Analysis of the Typographic Examinations AY Se eiabis 40 126 Fig 3 17 Passage of a parallel wavefront through a refracting surface L Each ray of light consists of a sinusoid wave The positions at which all sinus waves have the same phasing form wavefronts which move towards the refracting surface on planes vertical to the propagation direction of the light There the parallel wavefro
53. amination A 3 Examination B 2 Difference display 4 Patient and examination data Fig 6 6 Display Compare examinations gt Inthe drop down list Examination B 3 select the examination of which the re sults are to be subtracted the subtrahend e g the corresponding examination of the right eye A graph showing the difference is then displayed below the graph of the second exami nation Example If you select Examination A in the top graph and Examination B in the bottom graph the difference Examination A Examination B is output in the Difference graph User Guide Keratograph 4 UG 70670 0209 en 103 126 6 Pupillometer Software Ay Ge HLHS Here again two indicators can be placed at any position in the graphs Movement of the indicators always affects all three graphs in equal measures 6 6 Pupillometry Camera Image gt Inthe Display menu select the menu item Camera Image The camera image cap tured with the infrared light is displayed as a magnified view ES OCULUS KERATOGRAPH x Patient Examination Display Lens fitting Settings Miscellaneous Print Fig 6 7 Display Camera image 104 126 User Guide Keratograph 4 UG 70670 0209 en AY OCULUS Settings 7 Settings The basic settings for the Keratograph software can be made using the settings gt Select the menu Settings The Change settings page appears Change settings Display units Color scale stepping Date form
54. aminations Cornea clear unobtrusive Horizontal oval or round shades central or slightly decentered when observed under direct ophthalmoscopy Someti mes one value is abnormal 7 5 to 6 5 Distored retinosco pic reflex Scissors effect Severe pla Clear cornea Fleischer s ring at apex base Cone and cone base are clearly visible with direct ophthalmoscopy Decrease in apex cido ring distortion thickness is not visible but can be measured Often one value is abnormal 6 9 to 5 3 Clear scissors effect retinoscopy is difficult to perform Often cornea is still clear apex has become slightly thinner and will eventually decenter Partial or circular Fleischer s ring Yogt Striae parallel striae may be visible 20 125 to 20 30 At least one value is abnormal 6 6 to 4 8 Distinct scissors effect retinoscopy is nearly impos sible to perform Apex has become thinner decentered and is often slightly cloudy Clear and mostly circular Fleischer s ring Yogt Striae are clearly visible Eventually Munson sign will appear 207100 Remarks 207100 to 20 40 At least one value is abnormal lt 5 or not mea sured Retinoscopy is impossible to perform The cornea is often scarred and opaque in the area of the apex Munson sign evident This is eventual end stage of Keratoconus Pre stage early
55. an artificial so called induced astigmatism Depending on the powers needed by the patient this can also be beneficial An additional cylinder correction is not possible with this lens due to the spherical front surface Bitoric compens This lens type has both a toric back and a toric front surface The induced astigmatism that the back of this contact lens would cause is Included on the front surface of the contact lens as a cylinder As the induced astigmatism Is neutralized by the front surface this type of contact lens corrects the corneal astig matism like a spherical contact lens but the toric back surface also allows better sta bility of the lens on the eye to be achieved Due to the neutralization of the induced astigmatism the power of this contact lens does not depend on its rotation incli nation An additional cylinder correction is not possible with this lens type either As the refractive index n is not needed for bitorically compensated lenses the field n and the material selection field are disabled Bitoric Bitoric lenses also have a toric back and a toric front surface The axis posi tions of the two surfaces are independent of each other The back surface torus can thus be determined first purely for fitting purposes and then the necessary front Surface torus and Its axis position can be calculated from the over refraction The calculation of bitoric contact lenses must be done by the contact lens manufacturer there
56. at Language Diopter Abs Normal DMY O German mm C Rel Fine O MDY English O Rel Medium C YMD French Curvature radius Rel Coarse Italian Sagittal Sign of Spanish Step o fs T Tangential P mm separation e C Polish Presentation K Values 3D Image Release default Complete C Diopter Red Green Unlocked Orginal mm Green Red Locked Color table B Shogo sigi ai aeta C Lens measuring Fourier maps Internal R hor R wer C On Dec 5ph added C External C Rflat R steep Off C Irr Sph added Export Print Communication EyeLite Kao C Color C Serial Ring illumination normal bright Contact lens gt Version 1 4r1 7H Fig 7 1 Settings screen After you have made all of the settings described below you can close the screen again with the buttons at the bottom of the screen The following options are available m Use button The present settings are applied and are used until the keratograph software is exited and is subsequently restarted The last settings that were saved are then used again a Save button The present settings are applied and are saved They are thus avail able even after exiting and restarting the keratograph software Cancel button None of the changes are applied The settings that were last saved remain in effect Keratograph Software Version Number The software version of the keratograph software is displayed at the bott
57. at the respective point in time is plotted on the ordinate Y axis The scale of the ordinate can be changed gt Click on the ordinate with the mouse button A selection box appears gt Select the desired scale 4 mm 6 mm 8 mm or 10 mm The graph is resized accord ingly You can also move two indicators 3 to any position in the graph gt Dodo this click on an indicator with the mouse and while holding down the mouse button slide it to the desired position gt Proceed in the same way for the second indicator Ihe corresponding values are up dated accordingly in the data field sect 6 4 3 page 101 User Guide Keratograph 4 UG 70670 0209 en AY Gees 6 Pupillometer Software 6 5 Comparison View of the Pupillometry In addition to the patient and examination data sect 6 4 7 page 700 two pupillometric measurement time scales can be displayed here sect 6 4 4 page 702 Note This view is particularly beneficial for detecting anisocoria unequal pupils Therefore first execut the automatic program Anisocoria test gt First load the examination sect 3 2 page 27 that is to be used as the basis the min uend e g the examination of the left eye gt Inthe Display menu select the menu item Compare Examinations The following tab appears YS OCULUS KERATOGRAPH x 4 Demo Pa SCS moaz Anisokorietest 25 02 02 16 20 Right cin mm m ee OO OO a SO SS 3 25 02 02 16 22 Left gt 1 Ex
58. at the top right 1 Colored A full color surface map is presented The color on the surface corresponds with the assignment to the respective radius of curvature color bar m Red Green The map is shown as a wireframe If you look at this map through red green spectacles you get a truly three dimensional effect Realistic In this map the actual shape of the cornea is displayed when the Exag gerate slider control is slid fully to the left By sliding the slider control further to the right the deviations of the measured cornea from the reference shape are shown exaggerated making it easier for you to diagnose an astigmatism or kerato conus 30 126 User Guide Keratograph 4 UG 70670 0209 en AY BSeggysS 3 Analysis of the Typographic Examinations Curvature In this presentation the height corresponds to the curvature at the re spective point Any differences in curvature of the cornea are therefore more appar ent than in the Realistic presentation To enhance this effect even more you can slide the Exaggerate slider control all the way to the right maximum exaggeration Note The map presented when the Curvature option is selected does not match the actual course of the cornea In this presentation a sohere would appear as a flat surface as the curvature is the same at each point on the surface Each of the above mentioned map types can be rotated to any position using the buttons 2 in the Rotation box
59. box EyeLite A special fitting program from the company MPGE amp E is available for fitting MPG amp E Mu eller Welt contact lenses You can obtain this program free of charge from MPG amp E When User Guide Keratograph 4 UG 70670 0209 en AY Seuss 7 Settings this program is used the fitting rules of the company MPG amp E are applied to generate a suggestion of which contact lenses to use based on the measured corneal geometries gt First install the program EyeLite gt Then open the EyeLite program A dialog box appears for input of a licence code EyeLite Kunden Rechts Links Logbuch Das Programm ist noch nicht registriert Sie k nnen jetzt den Registriercode eingeben Seriennummer DCDEN74D EEE 1 2 Se Lizenzcode 1 Serial number field 3 Settings button 2 Licence code field Fig 7 3 Request for the licence code for the EyeLite software gt Call the company MPG amp E s fitting help desk at the number 04322 750 500 and ask for the free licence code Have the serial number of the EyeLite software 1 ready at hand Enter the licence code into the appropriate field 2 of the EyeLite software Confirm your entry with the OK button Press the Settings button 3 Activate the Topograph tab panel VVUVY The following screen appears Finstellungen Optiker Topograph Lizenz Versionsnummer Standardeinstellungen Database T_ 0 None C Medmont Studio 3 f NIDEK
60. btrahend 70 126 User Guide Keratograph 4 UG 70670 0209 en AY Seuss 3 Analysis of the Typographic Examinations Example If you activate Examination 1 with the top option buttons and Examination 2 with the bottom option buttons the comparison map will be calculated in the same way as for the Refractive Compare map You can also calculate the inverse here i e the difference of exam 2 to exam 1 Select examination 2 with the upper options button and then exami nation 1 with the lower options button to do this The corresponding results will be output in the difference display again in the lower left 6 User Guide Keratograph 4 UG 70670 0209 en 71 126 3 Analysis of the Typographic Examinations AY OewawsS 72 126 User Guide Keratograph 4 UG 70670 0209 en AY Seweuys 4 Contact lens fitting 4 Contact lens fitting Measurement of the corneal thickness geometry enables thorough user support for fit ting contact lenses Inserting a contact lens and checking the fit of the lens can be sim ulated on the computer without having to bother patient gt Select the menu item Lens fitting OCULUS KERATOGRAPH Dat 0 B 11 11 22 Eye Right Exm time 16 24 00 Manufactur Mactan lene z 3 Eccentricity of major meridians Lens Mw compact AS 06 z Degrees peripheral rO mm 7 75 Ecc 0 60 l Toric ro 7 75 fmm 9 20 E Suggestions CF
61. c module without installed APEX r software If the APEX r software is installed the following screen appears B34 HECHT ANPASSUNG Datei Lizenz Tools Einstellungen Hilfe Formstabile ACL ber Endg ltige Bestellliste g Anpasser Hechtvarschlaj 2 Fisaulides Brillenrefraktion Contactlinse ausw hlen Vorschlag errechnet ASCON BIAS KA1 KA4 KERATOKONUS QUADRO seeFree WEICHELINSE spharisch ASWert 7 H 10 7 70 H wpe 24 C Ascon MAC C torisch OKS r Essential Typ B asph rische Multifokal Linse Fig 4 10 Hecht basic module with installed APEX r software gt Select the desired lens gt Finally press the button Fluo image in the Hecht software The Hecht software is closed and the fluo image for the selected contact lens is displayed 82 126 User Guide Keratograph 4 UG 70670 0209 en Ay BSegeysS 4 Contact lens fitting Note To change the geometry data of a Hecht lens you must always first press the Hecht CL button For that reason the respective input fields in the keratograph software are disa bled after a contact lens has been selected in the Hecht software This ensures that a con tact lens selected in the Hecht software can only be modified using the Hecht software As soon as another contact lens suggestion or the manufacturer is selected the input fields are enabled again 4 2 5 Power Calculation of Rotationally Symmetric Lenses The CL Power module is used to calculate the necessary refr
62. changed the fluo image is automatically recalculated m n QOn back toric lenses the refractive index n of the contact lens material determines the degree of the induced astigmatism and thus also the toric effect of the contact lens gt Enter the refractive index of the contact lens material in this field Note When using back toric contact lenses the refractive index n must always be entered man ually It is not saved with the other contact lens parameters in the contact lens database gt Alternatively select the name of the material in the field at the right of the refractive index The appropriate refractive index is then updated accordingly User Guide Keratograph 4 UG 70670 0209 en 4 Contact lens fitting 85 126 4 Contact lens fitting 86 126 AY CHLOS Note The various materials and their corresponding refractive indices are saved in the file C TOPO N MAT TXT in the form Refractive index Material name You can add to this file at any time using a text editor Selection of the Toric Lens Type You can compare different lens types e g back toric or bitoric with respect to their cor rective power gt Choose one of the following three lens types Toric The back of this contact lens is toric for better stability on the eye the front however Is spherical Due to the difference in the refractive index of the contact lens material and the tear fluid the toric back side of the lens causes
63. d gt Click on the Change button in the Zernike Fit Parameter box 1 with the left mouse button The following dialog appears User Guide Keratograph 4 UG 70670 0209 en Reference Shape Diff 0 000048 ck E amp amp E amp E amp amp ff 8 8 amp x Xl x xl Xl IZ 0 002353 IZ 0 001177 iZ 0 002058 Iz 7 0 003493 Z 0 000566 iZi 0 000379 zI 0 000512 Zi 0 000219 IZ 0 000065 iZi 0 000106 IZ 2 0 000022 Zi 0 000064 zi 0 000028 izi 0 000025 Aberrat Coeff 2 3 4 43 126 3 Analysis of the Typographic Examinations AY Sle elie sy Change Zernike fit parameter x substract reference shape Zernike maximum C No Constant 8 0 O Sphere mean r O Topography O Ellipse mean r mean Ecc Ellipse mean r Ecc 0 75 Order Calculate new Cancel Fig 3 20 General settings for the Zernike analysis gt Inthe Subtract reference shape box select the reference shape that is to be sub tracted from the measured height data The following reference shapes are available for selection Sphere mean r Sphere with the mean central radius of the measurement Ellipse mean r mean Ecc Ellipse with the mean central radius and mean eccen tricity of the measurement Ellipse mean r Ece 0 75 Ellipse with the mean central radius and an eccentric ity of 0 75 gt Inthe Zernike maximum box enter
