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MEDMONT E300 - The Contact Lens Laboratory of South Africa

1. Leutron PCI Capture Card USB Video Converter Box Figure 47 Choosing Video Source Capturing Calibration Images 66 The Calibration Wizard captures five separate images of the calibration object at different locations within the instrument s working range see Figure 48 It analyses these images to measure the error in the current calibration To start mount the calibration object in the E300 chin rest There is a slot beneath the top rail of the chin rest and a 4mm hole facing the E300 Hold the calibration object with the ball facing the E300 and slide the tab with the threaded hole into this slot from beneath While holding it in position insert the retaining screw with the knurled knob into the hole and screw it into the tab Alignment is not important and only tighten finger tight The E300 joystick allows positioning in three dimensions Move the joystick in the desired direction for movement left and right and for closer to or further away Rotate the joystick knob for movement up and down clockwise to raise anti clockwise to lower Position the instrument to align the centre of the rings with the central cross hair and the focussing bar over the central horizontal cross hair When the instrument is properly positioned the wizard will automatically capture the image Press the Next button and repeat the process to capture each of the five images Medmont E300 Corneal Topographer Calibrating the E300
2. fj A Wong John Right 25 Nov 98 12 35 PM Ba B A Axial Power GJ medmont Bag EP Rae 255 spp 285 3 33 medmoni 10 0 v Standard Power Diff 48 49 32 24 18 085 00 O08 18 24 32 4 Figure 16 Compare View Changing the View Settings You can customise the information displayed for a Patient Exam for each Exam View Mode see Setting the Exam View Mode on page 24 Once an exam is selected the Display ribbon bar tab will become available see Figure 17 allowing you to set both the Map Type to display and for setting a considerable number of options 2 cs Top 50 Colour Map Opacity e i p Opacity 1 Image Z Cartesian Grid Readout Z Attributes e Eccentricity 7 KY Perspective 0 Perspective Scaling Colour Map Polar Grid Z Annotations Bottom Data Settings Auto Sim K Units Numeric Data M Keratometrics Cross Section Sim K Reset _Map Type __ Options Show Hide f Data Blocks Defaults Figure 17 Map view settings dialog These options are applied to the image as you change them and are immediately visible You can click at any time on the Display gt Defaults gt Reset button to restore the software defaults 26 Medmont E300 Corneal Topographer Analysing and Viewing Exam Results Map Types The Map Type controls the type of data displayed for a Patient Exam The types displayed in the following list are selected from the drop down boxes on t
3. Toggles on and off the display of the Keratometrics The steep axis is calculated as the spoke with the highest average axial power whilst the flat axis is always set at 90 degrees from the steep axis Readout Toggles on or off a readout marker white cross relative to the keratoscope axis The data values at that location are displayed in the bottom right hand corner of the exam Annotations Toggles on or off the Annotations stored within the exam Cross Section Toggles on or off a cross section of the displayed data in a tabbed window below the colour map A white indicator line is displayed over the colour map to indicate the source of the cross section Medmont E300 Corneal Topographer Menu and Icon Reference Attributes Toggles on or off the Attributes panel which is displayed below the exam Top Drop down controls for the top left hand side data block see Text Data Blocks on page 33 Bottom Drop down controls for the bottom left hand side data block see Text Data Blocks on page 33 Edit Tab Items The Edit tab is added by the E300 component It is only displayed when a Patient Exam is selected u pP jm e o ae e gt P P r s of et Text add a text annotation to the image Callout add a callout annotation to the image Ruler create ruler annotations used to measure distances on the image Circle create circle annotations Ellipse create el
4. The Display tab is added when a graphical E300 view is selected or taking an E300 exam see Setting the Exam View Mode A 4 o es PF ss G p g Reset resets the zoom and pan to the default settings for the displayed view Zoom In zooms in on the displayed views Zoom Out zooms outwards on the displayed views Pan Left pan to the left of the displayed views Pan Right pan to the right of the displayed views Pan Up pan towards the top of the displayed views Pan Down pan towards the bottom of the displayed views Select set the cursor mode of the displayed views to enable selection of the section indicator and cursor readout Pan set the cursor mode of the displayed views to enable interactive panning using the mouse Zoom set the cursor mode of the displayed views to enable zooming using the mouse Change displays the contact lens design dialog and allows you to select the contact lens design and alter the manifest refraction only available when a contact lens has been selected Edit displays the contact lens designer for the selected lens design and allows you to edit the lens parameters only available when a contact lens has been selected Planar image data 1s displayed as a plan color map Perspective image data is display a color map overlayed on a perspective 3D view of the eye Reset Resets the Display tab options back t
5. MEDMONT E300 CORNEAL TOPOGRAPHER USER MANUAL Medmont Pty Ltd 5 56 Norcal Rd NUNAWADING VICTORIA 3131 AUSTRALIA Phone 61 3 9259 0800 Fax 61 3 9877 643 1 e mail help medmont com au Web www medmont com au Doc No P 1470 V2 4 MEDMONT Dec2012 CE Table of Contents MANUAL CONVENTIONS nina ten nada seiseote 1 INTENDED PURPOSES aa aaaea 2 Power CONNEC OM ER ne ns is de l ei et nn ase 2 Standard E300 Accessories c csccscoccoscsccscoccoscsscecescascsccecscancsccecesces 3 Optional System Accessories available from Medmont 4 Se PASS ee suena 4 Consumables seven hi Ra a te SR Maintenant 4 THE 00 SONATA nd at en 5 Software Conventions 5 WARRANTY aaea IN a sms miens 6 IMPORTANCE E St Vi ee 7 Explanation of Symbols and Labels 8 O Regulatory Information This instrument complies with all applicable Regulatory requirements and Safety Standards Classification Clinical Results Accuracy and Calibration Radiation Electromagnetic Compatibility and Emissions This instrument conforms to the EMC Standard IEC 60601 1 2 The device emits no harmful or undesired electromagnetic emissions 10 OO l l Interference 10 Side effects 10 Electrical safety of medical electrical system 10 Disposal 10 INSTALLATION iiianoe sonde ist 11 PC and Associated Equipment Requirements ccccccceeeeeeeeeeeeees 11 Instrument Environment Reine Ris sen fr n
