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User Manual Automated Perimeter

1. Figure 69 Overview Print settings dialog The default display returned to at any time by clicking on the Defaults button presents six B amp W graphical exam images and the standard set of statistical summaries as shown in Figure 70 Note that if you have ticked Always display the External ID on the Configure tab from Preferences the external ID will be included in the printout The set of six buttons grouped as three rows of two buttons allows for selecting the display parameters for any of the corresponding six graphics Click on the top left button Clear the Shaded Greyscale checkbox then click on the Apply button The Preview window will be re drawn with the top left graphic now showing a standard colour map display You might like to explore changing the parameters for the other graphics Whatever you set up here becomes the default for subsequent Overview prints so if the standard display does not suit your practice you can change it here at any time Medmont Automated Perimeter 113 Printing the Exam Results Figure 70 Print preview for an exam Overview Print The checkboxes in the Common Settings grouping provide some additional options Checking the Non Linear Scaling and or Numeric Tick Marks checkboxes will make these changes but the result can tend to crowd the display somewhat By default there are no attributes assigned to an Overview Print so checking the Attributes checkbox will make
2. The Perimeter Test Control Window With Medmont Studio running on the Home tab click Perimetry Exam to start the Test Control Figure 6 shows a typical initial test control window including the video Eye Monitor Figure 6 The Test Control screen with Eye Monitor The window will appear full screen overlaying the Medmont Studio window Medmont Automated Perimeter 23 Testing a Patient Note that if the Test Control window is full screen it will completely hide the Medmont Studio window However the Studio window still exists and is completely independent of the Test Control window However the new Test Control window is dependent on Medmont Studio so closing Medmont Studio will also close the Test Control You can move between these windows using the Alt Tab keyboard combination or by selection from the Windows Task Bar The window shown in Figure 6 is a representation of the perimeter It shows the set of light points that make up the test field defined in the selected Template Each light point in the field is shown as a small black circle containing a blue number These are the light points included in the field Light points not in the test are shown as light grey The number in each circle is the starting exposure level in decibels and 1s based on either the patient s previous exam or an Age Normal Hill of Vision distribution The green light points are arranged in concentric circles with radii of 1
3. The Text option on the Edit tab changes the cursor to allow you to place a text annotation on the image Click at the location that you want the anchor for the annotation to be placed The Text Annotation dialog see Figure 57 is then displayed allowing you to enter the text Eda Annotation Font Arial Bold 12 Point 5 Background o Transparent TetCor Q Text Alignment Left d Vertical Position Top x Save as default Cancel Figure 57 Text Annotation Dialog Callout Annotations The Callout option on the Edit tab changes the cursor to allow you to place a text callout annotation on the image This consists of a text label and line pointing to the selected anchor location Again a dialog is displayed to allow you to enter the text for the annotation Ruler Annotations The Ruler option on the Edit tab allows you to make an angular measurement in radians between any two points on the test result Shape Annotations The annotation tools allow you to define seven types of shapes on your exam images these are shown in the Studio User manual and are 1 Circle Annotation Ellipse Annotations Rectangle Annotation Square Annotation oo ee Curved Area Annotation Medmont Automated Perimeter 97 Analysing and Viewing Exam Results 6 Freehand Area Annotation and 7 Polygon Area Annotation Click on the desired shape tool from the Edit tab Move the mouse to the image pane the
4. Callout Showifselecte Callout Settings F Save as default Cance e oK Figure 58 Edit Shape Annotation This dialog allows you to choose the colour style and line width of the shape You can also add a callout to the shape that allows you to associate text with the shape The Callout box allows you to select the option that controls the visibility of any text associated with the shape Select the Show Medmont Automated Perimeter Analysing and Viewing Exam Results always or Show if selected entry to enable the Callout Settings button and then click on this to display the text annotation dialog see Figure 57 to edit the text and display properties Locking Annotations Once an annotation has been created it can be locked meaning that it cannot be altered or repositioned until it is unlocked This is to avoid accidently moving or otherwise altering an annotation while left clicking on the exam data to view critical readout data or otherwise navigate around the image data Once you have selected the annotation you can change the status of the locking mechanism in 2 ways 1 Directly on the annotation itself Right l le Select click to bring up the annotation menu and F select Lock to toggle the current status of M Pan the lock 2 Reset View 2 From the menu Select Annotate gt Selection gt Lock to toggle the current I Lock status of the lock A oS Delete Annotation The loc
5. Now when a point completes its value 1s compared with the age normal value for that patient If the difference is greater than 6 dB then the set of this point s neighbours are automatically added to the test field and will be subsequently tested Thus a suspect isolated point will automatically cause its neighbours to be examined If these neighbours are also outside the age normal difference they will be extended in turn This will continue until either a set of border points are discovered that are within the age normal difference or either the outer boundary setting see below or the edge of the perimeter is encountered This functionality also applies to test template boundaries and a suspect on a boundary will automatically extend the boundary to the perimeter limits With this checkbox ticked and without some limit a patient with a below age normal hill of vision would progressively have the field extended until all light points available are included in the test To prevent this you can specify an outer boundary in degrees using the Outer Boundary spin box With this set propagation will progress outwards to include this boundary but no further Retest Abnormals A point is considered abnormal if three conditions are satisfied 1 It deviates by more than 6 dB from the mean of its neighbours Medmont Automated Perimeter 35 Testing a Patient 36 2 The variation within the neighbourhood is reasonable for thi
6. Selected list Medmont Automated Perimeter Analysing and Viewing Exam Results Arrange Attributes M700 Exam x J Show Undefined Attributes Select the attribute s to be displayed Available Selected Sort IOP k Fixation Losses False Negatives False Positives Fluctuation ____ HoV F Level p HoV Slope t Overall Defect Pattern Defect Lens Sphere Lens Cylinder Lens Axis Trials Figure 51 Arrange Attributes dialog The up and down arrows on the right allow for changing the order in which the selected attributes are displayed The top item will be the first attribute displayed Selecting an attribute in the Selected list and then clicking on the up arrow will move that attribute towards the top of the list Clicking on the Sort button will sort the column alphabetically Some statistics are not applicable to all exam types There will also be some pre Medmont Studio exams that will be missing the later statistics These attributes are normally shown in italics with no value By un checking the Show Undefined Attributes check box these particular attributes will be automatically removed from the list Section Tab The Section tab shown in Figure 52 can be displayed for any shaded or colour data view see Plan View on page 84 It displays a graph of a 2D slice through the data with eccentricity in degrees for the horizontal axis When the tab is selected a section line is displayed on the m
7. a false positive error is recorded The rate of these false positive presentations decreases during the course of the flicker test ee o Table 5 Relationship between eccentricity and flicker rate The test field used for the Flicker Test extends to 22 eccentricity Full Test This test uses a full field of 50 It is normally recommended that either a Fast Threshold or 3 Zone test strategy be used with this test to minimise the test duration Glaucoma Test The Glaucoma field is a variant of the central 30 field and has an extension to 50 on the nasal horizontal meridian This field could be used to follow progress of a glaucoma field defect as an alternative to continuing with using the central 30 field Macula Test The Macula field covers the central 10 and has extra test points located at 1 from fixation on perimeters so fitted Medmont Automated Perimeter 55 The System Test Templates Neurological Test An option available on the M700 is a special test designed to quickly evaluate neurological visual fields Normal full field tests on patients with quadrantal or hemianopic defects will spend a lot of time testing points which the patient cannot see This significantly extends the test time and creates unnecessary stress for the patient This test uses a full 50 field like the Full Test but with Test Inside Not Seen Regions turned off see Test Inside NOT SEEN Regions on page 34 The tes
8. 3 6 10 15 22 30 40 50 60 70 and 80 A graphic in the lower right hand corner provides a key to the ring radii For perimeters so fitted the red light points are similarly arranged in concentric circles with radii of 0 2 4 5 8 5 12 5 18 5 and 26 The 1 through 50 rings are referenced to the central Fixation Point while the 60 70 and 80 rings are referenced to the left and right offset fixation points respectively Based on the selected eye to test the current Blind Spot is shown as a grey circle containing the white letters BS The controls and text groupings in the left hand pane provide for the test setup and monitoring and are described in Controlling a Test in Progress on page 37 Preparing the Patient 24 In order to produce good quality and accurate results some precautions should be followed in positioning the patient correctly While these are well known and standard practice for automated perimetry examinations we here reiterate the most important points as they apply to the Medmont Automated Perimeter Taking some care in positioning the patient and ensuring he or she is comfortable and aware of what will happen reaps rewards in consistent and valid test results Medmont Automated Perimeter Testing a Patient The patient needs to understand that the nature of the test is for her to report what she sees peripherally while her gaze remains fixe
9. 82 Perimeter Test Tool Green LED Group display Perimeters fitted with red light points can also be tested by selecting RED under the LED Groups option At any time the practitioner may adjust the intensity of the illuminated light point by adjusting the Intensity value The intensity value may be adjusted by pressing the up and down arrows next to the Intensity value field The address and number fields are for engineering purposes only and should be noted down in the case of a faulty light point Service For servicing and repair please contact your local agent to advice on suitable and qualified providers Medmont will make available on request to the service provider circuit diagrams components parts lists and instructions etc as required 130 Medmont Automated Perimeter Troubleshooting 19 Troubleshooting This section is a guide for the user to identify describe and remove certain errors associated with unusual circumstances and or rare external events If the actions described do not fix the problem do not attempt to repair the device yourself or use unqualified personnel Please call your agent for assistance Undesired effects may occur due to unexpected electromagnetic interference like fast transients electrostatic discharge and voltage dips Loose USB mouse connector Unplug and reconnect mouse or reboot if unsuccessful CAUTION Loose connectors in Re connect and restart application communicatio
10. It is now possible to overlay a captured retinal image over a completed Medmont Automated Perimeter exam This semi transparent overlay can act as a visual aid assisting you in locating and identifying retinal anomalies based on comparison of your field screening results to captured images of that same eye s retina A visual field exam with a retinal overlay applied will look like this Medmont Automated Perimeter 73 Analysing and Viewing Exam Results 74 OD 1 22 NO PD 10 08 SF Disabled CA Superior nferior Defect 0 Figure 30 Retinal overlay To overlay a retinal image you must first have a retinal image of the same eye and patient which was captured using Medmont DV2000 Diagnostic Video Imaging software The optic nerve disc must be defined for the image before attempting overlay This is done by selecting the Define Disc icon from the toolbar and drawing a curve around the perimeter of the disc by clicking consecutive points around the disc with your mouse This will intuitively draw a natural curve After you have drawn your final point around the circle right click your mouse to let the tool automatically join and complete the curve for you based on the points you have defined Figure 31 Optic nerve disc before being defined Medmont Automated Perimeter Analysing and Viewing Exam Results Figure 32 Optic nerve disc after being defined The image must be captured us
11. L 3 May 1993 7 58 00 AM Glaucoma Test Sample User Sample Practice 15 53 28 Fair 3 14 21 Good 1 15 7 Excellent Figure 24 Patient exam statistics view The example in Figure 24 shows portion of a display sorted by decreasing test duration The width of individual columns can be resized by moving the mouse over the column boundary in the header until the cursor changes to two vertical bars then click and drag the boundary to suit Selecting a patient will still open a window to the right of this display that shows that exam result field display in the current exam display mode see Display Options on page 87 Figure 25 shows an example with a slice of the main window and a patient selected Figure 25 Patient exam statistics and map view Medmont Automated Perimeter 69 Analysing and Viewing Exam Results Setting the Exam View Mode The View Mode controls how the selected exams are displayed Select the View mode from the View ribbon tab Display ise at Ea Diff Details Compare Combination rte ira Active View The following sections discuss these modes Exam Details View and Editor Clicking on Details from the top of the patient tree displays tabular information about the selected exam and allows the addition or editing of comments see Figure 26 The summary collects in one place all the details and statistics associated with that exam and includes a thumbnail view of the result field Smith Ben 1
12. Non Linear Scaling setting see Non Linear Scal on page 88 A Level example showing both Linear and Non Linear scaling of the same exam is shown in Figure 40 Medmont Automated Perimeter 79 Analysing and Viewing Exam Results 80 i James Dorothy Left 21 Mar 1989 2 53 00 PM Central Test y James Dorothy Left 21 Mar 1989 2 53 00 PM Central Test Figure 40 Level visualisation showing Linear scaling on the left and Non Linear scaling on the right Age Normal Deviation This displays the difference between the patient s threshold result and the Age Normal Hill of Vision for a person in this age group An example is shown in Figure 41 A single dot means the point is within 6 dB of the age normal A negative number means the point is below this boundary at that light point position 1 e the point was seen at more than 6 dB brighter than the age normal The outer boundary of this plot is at 22 eccentricity The mean deviation for the entire field is given by the Overall Defect described in Overall Defect on page 64 Note this measure is only available for tests that compute a threshold j James Dorothy MMP 21 Mar 1989 2 53 00 PM Left Central Test Figure 41 Age Normal visualisation Medmont Automated Perimeter Analysing and Viewing Exam Results Patient HoV Deviation The patient HoV deviation shows the difference between this patient s actual HoV and what the patient
13. Note that small defects may be missed with this field Central 22A Test This test is designed for fast screening of patients consequently it is limited to the central 22 only The initial test pattern uses a relatively high density of 45 points including four test points at 1 eccentricity It uses the Fast Threshold strategy and the spatially adaptive algorithm and therefore ideally suited where there are only large or no defects expected Central 22 Test This test is similar to the Central 22A Test It includes some additional test points at 10 eccentricity and does not use the spatially adaptive algorithm It therefore produces more consistent test times and is ideally suited for performing very quick screening tests on patients It uses the Fast Threshold strategy CV 100 Point Test This test is a binocular test which tests 100 points An initial patient Hill of Vision HOV is calculated and then remaining points are exposed according to the HOV The test uses a 3 Zone strategy when exposing remaining points Points may be seen at the expected HOV level Odb or not at all Upon completion of the test the CV score is calculated based on the number of points seen at the expected HOV level and the number of points seen at Odb Medmont Automated Perimeter 57 The System Test Strategies 8 The System Test Strategies The Automated Perimeter software provides a comprehensive set of test strategies These
14. Points with seen values above the Age Normal are replaced by the Age Normal value to prevent points of exceptional vision generating spurious depressions The difference results are collected for the nine zone pairs Depending on the magnitude of this adjusted difference the following messages may be displayed No local defects There is no discernable difference between the superior and inferior zones Superior or Inferior A significant number of superior OR Depression inferior zones are depressed relative to their matching zones Superior Inferior A significant number of both superior Depression AND inferior zones are depressed Inferior Depression A significant number of the inferior Superior Defect zones are depressed and one or more superior zones have a high difference Superior Depression A significant number of the superior Inferior Defect zones are depressed and one or more inferior zones have a high difference Superior or Inferior One or more superior OR inferior zones Defect have a high difference Superior Inferior Defect One or more superior AND inferior zones have a high difference Note that these results are intended to highlight the difference between small matching opposite superior and inferior zones If the depression or defect is not hemi field based then these statistics will not help Note also that the outer radial boundary only extends to an eccentricity of 22 Depressions and defec
15. This dialog allows you to select from the set of available regressions preset the eye and select the time period that the regression covers By default the latter is all exams for the selected patient You can also move a selected regression up and down the display using the up and down arrows If you select a regression and click on the Add or Edit button you will be presented with the Add Edit Regression Graph dialog shown in Figure 64 It allows you to select change a regression define the Y axis data boundaries and select the regression type 106 Medmont Automated Perimeter Regression Analysis KA Add Edit Regression Graph Ea Graph Type M700 Exam Pattern Defect Zone Full 0 Line Style Median gt w v Auto Scale Values Min Value 0 00 Max Value 15 00 Cancel J Apply J OK Figure 64 Add Edit a Regression Graph For a histogram regression the Zone drop down box not shown here allows selection from the list of field subsets see Field Subsets on page 105 The Line Style drop down allows selection of the available regression types either Point to Point Least Squares Median Fit or None see The Regression Types on page 104 The default is Least Squares Medmont Automated Perimeter 107 Printing the Exam Results 12 Printing the Exam Results There are many options when printing an exam result although in most cases accepting the defaults will provide a more than adequate resu
16. are associated with the patient s blind spot If a right eye exam is selected the Nasal chart will be to the right side of the exam window If a left eye exam is selected then the two M700 Nasal charts will be on the left hand side of the exam view Data View The displayed data can be viewed in a number of different ways Numeric Data View Select this button e from the Display tab For the threshold strategies each point is represented as a number expressed in decibels unless if it was Not Seen in which case it is shown as a NO For the specialist strategies such as the Three Zone Strategy see Three Zone Strategy on page 60 a point may not have a numeric representation This is the view to use when you want quantitative results from a Threshold strategy exam not a Screening strategy as these define the threshold values the patient can only just discern By default the light points are displayed as a scaled projection of their spatially correct positions on the perimeter dome The mapping is a non linear radius function that expands the high resolution clustering of light points in the foveal area to allow a more even visual display You can toggle this to a linear scaling as required see Non Linear Scal on page 88 Only the points that make up the test field are displayed Figure 40 shows two numeric data views with different scaling Numeric Grid Data View Select this button Ab on the Display tab This shows the li
17. blind spot monitoring yourself by un checking the Auto Blind Spot checkbox and clicking on the light point with the mouse Blind Spot Fixation Monitoring Automatic Mode In automatic mode the blind spot monitor will initially expose the centre light point of this group You can select a different initial point by un checking the Auto Blind Spot checkbox clicking on required blind spot light point and then checking the box again If the initial start point is Not Seen after two exposures then this light point becomes the blind spot light point in subsequent exposures and the test proceeds immediately If it is seen then its neighbours will be progressively exposed until one is Not Seen for two consecutive exposures During the search for the blind spot points will have a red X displayed as an indication that they were seen The blind spot monitor in Figure 14 shows an example of this sequence Medmont Automated Perimeter 43 Testing a Patient I Auto Blind Spot iti x x x Figure 14 Blind Spot Monitor locating the true blind spot When No Blind Spot is Found If all blind spot light points are seen then the dialog shown in Figure 15 is displayed Apart from simple lack of patient fixation this could mean either e the wrong eye was selected or e the patient positioning was incorrect If the wrong eye was selected restart the test with the correct eye otherwise reposition the patient and if required p
18. cables other than those specified with the exception of transducers and cables WARNING sold by the MANUFACTURER as replacement parts for internal components may result in increased EMISSIONS or decreased IMMUNITY of the M700 USB Automated Perimeter The M700 USB Automated Perimeter should not be used adjacent to or stacked with other equipment and that if adjacent WARNING or stacked use is necessary the ME EQUIPMENT or ME SYSTEM should be observed to verify normal operation in the configuration in which it will be used Guidance and manufacturer s declaration electromagnetic emissions The M700 USB Automated Perimeter is intended for use in the electromagnetic environment specified below The customer or the user of the Automated Perimeter should assure that it is used Compliance Electromagnetic environment guidance in such an environment The M700 USB Automated Perimeter uses RF energy only for its internal function Therefore its Group 1 RF emissions are very low and are not likely to cause any interference in nearby electronic equipment RF emissions Class A The M700 USB Automated Perimeter is suitable CISPR 11 for use in all establishments other than domestic and may be used in domestic establishments and 12 Medmont Automated Perimeter RF emissions CISPR 11 Important Facts IEC 61000 3 2 those directly connected to the public low voltage power supply network that supplies buildings use