64. d during an examination with the keratograph are subsequently analysed and displayed by the keratograph software In general the results are output as numerical values as well as graphical representations Different display modes are pro vided in the program for the various applications and different types of measurement depending on how the keratograph is equipped whereby you can switch back and forth among the display modes quickly and easily Furthermore the standard information for the individual displays can be customized 1 1 Layout of the Documentation A folder with several different documentation Items is supplied with the keratograph QUICK GUIDE m Measurement procedure in the form of a checklist INSTRUCTION MANUAL m Design and operating concept of the unit Description of all measuring procedures on the Keratograph 4 Basic patient data management instructions All safety relevant advisements for using the Keratograph Attention All safety related information for use of the keratograph are given in the Operating Man ual for the unit only It is therefore imperative that you have read and understood the complete Operating Manual before using the keratograph USER GUIDE Analysis of the examinations by means of different display modes Detailed documentation of the patient data management system m Description of the contact lens fitting program Detailed information about the optional imaging and pupill
65. d in the bottom segment The KI is elevated for keratoconi in particular Sagittal Median value top sagittal Median value bottom m CKI Center Keratokonus Index Similar to the KI the CKI is the ratio of the sagittal radii mean values in the central and in the peripheral ring The CKI is especially in creased for central keratoconi 52 126 User Guide Keratograph 4 UG 70670 0209 en AY SewLews 3 Analysis of the Typographic Examinations sagittal Median value central ring Rmin The RMin is the smallest sagittal curvature radius in the entire range of meas urement The RMin is low for keratoconus m HA Index of Height Asymmetry The IHA is a measure for the symmetry of the height values relative to the horizontal meridian as the axis of reflection Each point of the top area Is compared with a point mirrored on the axis of reflection The mean difference of the absolute height values is generated without generating the mod ulus The IHA is sometimes more sensitive than the IVA User Guide Keratograph 4 UG 70670 0209 en 53 126 3 Analysis of the Typographic Examinations AY Tecni S 54 126 Height Map Measurement minus Reference Shape r 7 7 3mm Ecc 0 67 Rh 8 15mm Ry 7 30mm Ach 5 2 Exz 0 57 IHD Index of Height Decentration The IHD is obtained from the Fourier analysis of height values and reflects their decentration in vertical direction The amount of the prismatic component Is determined
66. ding Bitmaps Export Cancel 2 1 button 3 Including Bitmaps checkbox 2 Cancel and Export buttons 4 Saving destination selection Fig 2 4 Export patient data dialog Normally you enter your preferred data import and export options once in the Settings area sect 2 6 3 page 14 Carrying out the following steps will then be partially omitted for example selecting the destination gt Select the Target 4 you would like for the exported data Note Ideally patient data export takes place via the option Single file U12 The patient data management system software must however be version 2 65 or later gt Activate the checkbox Including Bitmaps 3 if it is presently deactivated gt Press the button 1 to the right next to the Folder box User Guide Keratograph 4 UG 70670 0209 en 2 Patient Data Management AY OBFawsS 6 126 gt Inthe dialog that appears select the folder or the file to which the patient data should be exported gt Confirm your selection with OK or Save gt To export the data press the Export button 2 2 4 3 Importing patient data In case you keep patient data on a USB stick you can import this data The different soft ware versions are compatible as a matter of principle so that you can import data even if they have been exported from a later or earlier version of the patient data management system Note In order to be able t
67. e fitting program via the EyeLite menu item in the Mis cellaneous menu ES OCULUS KERATOGRAPH Patient Examination Lens Check Display Lens Fitting Settings PAES EN mE Start Keratograph Name Demo Imagin ging Test communication Dat o B 1 11 11 Set shutter Set ports Fig 7 6 Calling the EyeLite fitting program Wohlik checkbox An interface to a fitting program of the company Wohlk is presently in the works K40 checkbox The interface can only be used by Care Vision Laser clinic gt Activate the checkbox K40 if applicable 7 1 9 Settings Date gt Select the format for display of the date You can choose any of the following for mats a DMY Day Month Year e g 11 07 2008 MODY Month Day Year e g 07 11 2008 110 126 User Guide Keratograph 4 UG 70670 0209 en AY Beggs 7 Settings YMD Year Month Day e g 2008 07 11 gt Select the sign of separation that you want to appear between the day month and year The default setting here is a period full stop 7 1 10 Settings 3D Image gt Match the grid for the 3D presentation to the 3D spectacles that are being used Red Green The red lens is on the left the green lens on the right m Green Red The green lines in on the left the red lens on the right 7 1 11 Print settings The presently displayed screen can be printed out on a connected printer by activating the Print menu item in the m
68. e apex In the Zernike 2D map center and in the simulated fluo image right the apex position is easier to see as elevation values are used here for the mapping purposes Fig 3 24 Comparison of sagittal radii Zernike 2D and fluo image maps Note As the disease progresses the position of a keratoconus apex generally moves temporally downwards 48 126 User Guide Keratograph 4 UG 70670 0209 en AY SewLuws 3 Analysis of the Typographic Examinations 3 6 Indices On this screen various indices in particular are output which reduce the high quantity of keratograph measurement data to just a few characteristic values A statement about the Shape of the surface of the cornea can be made with the help of these indices gt Inthe Display menu select the menu item Indices The following tab appears E3 OCULUS KERATOGRAPH alx Patient Examination Display Lens fitting Settings Miscellaneous Print Name Demo Patient Exm dat 09 07 96 PatiD 00000000 Dat 0 B fi 1 11 22 Eye Right Exm time fi 6 24 00 Infotext J 150 N Decentration vertical Indices Ecc at 30 lt Curvature 4 3 140 T Ey T T T T T IS 28 ee IVA 0 14 0 54 KI 1 02 rs CKI 1 01 j Rmin 7 36 l IHA 8 5 0 45 IHD 0 005 ABR 0 0 w J AA 65 0 50 ih Horizon 0 60 Vertical 0 52 Keratoconus Level Topogr Progress of Indices Right Current Date 96 ISV IVA KI CKI IHA IHD ABR
69. e left color bar is assigned to the height data Different colors are assigned to the various values of deviation The resolution of the color bar i e which deviations are represented with a color can be adjusted gt Click on the color bar with the left mouse button The following selection dialog box appears 150 300 500 zai Fig 3 37 Scale selection gt Select the desired resolution from the list of options User Guide Keratograph 4 UG 70670 0209 en 63 126 3 Analysis of the Typographic Examinations AY OCHLWHS 3 8 3 Example of a Height Map Application The conventional presentation of keratoconi using sagittal or tangential radii can be ar tificially falsified The position of the apex is often shown at an inaccurate location Clin ical findings in conjunction with fluo images show that the height value map is more realistic he conus apex is always located at the end of the loop like bulge of the contour lines Due to the tilt of the lens on the eye the apex in the fluo image is located somewhat closer to the loop Note In the following example maps the left image shows the map for the left eye and the right image that for the right eye Presentation by means of Sagittal Radii The hourglass shape in the center of the map is an artifact inherent to the display method In the right eye the apex appears to be located nasal and inferior while in the left eye it appears to be located inferior Presenta
70. e values and are displayed To check the data stream the camera image also appears The communication status is displayed in the bottom line Communication OK Error correction only very seldomly needed data transfer Is reliable Communication problematic Errors occur frequently but could always be corrected up to now Communication very problematic Errors occur very frequently and cannot always be rectified even after several cor rection attempts You must use a smaller package size Press the End button to end the communication test Set Shutter Use the slider control to set the shutter speed of the keratograph s electronic CCD camera Shutter 151 4 mi End gt Press the Send button to confirm gt Press the End button to end the operation Set Ports Activate or deactivate the functions 126 126 Free Keratometer test marks Ring Illumination Glare ring User Guide Keratograph 4 UG 70670 0209 en
71. easuring point 2 Measur ing point 2 is shown as a circle The following numeric values are output for these two measuring points Radius Radius of curvature at the measuring point in mm Opt Power The optical power in diopters calculated from the radius of curvature Zone dia Diameter of the circle on which the measuring point lies in mm E y E Meridian Position of the meridian of the measuring point in degrees Color The color assigned to the curvature in the color map When you have defined two measuring points the following measurement differences are also output at the bottom left Radius Radius of curvature at measuring point 1 Radius of curvature at measur ing point 2 User Guide Keratograph 4 UG 70670 0209 en AY Sewuews 3 Analysis of the Typographic Examinations Opt Power Calculated optical power at measuring point 1 Calculated optical power at measuring point 2 Distance Distance measuring point 1 measuring point 2 Other Settings gt Press the Grid button at the bottom right of the color map to display or hide a scaled polar coordinate system gt Press the Num button to display or hide the numeric values for the radii of curva ture or the optical powers in the topography map EF OCULUS KERATOGRAPH Patient Examination Display Lens fitting Settings Miscellaneous Print Last name Demo First name Patent Dat o B 11 11 22 Exm Dat f
72. ed en eget dato dda 1 t1 Layoutort the 1 OC IGT CaN UG Fs cerasastmnsrescseanstiaiiesssesnzeivancisesniettpectninicevincteueenaaieeaneannantectein 1 12 OUI the User GUNE enisinia EEE eee 2 E OWLS O a T a mnenduaunne 2 2 Patent Data Management a seratcesacts cedsesecusescoseetdeencussdtsevostaieseaendsdussebseenctbedtosadoosttieseasecsbcsteuesssivecentcies 3 2 1 Starting the Patient Data Management u ceesssesssessssesssesssesssesssscsssesssesssecsseceseeeseeesses 3 ew ammo Rel Lge MLA Ken N Liles dS eE E S ne error er 3 23 Selecting od 410g 6 Patil serieren ee ee eee eee eee 4 2A Manage pauc gt Asiae eai aE AEEA EEA 5 2 4 1 RENET E D eO 5 2 4 2 018 aisle Paten Caa donssa 5 2 4 3 Iimporing patent or i panes tenon eee eee aaa i 6 As DO 6s 40 Rereene enn ene nPop rCO PRT Pree OREN Oe rere einer eC eee ee ereee 1 2 5 1 BAGUD O I e e E T 8 252 PE CONS IC aha creat tesscosscussepscdavcconscssescianiseeastedcvesetocicasced ioiusssndoeecasbedouauasunndie 9 2 5 3 POA E Oa lt 0 an ent rven au nrEEI TERT none At as eOeESereeO 9 D RUN cece seme etateec ote essed ce cece esate scmerode EE 9 2 6 1 ANE a O ca cee scne maces opeced ssa eS cltstt doce seeedlcessateezststcaciceasteee ade cacuessseeesse 11 26 2 TONGS I E E 13 aeS mm 14 619 8 00 9 Gat a E E 14 2 6 4 EA O e senses cxte ve eate eves ste esata E nee 16 2 6 5 MMM VS o E E A A E E 17 2 6 6 Smartcardreader tab seruran ei 18 2 6 7 ANST e Mec aSec haan tee fhectcaanbb ec kok
73. enter in diopters m Ecc Mean eccentricity of the cornea Pupil dia Pupil diameter in mm m Iris Iris diameter in mm m Apex Radius in mm and dpt h Difference in height between the apex point and a height value on the cornea ina changeable diameter around the apex The height is calculated on the horizontal meridian of the astigmatism with the weighted mean value using the following equation h 2 Temp 1 Nasal 3 gt Change the diameter by pressing the or the button accordingly or enter the diameter directly into the field User Guide Keratograph 4 UG 70670 0209 en 3 Analysis of the Typographic Examinations AY Ge eiab sy 60 126 Note gt The determined height values can be sued for fitting Ortho K lenses 3 7 3 Spectacle power The patient s refractive values can be entered into the individual fields in the Spectacle power box 2 Sph Sphere m Cyl Cylinder always negative Axis Cylinder axis m cvd Corneal vertex distance The corneal vertex power cvd 0 is calculated from these values and is displayed gt Enter the patient s spectacle power values If you change these a confirmation dia log box appears Change the stored spectacle power walues Fig 3 34 Changing the spectacle power values 3 8 Height Map During the mathematical analysis of the measurements the keratograph generates a three dimensional height model of the cornea the so ca
74. enu bar of the keratograph software gt Select whether the screen page background is to be printed out in B W or in Color 7 1 12 Ring illumination settings Note You can only make settings here when the USB option is activated in the Communica tion box gt Select whether you want normal ring illumination or extra bright illumination The bright setting is recommended for examining patients with very dark eyes 7 1 13 Settings Language gt Select the language in which the user interface of the keratograph software Is to be displayed 7 1 14 Release default settings gt Select whether initiation of the measurement is to be activated by default setting Unlocked after the menu item New examination eye has been activated in the Examination menu gt Ifyou select the Locked setting you must press the spacer bar after activating the respective menu item to activate automatic Initiation of the measurement also applies for the menu items New Examination Near vision height and New Exam ination Lid angle Note If the appropriate optional software module is installed for your keratograph this setting Si User Guide Keratograph 4 UG 70670 0209 en 111 126 7 Settings 112 126 AY CHL 7 1 15 Fourier maps settings gt Activate the respective checkboxes if the decentration and irregularities of the spherical part are to be added in the Fourier map presentations