6. Medmont E300 Corneal Topographer 61 Fitting Contact Lenses s Top 2 7 aotmet vi Secti amp F Save Fli sea e Eccentricity 50 Colour Map Opacity 4 Cartesian Grid Readout Attributes Bottom 2 Change Edit amp Undo 2 Polar Grid mm 7 Sim K Units Z Annotations Lens Parameters Sim K v Reset Design Show Hide Data Blocks Options Defaults Figure 44 Contact Lens View Settings Dialog Printing the Contact Lens Design First select the contact lens or lenses that you wish to print by selecting them in the Explorer pane Select the printer to print to and paper size by navigating to Application Button gt Print then click the Settings button To print immediately navigate to Application Button gt Print then click OK Alternatively navigate to Application Button gt Print Preview to adjust titles and margins and view output before printing A typical fluorescein print is Shown in Figure 45 Medrnart Starin Version 443 OI Onc 2804 O420 11 PM Figure 45 Example fluorescein printout in Print Preview 62 Medmont E300 Corneal Topographer Managing Exams and Calibrations 9 Managing Exams and Calibrations This section describes general housekeeping procedures for managing various aspects of the E300 database Editing Exam Details Select the Patient Exam entry in the Explorer pane and select Details Exam View mode see Setting the Exam View Mode on page 24
7. 41 Spherical aberr HID Cancel Figure 32 Arrange Attribute dialog Note that the underline character embedded in many attribute names is displayed as a space on the map display Clicking the Sort button will sort the Selected attributes column into alphabetical order You can see the effect of any changes made in this dialog by clicking the Apply button Clicking OK will also apply any changes and dismiss the dialog Custom Attributes You can define your own attributes to extend this standard set Access the Attributes control dialog on the Configure tab by clicking Attributes Medmont E300 Corneal Topographer Analysing and Viewing Exam Results The Attributes dialog is shown in Figure 33 and shows the same set of names in the Name column as is shown in the Available column in Figure 32 The Description column shows the derivation of that particular attribute For example the Flat Angle attribute depends for its value on the FlatAngle system function The system functions have direct access to the current exam details Attributes Es Exam Type SMSE 62 Name Description New Y Age when Tested Calculated Edit FX BFS radius Calculated f Chord Length Calculated Delete iex Conversions Code Block FX Flat Angle Calculated f Flat e Calculated f Flat e Calculated Import f Flat K Calculated Export f Flat p Calculated FA Flat Q Calculated
8. Sorting E300 Exams The E300 Exams displayed in the Explorer pane can be sorted by any of the column headings when the E300 Exams tab is active Click on the heading for any column and the display will show exams sorted by entries in that column Click again to reverse the sort order Figure 30 shows an example of sorting exams by patient age 46 E300 Exams M Smith Sandra Right Smith Sandra Left Love Sarah A Love Sarah B Jones Chris A Jones Chris Citizen John i Citizen John L King Sue King Sue vq Jolly Nick Jolly Nick h Fifer Michele Fifer Michele aq Mills Karen Mills Karen L Wong John A Wong John L Wong John vq Wong John h Wright Sally A Wright Sally h Peterson M A Peterson M h Fredericks Fredericks Left Right Right 22 Dec 1998 11 4 2 Dec 1998 11 4 3 Dec 1998 4 11 3 Dec 1998 4 09 2 Dec 1998 9 27 4 Dec 1998 4 34 4 Dec 1998 4 35 5 Dec 1998 11 3 5 Dec 1998 11 3 2 Dec 1998 12 5 2 Dec 1998 12 5 25 Nov 1998 12 25 Nov 1998 12 4 Dec 1998 1 15 4 Dec 1998 1 14 27 Nov 1998 10 27 Nov 1998 10 25 Nov 1998 11 25 Nov 1998 11 3 Dec 1998 3 41 3 Dec 1998 3 40 Post op Post op Figure 30 E300 exams sorted by Medmont E300 Corneal Topographer Age Analysing and Viewing Exam Results E300 Attributes The Attributes view see Figure 31 provides a summary of the derived attributes of
9. The software displays the Patient Exam details see Figure 14 Enter or change any of the details Any changes will enable a Cancel and Save button Press Save to save your changes The Cancel button discards any changes Moving an Exam to a Different Patient If you accidentally capture an exam against the wrong patient it 1s possible to transfer the exam to another patient Click on the Change button and enter the details for the correct patient Click OK to make the transfer Changing the Calibration Used for an Exam The software sets the calibration used to analyse a Patient Exam when the Exam is captured It is possible to change this using the Calibration drop down box Usually the only reason for doing this would be if you discovered that the instrument has gone out of calibration see Calibrating the E300 on page 65 Once you have re calibrated the instrument select the Patient Exam that you wish re analyse and select the new calibration using the Calibration drop down box When you next view the Patient Exams in Map Combination or Difference View Mode they will be analysed using the new calibration Categories Categories are user defined words or phrases that describe the nature of the examination You can add delete and change the available categories see the Medmont Studio user manual Categories are displayed in the Details view which can be accessed by selecting the Details button from above the patient tree see Fig
10. Zoom Pan ribbon bar group The shape of the cursor will change to reflect the current cursor mode In Pan mode click on the image and drag the mouse 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 Medmont E300 Corneal Topographer Analysing and Viewing Exam Results down If you hold the Ctrl key down while clicking then you zoom out instead of in Using the Section Display The section display see the lower part of Figure 26 provides a graph of a user selected cross section through an image map You enable the section display as described in Cross Section page 32 The white section indicator line on the image shows the location of the cross section data source The dotted half of the indicator corresponds to the dotted portion of the cross section data The indicator has three handles Use the left mouse button to click and drag the handles to a new location Rotate the cross section about its centre using the outer handles Move the cross section through the image using the centre handle The cross section data update
11. AM AR 9 Dec 1993 1 09 00 PM HR 26 Apr 1994 1 24 00 PM BI L 25 Jul 1994 1 14 00 PM HRR 26 Aug 1994 11 19 00 AM E QAR 1 Oct 1994 12 28 00 PM L A R 4 Dec 1998 4 34 24 PM L L 4 Dec 1998 4 35 12 PM f Jones Chris FR L 26 Apr 1989 3 43 00 PM Bl L 26 Apr 1989 4 21 00 PM J R 2 Dec 1998 11 44 12 AM L 2 Dec 1998 11 44 54 AM King Sue amp Love Sarah Marshall Trevor SAL 20 founa AT Pati 8302000 im 391300 Ex Go700Ex Figure 12 Select and Display an existing exam The View pane now displays the exam result s Figure 12 shows a single right eye image How the exams are displayed depends on the current View Mode Medmont E300 Corneal Topographer 23 Analysing and Viewing Exam Results Setting the Exam View Mode The View Mode controls how the selected Patient Exams are displayed You select the View mode from the top of the patient tree Es 0 89 ga Figure 13 Possible E300 display mode options The selections for the various modes are Details View Click on the button at the top of the patient tree This displays textual information about the selected Patient Exam see Figure 14 It provides for the clinician to add comments and where an exam has been attributed to the wrong patient to change the owning Patient see Editing Exam Details on page 63 FL Gtizen John Left 3 Dec 1998 4 11 03 PM Patient Citizen John Change Exam Date 3Dec 1998 04 11 03 PM fy Eye Left Rig