19. complete patient exam history Prints up to six exams per page six rows by four columns and multiple pages if necessary You can select whether you print left right or both eyes There is a third option that covers printing Regression Analyses and this will be covered later Before beginning select the sample database Select patient John Citizen and then the right eye exam for 11 Sep 1990 On the Display tab click on Numeric For this example also ensure the Hill of Vision Data Non Linear 108 Medmont Automated Perimeter Printing the Exam Results Scaling Numeric Tick Marks Statistics and Attributes check boxes are ticked Printing the Current Display Click on the Application button then click Print Preview to bring up the Print dialog The Printer dropdown box will display your current default printer _ Select the Print Report to Preview Printer Brother HL 5170DN series z Current Display Settings Threshold Overview Print Default Delete Threshold Overview Print 2 exams per page Threshold Multi Print Set Default Threshold Multi Print Difference From Baseline New Threshold Overview Print Difference From Baseline Cancel DK Figure 65 Print setup dialog For a start we will explore the Current Display option shown in Figure 65 so select this and then click on the OK button This will present a full screen print preview display similar to Figure 66 essentially a w
20. filled box defining a point not seen at all Note that the map display see Numeric Data View on page 84 contains the most information from this strategy s results Fixed Level Strategy This strategy is essentially a go no go test All points are exposed at a clinician defined level by default set at 5 dB The point is completed after this one exposure and flagged as either Seen or Not Seen The strategy is thus a very fast test for whether a patient has any serious defects but where it is not necessary to know whether a defect is absolute or not The Map display for this strategy 1s similar to the Three zone strategy shown in Figure 19 except there are only two states a dot defining a Seen point and a filled box defining a point Not Seen An example using the special Binocular Driving Test field 1s shown in Figure 20 Note that the map display see Numeric Data View on page 84 contains the most information from this strategy s results Medmont Automated Perimeter 61 The System Test Strategies g Way Joe Both 3 May 2005 10 46 52 AM Binocular Driving Test Age 37 Years 2 Months Sn 99 120 83 FP 1 11 9 Excellent Figure 20 A Fixed Level strategy map display Age Related Strategy 62 This is a two step strategy where the first exposure is at the 95 confidence level for the patient s age only in 20 healthy patients will not see this level by chance alone If this is Not Seen a second expos
21. ie ae EN Ring 15 Angle 237 Level 1 7 di Meamont Studio Verson 6 0 0 11 24 Sep 2014 04 11 61 PM Figure 67 Printing test results for Both Eyes Printer Settings Clicking on the Application button clicking Print and then clicking on the Settings button brings up the Print Report Settings dialog shown in Figure 68 This has the familiar controls for setting the destination printer paper size units margins etc but in addition has a text box for setting a Print Title By default this is set to Medmont Studio One use for this 1s to enter your practice name as the text is remembered between sessions and will therefore be the header on all subsequent printouts A further option is the Greyscale checkbox beside the printer selector dropdown control Some black and white printers have difficulty translating colour imagery and if this is your case checking this box will ensure that colour images will be translated into greyscale images before being sent to the printer Some additional options will appear in this dialog that depend on the currently selected and formatted display Medmont Automated Perimeter 111 Printing the Exam Results E Threshold Print Settings x General Overview Print Report Name Threshold Overview Print Printer Brother HL 5170DN serie v Grayscale Print Title Sample Practice Paper Size Ad Width 21 01 Height 29 69 Orientation U
22. is included for terminology that originated with Medmont It also includes some common terms where they apply to Medmont equipment It is not a glossary of perimetry Terms that appear in the glossary are underlined in the text 2 Medmont Automated Perimeter Introduction 2 Introduction The Automated Perimeter software is designed as a component of Medmont s integrated clinical environment called Medmont Studio Medmont Studio is an extensible software framework that allows the controlling software for different medical instruments to be fully integrated into a single working environment See the Medmont Studio documentation for help on installing and using the Studio environment Variants The Automated Perimeter may be configured at purchase as a number of optional variants M700 USB C standard model including CCD camera for fixation video monitoring M700 USB CR additional Red light perimetry 650nm M730 Focus Max 30 degree field incl stray light shroud Intended Purpose The Medmont Automated Perimeter performs rapid and reliable screening and threshold tests of visual fields while providing comprehensive control over the test and detailed information on its progress The clinical applications of visual field testing using the Automated Perimeter can include tests for Glaucoma Flicker Perimetry Binocular Testing including Driving Tests Neurological Testing Macula Testing Peripheral Vision Testing and othe
23. language commonly used for data exchange See the section on Exporting and Importing Data in the Medmont Studio manual for an explanation of the various format options Click the Application button then click Import and navigate to the CD ROM Move into the Sample Data directory and select the file M 700SampleData mcf Click on Open and the database will be imported into Medmont Studio under the User name Sample User You can explore this database and get to know the software without fear of accidentally corrupting or losing an entry as you can always re install it at any time from the CD ROM If and when you no longer need this you can delete it 124 Medmont Automated Perimeter Power On Self Test 16 Power On Self Test When a clinician starts a new exam from Medmont Studio the software initially requests that the perimeter perform a self test operation This quickly scans all perimeter lightpoints and a number of hardware controller parameters If any of these are outside limits a diagnostic message 1s displayed Initially the perimeter controller just indicates to the perimeter test software that one or more light points are outside the allowable range and the software will display the message shown in Figure 79 Perimeter Self Test Failed X G One or more green light points in the perimeter are outside their test range Click OK and the software will search For the Failed LEDs Figure 79 Failed Light point initia
24. no change until you add some attributes via the Attribute Options button This will display the Threshold Exam Attribute Options dialog see Figure 51 and allow you to add attributes as required The Retinal Overlay checkbox will add any registered retinal images to the print preview Refer to Retinal Overlay View on Page 73 for more information on registering and using retinal images with perimeter exams The Overlay Opacity sets the transparency of the graphic shown in the Plan view when combined with a retinal overlay If the retinal overlay option is not checked then the opacity has no effect M700 Exam Print Report Click on the Application button and click Print Preview to bring up the Print dialog shown in Figure 65 Select New Select the M700 Exam Print Report Click on the OK button This presents a full screen print preview similar that in Figure 71 Print Preview for an M700 Exam Print Report 114 Medmont Automated Perimeter Printing the Exam Results Click on the Settings button to open the print report settings dialog Click on the Advanced tab to show additional settings 29 Years 0 Months Overall Defect HFA PSD 4 85 Fluctuation is Supenor Depression HoV Slope 18 5 dB Fixation Losses 429 103 4 2 Duration mmHg Lens Sphere 0 00 Lens Axis i Medmont Studio Version 6 0 0 11 25 Sep 2014 09 25 29 AM Figure 71 Print Preview for an M700 Exam Print Report Medmont Automated Perimeter 115 Printing
25. of the perimeter and chin rest are correct If the chair is too far away or the perimeter too low the patient will be bent uncomfortably forward during the test Consequently her face may be tilted forward and her eyelids and eyebrows in a position to interfere with the upper visual field If the chair is too close or the perimeter too high the patient may be off balance and continually strain to maintain her position at the perimeter The instrument may be too close if she feels the need to prop herself up with her arms back or hold onto the instrument to keep from falling backward Running the test in demonstration mode for a while as described in Demonstrating the Test on page 30 can let the patient see what will happen and to become familiar with using the response button Express Testing a New Exam 26 With Medmont Studio running 1 Click on the New Test B button to start the Test Control Figure 6 shows the initial test control screen with a right eye Glaucoma test template selected 2 Select the type of exam the Template from the drop down selection box This will define the Field and Strategy to be used during the test 3 Click the Right or Left eye button as required to swap the blind spot and match the eye being tested 4 When you are ready click on the Start P button Medmont Automated Perimeter Testing a Patient 5 The exam will begin You can pause and stop the exam using the Pause Wl or Sto
26. perimeter has not yet been configured Please refer to page 19 to configure a new perimeter before continuing Perimeter Test Tool window will then be displayed 128 Medmont Automated Perimeter Cleaning Maintenance and Service U Perimeter Test Tool LED Groups Targets Figure 81 The Perimeter Test Tool Target LED Group display By default the Targets LED Group is selected this 1s used for testing the perimeters various fixation targets By clicking on a specific target within the Perimeter Test Tool window with your mouse the fixation light point should then be illuminated on the perimeter Selecting the Green LED Group will allow all green light points not including the fixation targets within the perimeter to be tested Testing 1s done by clicking on a single light point within the Perimeter Test Tool or by selecting an option in the Ring drop down box under Test Pattern When a single light point 1s selected the corresponding light point will illuminate on the perimeter If a ring is selected the program will illuminate each light point which lies on the selected ring The practitioner should confirm that the corresponding light point is lit in the perimeter Medmont Automated Perimeter 129 Cleaning Maintenance and Service U Perimeter Test Tool LED Groups Targets Green Test Pattem Individual LED Intensity 0 Number 0 Address 134 Figure
27. radio button called Conditions are AND ed is checked and click on the New button to bring up the New Simple Condition dialog shown in Figure 78 amp s2 New Simple Condition Exa Field Operation Value Last Name y LIKE m Compare to a value Compare to another field Cancel OK Figure 78 The simple sorting condition dialog What we are going to do here is combine a number of simple filter conditions to make a composite condition The composite condition will be applied to all the selected patients and all of the simple conditions must be true for a particular patient exam before that patient will be included in the filtered set The simple conditions to apply are The patient must be Female have a Pattern Defect greater than 12 and their age when tested should be less than 40 122 Medmont Automated Perimeter Perimeter Filters If you are using just the demonstration database this should reduce the patient display to just the one woman Fifer Medmont Automated Perimeter 123 Installing the Demonstration Database 15 Installing the Demonstration Database The CD ROM contains a demonstration database that you can use to explore and experiment with the Medmont Automated Perimeter software capabilities Use the Import feature of Medmont Studio to import the database Data that is exported from or imported to Medmont Studio is in a specialised XML format eXtensible Markup Language a markup
28. remove it if the field extends past the 30 ring where the lens holder frame could interfere with the patient s vision Binocular Single Vision Test 52 A special feature of the M700 is the facility to test and quantify diplopia or Binocular Single Vision BSV defects The test requires the use of the supplied chin rest adaptor that is placed on top of the standard chin rest and allows the patient s head to be positioned in the middle of the chin rest In this test the stimulus duration is several seconds much longer than the normal exposure times shown in Table 1 As each stimulus appears at maximum intensity the patient observes it while keeping their head stationary and is asked to decide whether the stimulus appears as a single or double spot If it appears as a single dot the patient presses the response button once if it appears doubled the patient presses the button twice The test rapidly screens a patient s field for the presence of BSV defects and accurately maps the extent of any defect If the button 1s pressed once a dot will appear on the tested cell position Pressing the button twice will result in a D being recorded in that cell position If the patient fails to respond at all by the end of the exposure time a NO signifying no response will be displayed The cell will subsequently be re tested and if the patient still fails to respond a NO will be recorded in that cell position Medmont Automate
29. that were not already tested are now tested to ensure that the testing process appears random to the patient Binocular Driving Test This is very similar to the Driving Test see above but the patient is tested with both eyes open and they can wear their own prescription lenses where applicable The blind spot monitoring is disabled and all light points are displayed at a fixed level The clinician can set the level in the Template Editor see Figure 8 The three targets are presented in the same way central right then left Flicker Test 54 A feature of the Medmont Automated Perimeter is an ability to generate a flickering stimulus It has been shown that under certain circumstances evidence of visual field losses can be detected more readily with a flickering stimulus then with a normal static stimulus In the Flicker Test the stimulus is flashed on and off at equal intervals with a flicker rate that varies with eccentricity The relationship between flicker rate and frequency 1s shown below in Table 5 For this test the patient is required to only respond if the stimulus is perceived to be flickering If the target is visible but flicker 1s not apparent Medmont Automated Perimeter The System Test Templates then the patient should not respond To assist the patient in making this discrimination a high rate of non flickering targets 1s presented at the start of the test If a response is made to these static targets
30. to the age normal Unexpected point values are represented by the same graphic symbols shown in Figure 44 Difference from Baseline The Difference from baseline is calculated on a point by point basis assessing the deviation from the corresponding point from the selected baseline A defect is defined as a deviation from the baseline of gt 8 1db for the inner 6 rings or gt 10 4db for the outer rings Rings beyond 22 are not analysed If a point has a greater deviation than the tolerances specified above it will be indicated by an unfilled square O If on a subsequent follow up exam the point remains beyond this tolerance it will be indicated by a half filled square ml If on the third follow up exam the point still remains beyond this tolerance it will be indicated by a completely filled square I If a point is seen in the baseline exam but not seen in the two most recent follow up exams it will be indicated by an X symbol This indicates that the defect is beyond the detectable range Pattern defect plots are represented by four charts at the bottom of the exam view and only display points from the baseline to the currently selected exam For example the M700 Exam Pattern Defect Superior Temporal Medmont Automated Perimeter 83 Analysing and Viewing Exam Results 84 chart would represent the top left hand zone of Difference from baseline view The two Nasal charts Superior and Inferior
31. 2 Click on the Recalculate button in the left of the Data tab to re evaluate the attributes and you should see the computed value If you browse to another threshold exam this attribute will be undefined and shown in italics or not displayed at all depending on whether the Show Undefined Attributes option is selected This is because the overhead for Medmont Studio to automatically re evaluate attributes every time would introduce an annoying delay as you browse patient exams Click the Recalculate button to force the attributes to be re evaluated for the selected exam If the HoV functions are still undefined the cause will be that the test did not use a Fast or Staircase Strategy Adding Annotations 96 Graphical annotations can be added to visual field exams using the options on the Edit tab Annotations are stored with the exam and may be printed exported imported and viewed with Medmont Studio Viewer Display of annotations can be turned off for the current view by deselecting the Annotations option on the Display tab Annotations can even be added to the comparison view of two exams In this case the annotation is stored and the next time the same two exams are compared the annotation is displayed Note that for multiple views Annotations may need to be enabled in the Settings dialog for the particular view before they are visible Medmont Automated Perimeter Analysing and Viewing Exam Results Text Annotations
32. 2 Medmont has already defined an extensive set of attributes You can define your own statistics that are based on this standard set We will first examine some of the standard attributes and then proceed to develop some new ones as examples On the Configure tab click Attributes to display the Attributes dialog in Figure 53 Medmont Automated Perimeter Analysing and Viewing Exam Results Attributes Exam Type BORMES E Duration Calculated i False Negatives Calculated f 4 False Positives Calculated f 4 Fixation Losses Calculated f 4 Fluctuation Calculated Calculated Calculated Calculated Calculated Entered Calculated Calculated Calculated Fil is rael Pinta D E ated Figure 53 Attributes dialog The Attributes dialog is shown in Figure 53 and shows the same set of names in the Name column as is shown in the Available column in Figure 51 The Description column shows the derivation of that particular attribute For example the HoV Slope attribute is calculated from the GetHOVSlope system function The system functions have direct access to the current exam details Editing an Attribute Definition Some attributes are computed or derived from system functions For example the Duration system function returns the duration time of the current exam in seconds although the standard Duration attribute is given in minutes The definition for Duration is shown as Duration 60 converting seconds to minute
33. 2 May 2008 3 06 24 PM Right Glaucoma Test Patient Smith Ben Change Test Glaucoma Test Eye Right Age 72 Years 3 Months Date Time 12 May 2008 3 06 24 PM fay Test Duration 9 Min 23 Sec Trials 303 107 2 8 Strategy Fast Threshold Flicker OFF Lens 0 00 0 00x0 Overall Defect Fixation Monitoring Blind Spot Pattern Defect Fixation Loss HoV Slope 2 9 dB 10 False Positives HoV 3 Level 25 1 dB False Negatives Cluster Analysis Fluctuation Disabled Test Reliability 3 Retest Abnormals Disabled Categories Y Practice Sample Practice y Clinician v Comments Figure 26 Patient exam details view Save and Cancel buttons will appear in the bottom right hand corner if you modify the Categories see Medmont Studio User manual or add or edit in Medmont Automated Perimeter Analysing and Viewing Exam Results the Practice Clinician or Comments text box Clicking on Save will add your changes to that particular exam record A statistic that only appears on this form is the Test Reliability score This uses a combination of the test s false positives false negatives and fixation losses to rate the reliability of the test on a score of O to 10 This is an excellent first access statistic where scores of about 6 or less should trigger a closer examination of the base test reliability statistics Moving an Exam to a Different Patient If the selected exam was inadvertently assigned to the wrong patien
34. 3 dB buckets with a Y axis out to 35 dB The dark vertical base line defines the range of values encountered Buckets are joined point to point and filled with green colour for the left eye and blue for the right The transition to zero from the outer boundaries is also joined by straight lines and colour filled For example the dimmest value Medmont Automated Perimeter 103 Regression Analysis seen in this example is at 21 dB The histogram shows the 21 dB bucket level connected to zero at the next dimmest bucket 24 dB The reason for this is that the exact distribution of points between 21 and 24 is unknown only that there were some at 21 and none at 24 so a straight line connecting the two is the best estimate possible Not Seen values or absolute defects when they exist are shown in red below the 0 dB line at a notional 3 dB value There are some Not Seen points in this example The black horizontal line extending from edge to edge of the histogram is the histogram mean value Note that on the display the regression line is drawn after the mean line so in some cases the latter may not be visible The horizontal axis provides yearly major markers and additional monthly minor markers when the history period extends over less than four years There will always be at least one year marker The graphics are translucent and where two or more histograms overlap you should still be able to see the overlain graphic You c
35. If the Age Based Lens option is checked then the default lens parameters are calculated automatically based on the patient s current refraction see Lens Details on page 38 If non zero lens values are specified you will be asked to insert the correct lens in the lens holder before the test begins Click the Multiple Fixation Target check box to switch between the four point foveal loss target and the single point fixation target on perimeters so fitted Click the Auto Blind Spot checkbox to switch between automatic and manual blind spot control see Blind Spot Fixation Monitor on page 42 You can click on the Slow Response Settings button at any time if the patient has trouble responding in time Starting the Test When you and the patient are ready click on the Start P button to begin the exam You can pause and stop the test from the same menu The run Medmont Automated Perimeter Testing a Patient pause and stop functions are also available as toolbar buttons as detailed in the Express Testing a New Exam on page 26 Monitoring the Test The Test Status area groups a number of indicators that monitor the exam see The Test Status Group on page 42 The Blind Spot Monitor graphic at the lower left indicates the current blind spot as a dark grey spot The speaker will beep if the patient sees the blind spot For perimeters so fitted a small video image from a camera focused directly on the patient s eye is disp
36. If the patient does not respond within the Response time then as soon as this ends the Delay time is skipped and the next Exposure time will start immediately The minimum setting for all three delays is 0 1 seconds If you take the Response time below the Exposure time then the Exposure time will track the Response time The same is true for taking the Exposure time above the Response time 32 Medmont Automated Perimeter Testing a Patient Ticking the Adaptive Response checkbox means that as the test progresses the response time will adapt based on how quickly the patient responds to exposures The exposure time is also adjusted proportionately The adaptation will not shorten the response time below a minimum of 0 1 seconds The adaptation is also carefully controlled to ensure any changes to the times are applied gradually The Settings Group The controls in this group provide for selection of the various Strategies available along with a number of monitors and adaptors that can affect both the way the test proceeds and the confidence level of the results The strategies available and how they work are covered in The System Test Strategies starting on page 58 The following explains each of the functions enabled by the checkboxes in this group False Negatives This is an additional exposure randomly inserted at around every tenth normal exposure and therefore lengthens the test time somewhat It selects a random light poi