75. es and is thus also available later Cornea group box The keratometric data for the cornea that have been determined by the keratograph are displayed here rO mm Central radii Cor Ast Corneal astigmatism central Axis Rf Axis of the flat meridian Remaining power group box The values for the expected remaining power are shown here User Guide Keratograph 4 UG 70670 0209 en AY OCULUS 4 2 6 Calculating the Power of Toric Lenses The power calculation for toric lenses is basically the same as that for rotationally sym metric lenses sect 4 2 5 page 83 CL power calculation spectacle power Test lens toric cvd 0 EF Tori Sph DJ 5 25 Sph D 5 75 z eh en Cyl D 2 25 Incl 5 Bitoric Axis 5 n 1 415 Boston X0 cvd mm 16 rO mm Comment Cornea Remaining power r fmm oph Cor Ast Cyl Axis Rf a Axis Fig 4 12 Power calculation module for toric lenses However additional contact lens parameters can be set in the Test lens toric box Incl The inclination rotation of the contact lens can be changed here First select the inclination so that the flat meridian of the back of the contact lens matches that of the cornea gt Correct the rotation in the field Incl if this value does not correspond with the ac tual position gt Exit the power calculation module by pressing the Back button After the inclina tion has been
76. es for the following maps Original and Spherical components and m Decentration and Irregularities when the spherical component has been added The right color bar applies for the following maps m Regular astigmatism and m Decentration and Irregularities when the spherical component has not been added Note The color bar that applies for the respective map is shown at the bottom right of that map Org or 3 4 5 Application Example for Keratoconus In a patient with keratoconus the following deviations from maps of healthy eyes can be found to a greater or lesser extent depending on the stage User Guide Keratograph 4 UG 70670 0209 en 37 126 3 Analysis of the Typographic Examinations AY BGs Spherical component opherical equ The minimum radius of curvature Spherical RMin is steeper and is generally below 6 87 mm in the sagittal radius map and generally below 6 93 mm in the tangential radius map The eccentricity value Spher Eccentricity can also exceed the normal value of 0 85 However these two values are inconsistent and cannot be used alone as an Identifying feature for a keratoconus Decentration and Spherical Component The directional axis of the decentration is generally vertical or vertically sloped according to the apex position of the conus and is shown very clearly in the decentration and spher ical component map In healthy eyes the directional axis of decentration is gener
77. f the Fourier Indices The Fourier indices are displayed as numeric values at the bottom left 6 of the screen These provide a quick characterization of the corneal surface Note Pathological values are automatically highlighted in red in the display The following individual indices are output Spherical RMin Minimum radius of curvature of the spherical component Spher Eccentricity Corneal eccentricity calculated from the spherical component Note gt Do not confuse this value with the eccentricity at 30 determined with the sagittal radius measuring method Max Decentration Maximum value and position of the decentration in the De centration map User Guide Keratograph 4 UG 70670 0209 en AY Seuss 3 Analysis of the Typographic Examinations Astigma central Difference in curvature and axis position of the regular central astigmatism Astigma peripheral Difference in curvature and axis position of the regular pe ripheral astigmatism Irregularities Mean value of all deviations in the Irregularities map 3 4 4 Color bars Two color bars are displayed in the Fourier map m The left color bar 8 is the same as that shown in the topography map in the over view screen sect 3 7 2 page 23 Org is displayed in the last line of this color bar The right color bar 3 represents the relative scale is displayed in the last line of the color bar The left color bar appli
78. fferent fittings If more than seven fluorescent images are created then the uppermost icon will be re moved and the one at the bottom will be moved upwards gt Select the desired simulation via the fluo icons gt lo delete a fluo icon click on it with the right mouse button A query will appear to ask if you would really like to delete the image gt Press the Delete button The icons below are moved upwards again Changing the scale of the fluorescent image The display for the fluorescent image simulation can be adjusted similarly to that of the color bars of the maps gt Click with the left mouse button on the color bar to adjust the indicated setting The following dialog appears h 150 O00 300 Fig 4 6 Detail Contact lens fitting Select the maximum color scale value The green shades are distributed from 0 dark green to the value set here light green As a default the value 100 um is selected The selection of another maxi mum value is helpful for example in the case of a keratoconus since the distance range at the edge area of poorly fitting contact lenses distances gt 100 um is easy to recognize In case you select another maximum value as the standard value the note Scale appears next to the color scale gt To finish press the Save button A new fluo image will be created with the changed settings 4 2 3 Selection of the Mode of Display In the top right part
79. fore the field Sph D is also disabled here After selecting the contact lens type press the Suggestion button You are then given the optimal test lens for this contact lens type Note After the Suggestion button has been pressed the contact lens type is not changed i e this function does not suggest a type of contact lens but simply determines the optimal test lens based on the manually selected contact lens type User Guide Keratograph 4 UG 70670 0209 en AY Beggs 4 Contact lens fitting 4 2 7 Calculation of the Power for Soft Lenses Calculation of the power of soft lenses is generally easier as a tear lens is not produced CL power calculation x spectacle power Test lens soft cvd 0 Sph D 5 25 Sph D 5 75 Cyi D 2 25 E cyi D 2 50 H Sysslar AST Axis 5 cvd mm 16 rO mm 8 60 Comment Cornea Remaining power r jmm sph Cor Ast Cyl Axis Rf a Axis ee Fig 4 13 Power calculation module for soft lenses The power calculation module first calculates the powers at a cvd 0 and then transfers the rounded values into the Test lens soft box To calculate the expected remaining pow er of this contact lens the axis position of the spectacle power Is used 4 2 8 Saving and Loading the Fitted Contact Lens gt Press the Back button to exit the Contact lens data screen A confirmation dialog box appears in which the contact lens data are summarized and di
80. fractive display This display 4 enables an evaluation of the optical effect of the cornea anterior surface The focal distance is specified with Snell s law for this whereby the spherical aberration is considered and graphically displayed The difference of the curvature display is clear if the topographical display is compared to a sphere In the Curvature display only one color is displayed since the curvature of a ball is the same across its surface In the Re User Guide Keratograph 4 UG 70670 0209 en AY Seuss 3 Analysis of the Typographic Examinations fractive display the refractive power becomes larger at the periphery since the focal dis tance of the outer region does not match with that of the central region due to the spherical aberration Fig 3 33 Snell s law gt Click in the curvature map or in the refractive map The curvature value and the cor responding refractive power at that location are displayed 3 7 2 Data fields The following values are displayed in the data fields 3 below the refractive map Rh Central horizontal radius of curvature in mm and diopters and its axis position Rv Central vertical radius of curvature in mm and diopters and its axis position Note On the Change settings screen sect 7 7 6 page 708 you can select whether the hori zontal and the vertical radius of curvature or the falt and the steep radius of curvature are to be displayed Astig Astigmatism in the c
81. geometries Here too the appropri ate fluo image can be simulated allowing simple and difficult fits to be conducted in a Structured manner In addition to the Hecht basic module the company Hecht also offers extended software modules With the help of these modules the individual contact lens zones can be defined in more detail m Seefree module m Expert version m Expert Seefree module m Expert Quadro module m Expert Seefree Quadro module Furthermore all of the above mentioned versions of the Hecht fitting program can be upgraded with the APEX r software This module allows he optimal contact lens power to be calculated A personalized fitting contact lens rotationally symmetric toric keratoconic etc to be calculated and Calculation of the final contact lens User Guide Keratograph 4 UG 70670 0209 en AY Sekilbis 4 Contact lens fitting You can also conduct two additional measuring functions with the help of the APEX r software Lid angle measurement sect 3 6 page 49 m Near vision height measurement sect 3 5 page 39 Contact information Hecht Contactlinsen GmbH Dorfstra e 2 4 D 79280 Au bei Freiburg Tel 0761 40105 0 Fax 0761 40105 22 info hecht contactlinsen de Working with the Hecht Basic Module gt Press the button Hecht CL Fig 4 7 page 81 on the Contact lens fitting screen Manufactur MPG amp E MiillerWelt Lens MYY compact AS 06 rO
82. h 4 UG 70670 0209 en 23 126 3 Analysis of the Typographic Examinations AY OBwawsS 24 126 The Change settings sect 7 7 5 page 107 screen on which you can make the desired settings opens 3 1 3 Numeric extremes map The numeric extremes map 2 gives you a quick numeric view of the corneal topography Fig 3 4 Numeric extremes map The minimum and maximum radii of curvature are shown in this map on rings with di ameters of 3mm 5 mm and 7 mm around the topographic center The maximum curva tures are shown in red the minimum curvatures In blue The degree of astigmatism and the corresponding angle position are thus easy to Identify 3 1 4 Keratometric data Detailed examination results are displayed in the bottom section of the screen 3 Keratometric data major meridians perpendicular d 3mm Rh 7 60mm Ry 7 40mm Ast 2 40 Fig 3 5 Keratometric data The location of the two major meridians on the 3 mm ring of the cornea are output In the right section of the chart By definition these are always perpendicular to each other The following measured value is displayed below that User Guide Keratograph 4 UG 70670 0209 en AY BSeggysS 3 Analysis of the Typographic Examinations AA Percentage of the effectively measured i e not interpolated corneal surface Analysed Area The middle section of the chart shows the progression of the curvature on these major meridians from the center 0
83. he contact lens on the cornea Field R L A positive value describes movement to the right and a negative value a movement to the left Field U D A positive value describes an upward movement and a negative value a downward movement Field Incl Contact lens rotation This is the angle between the horizontal and connecting line of both selections A positive value describes a clockwise rotation and a negative value describes counter clockwise rotation 90 90 Fig 4 4 Inclination angle definition The individual fields in the group box Tilt 3 display the tipping of the contact lens on the cornea Field R L A positive value describes tipping to the right and a negative value a tipping to the left User Guide Keratograph 4 UG 70670 0209 en AY Seweeis a Field U D A positive value describes an upward tipping and a negative value a downward tipping 4 2 2 Fluorescent image simulation This display visually outputs the distance values between the cornea and contact lens gt Press the Calc fluo button on the Contact lens fitting screen J OCULUS KERATOGRAPH 4 Contact lens fitting Dat 0 B 11 11 22 Eye Right Exm time fi 6 24 00 Lens MPG M MWC AS 06 r 7 75mm Ecc 0 60 D 9 20mm i a Lens MYY compact AS 06 r rO mm 7 75 l Toric r0 775 H Suggestions MYC AS 06 CFA AS A90 AS 100UV AS 7 85 wohlk perfec 7
84. ically The influence of the corresponding coefficients can be better approximated in this way gt Activate the Reference shape checkbox as required When this is activated the height data of the reference shape are added to the polynomial data A realistic pres entation Is thus possible even when using a reference shape gt If you deactivate the Reference shape checkbox the position and height of the apex are also output In the 2D presentation this point is marked with a black cross Note The height of the apex represents a measure for the severity of the keratoconus The more advanced the keratoconus the greater this height will usually be gt Activate the Diff checkbox as required If this is activated the deviation from the Original data are added to the height data This deviation occurs because the used polynomials are fitted to the original data as well as possible but a deviation still exists The higher the order of the used polynomial the better a fit can be achieved and the lower the deviation will be Note The standard deviation of the original data to the Zernike polynomials is shown after the checkbox in the field Diff Now select the display form in the second step gt Select the option 2D for the 2D display User Guide Keratograph 4 UG 70670 0209 en AY Seegses 3 Analysis of the Typographic Examinations Fig 3 22 Zernike display in 2D gt Alternatively select the option
85. ieaia ence E A 111 KA R 16 E ier oe neces 111 Akl USMS MOMMA ONL SEIS siepi ies sen eune E niee i 111 Akla engs language scessccnsvccte sinc ecpacsetescoteesarceasaviescttedetenscaevaseepavdeveccptiewrtcoewnet 111 7 1 14 Release default SETTINGS sesscissccasicassosaccgssbsccossesavioscesncesgecasscasecaucedaceascisacossnces 111 T EOU a e a A 112 7 1 16 Communication settings eecssscsssecsecssecssecsssesssecssscssecsssecssecsssesstecseesseees 112 ey Mae Ss eS N Seen ere ee Te nen Te eT Tre men Treen mn tte nearer t 112 7 2 1 ATA E e216 ok pO dice eee eee eee ee ener een eee ene ae 112 L2 U EOI aeee A E E A 115 Z3 Choose Contact EENS sseui ee eaae E EEE 115 7 3 1 EO HM Ts GCOC y ress a 116 7 3 2 Editing manufacturer data and lens TYPES 117 7 3 3 Editing individ al contactlens data sosssssssossrispsesossssssirissssss 117 7 3 4 Adding Rigid Contact Lenses sssssssssssssss11111111111rrrinrsrssssssssssssnsesererrnnrrrrnrnnns 117 7 00 Add Saft LENSES acccsccoscsasveactsacvascusviencicintoucteiwedavenstsdsiudesbeecossctsteuauecavesnetemncsnelacts 121 7 3 6 Import and Export of Contact Lens Data eis c nscitha ccidisc cos cdacsasenssieconsciuesss 122 A WA NS sete E 124 8 IWISCONAMEOUS FUNCTIONS esieuscesdeconccusscasegencysies ts3isuasiticnesedactuncdndaavensilwdsvedtnnsstesiediicvesdsnctavcteseasvesent 125 User Guide Keratograph 4 UG 70670 0209 en iv iv AY OCULUS 1 General notes All data that are recorde