12. Display on page 43 onto the steep or flat axis Zoned K If Zoned K is selected in either the top or bottom data blocks then the Zoned Keratometric display will be enabled The Zoned Keratometric display is divided into 3 zones 3mm 5mm and 7mm Each zone is independently analysed to locate the primary most steep and most flat and the secondary second most steep and second most flat area The primary steep and flat are indicated by a thick red or blue line whilst the secondary steep and flat are indicated by a thin red or blue line respectively Unit of measurements can be specified from the Sim K units drop down box on the Display tab Medmont E300 Corneal Topographer 33 Analysing and Viewing Exam Results 34 Sim K This displays the simulated keratometric Sim K values for the Steep in red and Flat in blue axes of the eye and the corneal cyl AK formerly dk The parameters include a number of changes from earlier versions that bring the E300 terminology more into line with current use Among others E Values are now referred to as e for eccentricity corneal cyl was previously dk and is now AK shape factors are now called e values There are also some newer terms such as asphericity Q e and p values p 1 e See Toggles on or off the display of numeric data at specific points on each 30 degree spoke The data displayed at each point will depend on the chosen map type Text Data Blocks on p
13. E300 Calibration Wizard 31838 Capturing Image 1 of 5 Mount the calibration object on the chin rest and align the topographer to automatically ca the image Press Next to continue ally capture the image Pi Figure 48 Capturing Calibration Images Checking the Current Calibration When the five images have been captured the wizard calculates the error in the current calibration and displays it see Figure 49 This screen allows you to choose to recalibrate the instrument or continue using the current calibration The wizard will recommend a course of action depending on the degree of error in the current calibration E300 Calibration Wizard E31838 Verification Complete The current calibration error is 0 109 Medmont recommends that instruments with an error greater than 0 15 should be recalibrated Quick Recalibration Full Recalibration Use the current calibration Recommended Note Quick Recalibration ge l thi Full nerally requires less than an hour 8 hours depending on the speed of your ibration error ni Recalibration may take up to computer and the current cal Figure 49 Verifying the Current Calibration Recalibrating the Instrument If you elect to recalibrate the instrument the Calibration Wizard will run the calibration process It displays the current status of the calibration see Figure 50 If you select the Quick Recalibration option then the calibration will stop automatica
14. EXD CSE KR a o et SUPPORT PAD O CE ESEMETE e ame seem EEFE EREN ref DRILL 82 5215 DEEP 4 PLES ee 35x16 CSK XR al a RAIL 4 Coe SELFTAP 2x foc oR Px NO CEN F No EDGE DRILL 35 00 DEEP ON BOTTOM SIDE 4 PLCS fe SELF TAPPER a25 PARHDO ER aa CHINREST T Figure 3 Table setup and dimensions Software Installation It is important that you read the Medmont Studio manual for additional details on installation 12 Medmont E300 Corneal Topographer Installation The E300 software is a part of the Medmont Studio software package A single CDROM is supplied with installation software for all Medmont Studio components e Insert the Medmont Studio CDROM and run the Setup program found in the root directory Select the E300 component when asked which components to install e Select the correct frame grabber hardware for your system e Restart the computer when the software installation is complete Running the Software Select Medmont Studio from the Start gt Program Files gt Medmont gt Medmont Studio 5 menu or double click the desktop icon Connecting the E300 instrument The following steps should be followed to connect the Medmont E300 Corneal Topographer to the PC for the first time Note the E300 Corneal Topographer requires Microsoft Windows XP SP2 or greater to be installed Connecting the USB Video Converter box l 2 4 Firstly connect the USB Video Co
15. Zernike Height Height Ray Error Map The deviation on the image plane between the focal point and a ray from an on axis distant object refracted through the cornea Refractive Power Map Displays the true refractive power of the surface in Diopters Tangential Curvature Map Displays the local curvature of the surface in mm Medmont E300 Corneal Topographer 29 Analysing and Viewing Exam Results Wavefront Error Map medmont m The difference in optical path length of a ray from an on axis distant object refracted through the cornea and the principle ray which passes through the centre of the cornea to an ideal spherical wavefront inside the eye divided by 550 nm the assumed wavelength of the light ray Wavefront Error Map Zernike Fit This is a decomposition of the wavefront error data in terms of the Zernike components Individual Zernike components can be added removed from the display by selecting the Display gt Map Type gt Data Setting button underneath the Map drop down list Selecting Show Residual will display the Zernike Residual This measures the error in fitting the wavefront error data iin using Zernike functions ee Residual Zernike Result Calculated Wavefront Error The data may be viewed as either a two dimensional plan as above or as a three dimensional image These views are selected by clicking the appropriate button Q Plan 2 dimensional Q Persp
16. beside each color Color scale A sequence of colors used to color a representation of a surface Elevation The difference between the height and either a best fit or user specified sphere e Eccentricity of an ellipse on a plane slicing through the reference axis and a specified axis on the surface The ellipse is fitted to the central point and a specified point on the surface axis Usually the steep axis and flat axis are used to give a pair of e values Flat axis The axis orthogonal to the steep axis Idealized eye A symmetric toric ellipsoidal surface based on the average values of one or more surfaces Inferior Superior IS index The IS is the difference measured in diopters between the average inferior power and the average superior power Installed instrument The instrument specified by its serial number that the software expects to use for image capture Medmont E300 Corneal Topographer Glossary of Terms Keratometric power For a given line through the centre of the surface this is the axial power at the point on the line where a keratometer would take its measurement maximized when the given line is the steep axis Power maps Axial tangential and refractive power representations of the surface measured in diopters Reference axis On the physical instrument the longitudinal axis passing through the centre of all the Placido rings In the mathematical 3 dimensional space in which the surface i