37. Information Technology Equipment and the Standards for Electromagnetic Emissions CISPR22 EN55022 and must be powered by an isolation transformer compliant to the WARNING medical standard EN IEC60001 1 UL2601 or CSA22 2 601 1 see Optional accessories on page 5 for products meeting these requirements that are available from Medmont Perimeter Environment 16 The background illumination of the Medmont Automated Perimeter is set at 10 apostilbs or 3 2 cd m2 except for some driving tests In order to avoid the possibility of uneven ambient lighting falling on the bowl surface all overhead lighting should be switched off and testing carried out in a dimly lit or completely darkened environment As the Automated Perimeter is a highly precise measuring instrument it needs to be located in a suitable and clean environment Medmont Automated Perimeter Installation Room temperature 10 C to 40 C Relative humidity 10 to 80 Keep the instrument away from direct sunlight to avoid unnecessary exposure to heat and light Software Installation The Automated Perimeter Software is a component of the Medmont Studio integrated clinical environment A single Flash Drive is supplied with installation software for all Medmont Studio components The installation procedure is detailed in the Medmont Studio User manual However if you are installing your Automated Perimeter on a PC for the first time you will need to tick the che
38. It takes a normal exposure time slot and uses the currently set times see You can access the Editor from the Test Control window by clicking the Edit gt Template gt Edit button You can also review and edit these settings from Medmont Studio on the Configure tab with the Template Setup option See Creating a New Template on page 36 for how to create a new template Here we discuss the various settings and the ramifications of any changes The Stimulus Parameters Group on page 31 but does not turn on any light point If the patient responds then the false positive counter 1s incremented The monitor shows these events as a seen not seen ratio and as a percentage for example False ve 2 15 13 Medmont Automated Perimeter 47 Testing a Patient 48 False positives usually indicate that the patient 1s responding to the rhythm of the exposures rather than the actual exposure itself pressing the button when they expect an exposure has occurred The patient may also be trigger happy believing he or she must press the button very quickly to get a good score In this case they should be told that the instrument waits for a time to receive the response after the brief light point exposure and they should be urged to make slower more deliberate responses By convention a false positive rate around 20 or higher is considered to indicate low patient reliability and consequently detracts from the reliability of the test resul
39. MEDMONT AUTOMATED PERIMETER USER MANUAL Models M700 USB C M700 USB CR M730 Focus Medmont International Pty Ltd 5 56 Norcal Rd NUNAWADING VICTORIA 3131 AUSTRALIA Phone 61 3 92590 800 Fax 61 3 9877 6431 e mail help medmont com au Web www medmont com au Doc No P 1904 V1 4 MEDMONT Oct 2014 Table of Contents MANUAL ORGANISATION ccccccccssssscccsccccssssscccssccesenes Software Conventions INTRODUCTION esechscsosascbente sicicctett iva vesusbusersneeDe dexetiacpeatouseversiues BN A WANS Sachs tea Serials acidic A axe peueasedscaee sxenessesee Miended PUD OSS sauces stig hot acatesatss Brathay a Standard ACCESSO E Sennan n Opona accessor ES T cede SPO PANS sanra WARRANTY eses cast cetacsiescretssecetncasteciecaisdatanscescnetai dainsetocleiatisseiss IMPORTANT FACTS bescicticcnesscpccscticedsseusseseasetiveccsadeesactacadeseuesse Essential Performance Classification Clinical Results Accuracy and Age Normals Electrical Safety of System Radiation Electromagnetic Interference Electromagnetic Emissions Side effects Instrument Damage Disposal Symbols and Label Sur lieder alahcet eel INSTALLA TION anae aaea eea a EEE POG Regui romen Sorre sa ates ic at ea tah Perimeter EnViIronMEN cesna a eta telcos Software Installation asneira System Hardware Installation ccccccccccccccccccceeeeeeeeeeeeeeees Medmont Automated Perimeter USB Interface M600 Perimeter Uperades c 2cc
40. NDJSEMAMJI JA Limit 1993 1994 1993 1994 M700 Exam Pattern Defect Inferior Temporal m Right M700 Exam Pattern Defect Inferior Nasal m Right 1993 1994 1993 1994 Figure 36 Difference From Baseline View A baseline exam must be defined before the Difference from baseline view can be displayed If the baseline exam has not yet been created for the patient and eye a prompt will be displayed as per Figure 37 i No baseline defined o a The patient you are reviewing does not have a baseline defined yet What would you like to do Automatically create a baseline for me This option will automatically create a baseline exam from the two oldest threshold exams Let me choose the exams to be used for a baseline This option will display the new baseline window Do this whenever select an exam which does not yet have a baseline defined Figure 37 No baseline defined prompt Medmont Automated Perimeter T71 Analysing and Viewing Exam Results The prompt allows two options l Zi Automatically create a baseline exam this will automatically create a baseline exam from the two oldest threshold exams Manually create a baseline exam this will display the Baseline dialog box allowing the user to select the desired exams from a list of compatible exams as per Figure 38 Baseline Patient Jolly Nick Eye Right Compatible Exams Template Strategy Fixat
41. Right Central Screening y 13 Jun 1990 1 58 00 PM Right Central Screening y 6 Jul 1990 10 02 00 AM Right Glaucoma Screening Baseline iy 6 Ju 1990 10 13 00 AM Left Glaucoma Screening iy 6 Sep 1990 11 22 00 AM Right Glaucoma Test iy 6 Sep 1990 11 33 00 AM Left Glaucoma Screening y 83 Nov 1990 9 00 00 AM Right Glaucoma Screening 8 Nov 1990 9 09 00 AM Left Glaucoma Screening iy 4 Mar 1991 2 46 00 PM Left Central Screening y 4 Mar 1991 2 58 00 PM Figure 39 Tree showing a selected baseline exam The Difference from baseline view is described further on page 83 Selecting the Map Type and Data View The Map Type controls the type of data displayed for a Patient Exam You select a map type from the Display tab The drop down selection box allows you to select from a set of available map types P z Select Level s shea dona Enable P E a M Pan Numeric Tic Marks Set Image R i PZoun Age N A Non Linear Scale 5 ae Annotations Zoom Pan Cursor Options Retinal Overlay Defaults Map Types The following details the options available for examining and interpreting patient exam data results Level This displays the raw threshold values in decibels For a threshold exam these are the brightness levels in dB the patient can just discern By default this display uses a non linear scaling to spread out the high resolution points in the foveal area You can remap this display to linear scaling with the
42. S vcssecesetetcscaceceentacebicceaseeseuedcdetdsssesaeutadecadsonsssceusictsadvedse Medmont Automated Perimeter Manual Organisation 1 Manual Organisation This manual is divided into four sections 1 Introduction and Device description The installation of the software and the perimeter 3 The set up for and performance of a test and the saving and reviewing of the results and 4 A reference section that elaborates on the introduction given in 2 In discussing the normal interaction between the software and those involved in a particular operation test or test review the manual uses the term Clinician to refer to the person operating the equipment and Patient to refer to the person undergoing the test The manual describes the M700 USB and M730 USB Automated Perimeter instrument models and software upgrades of all Automated Perimeters to Studio 5 Software Conventions When referring to menu selection the terminology Home gt Patient gt New means click on the Home ribbon bar tab then look for the Patient group on the ribbon bar and click on the New icon This format conforms to the Tab gt Group gt Action system for identifying menu items in a ribbon bar menu system 2 i we Move To Kos i bc SS MCopyto Digita Con Fod New Delete F Delete Image Topog Action Patient 4 Eram CTOUP Medmont Automated Perimeter 1 Manual Organisation A small glossary
43. See Creating a New Template on page 36 for how 58 Medmont Automated Perimeter The System Test Strategies to create a new template Here we discuss the various settings and the ramifications of any changes The Stimulus Parameters Group on page 31 you can set the Exposure time the Response time and the Inter Test Delay time for any test In all cases points are selected at random from the test field Fast Threshold Strategy This algorithm allows very quick thresholding of normal fields without sacrificing any accuracy in defect diagnosis An initial set of calibration points is fully thresholded to provide accurate data for the neighbourhood prediction function The strategy then uses an advanced prediction function to estimate the likely threshold value for a point based on its completed neighbours It subsequently fits an age and population based probability function to each new light point based on the point s neighbourhood of exposed points Exposures then use statistical techniques to quickly localise the patient s true threshold level Threshold Strategy In this strategy in order to locate the threshold of a particular light point a staircasing procedure is followed in varying the cell intensity The starting level is based on either the patient s previous result or the point s neighbourhood of exposed points If there is no response to a particular stimulus the intensity is increased by twice the minimum step
44. Using the Select M700 Exams tab 68 Medmont Automated Perimeter Analysing and Viewing Exam Results You can examine most visual field exam statistics in a single view by selecting the Exams tab at the bottom of the Explorer pane see Figure 23 and then expand the explorer pane by clicking and dragging the separator You can click on the heading for any column to sort the exams by that column For example clicking on the Age heading will sort patients by increasing age Clicking the same heading again will re sort by decreasing age 2 Patient Exam Template Categories Clinician Practice Fixation Losses False Negatives False Positives HoV 3 Level HoV Slope Overall Defect Pattern L6 Sep 1990 11 38 00 AM Glaucoma Scree Sample User Sa MEDMONT 0 20 0 Excellent R 8 Nov 1990 9 00 00 AM Glaucoma Scree Sample User Sa MEDMONT 3 25 12 Good L 82 Nov 1990 9 09 00 AM Glaucoma Scree Sample User Sa MEDMONT 1 31 3 Excellent L4 Mar 1991 2 46 00 PM Central Screening Sample User Sa MEDMONT 0 27 0 Excellent R 4 Mar 1991 2 58 00 PM Central Screening Sample User Sa MEDMONT 0 18 0 Excellent R 26 Aug 1991 11 28 00 AM Glaucoma Scree Sample User Sa MEDMONT 1 19 5 Good 0 14 0 Excellent R 21 Apr 1992 7 14 00 AM Glaucoma Test Sample User Sample Practice 1 47 2 Excellent 2 14 14 Good 0 15 0 Excellent R 14 Sep 1992 9 04 00 AM Glaucoma Test Sample User Sample Practice 3 51 6 Good 0 14 0 Excellent 0 14 0 Excellent
45. acking the circular targets on the eye patch or headband then it may adjust the calibrated iris location The centre of the current detected iris location is displayed as a small cross This cross enables you to verify that Video Fixation Monitoring is correctly tracking the patient s fixation Before each test point is exposed the perimeter checks patient fixation by analysing the live video If the patient is blinking or has temporarily lost fixation the perimeter intelligently waits until fixation is regained before exposing the test point This can greatly improve the reliability of test results by ensuring that tests are only performed when the patient 1s correctly fixated Video Fixation Monitoring can also be significantly faster than Blind Spot Fixation Monitoring because it eliminates the 2 to 3 seconds required for each blind spot check The Fix Loss statistic in the Test Status group displays the number of detected fixation losses as a ratio of the total number of fixation checks performed typically the number of exposures for example Fix loss 2 15 13 Video Fixation Monitoring Recalibration If the patient does not fixate correctly within a given period of time the perimeter will display the current blind spot test point for monocular exams to provide a secondary check of fixation If the patient does not see this stimulus then video fixation monitoring is automatically recalibrated If the patient sees the blind spo
46. affect how the data is displayed e g l Select vay Shaded Grayscale Z Readout E Enable Pe m a Pan Flara 12 Numeric m nes kasa Set Image aa Non Umear Cale n seer l an A ki P a WY Perspective 44 Numeric Grid Mentine 30 Opacity a Zoom Pan Cursor Map Type Options Retinal Overlay Defaults Figure 48 Display Ribbon tab Shaded Greyscale Selecting this option changes the colour display to a grey scale view Figure 49 shows the effect of this change on Figure 52 Mowbray Low Mb 24 May 1903 2 44 00 PN Laft Contra Test Q medmont Figure 49 Grey scale view This type of grey scale patterning matches the similar view provided in pre Medmont Studio M700 and M600 software Numeric Tick Marks In all the map views you can choose whether the significant radii in the display have degrees against the tick marks or not In some map configurations the numeric tick marks can clutter the view so in all cases whether they are on or off is optional Medmont Automated Perimeter 87 Analysing and Viewing Exam Results Note that the background of the numbers in the numeric views will override all other graphics to ensure the numbers are always visible In some views this may mean the numeric tick marks are partially obliterated Non Linear Scale By default the numeric Level display see Level on page 79 uses a non linear scaling to map points towards the perimeter centre to spread
47. ain map view to indicate the location of the slice of data being displayed You can move this line anywhere over the view to explore a specific cross section Moving the Cross Section The section line has three small handles in the middle and at both ends Use the mouse to click on the centre handle and still holding the button down try moving the mouse around The line maintains its angular orientation but the line centre follows the mouse You can position the line centre anywhere on the image Medmont Automated Perimeter 91 Analysing and Viewing Exam Results Oy Sorat 26 May 1969 2 4400 PM Left Central Test N 6 Ss 1 1 1 2 24 2 iM 2 x Q medmont Figure 52 Adding the Section tool 0 a 8 1 7 77 nO 50 Now click on the handle at one end of the line If you hold the button down and move the mouse you rotate the line around its current centre point Once the mouse has captured the handle and you hold the button down you can move the mouse anywhere The section tab updates continuously to reflect the data at the specified location Note that the section indicator and the section profile have two halves with one half solid the other dashed This allows you to correlate the cross section with the location of the indicator on the view as the indicator is rotated Comments Tab This tab allows you to add or edit comments for the exam Adding and Editing Attributes 9
48. aln Ch Last Name First Name External ID las ANENA _ Camala 4 WW Search S Refresh New Patient cancel OK Figure 7 Select Patient window Being able to perform an exam or a sequence of exams without previously selecting a patient simplifies performing general screening tests However to save an exam result it must be associated with a patient To check if a patient Medmont Automated Perimeter 27 Testing a Patient has been previously tested you can browse the patient list in Medmont Studio The simplest selection method is to type their family name or just the first few letters in the Medmont Studio Explorer pane then press Enter The first entry that matches the letters entered will be highlighted in the patient explorer window Select an existing patient by highlighting their name or enter a new one as detailed in the Adding a New Patient section of the Medmont Studio User manual Starting a New Exam 28 Here we elaborate on the steps defined in Express Testing a New Exam on page 26 Again we assume you have started Medmont Studio To start an exam on the Home tab click Perimetry Exam Test Settings Select the type of exam or template from the drop down selection box see Selecting a Test Template on page 38 Click the Eye button to swap eyes see Selecting the Eye on page 38 Click the Lens button to change the lens to use for testing the patient
49. an use the select capability to highlight them separately for greater visibility Figure 62 Complete level histogram plot The Regression Types The regression lines are fitted to the mean values for histograms and to the points themselves for single value statistics The default least squares method is perhaps the most common regression and is based on minimising the sum of the squares of the differences in the points that make up the sample This method works well for data that is reasonably distributed and where the data approximates a straight line However least squares is not so effective when the data contains significant outliers as each point has equal weight and the outliers tend to skew the regression away from its true position A more robust median regression using M estimates that minimises the absolute deviation gives outliers less 104 Medmont Automated Perimeter Regression Analysis weight and in general provides a better fit for highly variable data Median fit is the second regression option see Regression Options on page 106 Field Subsets K Central D Macula Nasal Superior Temporal Superior Full Peripheral D Nasal Inferior KP Temporal Inferior Zone These buttons are added to the toolbar when regressions are selected They define the zones in the field that will be included in the regression analysis Clicking one of these buttons will re graph the data for that data subset The subse
50. ap is fitted just above the patient s eyebrow These targets are used by the perimeter to track and correct for patient head movement so it 1s important that they are not obscured by the patient head rest or the lens holder Note that the actual camera s field of view is larger than that displayed in the video monitor window so the targets do not necessarily have to be visible in the video monitor window When the test begins the perimeter locates the patient s iris and uses this location as a calibrated reference point for determining if their fixation changes during the test Positioning the Patient for Binocular Driving Test Special consideration must be made for the Binocular Driving Test For the first half of this test the patient will be centrally fixated as per normal As the test progresses the patient will be prompted to view alternate fixation points firstly to the right and then to the left bringing the test to completion Medmont Automated Perimeter 45 Testing a Patient 46 When prompted for each of these alternate fixation points advise the patient to turn their head slightly in the direction of the new fixation point rather than moving only their eyes This will allow for more reliable iris tracking Video Fixation Monitoring during the Test The current calibrated iris location is displayed as a circle outline on the video monitor window If the perimeter detects that the patient s head has moved by tr
51. appear random to the patient This process will then be repeated on a second fixation target when prompted by the computer to complete the exam Statistics on the results of the exam can be viewed once the exam has been saved Driving Test The standard full field of the M700 extends to 50 eccentricity which covers all normal field testing applications There is a special Driving Field included as a standard M700 field that extends the measurable field to 80 temporally and 50 nasally by using eccentric 30 fixation targets To carry out this test select the Driving Test and test the central 50 in the usual way with the patient fixating on the central fixation target If a Medmont Automated Perimeter 53 The System Test Templates correction lens has been used you will be prompted to remove this once the central 30 field has been completed When most of the points in the 30 to 50 field have been tested the computer beeps and the dialog shown below in Figure 18 is displayed Change Fixation Ci Reposition the patient to observe new fixation target Figure 18 Change fixation dialog for extended fields At this point you should ask the patient to look at the eccentric target that is now illuminated check that the patient is looking at the target and then click OK Continue the test testing the temporal field from 50 to 80 During this phase those points in the original 30 to 50 field
52. are summarised here and elaborated on in subsequent sections Fast An efficient modern technique that uses a Threshold sophisticated probabilistic algorithm to quickly approach and bracket a patient s threshold Threshold The classic staircase exposure method where the patient s threshold is bracketed in steps the clinician can set Screening Four selected calibration points are accurately deprecated thresholded using the Fast Threshold strategy An initial Hill of Vision HoV see Statistical Indexes on page 63 is then computed based on the calibration result Subsequent exposures only attempt to threshold Not Seen light points Three Zone Points are exposed at a predicted level based on an initial Fast Threshold calibration of four selected points If the point is seen then it completes Otherwise its next and final exposure is at 0 dB and it completes as either Seen or Not Seen Fixed level A go no go test where all points are exposed only once at an exposure level the clinician can set The point completes as either Seen or Not Seen Age Related A strategy with a maximum of two exposures where a fast age related vision profile is the primary concern Stimulus Presentation As described in You can access the Editor from the Test Control window by clicking the Edit gt Template gt Edit button You can also review and edit these settings from Medmont Studio on the Configure tab with the Template Setup option
53. can continue Medmont Automated Perimeter 39 Testing a Patient 40 Choosing a Slow Response Setting Use the Slow Response button at any time to select the Slow settings as defined in the Stimulus Parameters group in the Template Editor see You can access the Editor from the Test Control window by clicking the Edit gt Template gt Edit button You can also review and edit these settings from Medmont Studio on the Configure tab with the Template Setup option See Creating a New Template on page 36 for how to create a new template Here we discuss the various settings and the ramifications of any changes The Stimulus Parameters Group on page 31 When you press this button the test will start or continue using the slow settings The button will change from a snail to a rabbit W and if you press the now Standard button the test will revert to the standard exposure time settings Test Point Colours during Testing Once the test is running you can monitor the patient s responses from the Test Control window The colour of the test point text in each of the included points on the field display denotes its current state blue as yet untested red exposed but as yet not seen green exposed and seen white final completed state The grey points are not included and will not be tested Apart from the blue untested points which show the initial exposure level the number in the circle is the Jast exposed value in dec
54. ckbox in the software drivers dialog shown in Figure when this is displayed during installation Select software drivers for any instruments that you intend to connect to this computer M700 M730 Automated Perimeter _ Legacy Leutron E300 Corneal Topographer Topographers connected via USB converter box will use built in Windows drivers DV2000 Digital Imaging Leutron card AVT Firewire Driver _ Picolo card Alkeria Elite Firewire Driver _ Flashbus card Point Grey Driver Figure 1 Device driver installation dialog See the Medmont Studio documentation for more details on installation System Hardware Installation Medmont Automated Perimeter The Medmont Automated Perimeter setup consists of three basic components e The perimeter unit which presents the stimuli to the patient Medmont Automated Perimeter 17 Installation e A separate Personal Computer which controls the perimeter and all test functions e Isolation transformer used to provide the extra electrical safety protection for the patient which the PC does not have Connect Patient Switch and USB cable into the connector on the lower right hand side of the perimeter as labelled Peripheral e g printer s Automated Perimeter USB Mains Power Figure 2 Perimeter power connections A hospital grade power cord must be used to achieve reliable grounding WARNING When setting up the inst