86. in eeaeee eaa eaea Er EREE EEE Ei 43 35 5 Zernike coeficient display ssi dcesescecescesnccexectsssncasceariecssissevearneneitenseetoeneeeiciesect 44 3 5 6 Graphical MCS TOA oxsctoscsczesicntcnandeseessusfaasaasabshccdass osscunsdistednsdassennssabtolectdassduantneae tt 46 SO OES TENE E A AAE AE NE E E 49 3 6 1 WOE ae E E 50 3 6 2 POO O O E a namer ta era men este Peet ernest rar rE ene Tet enn 5D 3 6 3 Presentation of the Corneal Eccentricity ceesessssesssesseesseesseesseesesseeeseeen 56 364 HOOD OIC Classification ccees tet coetee secavetbteccdacscostentistceaeceuessccstincnetecaada 56 CO POE oaC se 58 3 7 1 Refracuve display cz eis ieena aieri EE anesse 58 3 7 2 O TEI e et scents acta ses coms se ec eecaedecaesetce tsi secuctauae 59 ITa P ON T ae ee E R 60 O A EE AA A EE 60 3 8 1 PG UN E aa E E E 62 38 2 FV VON EE E E A A 63 3 8 3 Example of a Height Map Application 64 o T EE E E cere errs eee ee era ei 65 3 0 1 Zooming In the Presentation secckasctseseceatsccivcuesiisscesttiasepnehasetcudsscuslaartooscwsdtblec 66 39 2 Determination of an Angle vassccsnctssesssevasesicesitescccucaes secuscesncisseiasbedenenercielcc sien 67 39 0 Determinanon Ofa IS CAICE sss 67 AO ol 2 1h 016149 6 2 ar AE EA E EE EE EERE 68 SPO Diere nce display ossis isie 69 210 2 VCS TING the Meraian Plane sesse e e tac eee neeeneease 69 3 117 Compare CX ACA ONS ss cxcosexstceesscencecs cectsesdesernchossecsseresatetepdesnuetactdeschussenageltSasstctasdestensta
87. in the top left section 9 of the screen sect 3 1 1 page 22 The topography map 7 is displayed below that sect 3 7 2 page 23 The individual components of the Fourier Analysis are displayed as color maps in the right hand section of the screen 1 2 4 and 5 3 4 2 Color Maps of the Components Spherical Component 1 The arithmetic mean of all radii for each ring wave component of the Oth order are shown in this map This mean value can also be interpreted as the spherical portion of the radii per ring The eccentricity of the cornea compared to a rotational ellipsoid can be ap proximated from this Guide For normal eyes this value is below 0 85 User Guide Keratograph 4 UG 70670 0209 en 33 126 3 Analysis of the Typographic Examinations AY CHELU 34 126 Decentralization 2 The wave component of the 1st order is equal to a uniform sine wave which passes through a minimum and a maximum during a rotation on the respective radius ring It represents the tilt between the optical axis of the keratograph and the optical vertex of the cornea Note Note that this function only provides relative values as its arithmetic mean is zero For the wave of each radius ring the position of the minimum value is shown with a white ring and the position of the maximum value is shown with a black ring The different axis positions of the decentration on the individual rings are thus easy to identify Guide For normal eye
88. ine presentation Here however the color bar has a resolution of 0 10 mm or 0 5 dpt Rel Coarse This setting is also more or less the same as the Rel Fine presentation Here however the color bar has a resolution of 0 20 mm or 1 0 dpt Note The selected settings are also output below the color scale 7 1 6 Settings K Value Presentation The settings in this box relate to the presentation of the keratometric data sect 3 7 4 page 24 gt Select whether the central radii Rh and Rv or Rf and Rs are to be displayed in the overview In mm or in diopters gt Deactivate the checkbox Show sign of astigm to display the astigmatism without preceding algebraic sign as a vector If the checkbox Show sign of astigm is activated the following applies m Preceding sign Rv gt Rh inversus Preceding sign Rv lt Rh rectus gt Select whether the horizontal and the vertical radius option R hor R vert is acti vated or the flat and the steep centra radius option R flat R steep is activated are to be displayed 7 1 7 C Lens measuring settings gt Activate the On option if you want to measure the back surface of the contact lenses The additional menu Lens Check with the menu item Back surface appears in the menu bar 7 1 8 Settings Export Using these options fitting programs for contact lenses from different manufacturers can be embedded into the keratograph software Check
89. ing details are also displayed m red blue 4 Ring edges determined by the image processor white black 3 and 5 Cornea and pupil white black cross 1 Center of the pupil Creating an Info Text You can enter a comment or info text at the top edge of the camera image 4 gt Clickin the top area of the camera image with the mouse A dialog box opens Cancel gt Enter the desired comment or info text and press OK to confirm Fig 3 7 Change info text dialog Note The info text is also displayed later when the examination is reloaded 26 126 User Guide Keratograph 4 UG 70670 0209 en AY Sew Lys 3 Analysis of the Typographic Examinations Manual Measuring Function You can measure the distance between any two points in the camera image with this measuring function gt Click the left mouse button on the point in the camera image at which you want the measurement to start The mouse pointer is now shown as a Cross gt Now move the mouse pointer and the distance between the start point and the cur rent mouse position will be displayed in mm gt Once you have reached the end point for the measurement click the left mouse but ton again The arrow head and the associate distance will now be permanently dis played 4 y k p Fig 3 8 Measuring function in the camera image gt To delete all dimensional arrows select the menu item Overview in the Display menu again 3 2
90. is used If you simply want to compare the color presentations of the keratograph with the color presentation of other topographs you should select the setting External You can then match the colors used on the keratograph accordingly To do this gt Open the file TOPO COL in the C TOPO directory with a text editor gt Now enter the number of the color grade in front of the colon from O to 63 gt Enter the corresponding RGB color code after the colon Example 00 252 252 252 0 The RGB code 252 252 252 is used for the color grade 00 Black 0 is used for the color of text 7 1 95 Color scale stepping settings The color scale and thus also the color presentation can be displayed with different color scale steps sect 3 1 2 page 23 User Guide Keratograph 4 UG 70670 0209 en 7 Settings 107 126 7 Settings 108 126 AY Sern Abs Normal With this setting each color always describes the same permanently assigned value In the middle area the color bar has a resolution of 0 20 mm Below 6 6 mm the gradation is 0 4 mm above 10 5 mm the gradation is 6 mm Rel Fine With one of the three relative settings the middle of the color scale cor responds to the mean radius of curvature of the front of the cornea When the op tion Rel Fine is activated the color bar has a resolution of 0 05 mm or 0 25 dpt Rel Medium This setting is more or less the same as the Rel F
91. kbox Enable 4 if the automatic backup should be executed with the settings specified Import Export group box You can enter settings in this group box for import and export of patient data manage ment user interface data Note The settings specified in this tab for import and export of data can be overwritten Only typical settings are entered here gt Select the folder via the folder selection button 1 which should be pre selected as the standard for import or export gt Inthe Format dropdown list 3 select whether import or export should normally occur in one folder or in a single file U12 User Guide Keratograph 4 UG 70670 0209 en 15 126 2 Patient Data Management AY OCULUS 2 6 4 Email tab Settings Default T ext Subject Export from OCULUS Patient data management Body Dear Sir or Madam f Disabled C MAPI C SMTP 1 attached you recieve the examinations of the following patients 2 SMTP Server PO Use authentification Emailaddress o 3 User PO Password 7000 Version 6 0210 Save Cancel 1 Mail connection selection 3 SMTP connection selection 2 Standard text for subject and body text Fig 2 12 Email tab With the three options buttons in the upper part of the tab 1 you can determine wheth er the email connection is active and if it is how the transfer of data should take place gt Activate the option MAPI if an email program e g Microsoft Ou
92. l function again Fig 3 13 Decomposition into two sine and one cosine wave The topography map generated by the keratograph can be broken down into Individual components using a Fourier analysis The original image Is first divided up into individual concentric rings The curvature on each ring is then broken up into the Individual sine or cosine waves gt Inthe Display menu select the menu item Fourier Analysis The following tab ap pears 32 126 User Guide Keratograph 4 UG 70670 0209 en AY Sew s 3 Analysis of the Typographic Examinations E3 OCULUS KERATOGRAPH Patient Examination Display Lens fitting Settings Miscellaneous Deiat 1 9 Lastname Demo E AE First name Patient Dat o B M11122 Exm Dat 09 07 96 Eye Right ae 7 Spherical equ Regular astigmatism Irregularities Ea oo i z A N 6 Fourier Indices Spherical RMin Spher Eccentricity 0 56 Max Decentration 0 21mm 193 Astigma central 0 18mmj2 Astigma peripheral 0 24mm 4 m Irregularities 0 021 h 1 Spherical component 6 Fourier indices 2 Decentration 7 Original topography map 3 Color bar relative 8 Color bar absolute org 4 Regular astigmatism 9 Patient and examination data 5 Irregularities Fig 3 14 Fourier Analysis display The patient and examination data are displayed
93. lled height data This model is the basis for all additional calculations User Guide Keratograph 4 UG 70670 0209 en AY SewVeas gt Inthe Display menu select the menu item Height Map WA OCULUS KERATOGRAPH Patient Examination Display Lens fitting Settings Miscellaneous 4 eo ae Exm dat 09 07 36 Dat o B T1122 Eye Rig S S Exm time 16 24 00 Original Height Map 3 Measurement minus Reference Shape r 60mm Ecc 0 66 frat ccp ml 1 Original topography map 3 Elevation 2 Reference shape 4 Patient and examination data 3 Analysis of the Typographic Examinations Fig 3 35 Elevation display Use of elevation offers the following advantages Elevation provides an exact statement of the true surface figure of the cornea The position of the keratoconus apex in the elevation display corresponds rather with re ality than the position in the sagittal or tangential radial display Elevation provides ample information which can only be determined by additional calculations Elevations can be defined independent of device type as an exchangeable standard Fewer fixation artefacts results when elevation is applied Pseudokeratoconi occur less frequently for this reason Elevation data is the starting point for analyzing aberrations of the cornea surface The height data reveal how much of the cornea would mathematically have to be removed in laser surgery procedures In order to achieve the desired refe
94. llows the image processing to be checked for accuracy and allows you to assess the reflection of the Placido system yourself Press the button again to switch off the ring edges again Press the Pupil Iris button to mark both the edge of the iris and the pupil You can thus check the measurement of the corneal diameter Press the button again to switch off the markings Activate the Ql button at the top left of the camera image Move the mouse to the desired place in the camera image and click the left mouse button A zoomed in view of the section of the camera image around the position at which the mouse is located is displayed in a separate window for as long as you hold down the mouse button Press the right mouse button to cancel the zoomed in view again User Guide Keratograph 4 UG 70670 0209 en AY Be ele hey 3 9 2 Determination of an Angle You can determine the angle between any two lines in the camera image gt Activate the button at the top left of the camera image gt Move the mouse to the starting point of the first line and press the left mouse but ton This point is also the starting point of the second line gt Move the mouse to the end point of the first line and press the left mouse button again gt Move the mouse away from the end point of the first line to the end point of the second line The display of the angle between the two lines is continuously updated as you move the mouse gt Press the
95. meter The reason for this is that a decentration or high corneal aberrations e g three or four wave affect the amplitude and the axis po sition of keratometer measurements Irregularities 5 All remaining wave components are added and are shown in turn as Irregularities in the form of relative values Guide For normal eyes the mean value of the irregularities in the sagittal radius map is below 0 030 mm and In the tangential radius map below 0 141 mm An inverse correlation exists between the irregularity and the best possible corrected vis ual acuity Only those wave components that cannot be corrected by sphere cylinder or prism are displayed in the Irregularities field If these irregularities are big the patient will only get good vision with rigid contact lenses The color map of the irregularities can also be adjusted such that the spherical compo nents are added Any three or four wave aberration is often easier to identify in this map than in the original one The setting is made on the Change settings screen sect 7 1 15 page 112 User Guide Keratograph 4 UG 70670 0209 en 35 126 3 Analysis of the Typographic Examinations AY OCES 36 126 Irregularities Sph Fig 3 16 Map of the irregularities with added spherical components Note The curvature value at any given point can be displayed in all maps by clicking on that point with the left mouse button 3 4 3 Display o