17. body acids and fats and makeup e Cone surface e Imaging lens front surface e Profile illumination window on RH channel just inside cone edge e Profile image window on LH channel inside cone edge Internal optical surfaces are not accessible without disassembly Do not attempt to disassemble or turn any of the sealed mounting screws as the alignment of the optics and the calibration may be altered considerably Do not put any objects into the cone other than those listed Recommended cleaning materials e Lunt free lens paper e Cotton applicators e Grease absorbing micro fibre cleaning cloth e g Luminex e Non smear optics cleaner The cone assembly is made of polymer products This means the cone is sensitive to mechanical surface damage scratches dents and may not be chemically resistant to certain solvents Medmont E300 Corneal Topographer pr Cleaning Maintenance and Service Do not use any abrasive cloth or strong organic solvents like acetone The image lens is positioned near the apex of the cone and difficult to access Unless the optical performance of the lens is noticeably affected we do not recommend approaching the lens Dust on this surface is not visible on the image Its effect is a lowering of image brightness and overall resolution not local blurs only The profile windows are 2 x 2 mm in size To reach the corners of these windows form the tip of a cotton applicator with tweezers t
18. eyes The tangential power for both images should have their centre in the same position relative to the pupil centre Ask the patient to open her eyelid as much as possible and close the other eye if necessary Capturing Patient Exams Click on the Home gt New Exam gt Corneal Topography button Lito display the E300 Capture View see Figure 7 The red illumination rings inside the E300 cone should turn on Ensure the Normal option is selected in Home gt Capture Mode gt Normal Figure 6 Capture Mode Figure 6 Selecting Normal single frames or Video capture control Medmont E300 Corneal Topographer 17 Testing a Patient 18 300 Exam No Patient Selected Re js m in eee Select Clear MdSaveAl QyAnatyseAl Ciear Right Let Normal Video Patient Figure 7 E300 Initial Capture Screen Select the eye to be examined in the Exam Details box the right eye is the default The focussing window shows live video from the E300 The green and red target overlaid on the focussing window provides three dimensional centring and focussing information The green crosshair indicates the keratoscope axis The red bar moving along a three dimensional runway indicates the distance of the eye from the optimal focussing plane The view is from the camera s perspective so if the red bar is at the top or narrowest part of the runway then the patient is still too far away The E300
19. is OFF Error indicator is flashing MEDMONT E300 USB device not displayed in Device Manger Illumination only comes on for a few seconds when computer boots up or when in Capture mode Instrument ON OFF switch on Check power adaptor is fully plugged in Return back to supplier for repair Ensure USB plug is properly connected at both the PC and converter box ends Return back to supplier for repair Disconnect and reconnect the USB connection to perform system reset Return back to supplier for repair Instrument ON OFF switch on Check status lights are showing correct power connection Check USB port is at least USB 2 0 or higher Check Windows XP SP2 or higher is installed Reboot the computer to re Initialise the USB port Return back to supplier for repair Instrument ON OFF switch on Check power adaptor and D plug to frame grabber are not loose Check frame grabber card is firmly in PCI slot Medmont E300 Corneal Topographer 79 Cleaning Maintenance and Service Distance bar in capture window not working oversensitive or jumping Instrument does not calibrate 80 Blue LED is normally always on when instrument ON OFF button is on Possible reasons One or more images taken out of distance range One or more images too far off centre One or more of the calibration balls not clean Profile optics misaligned Dirt on profile optics Too much stray light in imag
20. joystick allows positioning in three dimensions Move the joystick in the desired direction for movement left and right and for closer to or further away Rotate the joystick knob for movement up and down clockwise to raise anti clockwise to lower Figure 8 Focus examples showing Too Far In Focus and Too Near Medmont E300 Corneal Topographer Testing a Patient Using the joystick position the E300 relative to the patient s eye so that the reflection of the Placido rings is centred on the green crosshair and the red bar is over the horizontal green line Once this is achieved the software automatically captures the best set of images and displays them in the image windows along the top of the View pane with the best images to the right Images for automatic capturing are selected according to best centring focussing and least eye movement Figure 9 shows a typical capture screen display It may not be possible to align the red focussing bar over the horizontal cross bar for patients with deep set eyes because of contact between the bridge of the nose and the instrument In this case centre the Placido rings on the green crosshair and bring the red focussing bar as close to the horizontal green line as possible without causing patient discomfort Provided that the red bar is somewhere within the focussing range 1 e not at the very end the software will automatically compensate for the focussing error Best Image Liv
21. mapping for refractive power values in Diopters to color Similar to the USS scale but with a restricted range Normalized Power A normalized scale for mapping refractive power values in Diopers to a color scale using a linear Color Key such that it s upper and lower bounds correspond to the limits of the data in the image were Tl 38 Medmont E300 Corneal Topographer Analysing and Viewing Exam Results Universal Standard Scale USS An implementation of the proposed Universal Standard Scale for Corneal Topography by Smolek Klyce amp Hovis Maps refractive power values in Diopters to color re A K Scale Similar to the Keratron scale for mapping refractive power values in Diopters to color Additional color scales are e Standard Curvature Maps the axial and tangential curvature values in mm to color e Standard Elevation Maps the elevation values in microns to color e Standard Height Maps the corneal height values in microns to color e Fluorescein Maps the contact lens fitting clearances in microns to the Fluorescein color scale e The current Color Key type is displayed at the bottom left of each map display The keys are selected from the drop down box that appears by clicking on the down arrow beside the text see Figure 22 Medmont E300 Corneal Topographer 39 Analysing and Viewing Exam Results 40 35 00 k Standard Power K Scale Standard Power Unive