55. completed threshold values for these points are examined and their standard deviation SD computed The average fluctuation value is the mean of these deviations The severity setting is computed as shown in the table below 3 or more points with SD gt 2 5 i 2 or more points with SD gt 2 75 1 or more points with SD gt 3 05 Table 2 Fluctuation severity settings When Fluctuation measurement has been enabled the test report will include the mean fluctuation SF and up to three asterisks to indicate the severity of the variation Flicker Targets A special feature of the Medmont Automated Perimeter is its ability to generate a flickering stimulus It has been shown that under certain circumstances evidence of visual field loss can be detected more readily with a flickering stimulus than with a normal static stimulus In a Flicker Test the stimulus is flashed on and off with equal intervals at a flicker rate that varies with eccentricity For this test the patient is required only to respond if the stimulus is perceived to be flickering If the target is visible but flicker is not apparent then the patient should not respond To assist the patient in making this discrimination a high rate of non flickering targets is presented at the start of the test If a response is made to these static targets a false positive error is recorded The rate of these false positive presentations decreases during the course of the fl
56. ctrical and electronic equipment The instrument complies with the following harmonised standards IEC 60601 1 ed 3 Medical electrical equipment Partl General requirements for basic safety and essential performance IEC 60601 1 2 ed 3 Medical electrical equipment Part 1 2 General requirements for basic safety and essential performance Collateral standard Electromagnetic compatibility Requirements and tests As identification of its conformity the Medmont Automated Perimeter is labelled with the CE mark as shown below on the instrument label positioned visibly on the main body of the device CE 134 Medmont Automated Perimeter Representatives 22 Representatives The EU Authorised Representative BiB Ophthalmic Instruments Unit 8 The Orbital Centre Cockerel Close Gunnels Wood Road Stevenage Hertfordshire SGI 2NB England Tel 0044 0 1438 740823 Fax 0044 0 1438 356093 Your Local Medmont Authorised Agent 1s Medmont Automated Perimeter 135
57. d Lens option is not checked then by default tests are performed with no lens In either case you can change or clear the lens to use for a test by clicking on the Lens button Lens Details Sphere Cylinder i Refraction eh H 0 00 j X i Add Age Offset Figure 10 Lens details dialog The Lens Details dialog shown in Figure 10 allows you to manually enter the lens parameters to use for the test Clicking the Refraction button sets the default lens parameters for the patient based on their current clinical refraction If the Add Age Offset option is checked then the age based offset from Figure 10 1s automatically added to the sphere Note that changes made in this dialog apply only to the current test and do not alter the patient s current clinical refraction Setting Prompt to Save Normally when a test ends there are a number of actions available before the test 1s saved including the ability to analyse the result In a busy practice with many clinicians the possibility exists that in the subsequent analysis and patient discussion saving the result may be overlooked Save Test x Q Do you want to save the current test Yes No Cancel Figure 11 Save test result immediately dialog Click the Edit tab and checking the option Prompt to Save will bring up the Save Result dialog shown in Figure 11 immediately the test ends making a decision about saving the result necessary before events
58. d Perimeter Testing a Patient spot Once the test is running selecting a new blind spot point this way will schedule its exposure in the next time slot Note No action is taken if the manually selected blind spot point is seen It is now up to the clinician to move the blind spot to a new position The user can map the patient s blind spot by clicking on consecutive points until all have been exposed The red Xs assist in this operation and will subsequently define the blind spot boundaries Video Fixation Monitoring Video Fixation Monitoring is an optional alternative means of monitoring the patient s fixation in which the computer analyses the video of the patient s eye to determine where they are fixating Video Fixation Monitoring is only available if you have purchased the required Feature Pack license and have a perimeter fitted with the necessary video hardware Contact your Medmont representative for more information on these requirements Positioning the Patient and Calibrating Fixation Video Fixation Monitoring can be used for both monocular and binocular tests For monocular testing a special supplied eye patch must be fitted to the patient which has two small circular tracking targets on the strap For binocular testing the supplied headband with three small tracking targets must be fitted to the patient In either case you should ensure that the central target 1s located over the nose and the str
59. d Perimeter The System Test Templates A pattern of 21 cells is tested extending 30 superiorly and 40 inferiorly For each double response recorded all neighbouring points are also tested to accurately map the extent of the double vision Central Test For normal initial examination purposes the central 30 field is generally the most appropriate The Central test provides a rapid means of determining whether any significant field defect is present If a defect is found the Fast Threshold test strategy will quantify it by thresholding the defect area CV 100 Point The CV 100 Point exam is a Perimetric Residual three levels strategy exam used to determine the level of blindness in a patient Using both eyes the exam tests 100 points through an 80 field Then a blindness percentage is calculated using the Points Seen and Relative Defect points from the completed 100 point test Like the driving test the patient is first tested in the central 50 area fixated on the central fixation target At a specific point during the exam when most points in the 30 to 50 have been tested the computer will beep and a message is displayed The patient s fixation is adjusted to the new fixation target and the clinician selects OK to continue the exam The test will continue testing the temporal field from 50 to 80 Any of the original points not tested within the 30 to 50 field will also be tested to make the test
60. d for domestic purposes provided the following warning is heeded Warning This equipment system is intended for use by healthcare professionals only This equipment system may cause radio interference or may disrupt the operation of nearby equipment It may be necessary to take mitigation measures such as re orienting or relocating the M700 USB Automated Perimeter or shielding the location Voltage fluctuations flicker emissions Complies IEC 61000 3 3 Side effects No undesired side effects to patient or clinician or other persons are known when using this instrument under normal conditions and for the intended purpose Instrument Damage Never operate instrument in a damaged condition Contact your distributor to seek advice WARNING Disposal Some components in the instrument contain lead or polychlorinated biphenyls PCBs These substances can be WARNING harmful to human health and the environment Dispose the instrument and all the electronic accessories only through separate collection and not with normal waste For disposal at the end of the product life cycle please follow national regulations for disposal and recycling WARNING Symbols and Labels The following table explains the use of symbols in this manual Medmont Automated Perimeter 13 Important Facts gt Caution Attention A NOTE AN f mt i gt PATIENT SWITCH 14 Warning In the event of user error including use
61. d on the fixation target Sometimes all that is needed is an explicit instruction to look straight ahead at the fixation target and push the button when a light is seen anywhere on the perimeter The clinician may wish to explain that the patient can safely pause the test by holding the button down and that the test will continue normally when the button is released The patient needs to be told that the light point will be a brief flash after which there will be a short pause She also needs to know that she can respond after the light goes off so she is not frustrated if she finds it impossible to respond quickly enough while the light is still on Thus he or she should respond as quickly as possible but not too quickly that they respond in error The patient should also be told that some points will be very dim and that she should respond if they are seen but only if she is sure because at times they will be below her visual threshold and at other times the perimeter will only pretend to present stimuli Ensure the patient is aware that the multiple fixation targets inne four times will indicate the end of the test Especially if the patient has never undergone perimetry before it 1s best to test the non suspect eye first Otherwise the convention is to test the right eye first and the Medmont Automated Perimeter respects this convention The eye not being tested should be covered with the supplied eye patch If using video fi
62. diting Select a template and click the OK button to start the Template Editor fe M700 Templates 3 Mane Type Binocular Driving Test System Template Read Onl Binocular Single Vision System Template Read Only Edit Central 22A Test System Template Read Only Central Test System Template Read Only Refresh CV 100 Point System Template Read Only Driving Test System Template Read Only Flash Scan Test System Template Read Only Import Flicker Test System Template Read Only Export Full Test System Template Read Only we Glaucoma Test System Template Read Only Macula Test System Template Read Only Neurological Test System Template Read Only EE Peripheral Test System Template Read Only Close Figure 9 Selecting a base template Medmont Automated Perimeter Testing a Patient Defining the Field Figure 8 shows the template editor and a test Field for the selected eye The included light points in the field to be tested are shown as solid blue circles All other points are grey By selecting and de selecting points in this template display you can create test fields that address specific areas of interest You select a point by pointing to it with the cursor and clicking The point background colour will change to blue If you hold the mouse button down you can continue to select new points as you move the cursor over unselected points If you move the cursor to a point you have al
63. e For new systems navigate to the CD ROM disk e For older systems navigate to the floppy disk You will be presented with a standard Windows file selection dialog listing the calibration file Ensure the file with the ICF extension is highlighted and click on the Open button to load the calibration file Medmont Studio will display the perimeter dialog shown in Figure 5 Verify the serial number matches your documentation By default the perimeter name is the same as the serial number You can choose to give the instrument a local name at this point Click the OK button Edit M700 Instrument Name MWe25054 Serial Number Me825051 Cancel Figure 5 Perimeter Selection If you have a number of Perimeters installed on this PC you will need to select an instrument from the list for every test You can specify a default Medmont Automated Perimeter 21 Installation instrument by selecting it in the M700 Instrument dialog and clicking the Install button Verify that the M700 component has been installed by selecting help icon located in the top left hand corner of the main Medmont Studio window and select About Medmont Studio 6 This displays a dialog that lists among other things the installed components The Test button will be greyed out until a Perimeter is installed This button is used for regular testing of all light points on the installed Perimeter Refer to page 128 on testing light points for more i
64. e you pressed the button the faster the view will move You also need to remember approximately where that point was as you must cross over it to reverse the direction of rotation As an example to re orient the view so it is level and you are looking horizontally at the plane of the view as shown in Figure 47 we suggest you follow the following procedure Slowly rotate the view around its vertical axis using only the small left or right arrows until the highest or lowest point of the view plane is at the front of the view Now change to rotating the view about the horizontal axis using only the small top or bottom arrows and in the direction to bring the plane of the view level with your view as shown in the figure D Fredericks Fred Left 5 May 1989 1 28 00 PM Full Screening OD 0 04 PD 1 23 NO sF 0 00 CA No local defects o 3 6 9 12 15 418 21 24 ris a Figure 47 A Perspective view rotated to the horizontal plane While managing this view may take a little practise being able to rock the view from side to side while viewing from a particular aspect can give a very effective illusion of three dimensions The result can be a better insight into the reasons for the shape slope and depth of defects in the perceived field Medmont Automated Perimeter Analysing and Viewing Exam Results Display Options The Display gt Options tab see Figure 48 allows you to select options which
65. eas often producing an HoV more depressed than actual The Automated Perimeter software uses a robust statistical elimination technique to fit a HoV that estimates the real underlying HoV This is not a simple curve through the patient s best vision but a best estimate of the patient s HoV without any defects The patient s HoV is expressed as a linear slope parameter of dB 10 and a dB level at 3 eccentricity A sample HoV summary display is Medmont Automated Perimeter 63 Statistical Indexes Hill of Vision 3 5 dB 10 25 5 dB This means that at 3 eccentricity the patient s mean threshold was 25 5 dB and it fell away at 3 5 dB for every 10 of eccentricity Thus at 20 the HoV level would be 19 55 dB Overall Defect Overall Defect or OD is the mean difference between the Age Normal HoV and the mean deviation or Patient Based HoV This number is negative if the patient s HoV is less than the Age Normal HoV See Patient Based Hill of Vision and Age Normal Hill of Vision on page 63 Up to three asterisks are appended to this number as a severity indication They are age referenced and the various level boundaries are shown in Table 6 Table 6 The relationship between Overall Defect severity and the number of asterisks Pattern Defect The Pattern Defect or PD statistic is based on spatial correlation and is a measure of the clustering and depth of defects It is a scaled mean value of t
66. erce horis teeta enh eet ees econ 64 Cser Auta S19 5592s ctu h ss A 65 DCC Mir OEM ce crenata nese ety eaten ks E N 66 ING 629 6 Ciao Oita gases ete tected chica ee tected titer ae tenant 67 CN I scene A ene 67 ANALYSING AND VIEWING EXAM RESULTS cccccccccesssssseees 68 Selecting the Exam ResUl Sristi a on ele edhe a ee eawices 68 Setting the Exam View Mode 70 Selecting the Map Type and Data View ccccccccccccccccceceeeeeeeeeeeeeeeees 79 Map Types 79 Data View 84 Display Opon ee set ater a S 87 Shaded Greyscale 87 Numeric Tick Marks 87 Non Linear Scale 88 Annotations 88 Exim TiD eg 0 oe ee a OO AO ERE Ree At et 88 Data Tab 88 Section Tab 9 Comments Tab 92 Adding and Editing Attributes ccccccccecseeeeeeeeseeeeeeeesseeeeeeeeeeeeeeeees 92 Addin Amin OLatOns 25 0 Sosa cia ee eos eat 96 Text Annotations 97 Callout Annotations 97 Ruler Annotations 97 Shape Annotations 97 Edin ANHO ONS ate oxiteeat le a tate ee as 98 Locking AnnOtaiOnS esaa a a a a aera 99 PSU ANNON e cha tt ea ee ds eat 100 Saving and Abandoning Changes 100 Zooming and Panini oso eines vea denen 100 Medmont Automated Perimeter ill 11 12 13 14 15 16 17 18 19 20 21 22 1V Using the Mouse to Pan and Zoom REGRESSION ANALYSIS scescsctscciscetahascieacesecesecatersdivedadsbetecessssiesecesnensersis PIS CO ST arb NOUS aea a E en aceon The Rerression Ty CS aie hod ta ee te eee Feld Subs CUS dicate eabasi
67. error and unforeseen fault condition there may be a serious risk to health or life of patients or operator or product damage or loss may occur Caution In the event of user error or unforeseen fault condition damage to the device or its performance may occur Precaution Safety related instruction Refer to instruction manual booklet Alternating current Compliance with the EC Directive 93 42 EEC for medical devices Type B Equipment degree of electrical safety The date below this symbol shows the year and month of manufacturing WEEE mark Separate collection for electrical and electronic equipment Device contains dangerous substances do not dispose with normal waste Connector socket for patient switch Type B USB connector for USB cable connection to computer Medmont Automated Perimeter Important Facts COVER OPEN PC COM PORT IN PATIENT CANTON ENVIRONMENT Medmont International Pty Ltd Australia C G VAN Caution AUTOMATED PERIMETER 7 moneL M700 USB M VAR PI901V1 4 fvertissement A hospral grade power cord Waming must be used to achieve reliable grounding 5x 20 250VAC T400 mAL JSA at 250V THIS EN TEC 60950 CERTIFIED EQUIPMENT ES USED WITHIN PATIENT ENVIRONMENT USE TOGETHER WITH AN ISOLATION TRANSFORMER OR ADDITIONAL PROTECTIVE EARTH TERMINAL TO CAUTION SYSTEM GROUND PATIENT ENVIRONMENT ATTACH TO APTRCTED APPLIANCE This label 1s fou
68. etry Terms that appear here are underlined in the body of the manual Age Normal Hill of Vision An Age Normal Hill of Vision describes the hill of vision for each of three age groups and is based on standard age based population tables interpolated for the Medmont Automated Perimeter Blind Spot A stimulus positioned at the patient s blind spot to randomly monitor the patient s fixation during a test using the Heyl Krakau method Field A field is a collection of stimuli with a pattern devised to test one or more aspects of a patient s vision Fixation Point The fixation target at which the patient must fix their vision Offset Fixation Points These fixation points are offset from the centre of the bowl by 30 and provide for fields that exceed the normal 50 boundaries Strategy A strategy defines a methodology that starts with exposing a stimulus and then using the patient s response to decide on how that light point will be subsequently exposed if at all Template A template is a file that contains a test field along with additional parameters that define how the field is used in a test 126 Medmont Automated Perimeter Cleaning Maintenance and Service 18 Cleaning Maintenance and Service Warning Do not modify this equipment without authorisation of the manufacturer WARNING Cleaning Dust should be removed from the surface of the stimulator bowl with a clean damp soft and lint free clot
69. g and Viewing Exam Results The selected opacity level will be automatically applied to all visual field exams with an overlaid retinal image Difference from Baseline View Clicking on Difference from Baseline a icon from the top of the patient tree to display Difference from baseline view for the currently selected exam The view is divided into four sections baseline exam current exam difference from baseline and Pattern Defect An example is shown in Figure 36 Jolly Nick Right 26 Aug 1994 11 19 00 AM Baseline Exam 21 Apr 1992 Difference From Baseline 9 Dec 1993 26 Apr 1994 26 Aug 1994 1g NOLNO ho Se oe B as NO 1515 3 18 a i Ba g x z NO 1 E x 21 18 21 18 13 8 NO12 6 4g 21 18 9449 9 m o o o o x no ONO yono 24 24 12 BS 42 3M0 12 18 24 18 N65 Oo o No 15 NO 3 NO 18 o 2 ea E el oO o 12 15 gly 6 18 x sar is o 9 12 tlio 18 15 oO ojo eine a x o x o CurrentExam 26 Aug 1994 o SEa x o O ts no She 2 i NO No 1g 12 x No NO joNONO g 15 No s k a 6 0 15 18 NO yg NO NO NO Wo 18 720 x no NO No No 418 NO NO NO No NO ie je ee a nono 0 NO 0 ONOBS g a 0 No io te oe 3 No Nolo 9 ale 9 o z 4 6 s E 15 15 A Xx Maximum Defect o B Or6 i8 18 5 C P lt 5 Defect Non Repeated 3 gl9 9 j a fl P lt 5 Defect Repeated sing E I P lt 5 Defect Repeated x2 M700 Exam Pattern Defect Superior Nasal m Right Limi NMNDJFMAMJJASONOD FMAMJJA ON D I FMAMIJIASO
70. ght points re sampled onto a square grid If you are used to seeing perimeter data presented this way it provides an easy entry into using a Medmont perimeter Plan View Select this button on the Display tab This is a powerful tool for visualising the patterns present in the numeric views As explained in Display Options on page 87 this view can be in colour or shades of grey Both the colour and grey scale views are provided with a legend that associates a particular colour or grey scale with its corresponding level in decibels You can use the zoom and pan tools described in Zooming and Medmont Automated Perimeter Analysing and Viewing Exam Results Panning on page 100 to extract more detail and the cross section tool described in Section Tab on page 91 Perspective View Select this button Y on the Display tab The view drapes a rectangular grid over the Interpolated Shaded View and provides the dimensions of depth and hidden surface removal as additional visualisation cues Figure 46 shows an example hill of vision Qi Fredericks Fred Left 5 May 1989 1 32 48 PM Full Test OD 7 75 a PD 247 SF 0 00 CA No local defects oo 3 x N z A amp amp iN ie N n Figure 46 Perspective Hill of Vision view You can zoom and pan this view using the tools described in Zooming and Panning on page 100 but for the perspective view the mouse driven pan tool provides for c
71. gnetic environment due to fixed RF transmitters an electromagnetic site survey should be considered If the measured field strength in the location in which the M700 USB Automated Perimeter is used exceeds the applicable RF compliance level above the M700 USB 10 Medmont Automated Perimeter Important Facts Automated Perimeter should be observed to verify normal operation If abnormal performance is observed additional measures may be necessary such as re orienting or relocating the M700 USB Automated Perimeter gt Over the frequency range 150 kHz to 80 MHz field strengths should be less than 3 V m Recommended separation distances between portable and mobile RF communications equipment and the M700 USB Automated Perimeter The M700 USB Automated Perimeter is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled The customer or the user of the M700 USB Automated Perimeter can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment transmitters and the M700 USB Automated Perimeter as recommended below according to the maximum output power of the communications equipment Rated maximum output power of Separation distance according to frequency of transmitter transmitter a 150 kHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2 5 GHz d 1 2VP d 1 2VP d 2 3VP For transmitters rated at a maximum output power n
72. gt 95 dip in UT for 0 5 cycle 40 UT 60 dip in UT for 5 cycles 70 UT 30 dip in UT for 25 cycles lt 5 UT gt 95 dip in UT for5s Medmont Automated Perimeter Electromagnetic environment guidance Floors should be wood concrete or ceramic tile If floors are covered with synthetic material the relative humidity should be at least 30 Mains power quality should be that of a typical commercial or hospital environment Mains power quality should be that of a typical commercial or hospital environment Mains power quality should be that of a typical commercial or hospital environment If the user of the M700 USB Automated Perimeter requires continued operation during power mains interruptions it is recommended that the ME EQUIPMENT Or ME SYSTEM be powered from an uninterruptible power supply or a battery Power frequency magnetic fields should be at levels characteristic of a typical location in a typical Important Facts commercial or hospital environment NOTE UT is the a c mains voltage prior to application of the test level Guidance and manufacturer s declaration electromagnetic immunity The M700 USB Automated Perimeter is intended for use in the electromagnetic environment specified below The customer or the user of the M700 USB Automated Perimeter should assure that it is used in such an environment IEC 60601 IMMUNITY