96. mination data 3 Indicator line Fig 6 4 Pupillometry Overveiw Screen 6 4 1 Patient and examination data Infotext Anisocorie test Pointer 2 6 5mm Dat o B fi 1 11 21 Name Demo Pupil Anisokorie Pointer 1 2 7mm Examination A 01 03 02 11 17 00 Right Fig 6 5 Patient and examination data 100 126 User Guide Keratograph 4 UG 70670 0209 en AY OCULUS 6 Pupillometer Software Just like in the overview screen for a topography examination the most important patient and examination data are displayed in this individual map 4 sect 3 1 1 page 22 Last name and first name m Date of birth m Eye examined Examination date and time Additionally the following is displayed Pat ID Patient ID as assigned in the patient data management system Info text The name of the program with which the measurement was performed appears in this box by default Pupillogram or Anisocoria test You can change the text to anything you like by clicking in the field 6 4 2 Scaled down camera image Just like in the overview screen of a topography examination a scaled down camera im age 1 of the examination is displayed However there is no measuring function in the pupillometry and an informational text or comment cannot be entered here The zoom function is activated by default sect 3 9 1 page 66 gt Move the mouse to the desired place in the camera image and click the left mouse button
97. n Import Export gt Fig 7 11 page 116 on the Choose contact lens screen The following screen appears Import Export of contact lens data x Available contact lenses Mark Hetych Aktiv SoffS PRECI PR2 Mark Hetych AS SA bifo PRECI PREK Hetych AS SA 200 PRECI PRE Hetych Aktiv EK PRECI TOPO Hetych Bifo Aktiv PRECI FB Hetych Aktiv KAS PRECI A Hetych Aktiv ITO PRECI BAZ PRECI PRZ PRECI BFB PRECI PREK PRECI C2F PRECI PRE PRECI PRETI PRECI TOPO PRECI A TE PRECI FB PRECI PRETE PRECI A PRECI PR2K PRECI BAZ PRECI PRES 50 PRECI BFB PRECI SK PRECI C2F PRECI PRK10 50 PRECI PRETI PRECI AZ TE PRECI PRETE PRECI PR2K PRECI PRK8 50 PRECI SK Cancel Fig 7 16 Import Export of contact lens data screen All contact lens data that are presently saved on the PC are listed in the list on the left All contact lens data that are saved in the directory selected in the External field are listed in the list on the right Exporting Contact Lens Data gt Inthe External field enter the letter of drive and if applicable the sub directory to which you want to export the data Note To be able to select the sub directory here it must already exist on the data medium gt Press the button Free if necessary to determine how much space is still available on the data medium gt Inthe left list select the contact lens data that you want to export Use the buttons All or None in the Mark box if a
98. niste 70 Contact lens TINO eer r eaa amistad A 73 A A A AE Sn FEN TT VE 73 d CO eE c E EE E er 74 4 2 1 Selecting the Contact Lenses niisiis 74 4 2 2 FIMOFESCENE image SIMULATION scan icsnncznnsscaisurasasccieedenssdinsdsstentndesSesecariasadenetsaeds 77 4 2 3 Selection of the Mode of Display un essences 79 4 2 4 Use Hecnt Basie Modul sesno erence nem 80 4 2 5 Power Calculation of Rotationally Symmetric LENSES eee 83 4 2 6 Calculating the Power Of Toric LENSES eesessssssssesssccsseessecssecsssecssecsseesses 85 4 2 7 Calculation of the Power for Soft LENSES sssssscssssisstisseseiisiesissssissesass 87 4 2 8 Saving and Loading the Fitted Contact LenS 87 Honce nn o E A E E O O E A ATS E E R 89 5T Ordering te lmading Ora essees toe ae ert cere tee net ent eee 89 5 2 Activation and Setup of the Imaging Softwar e cssesssssssesssessecssessssessseessneeen 90 5 3 Loading of Videos or Individual IMAGES eessesssesssessecsseessscssesssecssecssecsecssecesecsseessees 92 5 4 Comparing a Fluo Image Simulation and a Video scieacrcesssessecesseccnsersssersorseaamocneses gg 5 4 1 identification of Images and Videos ssiiiiseesiiirersisiivisssiiisissiiisisicosoiisisressisii 94 5 4 2 Adjusting the CUS DI AY scectsccnsces scesarenvcnssccatnccslcapsahidarticadeatieatibarbeannueancihaeeecied 95 User Guide Keratograph 4 UG 70670 0209 en AY SBE eee O PFPuplometer oo Ware meneame neo ee ne noe nr ene ee 97 6 1 Ordering the Pupillometer SOf
99. nts gt Toenter anew patient in Patient Data Management click New gt Enter the patient s last name first name and date of birth completely in the patient window 8 User Guide Keratograph 4 UG 70670 0209 en 2 Patient Data Management 3 128 2 Patient Data Management AY COLEUS Fatient Last name Demo Save First name Patient Dat o B 07 02 1954 ID Mumber optional Cancel Fig 2 2 Entering patients gt gt gt Optionally you can enter an ID number for the patient To accept the entries you have made click Save The patient you have just entered now appears in the patient list Select this new patient from the patient list and start the Keratograph software 2 3 Selecting existing patients The patient list on the left hand side of the screen displays all previously examined pa tients in alphabetical order gt gt Click Search to quickly find the patient you require from the list Enter the patient s name or the first letter of the name In the Last name field The search can also be done using First name and Dat o B Optionally you can search for the patient by entering his or her ID number assuming that patient was assigned one when first entered Click the appropriate entry in the list to transfer that patient s name to the patient window This also brings up a list of any previous examinations for that patient in the examination window b
100. nts are dis torted ideally to spherical waves which run directly toward the focal point F these are symbolized by concentric segments of a circle around F However this ideal case is rarely achieved because after passing the refracting surface the real wavefronts show a deviation from the ideal spherical waves the difference range is indicated by small squares in the following figure Fig 3 18 Passage of a real wavefront through a refracting surface L The smaller this deviation or aberrations is the higher the quality of the refractive system is whether it be a telescope a microscope the cornea or the refractive media of the hu man eye In general The Dutch physicist Frits Zernike 1888 1966 succeeded in mathematically illustrating the deviation of the real wavefront from the ideal one using a sum of polynomials Each polynomial thereby bears the same name as the aberration it reflects e g astigmatism coma or spherical aberration Zernike polynomials are also referred to as circle polyno mials because they relate to a standardized unit circle and are shown with the help of polar coordinates Mathematically the individual Zernike polynomials are a circular surface characterized by polar coordinates with a power series in radial direction p and a Fourier like series in the direction of the angle In the general equation Z n m n represents the ordinal number of the polynomial in radial di
101. o work with patient and examination data that have been generated with the help of optional software additions such as e g imaging or pupillometry this additional software must be installed on the computer onto which the data are to be im ported Note Ideally patient data import takes place via the option Single file U12 The patient data management system software must however be version 2 65 or later gt Press the Import button below the patients list The following dialog appears User Guide Keratograph 4 UG 70670 0209 en AY OCULUS 2 Patient Data Management m Source C Folder File F dataexport 080610_100859 U12 Ss 1 5 m2 Control unit Patient list Previous examinations Lastname Firstname ae of ID S Date Time Device 4 Demo Astigmatismus 02 05 1968 anterior amp po 0 fi gt 1 25 06 2003 09 43 23 Pentacam R 2 06 2003 09 47 06 Pentacam 2 E ill lll ll S Y O gt Search l Match case Import Cancel 1 button 4 Patient list 2 Previous examinations 5 Select the source of the data 3 Import button Fig 2 5 Import dialog Normally you enter your preferred data import and export options once in the Settings area sect 2 6 3 page 14 Carrying out the following steps will then be partially omitted for example selecting the folder gt Select the option 5 which contains the source data Folder or Single file U12
102. of the display various values can be displayed in table form or the fluo image can be displayed You can select the display mode with the options in the Dis play box The following colors are thereby assigned to the values In the various tables m Red steep meridian User Guide Keratograph 4 UG 70670 0209 en 79 126 4 Contact lens fitting Ay Bers 80 126 Blue flat meridian Grey Interpolated values 1 Eccentricity In the table of eccentricities of the major meridians the eccentricity progression is listed from the inside to the outside A mean value of the eccentricity is calculated and dis played for each peripheral angle The individual central radii of curvature are listed in the left column Note The values at 30 are used to calculate the mean eccentricity 2 Progression of the Sagittal Radii In the table of sagittal radii of the major meridians the progression of the sagittal radii Is listed numerically from the inside to the outside A mean value of the sagittal radii is cal culated and displayed for each peripheral angle The individual central radii of curvature are listed in the left column 4 2 4 Use Hecht Basic Module General Information about the Hecht Software A special fitting program from the company Hecht Is available for fitting Hecht contact lenses This uses the fitting rules of the company Hecht to generate a suggestion of which contact lenses to use based on the measured corneal
103. ography software Parameter settings User Guide Keratograph 4 UG 70670 0209 en 1 General notes A 1 126 1 General notes 2 126 AY CELUS 1 2 Layout of the User Guide The following topics are covered in the individual sections of the User Guide Chapter 1 General notes Chapter 2 Patient data management with more detailed information about the dis play modes in the Operating Manual Chapter 3 Detailed descriptions in relation to the analysis of the topography exam inations Chapter 4 Contact lens fitting instructions Chapter 5 6 Description of optionally available extension modules for the kerato graph Chapter 7 8 Basic configuration of the program and service functions 1 3 Software Version This User Guide describes the following keratograph software versions and the patient data management system a Patient Data Management Version 6 02 Keratograph software Version 1 74 Note The patient data management software version is shown on the Settings screen within the patient data management program sect 2 6 page 9 The software version of the keratograph program is shown on the Change Settings screen within the keratograph program sect 7 page 105 User Guide Keratograph 4 UG 70670 0209 en AY Sehreis 2 Patient Data Management 2 1 Starting the Patient Data Management After you have switched on the PC it first loads the operating system It will then display
104. olor maps the corresponding value at that location is displayed in all three maps 3 8 1 Reference shape To present the height data in the form of height maps an ellipse is used in the program as the reference shape The advantage of this reference shape consists in the fact that is very close to the true shape of the cornea The topography of the reference shape is displayed at the bottom right gt Activate the rm button to use the mean central radius of curvature of the cornea and its eccentricity increased by 0 1 for calculation of the reference shape These pa rameters are ideal for displaying normal and astigmatic corneas and are often used in manual topography programs too gt Alternatively press the rf button to use the flat central radius of curvature of the cornea and its eccentricity increased by 0 1 for calculation of the reference shape This setting is beneficial for displaying keratoconi in particular as the apex position is immediately visible gt Alternatively adjust the radius of the reference shape in the field r and the ec centricity in the field Ecc directly gt Heed the following information about the two parameters r f you enter a value of O here absolute height data will appear m cc f you enter a value of 0 here a sphere will be used as the reference shape After changes are made in these fields all maps are automatically updated immediately User Guide Keratograph
105. olor refractive map sect 3 7 page 58 Height data sect 3 8 page 60 and Lens Fitting sect 4 page 73 gt Select whether you want the radii of curvature displayed as a tangential or as a sag ittal curvature User Guide Keratograph 4 UG 70670 0209 en AY SBE eee Fig 7 2 Tangential curvature left and sagittal curvature right The tangential curvature corresponds to the cornea curvature In the measuring point In this display corneal irregularities become more strongly recognizable The sagittal curvature corresponds to the length of one of the lots angled vertically to the tangent In the measuring point from measuring point until the point of intersection with the optical axis In this display the curvature value is dependent on the Incline in the measuring point and the relation to the optical axis is also important For this reason the Sagittal display represents rather the optical effect of the cornea 7 1 3 Settings Presentation gt Select how areas in the color maps that were not measured are to be displayed Complete Points that were not measured are interpolated and are marked with black dots Original Points that were not measured are not interpolated and are shown as white areas 7 1 4 Color table settings gt Select the color table that is to be used for the color presentations Internal The internal color table used by OCULUS is used m External An external color table
106. om right of the Change settings screen gt Keep this number handy when consulting with OCULUS Service Department em ployees User Guide Keratograph 4 UG 70670 0209 en 105 126 7 Settings 106 126 AY OCHERK Note The keratograph software version has nothing to do with the patient data management system software version sect 2 6 page 9 as these are two completely separate pro grams 7 1 General Settings You make all of the settings described below on the Change settings screen itself In ad dition depending on what software is Installed on your keratograph additional buttons are present with which you can open other screens 7 1 1 Display units settings gt Select whether you want the information displayed as a refraction power in diopters D or aS a radius of curvature in mm r The following formula is used for conver SION purposes D 1 3375 1 m dpt r Note The radius is entered in meters in the above mentioned formula 7 1 2 Curvature radius settings In general the display can be selected between the tangential curvature and the sagittal curvature This setting relates to all displays in which the radii of curvature are output e g Overview sect 3 7 2 page 23 Color topography sect 3 2 page 27 3D view sect 3 3 page 29 Fourier Analysis sect 3 4 page 37 etc It does not however relate to the Keratometer data sect 3 7 4 page 24 C