22. 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 Medmont E300 Corneal Topographer 47 Analysing and Viewing Exam Results 48 the Selected list or remove it from the Selected list The double arrows will move the entire Available list to the Selected list or completely clear the Selected list 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 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 automatically be removed from the list Arrange Attributes E300 Exam W Show Undefined Attributes Select the attribute s to be displayed Available Selected Age when Tested Flat Angle BFS radius Flat K Chord Length Flat e Flat Steep ngle Flat p _ Steep K Flat Q Steep e Focal point x al 1S Index Focal point y SAI Focal point z SRI H 0 0 Piston Pupil Width H 0 2 Defocus Pupil Area H 0
23. that particular instrument and its configuration If there s more than one instrument listed you will need to install the E300 instrument that will be used for E300 exams This can be done by selecting a particular instrument then clicking the Install button It is recommended that ALL instruments are calibrated after their initial setup due to transportation To calibrate the instrument select the instrument and click Calibrate For more information about the calibration process see page 65 Disconnecting the E300 instrument The following steps should be followed to disconnect the Medmont E300 Corneal Topographer from the PC and the Mains Power socket if the USB Video Converter box supplied Disconnecting the USB Video Converter box 1 Turn off the USB Video Converter box first 2 Disconnect the E300 Corneal Topographer 8 pin DIN plug from the USB Video converter box 3 Disconnect the USB Video Converter box from the PC by removing the supplied USB cable from the PC Disconnecting from the Mains Power outlet 1 Disconnect mains power by pulling off the supplied mains power cable connected to the USB Video Converter box Medmont E300 Corneal Topographer 15 Testing a Patient 6 Testing a Patient The following sections describe the steps to performing an examination with the Medmont E300 instrument Patient Selection The recommended practise is to have a patient selected before starting to capture and analyse an e
24. the edge as required You can also click and drag a column divider in the Exam row to vary the column s width The weighted Average Height column displays the weighted average of the corneal height at either end of the specified chord The weighting is designed to correct for corneal tilt this allows the value to be used in 3 party software that assumes a symmetric eye model The Export buttons produces a comma separated file CSV readable by most spreadsheets Exam Filters Exam filters allow you to restrict which Exams are shown in the Explorer pane Select the E300 Exams tab at the bottom of the Explorer pane and the select the Filter entry as shown in Figure 28 j 4 mW SJ Eten 26 Matching Entries 4 Tree Eram Images I E300 Exams M700 Exams Figure 28 E300 exam filter selection This displays the dialog shown in Figure 29 and shows the many criteria that may be used for exam filtering You can also define your own selection criteria in the Advanced filter tab Medmont E300 Corneal Topographer 45 Analysing and Viewing Exam Results Standard Advanced Clinician B F Find Exams Without a Clinician B To 5 Right Date of Exam Eye Left Categories y Age o H To 130 j Of Patients With Date of Birth B To B Male Procedures E 3 Clear Conditions v cea Categories ind Sex Female Figure 29 E300 exam filter selection dialog
25. 0mm with mounting screw e Standard Table Top e Chinrest e Instrument Cover Medmont E300 Corneal Topographer 3 Intended Purpose Accessory box including 2 Rail covers 4 mounting screws for chinrest 2 chinrest pins 1 box chinrest paper 2 Caution labels EN IEC60950 equipment Hospital Grade Power Cord for North America only User Manual including installation Guide Medmont Studio Software on CDROM medium Calibration file on CDROM Optional System Accessories available from Medmont TR2450 Medical Isolation Transformer 500W 230 240V Supply TR1150 VAR UL Medical Isolation Transformer 500W 100 120V Supply For use in North America the customer must supply their own UL CSA compliant extension cords between the Isolation Transformer and the peripherals e g PC monitor RS232 COM Port insulation plug Network Insulation plug Electric Table Model TE 302 Footswitch The combined rating of the PC Monitor and Peripherals must not exceed the rated power of the Isolation Transformer s Each of these accessories may be independently powered by their own Isolation Transformer that meets the required specification DV2000 Diagnostic Video Imaging software module Spare Parts Calibration Ball PN 0274 370 Consumables Chinrest Paper Type Sbisa box of 500 Cotton swabs Tapered double headed on 150mm wooden sticks Cat No MG 8112 100 bag of 100 Medmont E300 Corneal Topographer Intended Purpose The
26. 25 Nov 1998 12 35 00 PM 7 719 1876 1 0 27 0 46 8 30 u mean 7 719 1876 1 0 27 0 46 8 30 o standard deviation undefined undefined undefined undefined undefined J N t Export Print Print Preview ok Figure 27 Analysis Details Dialog The tabulated data shows the values for the currently selected exam The statistical measures of mean and standard deviation are also given The section and readout indicators of displayed exams are linked to the Meridian and Chord slider to provide visual feedback of the measurement location This means that if the Section tool is displayed clicking and dragging the Meridian slider will rotate the Section indicator line on the Map view to a matching angular position with the attribute display reflecting the data under the white data point cross Similarly clicking and dragging the Chord slider will move the cross along the Section indicator line Alternatively with this dialog displayed dragging the Section indicator line Medmont E300 Corneal Topographer Analysing and Viewing Exam Results around will move the dialog sliders correspondingly The data point cross will be displayed even if the Section tool is not While you can use the lower scroll bar to scroll through the tabulated attributes the dialog itself can be resized to display more or less of the tabulated data First move the cursor over an edge of the dialog When it changes to a double headed arrow click and drag
27. A Citize 50 00 58 99 medmont 4 49 00 57 43 igre NET 48 00 Ree oe er 55 86 47 00 5 i 54 29 46 00 z 52 72 45 00 51 15 44 00 165 A 49 58 43 00 P 4 48 01 42 00 80 i 46 44 41 00 44 87 40 00 43 30 39 00 i ae 41 74 38 00 ai 40 17 r 315 37 00 38 60 AT 3145 36 00 240 eee et 22 37 03 ate nine oe ee SE pe i 255 lt oes i 4 awe S y 4 35 00 s oe E Ey or tpt 35 46 aa a i rs RCE 2 Standard Power 2 Normalized Power Figure 25 An example difference between two exams showing how the differences visible with the Absolute Color Key on the left can be highlighted with a Normalised key on the right Zooming and Panning 42 You can zoom and pan the currently displayed Patient image by navigating to the Display gt Zoom Pan ribbon bar group You can use the Display gt Defaults gt Reset item to reset the default image view When multiple images are displayed zooming and panning of the images is synchronised The Capture focus window can also be zoomed but not panned as the keratoscope axis must always be visible for focussing Using the Mouse to Pan and Zoom You can also use the mouse to pan or zoom within a single image If the mouse is fitted with a wheel the wheel is always enabled as zoom control You can also change the cursor mode by pressing the spacebar clicking the right mouse button within the image and selecting an option from the popup menu or by navigating to the Display gt