73. h using a mild ria domestic solvent free cleaner Do not spray or pour cleaner directly onto surfaces All surfaces coming into contact with patients need regular disinfecting Standard instrument grade disinfectant solutions may be used e g diluted isopropanol Wipe surfaces with a damp cloth only Do not use strong oxidising agents or solvents as they could damage surface coatings Use soft non abrasive cloths only Maintenance For Medmont Automated Perimeters equipped with a CCD camera do not attempt cleaning the lens surface with cloth or any liquid cleaner Use a soft optics brush with blower or dry cotton swab only Multiple LED Light Emitting Diodes mounted around the periphery of the stimulator bowl provide the background illumination Although operated at a low voltage for a long life they should be periodically checked If replacement is required please ask your local Medmont distributor for spare parts and replacement instructions The vertical chinrest should be lubricated regularly to prevent dust entering the sliding mechanism and to prevent corrosion Wind up the chinrest to the upper limit Put a small amount of sewing machine oil onto a lint free cloth Wipe the steel shaft on the rear side to remove any dust and contamination A tiny drop of oil may also be applied to the rotating parts and joints of the lens holder mechanism Wipe off excessive oil immediately The frequency of the lubrication depends the envir
74. hat you see of the Medmont Studio display of this test but formatted to better suit the printed page Clicking on the S Printer button will print this image Export a Print Preview to the Clipboard In the Preview window if you click on the Clipboard button the review image is copied to the clipboard as a bitmap allowing subsequent pasting into any application that allows image cut and paste options Word PaintShop etc Export a Print Preview to an Image File If you click on the File button you can save the printer review image to disk in either BMP JPG or GIF image formats This makes for simple communicating of results where the image must be transported electronically such as by email Medmont Automated Perimeter 109 Printing the Exam Results Figure 66 Print preview window for the Current Display option Printing Multiple Images You can print the results for both eyes on the one page Select both tests in the Explorer pane hold the Ctrl key down while selecting then click through to the printer dialog Click the Settings button and set the display to Landscape see Figure 68 Now when you print the two views will be printed side by side similar to print preview shown in Figure 67 110 Medmont Automated Perimeter Printing the Exam Results Medmont Studio Page t Fiter Michele 4 Dec 1987 74 00 AM RIJ Glaucoma Test Q medmont Lene NU Miina F ea ow d o aa EA En Site gt
75. he Home gt New Bo button Demonstrating the Test 30 Before starting a test in the normal way you can run it in demonstration mode To the patient this looks just like the real thing However the results are not being monitored The clinician sees a dialog saying Press OK to stop demonstration and clicking on the button will conclude the demonstration Medmont Automated Perimeter Testing a Patient and return the test to ready status Run the test in demonstration mode on the Home tab by clicking Demo D When the demonstration stops it will flash the macula targets exactly as will occur at the conclusion of a real test This is an opportunity to point out to the patient how they will know that the test has ended Modifying Test Parameters A Template defines the Field of light points to be included in the test as well as various settings that make up that particular test An example template for the Central Test is shown in Figure 8 a view of the Template editor Central Test Settings System Template Read Only Name Centra st Exposure 1 10 Response Delay Strategy Fast Threshold bt Level 5 Min 3 Step or Left Eye Right Eye 30 10 50 Outer Boundary Cancel Figure 8 The Template Editor showing the system Central Test template You can access the Editor from the Test Control window by clicking the Edit gt Template gt Edit button You can also review and edit these setti
76. he product of a point s HoV deviation and that of its neighbours It qualifies the extent to which deviations are spatially correlated or clustered For example if deviations from the patient s HoV are distributed more or less randomly throughout the field then the PD will be small As deviations tend to cluster the index will increase particularly where both the absolute deviations and clustering are high 64 Medmont Automated Perimeter Statistical Indexes Pattern Defect Asterisks gt 2 8 P Dal gt 8 6 Table 7 The relationship between Pattern Defect severity and the number of asterisks Like Overall Defect severity asterisks are also provided for Pattern Defect and are a measure of the significance of the PD figure The relationship between the number of asterisks and PD number is shown in Table 7 Cluster Analysis The cluster analysis hemi field comparison facility in the Medmont Automated Perimeter divides the inner perimeter field into nine superior and nine matching inferior hemi field zones The outer boundary of the fields is just past the 22 ring The sector 30 on the blind spot side is excluded Figure 21 The eighteen hemi field zones for a left eye field Medmont Automated Perimeter 65 Statistical Indexes The analysis procedure first calculates the mean of the decibel values in a superior zone and compares the result with the corresponding mean in the matching inferior zone
77. hold down the Ctrl key while clicking on the required exams You can hold down the Ctrl and Shift keys to select the start and finish of a set of contiguous exams Click on the patient name to export the entire patient s record set Use the same technique of holding down the Ctrl key to select multiple patients for export Click on the database name to export all patients in that database The export formats are various forms of the XML eXtended Markup Language a universal markup language for data interchange However there are various versions that depend somewhat on your local language and whether Unicode characters are used or not The Save As Type drop down box allows for selection of ASCII mxf and Unicode muf representations and compressed ASCII mcf and compressed Unicode mzf versions respectively 120 Medmont Automated Perimeter Perimeter Filters 14 Perimeter Filters Filters are described in the Medmont Studio User manual However here we will setup a couple of simple filters that are perimeter specific A filter allows you to search the entire patient database for patients that satisfy specified criteria defined in terms of the patient s details and or exams For example to sort patients into either male or female groups click on the filter drop down or pop up box at the bottom of the patient pane and select the Filter entry see Figure 76 Figure 76 Selecting a filter This will display the Patie
78. ibels Points that are eventually exposed at zero decibels and are still Not Seen will have a white NO in their circle Monitoring the Test Progress The perimeter Test Control display shows exactly what is happening on the perimeter itself in real time The colours and dB values described in the preceding discussion allow you to follow the test as it progresses The values that a light point can take and the reasons are dependent on which test strategy 1s currently being used For an explanation of how the value of a light point changes as the test progresses see The System Test Strategies starting on page 58 Test Based on Age Normal HoV Where there is no previous test of this eye for this patient the initial values in a light point are based on a standard age normal Hill of Vision HoV Medmont Automated Perimeter Testing a Patient except for the deprecated Screening strategy see Screening Strategy on page 60 for the differences This same initialisation also applies if the previous test used a Three Zone Fixed Level or Age Related strategy Note that if no patient has been selected the HoV is based on a patient in the age group to 45 Test Based on Previous Exam When a previous result is used the initial value of each light point is based on its corresponding value from the previous test This setting 1s more likely to be closer to the patient s actual HoV than one that is age based and will theref
79. icker test Test Inside NOT SEEN Regions During a test when the patient still has not seen a light point even when eventually exposed at 0 dB it is flagged as Not Seen an Absolute Defect When a region of as yet untested points has a contiguous boundary of Not Medmont Automated Perimeter Testing a Patient Seen points it is called a Not Seen Region and will be recognised as such by the software When this checkbox is ticked Not Seen regions have no special treatment and all points will eventually be tested With this checkbox un ticked however as soon as a Not Seen region boundary is complete all points within that region will automatically be set to Not Seen It will therefore conclude a test early where Not Seen regions exist with the assumption that points inside these regions are likely to be Not Seen also Spatially Adaptive The Medmont Automated Perimeter allows you to easily create your own templates see Creating a New Template on page 36 and for some applications these may be quite sparse The system templates Spatially Adaptive Central 22A and the deprecated Quickscan are examples of sparse fields The advantage of a sparse field is a large area of the eye can be covered with only a few points allowing a fast exam The disadvantage is a defect may be hidden between the tested points and consequently missed Ticking the Spatially Adaptive checkbox provides a measure of confidence that this will not occur
80. ide of the Medmont Studio window is in Tree View mode Selecting a patient allows you to explore Thumbnail Views see the Medmont Studio manual and multiple exam Regression Analysis see Regression Analysis on page 102 Clicking on the small cross in the box beside each patient will expand the exam list for that patient A section of a typical patient list with a number of visual field exams displayed is shown below in Figure 22 The exams are sorted by date and time Fifer Michele 6 Nov 1959 j 2 Fredericks Fred 13 Apr 1920 3 Apr 1920 i 5 May 1989 12 02 00 PM Right Central Test S May 1989 12 21 00 PM W Right Central Test M 5 May 1989 1 28 00 PM y Left Full Screening i S May 1989 1 33 00 PM Left Full Test 3Dec 1998 3 40 56 PM Right Post op 33 Dec 1998 3 41 45 PM G1 Left Post op ro 77 Aug 2000 9 53 03 AM Left Handle Maurice 13 Sep 1926 Figure 22 An example patient list showing the left and right eye visual field exam icons for patient Fred Fredericks Select exams by clicking on either the exam symbol or the text To select multiple exams hold down the Ctrl key while clicking You can view up to four exams at a time The main View window displays the exam result s How the exams are displayed depends on the current View mode Smith Ben 17 Jan 1936 Smith Sandra 24 Dec 1980 Way Joe 10 Feb 1968 Wav Tim 3 Al v 49 found amp Patients Exams Figure 23
81. iew on page 73 for more information on registering and using retinal images with perimeter exams 116 Medmont Automated Perimeter Printing the Exam Results The Overlay Opacity sets the transparency of the graphic shown in the Plan view when combined with a retinal overlay If the retinal overlay option is not checked then the opacity has no effect Printing the Patient History You can print a summary of a particular patient s entire history for the left right or both eyes or any selection of exams from within that history The summary includes four field graphics and a subset of the statistical summaries To see the various options available as an example make sure patient John Citizen is selected click the button and then select Print Preview to bring up the Print Preview dialog Click on Threshold Multi Print selection and then on the OK button When the multi print display appears select Settings to bring up the Threshold Multi Print Settings dialog Click on the Multi Print tab to show the dialog in Figure 73 This is very similar to the Threshold Print Settings dialog in Figure 69 except you can select left right or both eyes and there are only four window selection buttons and they are in a horizontal line L Threshold Multi Print Settings Eye Left Right Both Sorting Field ExamDate E Ascending Common Settings F Non Linear Scaling E Attributes tt Arrange E Numeric Tick Marks E Annotat
82. ifferences between the exam result and the Age Normal are presented as symbols representing the probability levels as one of the graphics shown in Figure 44 The lt 5 symbol means the value of this point would occur in less than 5 of cases the lt 2 5 symbol means the value of this point would occur in less than 2 5 of cases and so on down to the lt 0 1 symbol Another way of looking at the say lt 5 value is that in 20 tests of normal eyes only would show a sensitivity value this low just by chance A dot symbol indicates that this particular point can be considered within the normal bounds Pat bi H c25 S 0 5 E 0 1 Figure 44 Hill of Vision probability symbols Patient HoV Probability This view can be used to determine whether a particular point or set of points are significantly different from the patient s own Hov after removing the fact that the HoV itself may be depressed An example is shown in Figure 45 82 Medmont Automated Perimeter Analysing and Viewing Exam Results Jolly Nick MW 25 Jul 1994 1 14 00 PM Left Glaucoma Test Q medmont Figure 45 Patient HoV Probability visualisation This is similar to the Age Normal Probability see Age Normal Probability on page 81 but measures deviations from the patient s own fitted HoV so points that show as dots have values that are to be expected for this particular field even though they may be considerably depressed compared
83. iiedcied nied ol ie DCC SUNG Sats esac les see sie aes c holt Rees ode sale Gass Installing the Perimeter ass oss 10 22 elacssece Seieediavadatadblcreaisenied PAIS shu ie ratasictaeticre saeoaneoy Aesmeeat aie ener eeementeate MES TING A PAHENI a a a a ra The Perimeter Test Control WindoW ccccceeeeeeeeeeees Preparo the Patient sasate edo eben sat oe inl orice ercae antes Express Testing a New Exam cccccccceeeeeeeeeeeeeseeeeeeeeeees Staruine a New Ex ain enserir eset i e E teeecdiadates Medmont Automated Perimeter Test Settings Starting the Test Monitoring the Test Changing Test Points during an Exam Pausing a Test Test Point Colours Saving the Completed Test Demonstrating the Vest iiss cs seci toast a s Modifying Test Parameters sorina n A E sa ce i a The Stimulus Parameters Group The Settings Group Creating a New Template Controlling a Testin Progress osneciencnsiseorieni aie is Selecting a Test Template Selecting the Eye Lens Details Setting Prompt to Save Choosing a Slow Response Setting Test Point Colours during Testing Monitoring the Test Progress The Test Status Group Assigning Sounds to Perimeter Events FEHE SYSTEM TEST TEMPLATES wccsccsiccceisccccea cession cccacesiscvceececacesesseguecnes Binocular Single Vision TeSt ssns ieni EES Central TES Gerent ere css Dir ae Bois aeee ot eee eres een mere ee rec Binocular Driving Testes a E I a Fieke r Bs enna re nN et oe RSI B Roh eee eee ene E
84. ing an Image Source which has been calibrated For details on how to calibrate your Image Source please refer to the DV2000 User Manual To use Retinal Overlay view simply select your desired visual field exam from the Tree View hold down the Ctrl key on your keyboard and select the corresponding retinal image you wish to overlay With both exams selected on the Display tab click Retinal Overlay gt Set Image This will automatically superimpose the retinal image over your visual field exam for comparison and review Overlay Opacity The opacity transparency of the retinal image overlay can be increased or decreased as desired using the Retinal Overlay gt Opacity control e m R Select ae g Shaded Grayscale M Readout Z Enable HE Numeric Tic Marks Pe m Pa OPianar 12 Numeric i R i Zoom 12 Non Linear Scale a ky Perspective 34 Numeric Grid Zoom Pan Cursor Map Type Options Annotations Figure 33 Threshold Exam Settings Dialog Medmont Automated Perimeter 75 Analysing and Viewing Exam Results The effect of changing opacity levels can be seen in the following screens NO PD 10 08 SF Disabled CA Superior Inferior Defect Figure 34 Overlay Opacity 30 Right 12 May 2008 3 06 24 PM Glaucoma Test OD 1 22 PD 10 08 SF Disabled CA Superior inferior Defect Figure 35 Overlay Opacity 70 76 Medmont Automated Perimeter Analysin
85. ion an age normal deviation in colour a patient HoV deviation as a perspective view and a patient HoV probability as a grey scale with Attributes iy Handle Maurice 26May1949 2 06 90 PM Left Corer Test Age Normal Deviation Level a we Q medmont W medmont om E2 S m Rieg 29 Angie 200 Level 315 0 dB v r 7 G 7 j Ring 29 Angle 205 Deviation No Data a Age Normal Denstma Q medmont z on Q medmont La Figure 28 Four different map views of the same exam Compare View Clicking on Compare from the top of the patient tree displays the Level view see page 79 of two selected exams and the difference between them This is a powerful tool for monitoring change You can display the data numerically or in grey scale or colour Medmont Automated Perimeter Analysing and Viewing Exam Results yA Mowbray Lois Left 26 May 89 2 44 PM Central Test ui B A Level 18 a 2 a O y Afa a a 2 24 n 18 0 24 24 a Sea ts Am n 2t 18 3 a ee ts 24 a 12 a 21 48 n 21 BS j 27 24 12 42 42 24 15 24 145 z 24 15 1 15 21 Lag 21 15 18 a 21 18 2 t24 a a o a a an a 15 a Mi na a5 O nojo aa A A 21 Ho 94 24 6 n 15 No 18 a a BS 18 2 2 7 5 5 42g A n 5 2 21 21 18 21 Figure 29 Exam difference display showing decibel levels with points having differences gt 6 dB highlighted Retinal Overlay View
86. ion Loss Date 21 Apr 1992 7 14 00 AM Glaucoma Test Threshold 1 47 2 Excellent 14 Sep 1992 9 04 00 AM Glaucoma Test Threshold 3 51 6 Good 23 Aug 1993 11 59 00 AM Glaucoma Test Threshold 0 46 0 Excellent 9 Dec 1993 1 09 00 PM Glaucoma Test Threshold 5 44 11 Good 26 Apr 1994 1 24 00 PM Glaucoma Test Threshold 1 39 3 Excellent 26 Aug 1994 11 19 00 AM Glaucoma Test Threshold 31 44 70 Very Poor x Please select one or more exams from the list to make a new baseline Figure 38 Defining a baseline The list will be filtered to only display exams which use either the Threshold or Fast Threshold Strategies for the selected patient and the same eye as the currently selected exam Fixation Loss percentage and the Test Template type will also be shown to assist the clinician to select the most appropriate exams Locate the desired exam s and then place a tick in the check box next to the exam When an exam has been checked the dialog box will provide feedback on the selected exam to let you know if the exam is appropriate for the requirements of the baseline exam Click OK once you have finished The Difference from baseline view will now contain the baseline exam and the difference exam The baseline exam will also appear as a separate exam in the patient tree as seen in Figure 39 78 Medmont Automated Perimeter Analysing and Viewing Exam Results Jolly Nick O 26 Mar 1960 iy 13 Jun 1990 1 51 00 PM
87. ions 40 EK Overlay Opacity AI Level 12 Numeric K Pian 13 Numeric Grid yl Perspective Defaults Traditional Grayscale E Section Defaults C Retinal Overlay Cancel Figure 73 Threshold Multi Print options selection dialog Medmont Automated Perimeter 117 Printing the Exam Results You can explore the effects of various selections by clicking on each button to make some changes and then clicking on the Apply button If you choose the defaults then you should see a preview screen similar to Figure 74 Medmont Studio Jolly Nick Date of Birth 26 03 1960 54 Years 5 Months External ID Unknown Level Age Normal Deviation Patient HoV Deviation eoat 1200 AM FL yaam EP wA ENN Ficer OFF y W ga a RURE yo tit 2 ata 12 1 jg 2 nonong OMIM MO a who wo no he no 2 w ed sa s 13 Wig o Mati g 5 wo l aat g 4 ia aa eanu Medmont Studio Version 6 0 0 11 25 Sep 2014 09 32 55 AM Figure 74 Multi print print preview screen Regression View Printing Printing a regression result is similar to the previous two but the selection dialog is rather different Again select patient John Citizen and click on the Regression button Click on the Application button then click Print Preview select M700 Regression Report and then click on the OK button 118 Medmont Automated Perimete
88. is dB year shown in a callout box at the top of the graphic The Defect graphics will include the one two or three asterisk limit lines if they are within the vertical axis bounds The eye buttons d on the toolbar and in the menu select which set of exams are displayed To display the view for both eyes click Both You can point the cursor at any histogram or data point and a click will highlight the selected exam in all plots Clicking the delete button on the toolbar will remove that exam from all plots The regression line will be automatically recomputed for the new set of exams You can restore the original view at any time by clicking on the regression button E You can bring up a Map view for the highlighted exam by clicking on the map view button or double clicking the histogram graphic All the usual map tools are available in this window for reviewing the exam result see Map View on page 71 Histogram Plots Histograms can be displayed to show the distribution of test point levels In this context they show the distribution of values for each exam over time The values are the Y axis and time the X axis The histogram is rotated 90 anti clockwise from a normal representation so the X axis does double duty by also representing relative histogram counts Figure 61 Portion of a Level histogram This histogram shown in Figure 61 describes a distribution of exam level values Level histograms are binned in
89. ked status of an annotation is indicated by the presence of a small lock symbol attached to the annotation as shown in Figure 59 Figure 59 Square Medmont Automated Perimeter 99 Analysing and Viewing Exam Results Deleting Annotations To delete an annotation select the annotation by clicking once on it click on the Edit tab and click Delete Saving and Abandoning Changes Changes and additions you make while working with an exam are not permanent You will notice that as soon as you add annotation two buttons will become active on the Edit tab Save Use these buttons or the menu entries to control the saving or not of any curer work If you do not use either the system will display a dialog when you attempt to move away from the edited image Zooming and Panning You can zoom and pan the currently displayed Patient Exam images from the Display tab using the Zoom and Pan menu items Use the Reset menu item to reset the default image view P H Select Pe m Pa A Hi P Zoom Zoom Pan Cursor When multiple images are displayed zooming and panning of the images from this menu entry are synchronised Using the Mouse to Pan and Zoom You can also use the mouse to pan or zoom within a single image Click with the right mouse button over the image The shape of the cursor changes to reflect the current cursor mode You can also change the cursor mode by pressing the spacebar or clicking the right mo
90. l error message When this occurs clicking on the OK button initiates an in depth analysis of the associated light points This analysis may take several seconds When it concludes it displays a message similar to Figure 80 Perimeter Self Test Failed S X G One or more green light points hawe Failed this kest An error summary has been written to the file C Documents and Settingstron 4pplication Data Medmont Medmont Studio Console BadGreenLeds txt You can print this and or emailiFax it to Medmont International It is unlikely the perimeter will be useable with this error However iF you start a kest with the Full Test template the Failed lightpointis will be highlighted in red Figure 80 Failed Lightpoint summary message The text file named in the message contains a summary of the failed light point s and is written to the current user s Application Data folder Documents and Settings Print this file before making a service call to assist Medmont and or its Distributors in locating the affected light points Typical contents for this text file where one light point has failed in the green array would be Bad Green Lightpoint List for Perimeter M233715 Address 0x27 Reading 2 29V Medmont Automated Perimeter 125 Glossary 17 Glossary This small glossary is included for terminology that originated with Medmont It also includes some common terms where they apply to Medmont equipment It is not a glossary of perim
91. l screen window similar to Figure 3 will appear Medmont Automated Perimeter 19 Installation Wg Organise New Exam Favorites Aa Van Der W e b 1 Jul 1956 R 2 Aalbers Frank 23 Feb 1963 7 i Aalbers Karin 23 Jul 1982 Aalderink 11 Aug 1993 Aalderink S 10 Oct 1991 Aarnink A 7 Nov 1963 7 i Abbink Britt 23 Oct 1993 Blake Matthew y 1 Jan 1989 Blood John 10 Sep 1943 ri Breaden Andrew 24 De 34 Briggs Warren 20 Oct 1917 Canon CR6 45NM 11 Oct 1990 Cherry Steven 16 Jan 1953 Citizen John 26 Aug 1961 Corneal Scar Corneal Denham Ada 18 Dec 1926 32268 CN1110 1 Jan 1990 l r3 Eye Composite y 1 Jan 1990 Fifer Michele 6 Nov 1959 Fredericks Fred 13 Apr 1920 a Handle Maurice A 13 Sep 1926 Harrison Emma 26 Mar 1990 Hennessy Pauline D 25 Apr 19 James Dorothy 19 Nov 1916 Jolly Nick 26 Mar 1960 amp Patients Exams Figure 3 Initial Medmont Studio Window To install your instrument on the Configure tab click Instrument Setup within the M700 group The M700 Instruments dialog shown in Figure 4 will be displayed Click on the Import button to import the calibration file 20 Medmont Automated Perimeter Installation U M700 Instruments Serial Number Figure 4 Install a new M700 Instrument dialog New systems are supplied with the calibration file on a CD ROM while for earlier systems this was supplied on a floppy disk