107. ometric or pupillographic examina tions with the keratograph The pupil size is thereby measured continuously within a cer tain time frame and is displayed on a time basis The pupil is illuminated with infrared light for measurement purposes The pupil size can also also be determined in the dark ness adaption state The keratograph also offers the option of switching two glare sources of different stimulus Intensities on or off thus enabling you to measure the pupil reaction to these glares You can also compare the pupil reaction e g of the right and left eye and calculate differential curves The optional pupillometry is available in the keratogrpah from software version 1 55 on and can be installed for all keratographs from the model Keratograph 2 on From model year approx 1998 and later 6 1 Ordering the Pupillometer Software Note If you purchased the pupillometer software when you bought the keratograph you do not need to order the software again Then simply set up the pupillometer software accordingly sect 6 2 page 98 In the appendix of the Operating Manual you will find a fax order form for ordering the optional pupillometer software If you didn t already purchase it when you bought your keratograph To order the software you will need the serial number and the so called De vice Code of the keratograph gt Take your keratograph s eight digit serial number SN that is printed on the OCULUS label on the power
108. on a ring with a radius of 3 mm in the absolute height data The IHD is elevated in cases of keratoconus Height Map Measurement minus Reference Shape r 7 7 3mm Ecc 0 67 Rh 8 15mm Rv 7 30mm an Ach 5 2 Exz 0 57 ABR Aberration coefficient The ABR is calculated from the Zernike analysis If no abnormal corneal aberrations are present then the ABR 0 0 otherwise the ABR 1 0 or higher depending on the severity of the aberrations KKS Keratokonus Stadium The KKS is based on topometric measurements but fol lows the clinical findings of Amsler s classical staging schema AA Analysed Area The AA gives the area of the corneal surface actually measured and not interpolated as a percentage of the total measuring field User Guide Keratograph 4 UG 70670 0209 en AY SewuLws 3 Analysis of the Typographic Examinations The device compares the measured values with the mean values and standard deviations of a normal population If the 2 5 times the standard deviation is exceeded the measure ments are deemed abnormal and are highlighted in yellow Pathological values which exceed 3x the standard deviation are marked In red gt Click the mouse pointer in the Indices field An information window appears on the screen showing the meanings of the index designations ISV IVA etc Indizes IS Index of Surface Variance Value of curvature Yariation from the mean curvature VA Index of Yerical As
109. on and buttons are available to you on all of this page s tabs The program version of the patient data management user interface is displayed be low and to the right 1 m There are two buttons below and to the left for saving 2 or discarding 3 the changes that have been made All changes are saved or discarded and then the page is closed 10 126 User Guide Keratograph 4 UG 70670 0209 en AY OCULUS 2 Patient Data Management 2 6 1 Main tab Settings Language 3 ail English 2 i Autocasing Optional tems for patient 1 Option Commenti Sanz Option Comment aot ons CC Version 6 02r10 Save Cancel 1 Optional patient entries 3 Language selection dropdown list 2 Autocasing checkbox Fig 2 8 Settings screen Main tab Language group box gt Select the language in the Language dropdown list 3 to be displayed on the pa tient data management user interface page gt Activate the Autocasing checkbox 2 as required If the checkbox is active the first letter of a patient s name and last name is always converted into a capital letter Optional items for patient group box Besides the five standard attributes of first name last name date of birth gender and ID up to five additional attrioutes can be freely defined gt Enter the identifier for the attribute in one of the boxes option 1 to option 5 for in stance Comments To be able to carry out en
110. os 07 96 Eye Right t CS C C xX Reference 1 Radius Opt Power Zone dia Meridian Color Reference 2 Radius Opt Power Zone dia Meridian Color Difference Radius Opt Power Distance Fig 3 10 Color Map large screen with grid and numeric values displayed 3 3 3D display The program offers the option of outputting the surface of the cornea as a 3D color map gt Inthe Display menu select the menu item 3D Cornea The following tab appears User Guide Keratograph 4 UG 70670 0209 en 29 126 3 Analysis of the Typographic Examinations AY OCHE E3 OCULUS KERATOGRAPH Patient Examination Display Lens fitting Settings Miscellaneous Print 5 Name Demo Patient Exm dat 09 07 96 Colored O Realistic Dat 0 B fi 1 11 22 Eye Right Exm time fi 6 24 00 O Red Green Curvature Exaggerate E 4 54 Move Slow Fast Rotation it e e Sagittal Absolut 1 Selection of the type of display 4 3D display 2 Adjusting the display 5 Patient and examination data 3 Color bars Fig 3 11 Display 3D Cornea The geometric ratios of the surface of the cornea can be easily demonstrated to the pa tient in this map The patient and examination data are output in the top left section of the screen 5 sect 3 7 1 page 22 The general mode of presentation can be set using the four options buttons
111. ottom right side Extended patient search Extended checkbox gt Activate the Extended checkbox The screen displays additional search parameters which reference previous examinations for example The procedure is similar to entering a new patient name Patient Last name Fe First name FC Dat o B T r T E Quit Search ID Mumber P W Extended Exam date T Ji Device Eye Type of exam Infotext Result Invert result Fig 2 3 Extended search 4 126 User Guide Keratograph 4 UG 70670 0209 en AY Sew sas 2 Patient Data Management 2 4 Manage patient data 2 4 1 Rename Patient Data Patient data can be changed retroactively after it has been added gt Press the Change button The entry boxes for patient data are now free the cursor jumps to the Last name field gt Change the entries in the individual boxes gt To finish press the Save button 2 4 2 Exporting patient data For example patient and examination data can be exported for forwarding to another clinic gt Select the patient and also one of the examinations in the respective list as required gt Press the Export button below the patients list The following dialog appears Export patient data 4 Target Single file U12 Folder Fdata export O80610100859 U120 eee 1 C Email C Folder C Control unit C Other PeiDats gt Memory required 3 47 MB 3 641 560 Bytes 3 M Inclu
112. pack or on the head of the keratograph and write it on the fax order form gt Open start the Keratograph software sect 3 1 page 22 gt Click on the blue menu bar OCULUS KERATOGRAPH to activate it 3 OCULUS KERATOGRAPH Patient Examination Lens Check Display Lens Fitting Settings Miscellaneous Fig 6 1 Menu bar of the keratograph software gt Enter the four letters lusp into the blank space gt he following dialog box appears showing the Device Code for your keratograph User Guide Keratograph 4 UG 70670 0209 en 97 126 6 Pupillometer Software Ay OCULIS Release Pupillometer Software Device Code 3 2055 Releasing Code Fig 6 2 Dialog box for activation of the pupillometer software Note Make sure that the communication between the PC and the keratograph is working prop erly Otherwise the Device Code cannot be read out correctly Also write this Device Code on the fax order form gt Send the fax to the company OCULUS The company OCULUS will then send you a document with the serial number of the unit the device code and the releasing code activation code for the pupillometer software 6 2 Activation and Setup of the Pupillometer Software If you purchased the pupillometer software later you must first activate it with the re leasing code for your keratograph Note If you already purchased the pupillometer software when you bought the keratograph you do not need to ac
113. poses the data are transmitted as packages which in the event that an error has occurred are transmitted again In the event of an error the data trans mission rate is reduced accordingly User Guide Keratograph 4 UG 70670 0209 en 113 126 7 Settings 114 126 AY GS gt Select the desired data package size from the available options 30 300 and 3000 or enter any package size between 30 and 3000 gt When selecting the package size heed the following information m he bigger the package the less often the data have to be transmitted for the pack age test If errors generally occur only rarely the transmission is faster with this set ting he smaller the package the less data have to be transmitted in the event of an error If a lot of errors generally occur the transmission is faster with this setting Automatic Setting of the COM Port You can automatically determine the parameters for the COM port to which the kerato graph is connected and can take these over into the keratograph software This is condi tional upon the port being correctly set up in the Windows system control panel gt Plug the OCULUS COM Port Detector into the COM port at which the keratograph is normally connected gt Press the Port detect gt button The utility program starts and determines the ap propriate settings Detect Interface for Keratograph 2 ipa a COM1 not available COM Answer No Use detected por
114. pplicable to make an initial selection gt Press the gt Export gt button to export the selected data If one or more of the selected contact lens types already exists in the target directory a confirmation dialog box appears User Guide Keratograph 4 UG 70670 0209 en AY OCULUS 7 Settings The lens type PRECI PR2K exists already at the disk Overwrite lens type All Cancel Fig 7 17 Dialog box Lens type already exists gt Select the desired option m Yes Only the selected lens type is overwritten No The selected lens type is not overwritten All All existing lens types in the target directory are overwritten without further confirmation being asked for Cancel Cancels the export of the contact lens data Note The changes when exporting data are executed immediately after the gt Export gt but ton Is pressed and the respective option has been selected where applicable Importing Contact Lens Data In principle the import of contact lens data takes place in exactly the same way as the export gt Inthe right hand list select the contact lens data that you want to import Use the buttons All or None if applicable to make an initial selection Note To import only those contact lens data that are on the external data medium but are not on the PC press the Compare button in the Mark box Only the contact lens data in question are then marked in the
115. ptured image 9 4 Comparing a Fluo Image Simulation and a Video You can also compare a video or a Single captured image with the fluo image simulation gt Load akeratograph measurement sect 3 2 page 27 gt Select the menu item Contact lens fitting sect 4 page 73 gt Activate the option Fluo image in the Display box of the Contact lens fitting screen to generate a fluo image simulation gt Then press the Video button Instead of the Contact lens fitting screen the stored videos and images are shown as a thumbnail view User Guide Keratograph 4 UG 70670 0209 en 93 126 0 Imaging 94 126 AY Sees Y OCULUS KERATOGRAPH Name Demo Imaging Exm dat 06 05 08 EEA i i FW 13C Vergleichsbild Dae ikiii Eye Right Exm time 14 08 52 lia Lens TECHN MA N r 8 10mm Ecc 0 10 D 10 20mm 16 05 08 12 40 09 Right 16 05 08 12 39 59 Right 16 05 08 12 32 41 Right Fw 13C Vergleichsbild Vergleichsbild zu 12 04 56 Einzelbild 1 16 05 08 12 32 31 Right 16 05 08 12 32 26 Right 16 05 08 12 11 52 Right Video Aufnahme Einzelbild 2 Vergleich mit Spaltlampe v Fullscreen I Details 2 frames Back Keratometer Distance of major meridian and contact lens CL power Sph 0 00 Cyl 0 00 0 cvd 0mm Sph 0 00 Fig 5 7 Fluo image simulation after activating the Video button 0 4 1 Identification of Images and Videos ergleich mit Spaltlampe A
116. r for German health insurance card 2 _ Enable if available Contig 1 Version 6 02r10 Save Cancel 1 Config button 2 Enable if available checkbox Fig 2 14 Smartcardreader tab You can configure a smartcard reader on this index so that you can directly import patient data via the patient s Insurance card into the patient data management user interface First you have to configure the smartcard reader usually only once gt Press the Config button 1 A page appears for you to select the type of smartcard reader you are using gt Select the Enable if available checkbox 2 to activate the smartcard reader 18 126 User Guide Keratograph 4 UG 70670 0209 en AY OCULUS 2 Patient Data Management 2 6 7 Misc tab Settings 1 Update database in a network with GO older than Version 6 0 This option is allowed once in a network environment only Version 6 02r10 Save Cancel 1 Checkbox for managing a database Fig 2 15 Misc tab Patient data management Is implemented in two different versions V2 x and V6 x In principle implementing both versions on the same network should be avoided In any case If the higher technical requirements of the new version V6 x cannot be circumvent ed then the corresponding settings must be specified on this tab gt Activate the checkbox on this tab 1 on exactly one PC with an installed V6 x ver sion gt Make sure that
117. r leaf clover 2Z6 6 Six leaf clover The keratograph performs a Zernike Analysis based on the measured height data for the front surface of the cornea gt In the Display menu select the menu item Zernike analysis The coefficients of the individual polynomials are calculated and output in plain text as well in a graphical display User Guide Keratograph 4 UG 70670 0209 en AY HEUWELS E3 OCULUS KERATOGRAPH 3 Analysis of the Typographic Examinations Patient Examination Display Lens fitting Settings Miscellaneous 7 oS Last name Demo First name Patient Dat o B 11 11 22 amp 8 8 C CUTO Exm Dat 0907 96 Eye Rit Sti CS C C COCC 8 7 6 5 4 1 Zernike Fit Parameter 2 Zernike coefficient 3 Adjusting the display 4 Zernike coefficient Fig 3 19 Zernike analysis display 3 5 4 General settings Customizing the Settings Load settings Save settings 5 Color bars 6 3D or 2D display 7 Patient and examination data 9max 8 0mm Order 8 Zernike Fit Parameter Ref Shape r 7 60 E 0 75 Change O 2D 3D Exaggerate Bo Scale Zernike Coefficients Z Separate Z Vectors All Off All On Display m Position e l e Rotate l e The parameters used to make the Zernike analysis can be adjuste