28. E300 Software The E300 Software is part of the Medmont Studio integrated software environment See the Medmont Studio documentation for help on installing and using the Medmont Studio environment Software Conventions The term Application Button refers to the circular button in the top left of the menu bar This button can have different icons but is always in the same position on the ribbon bar When navigating the application button menu we use the following notation Application Button gt Import m When referring to menu selection the notation 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 Y D LA i we MoveTo Ko lt P d Copy To Digit C A New Delete Delete Image Top Action Patient lt _ __ Group Some keyboard shortcuts can be used when setting spin box controls like the one shown here Use the numeric keys for direct entry up down arrows for small steps PgUp PgDn keys for large steps and 50 colour Map Opacity 22 the Home End keys to move to the opposite end of the currently selected number Home Configure Analyse Display Annotate Tab Home Configure Analyses Display Lu Medmont E300 Corneal Topographer 5 Warranty 3 Warranty The E300 Corneal Topographer
29. Eilunen A f Focal point x Calculated f Focal point y Calculated f Focal point z Calculated FES UM Ne Dintan LEP EP hi Close Figure 33 Attributes Control dialog To explore how you can define your own attributes we will change the Flat Angle attribute to display in radians First ensure the Flat Angle attribute is highlighted in the Attributes dialog Figure 33 and then click on the Edit button This will bring up the Edit Calculated Attribute dialog shown in Figure 34 Position the cursor after the text in the Expression edit box and add 0 01745 Now the Flat Angle attribute is going to return radians We need to make the display match this fact so change the text in the Units box to rad and change the Decimal Places setting from 1 to 3 At this point the expression editor should look like Figure 35 Medmont E300 Corneal Topographer 49 Analysing and Viewing Exam Results a f Edit Calculated Attribute Flat_Angle es Name Flat_Angle Display Name Flat Angle Units Decimal Places 0 Scientific Format FlatAngle OIG eeens kn en Data Functions peere ApicalCurvature sAngle AverageCornealHeight sAngle sHalfChord AxialCurvature sAngle sHalfChord BestFitSphereRadius CenteringScore Cancel Figure 34 Edit Calculated Attribute dialog When you are satisfied with this click on the OK button to copy the new expression to the
30. Saving and Abandoning Changes Changes and additions you make while working with an exam are not automatically saved You will notice that as soon as you add an annotation two buttons will appear on the Annotate gt Changes ribbon bar group the Save and Undo buttons Use these buttons to control the saving or not of any current work If you do not use either the system will display a warning dialog when you attempt to move away from the edited image Removing Artefacts It is now possible to remove known artefacts from E300 maps If tear film or other artefacts are present on the eye being examined they can be removed using this tool Select an E300 exam from the tree view and click on the Analysis gt Data Points gt Edit button If raw analysis data is not already present the exam will be re analysed This will enable the eraser tool CL Fifer Michele Left 5 Dec 1998 11 36 25 AM Tangential Power D md ini ns LL OL Ne i ee A OL A EL CO TS CO OL nee O ES CT F v Standard Power Figure 37 Eraser Tool With the eraser click and drag over any points you wish to remove from the map When clicked the white dots active test points will be replaced with black dots inactive test points 54 Medmont E300 Corneal Topographer Analysing and Viewing Exam Results Figure 38 Deleted Points If you wish to restore a deleted point hold down the Ctrl key and click again on that point
31. age 33 The applicability and usage of these terms is particularly well covered in the article Corneal Asphericity The e s p s and Q s of Corneal Shape by Swarbrick H in Refractive Eyecare for Opthalmogologists December 2004 Here we define the parameters of a prolate ellipse as Visual axis _ Tab gt This are the standard mathematical eccentricity values of the ellipse defined by the shape factors The E300 computes this from min b e oe max b Note that this e term for eccentricity cannot distinguish between oblate and prolate eyes e Eccentricity 2 e Values Formerly what Medmont called Shape Factor this displays the elliptical shape index for the Steep in red and Flat in blue axes of the eye and is computed from Medmont E300 Corneal Topographer Analysing and Viewing Exam Results p Values This is another shape factor and attempts to overcome the limitation of the e value and is computed as b ae Using this shape index a circle can be described by p 1 a prolate ellipse has a p value less than 1 and an oblate ellipse has a p value greater than 1 Q Asphericity This shape factor can be used to indicate how far a particular curve departs from sphericity The value for a sphere or in two dimensions a circle is given the value zero with prolate shapes having negative values and oblate shapes positive values O p 1 An advantage of Q factor is its being cent
32. al Conventions 1 Manual Conventions In discussing the normal interaction between the software and those involved in a particular operation exam or exam review this manual uses the term Clinician to refer to the person operating the equipment and Patient to refer to the person undergoing the exam A small glossary is included for terminology that either originated with Medmont or is common usage in corneal topography It also includes some common terms where they apply to Medmont equipment It is not a definitive glossary of corneal topography Medmont E300 Corneal Topographer 1 Intended Purpose 2 Intended Purpose The Medmont E300 Corneal Topographer is a computerised Video keratometer using Placido rings to map the surface of the human cornea The map is captured in three dimensions and can be displayed subsequently using a number of representations The cornea map can be represented in two dimensional surface coordinates Cartesian or Polar with the third dimension expressed in curvature mm optical power Diopters elevation mm or corneal height mm The map is presented as a 2D color map or a 3D perspective It can be displayed according to different definitions of curvature or elevation The options are axial curvature and power tangential curvature and power refractive power elevation corneal height shape factor and best fit radius The clinical applications include providing measured corneal data for co