92. layed below the blind spot monitor graphic During a test the exam state appears as a text message in the top left hand corner of the perimeter display i e Running Clinician Pause Patient Pause etc The perimeter display shows light points that are part of this test as black circles with blue numbers These are the included test points and they define a Field The number is in decibels and denotes the initial exposure level Test points that are non included are shown in grey Changing Test Points during an Exam You can select any point at any time using the technique described in Creating a New Template on page 36 Selecting a point will change its background colour to blue The point based options in the Test menu allow any selected point s to be added prior to the exam beginning You can also use selection to add or re test any point or group of points while the exam is in progress or even after the test has finished These options are also available on the test toolbar via the icons below Note that deselecting does not delete a point Q Add the currently selected point s Use this to add new points that are not included in the current field The point s become part of the current field and will be subsequently tested 5 Re test the currently selected point s Use this to retest points that are included in the current field They will be subsequently retested Deselect any currently selected point s The point and it
93. ld make the name more readable To enter the above expression you can make use of a number of editing shortcuts The first parameter in the above expression is the HoV level and this is returned by the GetHOVLevel function Click on the Data Functions tab so you can see the list of functions Scroll down until you see this function and double click it This copies that function into the Expression editor window at the current cursor position Continue entering the above expression using the same technique to enter the two occurrences of GetHOVSlope The completed dialog should look like Figure 56 Click on the Attribute Expression dialog OK button and then close the Attributes dialog Click on the Arrange user defined attributes button in the Data tab at the left to display the Arrange Attributes dialog Copy the new HoV_at 12 attribute from the Available list to the Selected list then click the Close button Medmont Automated Perimeter 95 Analysing and Viewing Exam Results f Edit Calculated Attribute HoV_3_deg_Level Sm Name HoW_at_12 Display Name HoW at 12 Units dB Decimal Places 1 Scientific Format GetHOVLevel 0 3 GetHoVSlope 1 2 GetHoVSlope Ske Lees JL sin Lcos tan x tog sat Jl atan Data Functions Attributes GetHoVLevel GetHoVSlope GetincludedPoints GetLensAxis GetLensCylinder Cema oe Figure 56 An Expression to evaluate HoV at 1
94. ll graphical facilities of the Analysis view by clicking on the Analyse Test button This brings up another window with the analysis Medmont Automated Perimeter 41 Testing a Patient 42 view see Analysing and Viewing Exam Results on page 68 showing the current exam field settings This view is tied to the current test in real time and will dynamically show the test as it proceeds using whichever particular data visualization view you choose to select You can move the window around and change its size to suit your requirements The position and settings will be remembered for subsequent use The Test Status Group In the left hand pane of the Test Control 1s a group of numeric and statistical monitors called the Test Status Group as shown in Figure 12 During a test these monitors are updated after every exposure Evaluated together they provide an indication of how the test is progressing and whether the patient is responding as expected Test Status Complete OA O3 0 Fix loss Of0 0 False ve Of0 0 False ve Of0 0 Response 1 10 Exposures Time OMinO Sec Strategy Fast Threshold Figure 12 Test status monitor group The following sections explain each monitor what it is showing and some suggestions on how it can be interpreted Percent Complete Monitor This shows the percentage of points in the field that have reached their threshold value measuring progress through the test Blind Spot Fixatio
95. lt Before continuing you should read the Printing chapter in the Medmont Studio manual This describes how printer setup is controlled from the Print Setup menu from the Application Button at the top and that each view type retains its own settings This means for example that a simple map view could be configured for portrait multi print while difference views could be set to landscape Here we will move from simple printing using defaults to configuring each print option The following discussion is considerably simplified 1f we use a known patient environment To this end we will refer to and use patients and exams in the sample database provided on the Medmont Studio CD ROM If you have not as yet installed this database we recommend you do so now see Installing the Demonstration Database on page 124 There are two basic ways to print exams Map Provides either one or six different views of the View currently selected exam The single view will be the current map view and this is most like a standard What you see print where what you print is what you can currently see The default Threshold Overview Print automatically formats six different views of the exam per page three rows by two columns along with most of the standard statistics and the patient details Later we will see how you can edit this format to suit your practice Multi Provides four views of every exam for the currently Print selected patient a
96. ment Integration Software Network licensing USB2 0 active extension 5m Medical Isolation transformer 230V 500VA TR2450 Spare parts Patient switch Occluder assembly Occluder with Target Holder M700 PCB USB Microcontroller Lens holder head Dust cover Binocular chinrest Fuse spare T400mA 250V pkt 10 Fuse 500mA microfuse Custom Custom PN 1482 242 PN 0762 279 PN 0472 280 PN 0473 379 PN 3044 379 model specific PN 0360 370 PN 0471 542 PN 1179 319 PN 1576 PN 1466 243 Medmont Automated Perimeter Warranty 3 Warranty This Medmont Automated Perimeter is manufactured with all due care and subjected to stringent testing before leaving the factory The instrument is guaranteed for 12 months from the date of delivery During this warranty period Medmont or an authorised agent will repair or replace all defective parts free of charge Such repairs do not extend the warranty period The replaced defective parts become the property of Medmont The warranty does not cover defects due to incorrect handling installation or setup unauthorised modifications non compliance with the requirements for computer hardware and associated mains powered equipment as specified in this User Manual loss of the license loss of income or service and repair costs for components and associated equipment Warranty claims are the responsibility of the agent where the instrument was purchased 6 Medmont Automated Perimeter Impor
97. mouse cursor changes to reflect the type of shape being drawn As their names imply the Circle Ellipse Rectangle and Square annotation tools allow you to create these shapes To create one click at the point where you want to place the shape and drag the mouse to complete the drawing You can create three types of area annotations To draw Curved or Polygon areas click on the first point and keep clicking until the second last last point Right click to complete the curve To draw a Freehand area click on the first point and drag the mouse around the required shape and stop dragging when you are finished Shapes can always be fine tuned by resizing or moving To move or resize a shape annotation click anywhere on the shape to select it Small circular hot spots will be displayed on the shape Click and drag the desired hot spot to move a particular point To move the whole shape click and drag from either any point on the shape except a hotspot or from the centre cross hair Editing Annotations 98 To edit an existing annotation double click on the annotation and the editor will be displayed allowing you to change the text or attributes Selecting a Text or Callout annotation displays the Edit Annotations dialog shown in Figure 57 allowing you to change the text and colours Selecting a Shape Annotation displays the Edit Shape Annotation dialog shown in Figure 58 li Edit Shape Annotation aap Style Solid Width 2
98. n Monitoring Blind Spot fixation monitoring checks that a patient is fixated correctly on the central target by periodically exposing a light point located at the blind spot of the eye being tested and checking that the patient does not respond Blind spot fixation monitoring cannot be used for binocular tests The blind spot monitors are two groups of eleven light points that are positioned on the perimeter bowl to fully cover all the possible left and Medmont Automated Perimeter Testing a Patient right hand blind spots Early perimeters used five light points The blind spot light points are always exposed at 0 dB A left or right handed graphic showing the set of blind spot light points that match the current Eye setting is displayed at the bottom of the monitor pane The left hand version is shown in Figure 13 M Auto Blind Spot Figure 13 Left hand blind spot monitor graphic The current blind spot point is shown as a darker grey circle The Fix Loss statistic in the Test Status group displays the number of times a blind spot light point was seen by the patient as a ratio of the total number of blind spot checks performed for example Fix loss 2 15 13 By convention a fixation loss higher than about 20 is considered to indicate low patient and consequently low test reliability By default the software handles selection of the blind spot light point automatically However you can set the light point to use for
99. n with computer or reboot Test mode interrupted changed Restart application or reboot if or unexpected events required and retest patient Voltage dips in mains may be Restart application and retest cause of repeating tests patient or reboot if required dimming lights incorrect Medmont recommend the communications with PC installation of an Uninterruptible inconsistent analysis or Power Supply UPS if unreliable blinking lights mains power causes problems Medmont Automated Perimeter 131 Specifications for M700 M730 models 20 Specifications for M700 M730 models Product Life Service life 8 years software support limited Studio software current platform only Operating system current and previous version Simulator Bowl Type Part hemispherical radius 300mm viewing distance 320mm integrated diffusing surface Binocular Chin Rest Supplied Stimulus Type Rear illuminated diffuser Stimulus Source Pale green LED wavelength 565nm optional Red LED wavelength 626nm Stimulus Size Goldman size III 0 43 optional Red 0 72 16 3dB 1dB levels from OdB max brightness to 46dB min brightness Background Illumination 10 asb 3 2cd m automatic level control German Driving Test 10cd m Fixation Target Yellow LED wavelength 583nm Fixation Monitor Heijl Krakau blindspot method and video fixation tracking Automatic video fixation loss detection optional 0 1 9 9 seconds adjustable for ex
100. nd on the PC port insulation plugs The plugs are for RS232 and Network ports These PC ports are to be covered if the PC is used within the patient environment Device Label positioned at the right rear of the instrument Fuse Rating label Patient environment comprises a 1 5m radius around area in which patient or some other person can touch parts of the medical system intentionally or unintentionally Note that the Patient Environment label is supplied as a separate item and must be fixed to the computer in a visible location Medmont Automated Perimeter 15 Installation 5 Installation The installation instructions and this user manual provide guidelines on the installation process Medmont or Authorised Distributors can provide this service for a fee Only a qualified PC technician should perform the hardware and software installation There are three basic tasks associated with setting up the instrument e Installing the software e Setting up the perimeter in a suitable environment e Connecting the perimeter to the software The Medmont Studio software can also be installed without a physical perimeter to allow analysis and review of Patient Exams PC Requirements When acquiring a PC for the Medmont Automated Perimeter please observe the minimum requirements as described in the Medmont Studio manual Use only a PC and associated equipment that has been safety tested to the Standard EN IEC60950
101. nformation PalSet 22 On starting a test for the first time after installing a perimeter that uses a Belkin video converter for the eye camera a dialog is presented giving step by step instructions on configuring this converter for PAL video operation This is required as the spatial framing of the camera is performed in PAL mode and this converter does not provide for software video mode setting Later perimeters use a different video converter and this setting is automatic Clicking the Run Palset button will start the PalSet program If the video system is working it will show the current view from the eye camera Click the Devices menu and it should show Hi Speed USB DVD Creator Click the Options menu ensure the Preview entry is selected and then select the Video Capture Filter option Click the Image tab and ensure the PAL radio button is selected Click OK and dismiss PalSet Click the OK button to dismiss the initial instruction dialog Medmont Automated Perimeter Testing a Patient 6 Testing a Patient The following sections describe how to perform a patient examination with the Medmont Automated Perimeter For those familiar with the instrument an initial express test is provided in Express Testing a New Exam on page 26 to quickly become familiar with the new software These sections deal with e Preparing and positioning the patient e Selecting the test and strategy e How the test is monitored while in progress
102. ngs from Medmont Studio on the Configure tab with the Template Setup option See Creating a New Template on page 36 for how to create a new template Here we discuss the various settings and the ramifications of any changes Medmont Automated Perimeter 31 Testing a Patient The Stimulus Parameters Group The three radio buttons in this group control the light point exposure times The times are in seconds The Standard and Slow buttons select the default times shown below in Table 1 while the Clinician Selected button enables the clinician to set other values Table 1 Default standard and slow exposure times Clicking the User Selected button enables the three spin boxes You can either replace the current entry by over typing or increment decrement the values using the spin box arrows Each exposure time setting affects a different part of a light point exposure sequence Exposure This is the time that a light point will be illuminated It can be the same as or less than the Response time Response This is the time in which the patient can respond It starts at the same time as the Exposure time It can be the same as or greater than the Exposure time Delay This is the time after the patient responds before the next exposure begins If the patient does not respond then this time is zero If the patient responds before the Response time ends then the Response time is cut short and the Delay time starts immediately
103. nits Portrait Centimetres Landscape Inches Margins Left 0 64 Right 0 64 Top 0 64 Bottom 0 64 _ Cancel J ok Figure 68 Print Report Settings dialog Threshold Overview Print Click on the Application button then click Print Preview to bring up the Print dialog shown in Figure 65 We will explore the Threshold Overview Print option so select this and then click on the OK button This presents a full screen print preview display similar to Figure 70 Click on the Settings button For this example make sure the Greyscale checkbox is not ticked and then click on the Overview Print tab Overview Print Settings The Overview Print settings dialog is shown in Figure 69 An Overview Print attempts to put as much information on the page as possible It provides for six graphical views of an exam plus a full set of statistical summaries including a selected set of exam attributes The Overview Print settings dialog gives you considerable control over how this page is displayed 112 Medmont Automated Perimeter Printing the Exam Results L Threshold Print Settings General Qwerview Print Common Settings Non Linear Scaling Attributes Aiiki Numeric Tick Marks W Annotations E 2 Exams per Page 40 Overlay Opacity Level E 12 Numeric ro Plan Lal Numeric Grid Ky Perspective Traditional Grayscale Section E Retinal Overlay Defaults
104. nsient surges or electrostatic discharge may affect the performance or results of the Automated Perimeter Avoid using the device while such high interference is present See Troubleshooting on page 131 for particular effects and solutions The device is compliant with medical standard 8 Medmont Automated Perimeter Important Facts EN TEC60601 2 Guidance and manufacturer s declaration electromagnetic immunity The M700 USB Automated Perimeter is intended for use in the electromagnetic environment specified below The customer or the user of the M700 USB Automated Perimeter should assure that it is used in such an environment io Electrostatic discharge ESD IEC 61000 4 2 Electrical fast transient burst IEC 61000 4 4 Surge IEC 61000 4 5 Voltage dips short interruptions and voltage variations on power supply input lines IEC 61000 4 11 Power frequency 50 60 Hz magnetic field IEC 61000 4 8 IEC 60601 test level 6 kV contact 8 kV air 2 kV for power supply lines 1 kV for input output lines 1 kV line s to line s 2 kV line s to earth lt 5 UT gt 95 dip in UT for 0 5 cycle 40 UT 60 dip in UT for 5 cycles 70 UT 30 dip in UT for 25 cycles lt 5 UT gt 95 dip in UT for5s Compliance level 6 kV contact 8 kV air 2 kV for power supply lines N A 1 kV line s to line s 2 kV line s to earth lt 5 UT
105. nt Filter dialog shown in Figure 77 The Standard tab is divided into two halves The top grouping is a number of standard patient parameters and the bottom grouping is a number of standard practice exam relationships For this example we just want to filter the patients to show all females Click the Female radio button in the top grouping and then click the Apply button Voila Click on the OK button and you can proceed to work with just the female subset of your patients We will now explore adding some advanced filters Note that the filters defined in the Standard tab are mutually exclusive with filters defined in the Advanced tab whichever tab is selected will be the filters to apply Medmont Automated Perimeter 121 Perimeter Filters Patient Filter 3l Standard Advanced Patients With Date of Birth E To E Clear Sex Male Female Clear Procedures Clear Conditions Clear Categories Clear Who Have Seen Clinician Clear Find Patients Without a Clinician Attended Practice 7 Clear Find Patients Without a Practice Exams between E and E Clear Clear All Cancel Apply ok Figure 77 Standard patient filter setup dialog Click on the Advanced tab in the Patient Filter dialog Click on the down arrow beside the New button and select the Composite Condition option This will bring up the New Composite Condition dialog Ensure the
106. nt from among those that have completed at a level of 9 dB or dimmer and exposes it at a level 9 dB brighter than its completed level If the point is Not Seen then the false negative counter is incremented It is therefore a reliability measure that the patient really did see that light point The test is normally only enabled for the thresholding strategies False Positives This is an additional pseudo exposure randomly inserted at around every tenth normal exposure and therefore lengthens the test time somewhat It uses a normal exposure time slot but does not expose any light point If the patient responds then the false positive counter is incremented It is therefore a reliability measure that the patient is not just responding to the rhythm of the light point exposures It 1s perhaps the most important indicator of test reliability Fluctuation Measurement Fluctuation measurement adds a further level of confidence by re testing a number of suspect points and recording the variability of these results as a fluctuation measure As the test progresses four spatially dispersed and completed points with the highest defect levels but not brighter than 3 dB are chosen for fluctuation testing and are re tested four times To ensure four points are chosen the Medmont Automated Perimeter 33 Testing a Patient 34 default threshold defect level is progressively reduced as the test proceeds When the test concludes the
107. nvironment Altitude lt 4000m Clinical Results Accuracy and Age Normals The Automated Perimeter is delivered to the end user quality tested and calibrated as per specifications While the device has exceptional long term stability it is not the responsibility of Medmont to police the accuracy of the device after delivery The device is calibrated and referenced against the Medmont Age Normal standard displayed as a dB scale Electrical Safety of System To ensure the safety of the Automated Perimeter system all associated equipment connected to it must be WARNING compliant to EN TEC60950 and powered by an isolation transformer compliant with medical standard EN IEC60601 1 UL2601 or CSA22 2 601 1 Any open communication port on the PC must be covered with provided port covers when the device is used in a patient environment When networking to another computer either the use of a network device with electrical separation of I Os or wireless network may be used Please contact your distributor as network performance may be affected Radiation The Automated Perimeter emits radiation in the visual range in the distinct wavelength of 565nm The levels of intensity of this illumination are below any levels known to be hazardous Electromagnetic Interference Strong electromagnetic interference from unprotected devices or portable and mobile RF communications WARNING equipment or mains disturbances voltage dips tra
108. onment in which the device is kept but is recommended on a 3 6 monthly interval Medmont Automated Perimeter 127 Cleaning Maintenance and Service Replacement of fuses Before replacing any fuses turn off instrument and remove power cord from mains supply and USB cord from instrument WARNING Only use fuses as specified Mains fuses are in the power inlet control open the fuse drawer with a screwdriver blade Always replace both fuses with labelled rating see Specifications on page 132 Fuses on the PCB Pull out damaged fuses from fuse holder on PCB by hand and replace with a new one Use Schurter type MSF fuse as specified only The Automated Perimeter contains no other user serviceable components Testing light points Like with any medical instrument regular testing of the M700 should be performed by the user to ensure the instrument is functioning correctly This should include the testing of the perimeter light points using the Perimeter Test Tool To start a new test on the Configure tab click Instrument Setup With the M700 Instrument Setup window open select the perimeter to be tested and then select the Test button to open the Perimeter Test Tool window If there are multiple perimeters configured be sure to check that the serial number of the selected perimeter matches the serial number found on the perimeter device label being tested If the perimeter to be tested is not listed then it is likely the
109. onsiderably more control To access the mouse tools place the cursor anywhere in this window and click the right mouse button This will display a small selection menu beside the cursor You select items by moving the mouse until the black selection bar is over your selection For perspective views click on the hand or Pan entry The normal arrow cursor should change to a small hand ui Some care is needed in becoming proficient of what we are about to do Not that you can do any harm but it is very easy to set the view spinning like a top The mouse can spin the perspective view about the centre line of both its vertical and horizontal axes Both axes pass through the centre of the perimeter with the axes where you would expect them to be in a two dimensional frame i e horizontal and vertical Hold the mouse steady anywhere in the window and click the left button The hand cursor will appear to clench Carefully move the mouse to the right the smallest distance Medmont Automated Perimeter 85 Analysing and Viewing Exam Results 86 you can manage You should see a small arrow appear to the right of the hand and the view should start to slowly rotate about its vertical centre line Experiment with moving the mouse very small increments in different directions With some practise you should be able to position the view so you can look at it from any direction even underneath Note that the further you move the mouse away from wher