118. radius rO enter 1 5 for A and O for B dr1 or dr2 Curvature difference of cornea for toric lenses In case the curvature dif ference is constant select the option dr1 constant or dr2 constant If this is not the case then select the option dr1 drO r1 rO or dr2 drO r2 rO This has the effect of transferring the ratio of the central radii to the periphery The individual zones are always linked e g Zone 1 is the area outside of the basic area with the corresponding width Zone 2 is the area outside of Zone 1 User Guide Keratograph 4 UG 70670 0209 en 7 Settings 119 126 7 Settings 120 126 AY Bera gt Note If you only want to define one peripheral zone make sure that the value 0 0 Is en tered in the field b2 For all other parameters of the second zone the same values must be entered as those for the 1st zone m The value in field 01 cannot be set to 0 Examples Rotation symmetrical lens with bevel 0 8 mm larger than central radius b1 constant b1 0 25 dr1 constant dr1 O r2 r0 A B A 1 00 B 0 80 Rotation symmetrical lens with bevel 1 5 times central radius b1 constant b1 0 25 dr1 constant dri 0 r2 rO A B A 1 50 B 0 00 O Cc Om Om Nn lt 5 CO b1 constant b1 0 40 dr1 constant dr1 0 r2 rO A B A 1 50 B 0 00 User Guide Keratograph 4 UG 70670 0209 en AY OCULUS
119. rder Note gt Double click on the desired examination in the progress of Indices to directly load the corresponding examination 3 6 3 Presentation of the Corneal Eccentricity The corneal eccentricity at 30 is displayed graphically in top center section of the screen 1 The axis position of the central radii is taken into account The red axis shows the steeper meridian the blue one the flatter meridian Here too red highlighted numbers in dicate pathological values The mean eccentricities in the two main meridians are dis played below the graphic display of the eccentricity 3 6 4 Topographic Classification The stage of keratoconus development is determined from the combination of several in dices sect 3 6 1 page 50 In addition to the stages attributes such as possible may also be displayed here Classification has been adjusted to the classical Amsler or Muckenhirn stadia as well as possible Nevertheless always bear in mind that the case is topography based and not a clinical classification gt Klick in the field Keratoconus Level Topogr to display a table listing the five levels of keratoconus developed by the company OCULUS along with the corresponding clinical features User Guide Keratograph 4 UG 70670 0209 en AY SeVreis Cor Indices IS KI Eccentri values are normal Retinoscopy No clear light or shadow move ment Hint of scissors effect 3 Analysis of the Typographic Ex
120. rection and m equals the frequency of the angle O per 360 Polynomials in which n is an even number and m 0 are always rotationally symmetric all others are angle dependent User Guide Keratograph 4 UG 70670 0209 en AY OCULUS 3 Analysis of the Typographic Examinations 3 9 2 Summary of the Most Important Zernike Polynomials Angular frequency m Z 4 4 Four leaf clover Z 3 3 Four leaf clover Z 2 2 Four leaf clover 4 2 Astigmatism 4 Z 1 1 Tripping Z 3 1 Coma Z 2 0 Focus Z 4 0 Spherical aberration Ordinal number n User Guide Keratograph 4 UG 70670 0209 en 41 126 3 Analysis of the Typographic Examinations Ay SCHLEWS 42 126 3 9 3 Definitions of the First Zernike Polynomials Zernike polynomials enable mapping errors to be described in the form of mathematical polynomials The individual polynomials each provide the name of the associated map ping error a Z 0 0 Elevation constant central height of the surface a Z 1 1 Tipping 1 in x direction 1 in y direction Z 2 0 Focus respective surface in the form of a conical section em 22 42 Astigmatism a 2Z3 1 Coma m Z 3 43 Three leaf clover Z 4 0 Spherical aberration m 24 2 Category 4 astigmatism m Z 4 4 Four leaf clover 25 1 Category 5 coma m 25 3 Category 5 three leaf clover Z 5 45 Five leaf clover Z 6 0 Category 6 spherical aberration m 26 2 Category 6 astigmatism 26 4 Category 6 fou
121. rence sur face from the original measurement Height data can be shown as absolute or relative values Relative means that the differ ence in height of the measurement and the reference surface are output The absolute sagittal height Pa of a meridian section denotes the difference in height be tween a local point on the cornea and a plane that comes into contact with the cornea in the center User Guide Keratograph 4 UG 70670 0209 en wo wo m an Aa nm M z a No z MN Sagittal Absolut 61 126 3 Analysis of the Typographic Examinations AY OCHLEWS 62 126 Absolut saggital height Fig 3 36 Definition of the absolute sagittal height The sagittal height difference Pp between the cornea and the reference shape can be a negative or a positive In case of a negative sign the reference shape ranges above the cornea a positive sign Indicates that the reference shape ranges below the cornea Sagittal height difference of cornea and reference shape Cornea Reference shape The following individual maps are displayed on the height data screen m Patient and examination data sect 3 7 1 page 22 m Standard topography map sect 3 7 2 page 23 Topography map 2 of the reference shape sect 3 8 7 page 62 Height data 3 as sagittal height differences between the corneal measurement and the reference shape sect 3 8 2 page 63 gt Ifyou click in any of the three c
122. right hand list This procedure is recommended for doing updates in which all existing data on the PC are kept and only new data from external data media are to be added gt Press the lt Import lt button to import the selected data into the PC gt Confirm in the confirmation dialog box if applicable The options are also the same as those for exporting data gt To apply the changes press the Save Quit button to close the Import Export of contact lens data screen Note The changes when importing data are only applied after the Save Quit button has been pressed to close the Import Export of contact lens data screen User Guide Keratograph 4 UG 70670 0209 en 123 126 7 Settings 124 126 AY CHL gt To discard the changes press the Cancel button to close the Import Export of con tact lens data screen Deleting Contact Lens Data You can delete contact lens data both on the PC and on the external data medium gt Select the contact lens data that you want to delete from either the left or the right list accordingly gt Press the Delete button on the appropriate side A confirmation dialog box appears Delete lens type CIBA Focus Tor at the disk No All Cancel Fig 7 18 Dialog box Delete lens type gt Confirm that you want to delete in the confirmation dialog box The options are also the same as those for exporting data Updating the Contact Lens
123. rs OCULUS recommends the code HDX4 MPEG 4 CODEC gt Close the Select Code dialog box gt Apply the setting by pressing the Save button on the Change settings screen SO Miscellaneous Functions Note The functions Start Keratograph and Test Communication can only be executed on units with a serial interface e g Keratograph 2 The Miscellaneous menu contains the following service functions Start Keratograph for serial interface only Restart the keratograph if the communication between the keratograph and the PC is disrupted Click on Start Keratograph The message Turn on keratograph appears Turn the keratograph off and then on again Pyy Then press OK to start the data transfer from the PC to the keratograph This function is also executed in the background every time the examination program is put into operation a Test Communication for serial interface only User Guide Keratograph 4 UG 70670 0209 en 125 126 8 Miscellaneous Functions AY OCULUS gt Click on Test Communication The communication between the PC and the keratograph is tested If a keratograph with a serial interface e g Keratograph 2 is being used this function determines the error status of the PC The number of corrected data packages and the quantity of transferred data are displayed The error rate errors per minute and the recommended data package size are de termined from thos
124. s in the sagittal radius map the maximum barely exceeds 0 43 mm in the tangential radius map barely 1 88 mm The color map of the decentration can be adjusted so that the spherical component is added This map gives a clear presentation of the conus position in which the apex is of ten easier to identify than in the original image The setting is made on the Change set tings screen sect 7 7 75 page 112 Decentration Sph io 5 Fig 3 15 Map of the decentration with added spherical component Regular Astigmatism 4 The wave component of the 2nd order is equal to a uniform sine wave at double frequen cy which passes through two minimums and two maximums during a rotation on the respective radius ring User Guide Keratograph 4 UG 70670 0209 en Ay OGOEWS 3 Analysis of the Typographic Examinations Note Note that this function too only provides relative values as its arithmetic mean is also Zero For the wave of each radius ring the position of the minimum value is shown with a red ring and the position of the maximum value is shown with a blue ring In addition central and peripheral astigmatism are indicated by red and blue lines A red line means a steep meridian a blue line means a flat meridian Experience has shown that the amount and axis position of the central astigmatism based on a Fourier Analysis correspond better with the subjective refraction that the measured central radii of the integrated kerato
125. s started new patient data are permanently searched for in the input file If new data are present they are automatically loaded and the examination program is started After the examination has been concluded the data are saved to the output folder and are available to the external program for further processing gt Activate the HL7 interface by activating the appropriate Enable checkbox GDT For the GDT interface 2 you only select an input folder When the patient data manage ment system is started new patient data are permanently searched for in the input file If new data are present they are automatically loaded and the examination program is Started gt Activate the GDT interface by activating the appropriate Enable checkbox User Guide Keratograph 4 UG 70670 0209 en 17 126 2 Patient Data Management AY OCULUS Default pat For the Default pat interface 3 you do not need to make any inputs except for in the checkbox lgnore ID gt Activate this checkbox if the patient ID supplied by the external program is to be ig nored No other inputs are necessary Every time the patient data management system is started a Default pat file is searched for in the installation directory for the connected devices When this file is present it is analysed accordingly and the examination program is start ed with the patient data that are stored there 2 6 6 Smartcardreader tab Settings Smartcardreade
126. splayed again ph Should the selected contact lens data and refraction data be stored E New CIBA AIRAQUA r 8 60mm D 14 20mm Sph 5 75 Cyl 2 50 Soft Store Back Fig 4 14 Confirmation dialog box for saving the contact lens data gt Press the Back button to resume the contact lens fitting process and e g to select a different contact lens gt Press the button Keep old data to exit the contact lens fitting program without sav ing the selected contact lens gt Press the button Store new data to save the contact lens and the power data When you have saved the contact lens fitting data for the patient they are automatically loaded the next time the contact lens fitting program is called up The data fields thus now contain the data for a fitted contact lens and not just a recommendation Therefore the blue highlight bar does not appear in the list of suggested lenses gt Press the button Calc fluo to re generate the fluo image This is not saved along with the contact lens data User Guide Keratograph 4 UG 70670 0209 en 87 126 4 Contact lens fitting AY OBwawsS gt If you then change the contact lens and power parameters a confirmation dialog box appears when you exit the contact lens fitting program gt Decide whether you want to save the new data or whether you want to keep the old data gt Which contact lens data and retraction data should be stored boat Old TECHN MC N r 75mm Ecc 0 6
127. t settings COM not available COM4A Answer 126 COMS not available Port COMA COMB not available speed 460 600 Baud Test COMA 129 126 126 460 800 Baud Rootmode Handshake Result COMA 460 300 Baud Bootmode detection BRO pacitacurtviiutactexs Time 1160ms Result Bootmode Handshake Fig 7 8 Output of the utility program gt Press the Use button to take over the port number data transfer speed and boot mode settings for the respective Interface into the system settings Note Searching is only done in COM ports COM1 through COM6 Higher COM port numbers COM7 COMS etc are not detected If the utility program was unable to find the COM Port Detector the following dialog box appears User Guide Keratograph 4 UG 70670 0209 en AY OCULUS 7 Settings Fig 7 9 COM Port Detector error dialog gt Press the Search Port Address button to search for the Com Port Detector in the COM ports 1 through 6 When a functioning COM port has been found a number is output for this in re sponse gt Configure this COM port in the Windows system control panel 7 2 2 USB Port Change system settings Mode Interface Online File Clipboard
128. t the setting Normal if possible If you have to select the setting High or Maximum for technical reasons for meas urements done with the Placido ring illumination switched on Glare the illumination must be switched off briefly The causes the Placido illumination to flimmer during the glare process This does not however apply for the less intense glare inner ring User Guide Keratograph 4 UG 70670 0209 en 99 126 AY CHLIS 6 Pupillometer Software Note Changes made to the brightness are permanently stored and therefore only need to be made once The selected brightness has no effect on the serviceable life of the camera as only the exposure times are changed 6 4 Pupillometry Overview Screen All analysis information is summarized in the overview screen to give you a quick over view of the measured pupillometric data YS OCULUS KERATOGRAPH Patient Examination Display Lens fitting Settings Miscellaneous 5 Name Demo Pupil Exm dat 25 02 02 Pat ID 00000000 Dat 0 B IREL Eye Right Exm time 16 17 Infotext Pupillogram 4 upil diameter Pointer 1 1 Minimum 3 5mm Pup 5 9mm Mean 5 3mm Time 6 4s Maximum 5 9mm e 0 2mm Stan dev 0 548 y 0 0mm Display X Pupil curve X Pos l Y Pos X Pupil edge Difference r Time dif 44 8s Slope Velocity 0 054mm s Ea 2 E m aaa H E 3 B 1 Scaled down camera image 2 Time scale tis 4 Data field 5 Patient and exa