33. attributes database Click on the Close button in the Attributes dialog and then force an attribute re computation by clicking the Recalculate button You should see the Flat Angle attribute now display in radians e Edit Calculated Attribute Flat_Angle Es Name Flat_Angle Display Name Flat Angle Units rad Decimal Places 3 Scientific Format FlatAngle 0 01745 AJ Lees JLsin Lcos Ltan Lexp ltes Lsant Lal letan Figure 35 Revised calculation to display Flat Angle in radians This is probably not the way you would want Flat Angle to display so repeat the above procedure and reverse the changes Insert the degree symbol by holding down the Alt key and typing 167 on the numeric keypad Creating a Composite Exam The iG Create Composite Eye function allows you to combine multiple E300 exams for the same patient into a single composite exam This can be 50 Medmont E300 Corneal Topographer Analysing and Viewing Exam Results useful for extending the coverage of the E300 by combining several off axis exams left right up down with a central exam to maximize the analysed coverage area It can also be used to improve the accuracy of the instrument and minimize transient tear film effects by providing an exam which is the average of several exams Select the exams that you wish to combine Ensure that the pupil was correctly detected in each exam If necessary redefine the pupil using the Annotate g
34. c to that design Editing the Lens Design Clicking on the Display gt Design gt Edit button 2 will display the contact Lens Designer dialog This is normally displayed automatically when you create a new contact lens The parameters that are displayed and can be changed in this dialog depend on the selected lens design An example for an ACL TriCurve is shown in Figure 43 Typically the controls allow you to change parameters such as the lens diameter base optic curve radius and peripheral curve parameters ACL Tri Curve Lens Designer Ex Lens Diameter J Toric v Auto Update Optic Zone ist Curve BOZD 7 80 Width 0 30 BOZR 7 52 Radius 8 72 lt Curve 2 Width 0 30 Radius 10 52 Default Cancel Figure 43 ACL TriCurve contact lens designer dialog 60 Medmont E300 Corneal Topographer Fitting Contact Lenses Enter values in the numeric text boxes by clicking the spin buttons or using the keyboard see Software Conventions on page 5 For some lens designs changing values may cause other values to be recalculated to match For instance when the base optic radius is changed the peripheral curve parameters are generally automatically updated For the lens design dialogs where this occurs the automatically generated values can be overridden by changing them manually and you can uncheck the Auto Update option if you do not want the peripheral curves to be updated when you change the base cu
35. d consequently this will impose a physical upper limit on the number of frames that may be captured King Sue Once the test has begun it can be restarted at any point uu j eae by clicking on Home gt Video gt Restart Restart dois R 15 Dec 2 will discard the captured images in the preview E Love Sarah window and capture a new set of images using the current capture control setting Navigate to Home gt Exam gt Save All button HA will save the video against the current patient A video sequence appears in the patient explorer window as shown above Alternate Methods of Patient Selection Exams cannot be saved unless a patient is selected If a patient or a patient exam is currently selected before starting the Capture window then a new exam is created for that patient Otherwise the exam is created without reference to a patient However a patient can be selected or deselected from the Capture window while capturing a patient exam The Home gt Exam gt Clear button clears the currently referenced patient for the exam If a patient 1s currently selected her name is displayed in the caption bar of the window Click on the Home gt Patient gt Select button amp to bring up the Find Patient dialog see Figure 11 Medmont E300 Corneal Topographer 21 Testing a Patient Find Patient Last Name First Name External ID Date of Birth Matching Patients Birth Date Sex External ID 4 y Citizen J
36. ded Medical Regulations require that the functional accuracy of equipment used for professional purposes be verified every two years This can be achieved by re calibrating the test object Medmont or their authorised agents can provide this service in return for a fee The E300 must then be re calibrated by the customer using the newly calibrated test object Medmont E300 Corneal Topographer 9 Important Facts 10 Radiation The E300 emits radiation in the visual range for illumination in the distinct wavelength 660nm red LED cone illumination 565nm green LED fixation target and 430nm blue LED profile illumination The levels of intensity of this illumination are less than 50 cd m below any levels known to be hazardous Electromagnetic Compatibility and Emissions This instrument conforms to the EMC Standard IEC 60601 1 2 The device emits no harmful or undesired electromagnetic emissions Interference Strong electromagnetic interference from other unprotected devices may affect the performance or results of the E300 If the use of such devices with high electromagnetic emissions cannot be avoided do not use the E300 and the device simultaneously 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 Electrical safety of medical electrical system All the equipment connected of the E300 topograp
37. device has been manufactured with all due care and subjected to stringent testing before leaving the factory The Topographer is guaranteed for 12 months from the date of purchase as evidenced by the invoice 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 Replaced parts become the property of Medmont The warranty does not cover defects due to incorrect handling installation and set up unauthorised modifications non compliance with the requirements for computer hardware and associated mains powered equipment as specified in the Users 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 outlet where the device was purchased The warranty and calibration is void if the QA seal between camera and optics housing is broken 6 Medmont E300 Corneal Topographer Important Facts 4 Important Facts The E300 Corneal Topographer is a highly accurate measuring instrument It measures and maps the surface of the human cornea and represents the results in various quantities and output forms that can be applied in various medical applications It combines these results with theoretical surface shapes to form the basis for precise contact lens fitting Medmont E300 Corneal Topographer 7 Important Facts Explanation of Symb
38. dmont E300 Corneal Topographer Notes on Shape factors e e p and Q How is the ellipse approximated Can you reconstruct height data from the shape factors Color Map Opacity Perspective Scaling Setting Elevation Map Options Setuns Upthe Color KROV SRE ne en alan ne eu Standard Color Keys Color Key Descriptions Custom Color Keys Difference Color Keys Zoomin and PARMESAN oi ns Using the Mouse to Pan and Zoom Using the Section DISDIAN Es e A Rates Displaying Analysis Details ccccccccccccccceeeeesesssesseseeeeeeeeeeeeeeeeeaaaas Erant eel Nol AS nn de Ont SFG OO TE Karis SR ewes eedaaae deck chance Nan E SOO AIH DUIS not en nn Red Arrange Attributes Custom Attributes Creaune a Composite Xan LE da Cr atin An idealized E yersin es tetes PCG AMO LAU ONS ace codec eats ra en en Re Text Annotations Callout Annotations Shape Annotations Annotation Attributes Editing and Deleting Annotations Saving and Abandoning Changes Remo INO Arei S sire be vcore ieee IR tacos icin das eae dated Printing the Exam CSUIS sss ananas Exporting the Analysis en E aA FITTING CONTACT LENS ES sssatsntes Creatine a new Contact ens ss nn Res Restricting the Available Designs cccccccccccssssssseeesseeeeeeeeeeeeeeeeaaaas Nelechiae the Mens DES in renier se ir an Edine the Lens D S te etant Movin beC ontact L in Contact Lens PArameters sn N Contact VIEW SLINGS iiss sie ciclo ne pes In ne ils Printine the Contact Len