110. or Right Left oon Gaedit Deaete A New Full Peripheral Nasal inferior K Temporal inferior Cren John 2 Bnggs Warren 191 a Canon CR6 4SNM 15 Sap 1900 nz 300A 7 11 5 29 1990 113600 07 7 Jan 1991 11 03 00 AM 217 00 Pu 123300 Pu 21 Jan 1992 10 45 00 Au 21 3 n1992 11 00 AM in 1992 10 48 sean 23 Jun 1992 10 57 00 AM aeos a 9 16 a AM SFeb 1993 93 00AN 20 Au 991993 10 3 5 00 AM 20 sup 0 1983 1036 0 AM n 1994 12 58 00 PM 20 Jen 0900 PM gr 9 0i u En 0 Ee U u 4 E 03 H i TATONOSFHAHDIATOND I EMANIOARONBD SPMAMD AS ONDIFHAN SAT ONG gy tert 121900 Pu 1983 134 0 1 Oct 1994 12 33 00 PM v Dec 1998 4 0917 PM ww 9 3 000 1996 4 11 03 Pu e no 7 Aug 2000 9 47 02 Au Pan 7 Aug 2000 9 48 06 AM oa v 49 found amp Patients Exams v Figure 60 The Regression Analysis view The four plots in the Figure show the Exam Levels histogram at the top then the Overall Defect plot the Pattern Defect plot and the Age Histogram at the bottom Off screen below these will be the HoV Histogram and Inter Ocular Pressure IOP graphic The latter will only have contents if the values have been added in the Data tab By default all exams for the selected patient for the selected eye are shown at once The plots are shown even if there is only one exam available When there is more than one exam a regression line is added with its slope in 102 Medmont Automated Perimeter Regression Analys
111. or new patients Three Zone Strategy This strategy performs an initial calibration procedure using the Fast Threshold strategy see Fast Threshold Strategy on page 59 during which the thresholds of four preset points are determined These calibration points are then used to set the initial levels for the subsequent three zone test The seen not seen decisions for subsequent light point exposures are If the point is Seen The point is completed If the point is Not The point is completed if the level was at Seen its brightest ie 0 dB Otherwise the point s level is set to 0 dB for the next exposure Thus points other than the calibration points can be exposed a maximum of twice The Map display of a Three zone strategy uses a different representation of a completed point that reflects the simplified thresholding strategy Figure 19 shows an example map display for a Three zone strategy central field test 60 Medmont Automated Perimeter The System Test Strategies gi Way Joe Left 26 Nov 2010 2 41 34 PM Central Test Age 42 Years 9 Months FP 0 11 0 Excellent Sn 83 NSn 16 RD 7 Points Seen X Relative Defects E Absolute Defects Figure 19 Three zone strategy map display showing different representation of exposed points The figure shows the Points Seen graphic as a dot defining a seen point the Relative Defect graphic as an X defining a point seen at 0 dB and the Absolute Defect graphic as a
112. ore be quicker to threshold particularly for an abnormal patient The initial values are the weighted mean of each point and its local neighbours to ensure extreme previous values are not used as starting levels Re Testing Points The ability to dynamically retest any point in the current field means you can change a field as the exam proceeds to meet any unusual situations or unexpected defects that appear during the test During the Exam For example if during the exam a particular point has concluded with what you consider a suspect threshold click on the suspect point to highlight it its colour will change to blue and then click on the Retest button The completed threshold number will change to the last tested value and the point will be retested before the exam concludes After the Exam Concludes You can also retest a point or set of points after the exam has concluded If you think a region is suspect highlight the associated points see Creating a New Template on page 36 and then click the Retest 5 button This creates a temporary field that will be immediately retested when you again press the Start P button The system automatically detects and retests statistically abnormal points if Retest Abnormals is checked in the Template Editor prior to starting the test see Retest Abnormals on page 35 Progressive Analysis In addition to the Test Control display you can monitor the test progress using the fu
113. ot listed above the recommended separation distance d in metres m can be estimated using the equation applicable to the frequency of the transmitter where P is the maximum output power rating of the transmitter in watts W according to the transmitter manufacturer NOTE 1 At 80 MHz and 800 MHz the separation distance for the higher frequency range applies NOTE 2 These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people Medmont Automated Perimeter 11 Important Facts Electromagnetic Emissions This device does not emit harmful or undesired electromagnetic emissions The device is compliant with medical standard EN IEC60601 2 MEDICAL ELECTRICAL EQUIPMENT needs special precautions regarding EMC and needs to be installed and put into service according to the EMC information provided in the ACCOMPANYING DOCUMENTS If the M700 USB Automated Perimeter is used in a domestic establishment or connected to the Mains Public Network following warning shall apply This equipment system is intended for use by healthcare professionals only This equipment system may cause radio WARNING interference or may disrupt the operation of nearby equipment It may be necessary to take mitigation measures such as re orienting or relocating the M700 USB Automated Perimeter or shielding the location The use of ACCESSORIES transducers and
114. out the high resolution points in the foveal area This is also the way the perimeter points are mapped in the Test Window perimeter display Toggling this checkbox or using the button allows you to see the points with either linear or non linear mapping Annotations This option allows you to select whether annotations which have been added to the map should be displayed Exam Tab Pane 88 A tabbed pane is located at the bottom of the Exam View to display additional information about the exam This pane can be expanded by clicking and dragging on the horizontal separator between it and the main view The pane can also be completely hidden by clicking on the small expand collapse indicator at the top right of the pane The content of the tabs is described below Data Tab The data tab see Figure 50 displays predefined and custom attributes for the exam By default the attributes displayed include Age Age of the patient when the exam was taken displayed in Years and Months Overall See Overall Defect on page 64 Defect Pattern See Pattern Defect on page 64 Defect Fluctuation Short term Fluctuation see Fluctuation Measurement on page 33 Medmont Automated Perimeter Analysing and Viewing Exam Results Cluster Analysis Seen Points Not Seen Points Relative Defects CV Index Fixation Losses False Negatives False Positives IOP See Cluster Analysis on page 65 See Three Zone Strategy on
115. p E buttons When the test completes you can click on the Analyse Test button to analyse the result If a patient or a test belonging to a patient was previously selected in Medmont Studio then the new patient exam is created for that patient otherwise the exam is created without reference to a patient Note that in the latter case the test initial values will be based on a standard Hill of Vision see Statistical Indexes on page 63 whereas if a patient has been selected then the initial values will be based on their most recent exam In most cases using previous values will produce a quicker test Note also that without defining a patient the HoV will be based on the 1 45 year age group which can bias results for older patients For all these reasons Medmont recommend the patient always be defined If the wrong patient was selected you can associate the test with the correct patient by clicking on Patient gt Select to bring up the Find Patient dialog shown in Figure 7 Clicking on Patient gt Clear disconnects the current test from its currently assigned patient Find Patient Last Name Clear First Name Clear External ID Clear Date of Birth Ev Cear Matching Patients Birth Date 10 Sep 1943 Breaden Andrew 24 Dec 1934 Male a Briggs Warren 20 Oct 1917 Male H Cherry Steven 16 Jan 1953 Male H Citizen John 26 Aug 1961 Male P Denham Ada 18 Dec 1926 Female R ar Rai ank
116. page 60 See Three Zone Strategy on page 60 See Three Zone Strategy on page 60 See CV 100 Point Test on page 57 See The Test Status Group on page 42 See The Test Status Group on page 42 See The Test Status Group on page 42 Inter Ocular Pressure this 1s a user entered attribute that you can use to record the patients IOP at the time of the exam Medmont Automated Perimeter 89 Analysing and Viewing Exam Results 90 Otizen John 11 Sep 1999 11 23 08 AM Right Gisscoma Test no medmont Ring 13 Angle 296 Level 17 0 d8 Panem Detect STS 6 85 Fluctuation 0 00 61 P 18 5 dB J HoV 2 Level y ys 9 E ES T E E E y or y er Di i p gt j 7 4 g o s 9 Oct 1 t1 Dex Te v4 ES Figure 50 Data Tab You can select the attributes to be displayed and their order by clicking on the Arrange user defined attributes button T on the left of the tab This displays the Arrange Attributes dialog shown in Figure 51 The Available column on the left is the list of available attributes while the Selected column on the right is the list of those attributes selected for display You can move any or all from one side to the other using the arrow keys in the centre The single arrows will move a selected attribute from the Available list to the Selected list or remove it from the Selected list The double arrows will copy the entire Available list to the Selected list or completely clear the
117. posure response and inter exposure delay times See Medmont Studio manual USB for the bowl interface Operating conditions 10 to 40 C ambient temperature lt 4000m altitude Maximum 80 relative humidity Transport Storage 40 to 70 C Conditions 10 to 100 relative humidity 500 to 1060 hPa pressure Compliances EN IEC 60601 1 Electrical safety EN IEC 60601 1 2 Electromagnetic Emissions and Immunity ISM Classification Class 1 Type B 132 Medmont Automated Perimeter Specifications for M700 M730 models M700 USB M730 USB 626W x 438D x 713H 500W x 400D x 660H Power requirements M700 USB C M700 USB CR M730 Focus 100 240 V AC 50 60Hz 0 25 0 15A Fuses Schurter5x20mm FST T400mA L 250VAC p n 1576 IEC EN 60127 2 3 UL 248 14 CSAC22 2 no248 14 35A 250V Microfuse Schurter MSF F500mA 125V AC IEC EN 60127 3 1 UL 248 14 CSAC22 2 no248 14 100A 125V AC DC Medmont Automated Perimeter 133 Declaration of Conformity 21 Declaration of Conformity The Medmont Automated Perimeter models M700 USB C M700 USB CR and M730 Focus have been manufactured by Medmont International Pty Ltd Australia and has been classified as a Class I medical device and is in compliance with the essential requirements and provisions of the European Council Directive 93 42 EEC and is in compliance with the provisions of the RoHS2 Directive 2011 65 EU on the restriction of the use of certain hazardous substances in ele
118. preference window you can play any of the assigned sounds by first selecting the sounds event and pressing the Play button If you want to assign a different sound then select the event and press the Browse button only files with a wav file extension can be assigned You can disable a sound event by un ticking the box beside the event This will maintain the Medmont Automated Perimeter 49 Testing a Patient link to the sound file but not play the sound when the event occurs Remember to click the Apply button after modifying to store the new sound preferences 50 Medmont Automated Perimeter The System Test Templates 7 The System Test Templates The Automated Perimeter software provides a set of built in system tests These are shown below in Table 4 Test Name Field Points M700 M730 Extent Binocular Single E Vision 30 Inferior 40 Cema ee Cema fo om fnr w Glaucoma Central 22 Nasal step 50 Neurological Full 50 Peripheral 30 to 50 Medmont Automated Perimeter 51 The System Test Templates Quickscan 22 30 40 v v deprecated 168 Table 4 Medmont Automated Perimeter Built in System Tests The following discusses the typical uses of these fields It is up to the clinician to decide on the most appropriate template for a particular test In each case if the patient requires a correction lens you will be prompted to insert the lens prior to starting the test and also to
119. pressed in seconds This is most useful as a relative measure when compared with a patient s previous exams Medmont Automated Perimeter Testing a Patient Exposure count Monitor This is the total number of exposures to date during this exam When compared with the Percent Complete monitor it gives an indication of the number of exposures required to reach a threshold value for this patient and test strategy Test Elapsed Time Monitor This is the elapsed time in minutes and seconds since the test began Strategy This is the strategy in use for the current template and is defined by the currently selected template See The System Test Strategies on page 58 for details of the available strategies Assigning Sounds to Perimeter Events Sounds can be associated to different events which occur during a patient examination for instance when a False Positive response is received Some events have default sounds already assigned when you install the software If you would like to assign sounds to unassigned events or change the default sounds then click on the Configure gt Studio gt Preferences dialog Once open select the User Settings tab and click on Sounds gt M700 in the tree list Once selected the M700 sounds preferences will now be displayed as per Figure 17 ser Settings Common Settings LIK t v Pa x Fi x x v v Figure 17 Sound preferences From the sound
120. r Printing the Exam Results This will bring up the view in Figure 75 Note that you can change these views to a landscape view by selecting Settings and clicking the Landscape radio button E Medmont Studio Version 6 0 0 11 24 Sep 2014 0123A PM Figure 75 Full screen Regression preview Medmont Automated Perimeter 119 Exporting the Analysis 13 Exporting the Analysis There are many situations where the results for a particular patient need to be shared In your own practice where there may be a number of networked computers you can easily view exam results from the shared database on any computer with Medmont Studio installed However what about the situation where your practice extends to several sites in a city or interstate and a result needs to be sent for a second opinion Or a patient moves elsewhere and their new clinician asks for their records Medmont Studio provides the ability to export a single exam a set of exams an entire patient a number of patients or the entire patient database Selection uses the same technique as patient review just select the items to export To export a single exam highlight it with a click click the Application button and then select Export An Export Selected Items file selection dialog will appear and you can navigate to your destination directory and select an alternate output name to the default Do the same to select multiple exams only now
121. ready selected and click again it will be deselected Likewise holding the button down and moving the cursor over previously selected points will deselect those points including the original points If the Mirrored Fields checkbox 1s ticked whatever modifications you make for one eye will automatically be mirrored to the other eye This will happen whether you review the other eye before exiting or not If you specifically need different fields for each eye you must ensure this checkbox is unchecked before exiting or moving to the other eye Only the fields can be different for each eye the parameters and settings always apply to both eyes Pressing the Clear button will create a perimeter devoid of points to be tested Saving a User Template Once you are happy with the stimulus parameters strategy settings and light point field enter a descriptive name and click the OK button Saving a User Template from the Test Window You may have developed a template while testing a patient and decided it was worth keeping Before you exit the test screen click on the Edit gt Template gt Save As button This displays a dialog that allows you to enter a new template name Clicking the OK button will save the current template under that name Controlling a Test in Progress You start a Test by clicking on the Home tab within Medmont Studio and clicking Perimetry Exam Figure 6 shows the initial test screen with a Central Tes
122. rovide additional patient education see Preparing the Patient on page 24 Recalibrate Fixation zx The patient is not fixated correctly do you want to recalibrate their fixation If you click No the current blind spot point will be used for fixation monitoring Figure 15 Fixation Lost dialog box Automatic Recalibration If the blind spot is seen during the test the PC speaker will sound a short beep to alert the clinician and perhaps the patient that fixation is not being maintained If the next exposure of the blind spot is also seen by the patient the perimeter assumes that the patient has moved and will automatically attempt to locate the new position of the blind spot by testing surrounding light points If it is unable to locate the new blind spot point automatically the Fixation Lost dialog box shown in Figure 15 is displayed If you choose to recalibrate the initial blind spot location procedure described above will start again beginning with the nominated initial blind spot by default the centre light point If you choose not to recalibrate the test will continue using the last selected blind spot light for blind spot monitoring and will not attempt to recalibrate if patient fixation 1s lost Blind Spot Fixation Monitoring Manual Mode In Manual mode the user takes over complete control of the blind spot Clicking on any of the eleven points will make that point the current blind 44 Medmont Automate
123. rs Easily followed instructions enable a clinician to quickly perform accurate visual field tests as well as providing the ability to easily design custom fields and tests Testing of the visual field is carried out using the technique of static perimetry with the stimulus targets being a set of rear illumination Light Emitting Diodes LEDs In the text the LEDs are referred to as light points Testing may select from two fields of different coloured stimuli one green set and one red set variant R model Medmont Automated Perimeter 3 Introduction Fixation performance is monitored by the Heiyl Krakau technique with random stimuli presentations in the blind spot or optionally using continuous video tracking of the patient s iris The patient s fixation performance is continuously displayed to the clinician both statistically and visually The Medmont Automated Perimeter shall only be used as described in this manual and only for the intended purpose Standard Accessories Medmont Studio 6 package Installation instructions Calibration file on CDR Power cord Spare fuses mains power Spare fuses PCB Patient switch Patient switch holder including fasteners Dust cover Binocular chinrest Eye Occluder Binocular target holder Mounting screws and washers USB cable Patient environment label incl com port insulation plug 4 Medmont Automated Perimeter Introduction Optional accessories Patient Manage
124. rument make sure there is enough space for easy access on the side the power entry module in order to show the instrument is energised and to WARNING ensure the power lead and switch can be reached easily for disconnecting power Connect the power lead to an isolation transformer as shown in Figure 2 only WARNING Avoid unnecessary power usage by turning off the unit at the end of each day This will also extend the life of the CAUTION unit 18 Medmont Automated Perimeter Installation USB Interface The perimeter is fitted with a standard USB 2 interface Due to the data rates required you cannot use a USB 1 cable The terminal is located at the right hand side of the unit Connect cable to this terminal and any terminal on the rear side of the PC M600 Perimeter Upgrades Older M600 Perimeter devices are no longer supported by Medmont Studio Databases for these older devices can be upgraded to the latest version of software Please contact your local distributor for further instructions on this process Licensing Medmont Studio must be licensed See the Medmont Studio user manual for the necessary steps Installing the Perimeter You must install your particular perimeter with the software before continuing Double click the desktop icon or select Medmont Studio from the Windows Start gt Programs gt Medmont menu A banner with the Medmont Studio logo is displayed while the software loads A ful
125. s Medmont Automated Perimeter 93 Analysing and Viewing Exam Results 94 Edit Calculated Attribute Duration Name Display Name Duration Units min Decimal Places 1 lt Scientific Format GetDuration 60 Nl Lees JL sin Lc05 JL tan Jlexe toa sant Let jkatan Data Functions Attributes GetDuration GetExposures GetFalseNegatives GetFalseNegativeT ests GetFalsePositives JE anes oe gt Paste Figure 54 The Edit Calculated Attribute dialog To explore how attributes are defined we will change the Duration attribute to display in seconds First ensure the Duration attribute is highlighted in the Attributes dialog Figure 53 and then click on the Edit button This will bring up the Edit Expression Attribute dialog shown in Figure 54 Position the cursor after the text in the Expression edit box and delete the 60 part of the text leaving just the system duration function Duration Now the Duration attribute is going to return seconds We need to make the display match this fact so change the min text in the Units box to secs and change the Decimal Places setting from 1 to 0 Here you can either overtype the existing setting or use the up down spin buttons At this point the expression editor should look like Figure 55 When you are satisfied with this click on the OK button to copy the new expression to the attributes database Click on
126. s background will revert to its previous state and colour Medmont Automated Perimeter 29 Testing a Patient There is no button to delete a point you have added using these methods However before the test begins or after it has concluded if you select the Edit gt Template gt Edit button these points are easily deleted in the Template Editor see Modifying Test Parameters on page 31 Pausing a Test Once a test begins the clinician may pause an exam by clicking the Pause button on the toolbar As with earlier Medmont perimeter software the patient can also pause the exam by holding down the patient response button Test Point Colours The colour of the test point text on the perimeter display denotes its current state Once the test begins the number in the circle is the last exposed value in decibels Points eventually Not Seen even at zero decibels maximum brightness have the word NO in the circle The number colours are Blue As yet untested Red Exposed but Not Seen Green Exposed and Seen White Final completed state Saving the Completed Test When the exam is stopped or concluded it can be saved by clicking the Home gt Exam gt Save lel button If the exam was performed without being attached to an existing patient clicking Save will bring up a list see Figure 7 from which a patient may be selected or a new patient entered You can continue testing with this or any other field template by clicking on t
127. s hill of vision would be like without defects see Patient Based Hill of Vision on page 63 An example is shown in Figure 42 y Jones Chris 26 Apr 1989 4 21 00 PM Left Central Test Figure 42 Patient HoV Deviation visualisation Values within a defined band of the HoV are displayed as a dot The band is 4 5dB out to 15 and 6 5dB beyond Thus someone with a relatively defect free HoV but simply depressed would display as a field of dots in this view even though they may show a significant number of negative numbers in an Age Normal Deviation view The defects shown by this display identify local losses or scotomas with the effect of any general depression removed Points that are Not Seen will be shown as NO s in this view Age Normal Probability This view compares the patient with a population of similar age An example is shown in Figure 43 It can be used to determine whether a particular point or set of points are significantly different from the Age Normal where the number itself except for very large deviations cannot give more than an indication that the point may be depressed Medmont Automated Perimeter 81 Analysing and Viewing Exam Results James Dorothy 21 Mar 1989 2 53 00 PM Left Central Test Figure 43 Age Normal Probability visualisation It processes the Age Normal Deviation data described in Age Normal Deviation on page 80 and presents it as a probability map Now the d