129. ta only Including Bitmaps 4 Save Restore 1 1 3 Backup director F data backup IE Free 937 66 MB 983 203 840 Bytes 2 Cancel 1 Restore button 4 Save button 2 Display free storage space 5 Backup data selection 3 Backup folder and button Fig 2 6 Backup dialog gt Select whether all of the data or only changed data should be backed up Note The patient data management user interface internally selects all backed up datasets Se lecting the option Changed and new data only only backs up those datasets which were not saved during a previous backup gt Select whether the examination data should be backed up including camera images Note If the bitmaps are not saved too then the camera Images captured during the examina tion can no longer be displayed after the data from this data backup have been restored gt Press the button to the right next to the Backup directory box 3 gt Inthe dialog that appears select the folder to which the data should be backed up gt Confirm your selection with OK User Guide Keratograph 4 UG 70670 0209 en AY OCULUS 2 Patient Data Management gt To back up the data press the Save button 4 The previously selected data will then be backed up to the corresponding folder 2 5 2 Reconstruct data If a loss of data occurs the data from a previous backup can be imported again into the patient data management user interface
130. ter the four letters lusm into the blank space gt he following dialog box appears showing the Device Code for your keratograph Release Option Imaging x Device Code 3571126 Releasing Code Fig 5 2 Dialog box for activation of the imaging software User Guide Keratograph 4 UG 70670 0209 en 89 126 5 Imaging Ay BeeraS Note Make sure that the communication between the PC and the keratograph is working prop erly Otherwise the Device Code cannot be read out correctly Also write this Device Code on the fax order form gt Send the fax to the company OCULUS The company OCULUS will then send you a document with the serial number of the unit the device code and the releasing code activation code for the imaging software 9 2 Activation and Setup of the Imaging Software If you purchased the imaging software later you must first activate it with the releasing code for your keratograph Note If you already purchased the imaging software when you bought the keratograph you do not need to activate the software gt Open the imaging software activation dialog box in the manner already described sect 5 1 page 89 gt Enter the release or activation code that you received from the company OCULUS into the Releasing Code field gt Confirm your entry with the OK button Finally you must set up the imaging software The necessary steps for doing so are done on the Settings screen gt
131. the entire contact lens The results are displayed in different fluorescent shades of green The data for the contact lens used is output in the center above the display User Guide Keratograph 4 UG 70670 0209 en 4 Contact lens fitting AY CHELU Movement and rotation of the contact lens gt Click with the left mouse button in the fluorescent image at any location and hold down the mouse button The edge of the contact lens is shown in red Lens PRECI PRETI r 90 7 60mm Ecc 0 40 D 9 30mm gt Move the contact lens within the permitted area A dialog confirmation box appears in which you are asked whether the lens is to be moved Toric contact lenses can also be rotated at the center gt Click the fluorescent image close to the white markings and hold down the mouse button The connection of both selection points is shown in red Lens PRECI PRETI r 90 7 60mm Ecc 0 40 D 9 30mm gt Rotate the contact lens A query appears asking whether the contact lens should be turned 78 126 User Guide Keratograph 4 UG 70670 0209 en AY Seuss 4 Contact lens fitting Even after moving and rotating the fluorescent image will be calculated and displayed with the new position of the contact lens The current position of the lens is displayed in the group box Position The previously created fluorescent image simulations can also be accessed via the above right fluo icons max 7 images in order to quickly switch between di
132. this checkbox is not active on any other PC which has version V6 x of the patient data management user interface Installed This ensures that the database is automatically adjusted if another PC with the older pa tient data management V2 x is installed User Guide Keratograph 4 UG 70670 0209 en 19 126 2 Patient Data Management AY OewawsS 20 126 User Guide Keratograph 4 UG 70670 0209 en AY Begs 3 Analysis of the Typographic Examinations 3 Analysis of the Typographic Examinations The keratograph software provides various ways of displaying the results of topographic examinations on the screen In this chapter the individual displays will be described in series In which they can be selected in the menu Display Most of these display options are composed of different individual displays These indi vidual displays are described in the sequence that they appear in the respective display option The description of further display options which contain the same individual dis play references the corresponding sub chapter where you will find the description of the individual display A printout of the screen page that is being displayed can be generated with the Print function in the menu bar at the top right Note The background of the screen can be shown in while for the printout sect 7 7 77 page 111 User Guide Keratograph 4 UG 70670 0209 en 21 126 3 Analysis of the Typographic Examinations Ay SCHLUSS T3
133. tion Fig 3 3 Color topography map The measured local radii of curvature are assigned a color in this map The exact assign ment can be seen on the corresponding color bar 1 Areas that were not measured are interpolated by the keratograph software and are shown with black dots 5 If you select ed the option Original on the Change settings screen the areas that were not meas ured are shown as white areas sect 7 1 3 page 107 By selecting a specific point in the map 3 with the left mouse button the value at the selected position is displayed directly Below the color bar the following information is provided The data is presented as a refractive power in diopters or as radii of curvature in mm The data is presented as tangential or sagittal radii of curvature Absolute assignment of colours to the values display Absolute ascribes each color a fixed assigned value Relative assignment display Relative assigns the same color to the mean value as with absolute assignment Every color however is assigned a value which is variably defined with the selected increment The selected increment is output as a numeric value in front of the unit of measure mm or diopters You make these settings on the Change settings screen in the Color scale stepping box sect 7 7 5 page 107 Adjusting color bar settings gt Click with the left mouse button on the color bar to adjust the indicated setting User Guide Keratograp
134. tion by means of Tangential Radi This method exhibits the same problems as those in the sagittal radii presentation but often provides clearer results 64 126 User Guide Keratograph 4 UG 70670 0209 en AY SewLuws 3 Analysis of the Typographic Examinations Elevation display The apex position on both sides is located at the temporal inferior pupillary margin Both are in very good agreement with the clinical findings ophthalmoscopy in regressive light and the fluo image Simulated Fluo Image Right Shows lens contact in the apex area temporal and inferior to the pupillary margin as well as nasal and superior Left Snows apex contact in the temporal temporal inferior area of the pupillary margin and nasal at the 9 10 o clock position 3 9 Camera image gt Inthe Display menu select the menu item Camera Image User Guide Keratograph 4 UG 70670 0209 en 65 126 3 Analysis of the Typographic Examinations Ay Tede S 4 66 126 BOE Patient Examination Display Lens fitting Settings Miscellaneous Print Pupil lris _ 2 1 Camera image 3 Rings button 2 Pupil Iris button 4 Buttons for conducting the analysis Fig 3 38 Presentation of the camera image The camera image of the measured eye is shown in original size in this presentation Press the Rings button to display the ring edges determined by the image process ing software in the camera image This a
135. tivate the software gt Open the pupillometer software activation dialog box in the manner already de scribed sect 6 7 page 97 gt Enter the release or activation code that you received from the company OCULUS into the Releasing Code field gt Confirm your entry with the OK button The pupillometer software is now ready for use gt Open the menu Examination The new menu item Pupillometer is now present here 98 126 User Guide Keratograph 4 UG 70670 0209 en AY OCULUS 6 Pupillometer Software 6 3 Setting the Camera Brightness The keratograph s infrared illumination differs from unit to unit The software can there fore be adapted to the differing brightnesses Note The brightness can only be changed in the Overview screen or after a pupillometer ex amination has been loaded m Make sure that a connection to the keratograph has been established Similar to the process for activating the pupillometer software type in the letters lusP i e I u s in lower case and P in upper case i e capital P Shift p Note When activating the pupillometer software you enter all letters in lower case but when setting the camera brightness the final P must be entered in upper case capital letter Select the desired camera brightness in the dialog box that then appears Pupillometer Settings Es Brightness Maximum Fig 6 3 Selecting the camera brightness gt Selec
136. tlook is installed on your PC and if the data should be sent using this program gt Activate the option SMTP if no email program is installed on your PC but you would still like to send the data via email In this case additional entries are neces sary in the SMTP group box Default text group box gt Enter the text in the Subject and Body 2 boxes which should normally be pre entered when email is sent You can adjust this text before email is actually sent e g particular to patients or examinations SMTP group box In case no email program Is installed on the computer several entries must be made here to send emails gt Contact your system administrator if you have questions about the individual en tries 16 126 User Guide Keratograph 4 UG 70670 0209 en AY OCULUS 2 Patient Data Management 2 6 5 Interface tab Settings HL Input folder P Output folder False a Enable 2 GDT Input folder ae Enable 3 Default pat Input folder a Ignore ID Version 6 02r22 Save Cancel 1 Settings for HL7 3 Settings for Default pat 2 Settings for GDT Fig 2 13 Interface tab Use this tab to enter the folder for different interface types and to activate or deactivate them The interfaces are used to read in patient data from other systems HL7 For interface HL7 1 you select both the input and the output folder When the patient data management system I
137. tries for the newly defined attributes proceed as follows gt Click with the right mouse button on the patient list and open the associated context menu gt Select the desired attribute e g Comments User Guide Keratograph 4 UG 70670 0209 en 11 126 2 Patient Data Management 12 126 AY See ue Patient list F i _ Lastname Firstname D ema J e Pes te et Pel te n Resize columns Lastname Firstname Date of birth ID comment Comment Commenta Comment CommentS ol 23 0 Keratoconus 02 0 Demo Keratoconus 05 01 The context menu will close and the attribute Comments will also be displayed in the upper part of the entry boxes for patients 1 as well as in the patient list 2 FY OCULUS Patient Data Management M Patient Fune Last name Demo New ed First name jAstigmatismus Change Dat o B 7 081976 Search ID Number high chamber angle Comment pn 1 Patient list Previc Lastname Firstname Date of birth ID Comment 2 Astigmatismus 02 05 1968 anterior amp posterior Demo Astigmatismus 05 09 1966 anterior amp posterior gt Demo Astigmatismus 07 04 1976 high chamber angle Fez D emo
138. xamples Fig 3 26 Normal eye left and astigmatic eye right Fig 3 29 KC stage 2 3 left KC stage 3 2nd fro left KC stage 3 4 2nd from right and KC stage 4 right Just like on the overview screen the curvature map 2 is displayed below the patient and examination data on the right hand side sect 3 7 2 page 23 3 6 1 Indices The following indices are output 7 User Guide Keratograph 4 UG 70670 0209 en AY SeuLuwsS 3 Analysis of the Typographic Examinations m SV Index of Surface Variance Standard deviation of the sagittal radii of the meas ured eye from the mean value mean sagittal radius The ISV is elevated for all ir regularities of the corneal surface scars astigmatism deformations caused by contact lenses keratoconus etc m IMA Index of Vertical Asymmetry The IVA is the mean value of all differences and represent a measure for the symmetry of the corneal radii relative to the horizontal meridian as an axis of reflection The difference of the sagittal radius of each point in the top segment is generated with the sagittal radius of the point offset by 180 in the bottom segment The IVA is elevated for skewed astigmatism axes for kerato conus or limbus ecstasia User Guide Keratograph 4 UG 70670 0209 en 51 126 3 Analysis of the Typographic Examinations AY OCHE Kl Keratoconus index The KI is the ratio of the sagittal radii mean values in the top an
139. ymmetry Value of curvature symmetry comparison of the upper and lower area Kl Keratoconus Index Increases with severity of keratoconus Center Keratoconus Index Increases with severity of central keratoconus Minimum Sagittal Curvature Smallest sagittal curvature in the measured area Index of Height Asymmetry Value of height data symmetry comparison of the upper and lower area Index of Height Decentration Value of the decentration of height data in vertical direction Aberration coefficient alue of the aberrations of the cornea calculated with Zernike Analysis Analysed Area Size of effectively measured area of the cornea Fig 3 30 Indices information window The following limits apply ISV gt 3 gt 41 Rmin lt 6 71 lt 6 71 IHD gt 0 014 2 0 016 3 6 2 Progress of indices If the individual examinations have already been calculated in the past all previously de termined indices are listed for both eyes in the bottom section of the screen 4 The in dices of old and new examinations of both eyes can thus be directly compared at a glance If more than five examinations per eye are available a Windows slider control appears User Guide Keratograph 4 UG 70670 0209 en 55 126 3 Analysis of the Typographic Examinations AY BGCuawsS 56 126 with which to examinations that are to be displayed can be selected The presently loaded measurement is marked with a blue bo

USER GUIDE System for measuring and analysing the cornea

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