128. s test 3 There are an adequate number of neighbour points 1 e the point is not isolated Defect points may occur during a test as a result of the patient responding incorrectly Ticking this checkbox will flag the software to recheck points with an abnormal value that were perhaps the result of the patient s momentary loss of attention or a similar accidental response With Retest Abnormals enabled at the end of the test an additional analysis is performed that examines each point in relation to its neighbourhood All points found to be significantly different from their neighbours are automatically flagged for retesting The patient sees no pause as these points are smoothly re integrated into the continuing test The retest is only performed once Creating a New Template A powerful feature of the Medmont Automated Perimeter is the facility to create specialist test fields that address particular patient situations For example it 1s easy to create fields that are specific to just a quadrant or hemi field Or you can define quite sparse fields of a few dozen light points that will test very quickly and rely on the Spatially Adaptive monitor see Spatially Adaptive on page 35 to explore into any defect regions Begin creating a new template from Medmont Studio On the Configure tab click Template Setup and then click the New button This displays the dialog shown in Figure 9 allowing selection of a base template for subsequent e
129. size and re tested If there is still no response the intensity 1s successively increased in equivalent steps until a response occurs or the maximum level is reached at which point a not seen result is recorded If there is a response to the initial stimulus the intensity is decreased in steps of twice the minimum step size until there is no response at which point a reversal is made in the direction of the intensity steps Once a transition occurs at a particular seen not seen or not seen seen level the cell intensity 1s then stepped in minimum increments until a second reversal is indicated The perimeter confirms the threshold by obtaining two consistent results in a given level range This bracketing technique for determining a cell threshold results in a very reliable measurement of the visual field threshold Medmont Automated Perimeter 59 The System Test Strategies Screening Strategy deprecated This strategy performs an initial calibration procedure using the Fast Threshold strategy see Fast Threshold Strategy on page 59 during which the thresholds of four preset points are determined These calibration points are then used to set the screening levels for the subsequent screening test A screening strategy will typically underestimate a patient s true field and so has little clinical use However it can be used to discover gross defects The Screening strategy is deprecated use the Fast Threshold strategy f
130. t False Negatives Monitor This monitor adds an additional exposure at about every tenth normal exposure It selects a random light point from among those that have been completed and at a level of 9 dB or dimmer and exposes it at a level 9 dB brighter If the point is Not Seen then the false negative counter is incremented The monitor shows these events as a seen not seen ratio and as a percentage for example False ve 2 15 13 In a normal field a high false negative rate suggests patient inconsistency Such inconsistency may occur if the patient changes what they consider to be Seen and Not Seen or if their state of alertness changes or if they slow down and believe it is too late to respond after the light point has gone off False negatives also occur as part of the disease state at locations with depressed sensitivity where visibility is highly variable In such cases the clinician cannot depend on consistent responses and a high false negative rate results An effort should be made to distinguish between inconsistency that is part of a disease process and inconsistency as a result of the patient s state of alertness or personality By convention false negatives of around 33 or higher are considered to indicate low patient reliability Average response time Monitor This is the mean value over all exposures during this exam of the elapsed time from the light point being turned on until the patient responds It is ex
131. t thus concentrates on the intact part of the field substantially reducing the total test time Peripheral Test The Peripheral field covers just the 30 50 ring of the periphery Note that the statistics associated with HoV Slope may have little validity with this test due to the narrow width of the field Quickscan Test deprecated This test is basically a Central 30 with a lower density of points that uses a Screening strategy and requires only about 90 seconds for completion The Screening strategy does not explore how good a patient s sight may be but does allow the depth of any defect to be determined It is not included with the installation but may be loaded from the Templates section on the distribution CD ROM Flash Scan Test This test is designed for fast screening of patients It uses the same pattern of points as the Quickscan Test When combined with the automatic video fixation tracking this test can be performed in less than 60 seconds This test uses the Age Related screening strategy Spatially Adaptive Test This is a sparsely populated version of a full field i e out to 50 with the Spatially Adaptive setting on and ready to use see Spatially Adaptive on page 35 It is thus a fast way to test a full field where only large or no defects are expected The spatially adaptive algorithm will fill in the details 56 Medmont Automated Perimeter The System Test Templates if any defects are found
132. t you can use the drop down box containing the patient s name to move it to its correct place Click on the Change button and then use the Find Patient dialog to select the destination patient Clicking on OK will move the exam to the new patient Map View Clicking on Map from the top of the patient tree displays up to four different exams from the same or different patients Use this View mode to display a full screen colour map image of a single exam or to display images of multiple exams An example showing four consecutive images for a particular patient 1s shown below in Figure 27 Fredericks Fred Right 5 May 1989 12 02 00 PM Central Test x Fredericks Fred Right 5 May 1989 12 21 00 PM Central Test Lvi 27 0 dB Lui 24 0 dB Lvi 27 1 dB Ring 1 Ring 1 Ang 90 gt Ang 90 Figure 27 Map view of four consecutive exams Medmont Automated Perimeter 71 Analysing and Viewing Exam Results More often you would use a single exam map view and the powerful view analysis controls described in Selecting the Map Type and Data View on page 73 to examine the results for one particular exam Combination View Clicking on Combination from the top of the patient tree displays four clinician selected views of the same exam The Map Type and settings for each image can be controlled independently Figure 28 is an example where the view is displaying a grey scale threshold level with cross sect
133. t boundaries are defined in Table 8 where the angular coordinate system is anti clockwise from 3 o clock ie 0 is at 3 o clock 90 is at 12 o clock etc Peripheral zone All radial points between 23 and 50 Top left arcuate All radial points between 9 and 23 and in the 90 to 180 sector Top right arcuate All radial points between 9 and 23 and in the 0 to 90 sector Bottom right arcuate All radial points between 9 and 23 and in the 270 to 360 sector Bottom left arcuate All radial points between 9 and 23 and in the 180 to 270 sector Table 8 Field subset boundary definitions Medmont Automated Perimeter 105 Regression Analysis Note that some fields have light points that extend asymmetrically past the 22 eccentricity the glaucoma field for example and selecting a peripheral zone plot in these cases will not be a peripheral plot but a plot of those points that extend beyond the 22 eccentricity Regression Options On the Display tab click Edit will bring up the dialog shown in Figure 63 i Regression Settings M700 Regression xs Eye Date Axis Left v Auto Scale Right From Date 14 Jun 1990 gp ToDate 29 Dec 1994 Graphs M700 Exam Level Histogram New M700 Exam Overall Defect M700 Exam Pattern Defect M700 Exam Age Histogram M700 Exam HoV Histogram M700 Exam IOP Apply J OK Figure 63 Regression Settings dialog
134. t stimulus or if this process occurs too often during the test then the Video Fixation Lost dialog Figure 16 is displayed Medmont Automated Perimeter Testing a Patient 4 Recalibrate Patient Fixation The patient is not fixated correctly What would you like to do Reposition the patient and try again Use relaxed video fixation tolerance Turn off Video Fixation Monitoring Figure 16 Video Fixation Lost dialog box This dialog optionally allows the clinician to relax the tolerance that the perimeter uses when determining whether testing of a point should be deferred until the patient is correctly fixated This can be useful if the test duration is being unduly prolonged by a patient s inability to fixate If the fixation tolerance is relaxed then testing is allowed to proceed even if the patient is not fixated provided the fixation loss 1s not too large In this case a fixation loss will be recorded Note that you can also use the Relaxed Video Fixation Tolerance option in the Options menu to set this option prior to or while running a test In this case the software remembers the setting you have selected and will use the same option for subsequent tests The Video Fixation Lost dialog also allows the clinician to turn off Video Fixation Monitoring completely and revert to Blind Spot Fixation monitoring False Positives Monitor This monitor performs a pseudo exposure about every tenth normal exposure
135. t template selected Medmont Automated Perimeter 37 Testing a Patient Selecting a Test Template The drop down text box at the top of the left hand control pane lists all system and clinician defined test templates see The System Test Templates on page 51 for a complete discussion of the Medmont supplied test templates When you select a new test template the field displayed in the test control window will change to reflect your selection Selecting the Eye Clicking on the Eye button swaps to the opposite eye field in the template Note that each eye can have different fields in user created fields All Medmont system templates have the same field for both eyes By default the right eye will be set for a new test The eye setting will automatically switch to the left eye at the conclusion of the right eye test Lens Details If the Age Based Lens option is checked in the test Options menu then the software will automatically calculate the default lens that should be used for the test based on the patient s current clinical refraction and their age The age based offset shown in Table 3 is added to the patient s current clinical refraction sphere value Table 3 Age based Sphere offsets For example when testing a 63 year old with a current refraction sphere value of 0 75 the default lens sphere value will be 0 75 3 25 4 0 38 Medmont Automated Perimeter Testing a Patient If the Age Base
136. tant Facts 4 Important Facts This manual does not provide guidance on interpretation of clinical results The clinician must ensure that he or she has received appropriate medical training in such interpretation Medmont cannot be held responsible for misdiagnosis of results Essential Performance Due to the possible effects of external electromagnetic interferences the essential performances of this instrument are e Component failures in the Automated Perimeter unit are not permitted e Changes in programmable parameters are not permitted e Reset to factory defaults are not permitted e Errors of a displayed numerical value sufficiently large to affect diagnosis are not permitted Classification Do not use this instrument other than intended and specified In accordance with IEC 60601 1 clause 5 the M700 and WARNING variants Automated Perimeter is classified as Applied parts to patient Automated Perimeter unit Protection against electric shock Class I Warning To avoid risk of electric shock this equipment must only be connected to a supply mains with protective WARNING earth Degree of protection against electric Type B Applied Part shock Equipment Protection against harmful ingress of Ordinary no protection water For indoor use only Mode of Operation Continuous Operation Oxygen Rich Environment This instrument is not Medmont Automated Perimeter 7 Important Facts suitable for use in oxygen rich e
137. te eee ree ne mene Ct Cement cee eee rer net mene cer rere tr CTA COMA LCS bs acaa oa nels ess ee A etree A Macula Tes ics ice ai fe So cle Ott Gee ba oleh hatha ceeds ING UL OIO GICAL VCS Arana AAA Peripheral Tos peur eevee ee Ci er ia er eee ree ee iar mee eR Quickscan Test deprecated enesesse delta atatsre seule tal cyte ditt Fiash Scan CS sears te het else east dees tisk ede seta andes esh dele Spatially Adaptive West sites cis eaedtectteet seth castes i EN Cnm S972 omen ete eee E OE Cental 22 Noi cae amen een rt Sede Decree so oaP aM emia seh Rare na a neh eerie ea CV Yo 00 Pott Vest une a eh ae ace eis THE SYSTEM TEST STRATEGIES ccccccccccccccccccccccccccccccccces Stimulus Presentation aaincis vd cis oaecsuse ham cecse te tivctadda de casos ebeGadestes dtekelssdathutss Medmont Automated Perimeter 10 Past Threshold Satepina e a E E ERE 59 Threshold Sttateey reai E eek oan eee 59 SCrEGhING Strate ey AEprecaled atic srucehs aiena aa 60 Three Zone Sie oy csc cae ee ee 60 Ered Cevo Bie nso oa eee ee eee ee ee me eee ee 61 Age Related SU AUC OY suspresi sasoian Merundctdeaustsh seruniae eousish Pernt daar 62 STATISTICAL INDEXES wesiccseseciscincatedstosescscarlasecetotasieeinctiotieteeieniadcieids 63 Age Normal Hill of Vision cccccccccccceeeeeeeeeeeeeeeeeeeeeeeeeeeeseeeeeeeeeeeees 63 Patient Based Hil Or Vis1OM accseceeesoellece ce ees acer eet ce 63 Go eNom eee oe eee ee ee NE 64 Pattern D
138. test Compliance Electromagnetic environment test level level guidance Portable and mobile RF communications equipment should be used no closer to any part of the M700 USB Automated Perimeter including cables than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter Recommended separation distance Conducted RF 3 Vrms d 1 2VP IEC 61000 4 6 150 kHz to 80 MHz Radiated RF 3 V m d 1 2VP 80 MHz to 800 MHz IEC 61000 4 3 80 MHz to 2 5 GHz d 2 3VP 800 MHz to 2 5 GHz where P is the maximum output power rating of the transmitter in watts W according to the transmitter manufacturer and dis the recommended separation distance in metres m Field strengths from fixed RF transmitters as determined by an electromagnetic site survey a Should be less than the compliance level in each frequency range Interference may occur in the vicinity of equipment marked with the following symbol C NOTE 1 At 80 MHz and 800 MHz the higher frequency range applies NOTE 2 These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people Field strengths from fixed transmitters such as base stations for radio cellular cordless telephones and land mobile radios amateur radio AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy To assess the electroma
139. the Close button in the Attributes dialog and then force an attribute re computation by clicking the Recalculate button You should see the Duration attribute now display in seconds e New Calculated Attribute Name Duration Display Name Duration Units Decimal Places 1 lt Scientific Format GetDuration 60 Figure 55 Revised calculation to display Duration in seconds Medmont Automated Perimeter Analysing and Viewing Exam Results This is probably not the way you would want Duration to display so repeat the above procedure and reverse the changes Defining a New Attribute For the next step we will develop a completely new attribute As an example say we need the best estimate of a patient s underlying HoV i e disregarding any defects at 12 eccentricity There are system functions for the computed patient HoV level and slope so we can use these to develop an expression for the level at 12 Remembering that HoV slope is given at the 3 ring and the slope is in dB 10 then the required new expression 1s HoV_at_10 HoV_Level 0 3 x HoV_Slope 1 2 x HoV_Slope Bring up the Attribute Expression editor again from Tools gt Attributes then click on the New button Select Expression Attribute Enter HoV at 12 in the Name box select 2 Decimal Places and enter dB in the Units box Note that a name cannot contain spaces Use the underscore character if spaces wou
140. the Exam Results Advanced Print Settings The advanced M700 Exam Print Report settings are show in Figure 72 The M700 Exam Print Report is designed to show all of the relevant information about an M700 exam on one page The attributes that are shown are automatically generated based on the exam strategy used L M700 Exam Print Settings General Common Settings W Non Linear Scaling W Attributes W Numeric Tick Marks W Annotations 40 S Overlay Opacity Level TE Numeric Plan 13 Numeric Grid LY Perspective Traditional Grayscale Section Retinal Overlay Defaults Figure 72 Advanced settings for the M700 Exam Print Report The default display returned to at any time by clicking on the Defaults button presents a single graphical exam image and a predetermined set of statistical summaries as shown in Figure 71 Changing any of these settings here will become the default for all future print reports of this type The checkboxes in the Common Settings grouping provide some additional options Checking the Non Linear Scaling and or Numeric Tick Marks checkboxes will make these changes but the result can tend to crowd the display somewhat The attributes that are shown are based on the currently selected exam s strategy These can be turned on and off via the Attributes checkbox The Retinal Overlay checkbox will add any registered retinal images to the print preview Refer to Retinal Overlay V
141. ts beyond this limit will not be detected by these statistics Seen Points The Seen Points attribute displays the ratio of the number of points the patient confirmed that they saw to the number of points that were actually 66 Medmont Automated Perimeter Statistical Indexes presented This attribute is only calculated for Fixed Level and Three Zone Strategies For example Seen Points 36 40 90 Not Seen Points The Not Seen Points attribute displays the ratio of the number of points the patient did not see to the number of points that were actually presented This attribute is only calculated for Fixed Level and Three Zone Strategies For example Not Seen Points 4 40 10 CV Index The CV Index or Perimetric Residual is a percentage of blindness in a patient The percentage is calculated by giving a value of 1 to each seen point 5 to each relative defect point then adding the resulting values together This attribute is only calculated for Three Zone Strategies See page 57 for information on the CV 100 Point test Medmont Automated Perimeter 67 Analysing and Viewing Exam Results 10 Analysing and Viewing Exam Results The following details the selection of patient exam results and setting the various examination display modes Selecting the Exam Results The first step in viewing exam results is selecting the exam s to view Exams are listed under each patient when the Explorer pane on the left s
142. tsis seis ielentbcealacsshindesddsta E RE OressiOm Opon sukani Gesell i E A Geb ads PRINTING THE EXAM RESULT G ccccesossssssccccccecscsssecccsccsossess Printins the Current Display succes tects saphees sides Gasheee eet heed aides Export a Print Preview to the Clipboard Export a Print Preview to an Image File Printing Multiple Images Printer Settings Threshold Over view Print sroti a Wsasedcactsenace MOO Exam Prnt Repor fesse sick ccs ot ed sa at ho aa Advanced Print Settings Printing the Patient History inic23 ccchcesisdesch aise eccle edad aaa Re oression View Prima 25 ice ete Race aes EXPORTING THE ANALYSIS wrssseccccccsscsascesceeets sccaosetssecnsscccocosasebsavetaeseatoe PERIMETER FIL TERS seese ae eaea onenetan iaaa oraaa INSTALLING THE DEMONSTRATION DATABASE eesesssssssssssssssssssee POWER ON SELF TEST oeeaaeaii neee iaaea aeaio GLOSSARY iceeccessed scdestecasutuctuccessce sence sicdastentececs wedssaestectiucssiedesbeatcecaceustssouelss CLEANING MAINTENANCE AND SERVICE eessssssssssssssssssssssssssssssesee CI on agement rae or te or rt ay ee eee ed rae OMe IVA TITS AIG urai tae oy ec an teats iisdedeu i geetaae ey eoadaatuiuiddenaunlaee Replacement of fuses Testing light points Service TROUBLESHOOTING asoni Ea aa aS aaeeea TEER SPECIFICATIONS FOR M700 M730 MODELS seessesssesssssssscssssssssessssee DECLARATION OF CONFORMITY eseeeececcccccssssssssscceecccsossosssssssssseeee REPRESEN TA TTY E
143. ure at the 99 9 probability is tried only 1 in 1000 healthy patients will not see this level by chance alone It provides a fast test where establishing a patient s general vision profile relative to their age is the first requirement It uses the same display as the three zone strategy of Figure 19 However in this case the Points Seen graphic denotes points seen on the first exposure the Relative Defects graphic denotes points seen on the second exposure and the Absolute Defects graphic denotes points that were not seen at all Note that the numeric map display see Numeric Data View on page 84 contains the most information from this strategy s results Medmont Automated Perimeter Statistical Indexes 9 Statistical Indexes The following statistical indexes are calculated for exams and displayed in the Data tab of the Exam view Age Normal Hill of Vision The age normal hill of vision is based on standard age based population tables interpolated for the Medmont Automated Perimeter For the green light points the three age groups are l to 45 years 46 to 60 years 61 years and over For instruments so fitted the age groups for the red light points are l to 59 years 60 to 74 years 75 years and over Patient Based Hill of Vision Estimating the patient s actual HoV can present a number of problems particular where there are large defect areas Simple mean values are often confused by outliers and defect ar
144. use button within the image and select from the popup menu In Pan mode click on the image and drag it in the direction you wish to move the image The image will continue to move in that direction while the mouse button is down or until a boundary is reached The speed and direction of movement is proportional to the distance of the current cursor position from the position when the mouse button was pressed In amp Zoom mode click on the point in the image that you wish to zoom in on The image will continue to zoom in while the left mouse button is held 100 Medmont Automated Perimeter Analysing and Viewing Exam Results down If you hold the Ctrl key down while clicking then you zoom out instead of in You can also use the central wheel of a mouse so fitted to control zoom Medmont Automated Perimeter 101 Regression Analysis 11 Regression Analysis The regression analysis tools allow you to explore the progress of a patient s results over time Regression views are available when a single Patient is selected in the Medmont Studio explorer pane This adds a Regression menu and the W regression button above the patient explorer pane Figure 60 is a full screen shot of Medmont Studio showing the Regression Analysis view for both eye exams for the patient selected The Regression menu and toolbar allow selection and manipulation of these views r pay tral M700 Regression F oa is SO Nasal Superior K Temporal Superi
145. xation monitoring then ensure that the circular head tracking targets on the eye patch or headband for binocular testing are correctly positioned and not obscured by the head rest See Video Fixation Monitoring for more information Ensure the eye to be tested is centred squarely in front of the fixation target Raise or lower the chin rest so the patient s eye 1s at the height of the marker on the chin rest frame Use the chin rest adjustment to get this correct The face may be turned slightly to the left when testing the right eye and slightly to the right for the left eye so the nose does not obstruct the nasal periphery of the field Medmont Automated Perimeter 25 Testing a Patient Similarly the chin should be positioned so the plane of the face is directed straight ahead or slightly upward thus putting the eye in slight down gaze to see the fixation target The side turn and upward tilt of the face should be neither exaggerated nor uncomfortable The only point is that the eye not be in a nasal or up gaze position where facial structures may shade the peripheral field If the patient requires a correcting lens be sure it is positioned close to the eye and that the holder does not restrict the field of view Use the video eye monitor shown here where fitted to both position the patient and monitor their fixation throughout the test Be sure that the patient 1s sitting comfortably in the chair and the height

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