39. e Too much movement in image Illumination defect Is bright light source present which contaminates profile signal If yes Remove light source or reposition instrument If no Check RH channel from front look in sideways into small rectangular opening Is blue light on If yes Has instrument been subjected to excessive shock vibration or impact If yes check calibration and recalibrate 1f necessary Identify problem re capture affected images 1f applicable and recalibrate Medmont E300 Corneal Topographer Specifications 14 Specifications Model Type Variant Product Method of measurement Coverage Field of View Illumination Power range Number of Rings Measurement Points Analysed Points Repeatability Calibration Object Footprint Eye level adjustable on unit Weight Power requirements PC and mains powered peripherals PC Printer Back Up E300 USB Life8 years software previous version of current operating system Placido Diameter 0 25 11 mm 11 5mmH x 1ImmV Red 660nm Green 565 nm Blue 430nm Luminance lt 50 cd m 10 100 Diopters 32 9 600 102 000 lt 0 1 Diopters R8 000mm 0 001mm Width 320mm Depth 400mm 352 382mm 5 5kg without table chinrest 100 240 V AC 10 VA PC not included 12 VDC 6W via E300 USB Converter Compliance with EN IEC60950 CISPR22 EN IEC55022 See Medmont Studio Manual Bubblejet Lase
40. e 120 IS index 280 Pupi Win 41 mm FistK 443D siepK 5200 SAI 405 Pupil Area 133 mm Fite os sepe 04s SRI 155 HVID Medmont Studio Version 5 0 0 14 16 Dec 2010 05 15 06 PM Figure 39 Standard exam printout in Print Preview Exporting the Analysis 56 The E300 software provides the facility to dump raw topography data for the selected exam to a set of text files This data can then be imported and manipulated by external software and tools First select the exam analysis to export Then click the Analysis gt Data gt Export button le Specify the root name and location of the files to create Typically the file name is based on the patient s name for example JohnSmyth The following files are created Filename axl axial curvature data in mm Filename tgl tangential curvature data in mm Filename hgt corneal height data in mm Filename dst radial distance data in mm Medmont E300 Corneal Topographer Analysing and Viewing Exam Results Filename slp corneal slope data Each line of the file contains the data for a single spoke centred at the keratometric axes with data points for each ring Missing data is indicated by zero values There are 300 spokes each with 32 rings Medmont E300 Corneal Topographer 57 Fitting Contact Lenses 8 Fitting Contact Lenses The E300 software provides a simulated fluorescein display for evaluating the fit of RGP contact lenses see Figu
41. e Video Figure 9 E300 Image Capture View Saving the Best Image Each image captured is awarded a score out of 100 based on centring focus and movement The score is displayed as a large white number above each captured image A good score for a normal eye will be over 75 Calibration balls can achieve scores of up to 100 Select the best image from those automatically captured Typically this will be the right most image Click on an individual image s Expand Collapse Medmont E300 Corneal Topographer 19 Testing a Patient button to expand the image to full screen You should consider the following factors when assessing images e Patient Fixation choose images where the pupil is centred with respect to the Placido rings e Eyelid Position choose images where the patient s eyelid does not obscure large portions of the cornea or cause large eyelash shadows e Central Ring Clarity choose images where the central Placido ring reflection is clearly visible For some patients with extreme conditions this may require shifting their fixation to get the central Placido ring area over an area with less surface irregularity Click on an image s Save button to save it You can also save the set of images by clicking on the Home gt Exam gt SaveAll HH button Alternatively you may decide to analyse the image before saving If this is the case then click on the Home gt Exam gt Save button kH A Patient Exam it
42. e to be covered if the PC is used within the patient environment 8 Medmont E300 Corneal Topographer Important Facts D Medmont Pty Ltd one E300 Device Label here shown for the USB CORNEAL TOPOGRAPHER x vor E300USB A variant positioned at bottom of base next to sn E3xxxx CE CT cable exit 12 VDC 6W via E300 USB Converter K 100 240 VAC 0 25 0 15A 50 60 Hz Regulatory Information This instrument complies with all applicable Regulatory requirements and Safety Standards Classification In accordance with IEC 60601 1 the E300 Corneal Topographer is classified Protection against electric shock Class I Protection against harmful ingress of Ordinary no water protection Mode of Operation Continuous Operation Clinical Results 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 For this reason Medmont cannot be held responsible for any misdiagnosis of results Accuracy and Calibration The E300 is delivered to the end user quality tested calibrated and as per specifications It is not the responsibility of Medmont to guarantee or police the accuracy of this instrument after delivery The E300 is delivered with a calibrated and certified test object with an accuracy based on the national standard The customer can verify the accuracy of the instrument with the calibration object provi
43. ective 3 dimensional A 3 dimensional exam view is displayed without the eye image An example for the same image used above is shown in Figure 18 30 Medmont E300 Corneal Topographer Analysing and Viewing Exam Results E Fifer Michele Right 5 Dec 1998 11 33 22 AM Axial Power meamo O ng Figure 18 A Perspective or 3 dimensional exam view When the Perspective view is selected the Display gt Options gt Perspective Scaling spin control is enabled and provides for magnifying the vertical perspective scaling see Perspective Scaling on page 36 and Software Conventions on page 5 For the Map View and Compare View modes the Display gt Map Type ribbon bar group shown below provides a quick means of changing the map and display type Map Type For the Combination View mode Figure 15 a different map type can be selected for each of the four display areas The Display ribbon bar tab contains a number of controls that can help in interpreting and analysing the exam results Each of the four display areas has a slightly different set of controls relating to the particular map chosen see Setting the Exam View Mode on page 24 Activating one of the four sub views by clicking on it will allow that sub view to be customised using the options on the Display ribbon bar tab Medmont E300 Corneal Topographer 31 Analysing and Viewing Exam Results 32 RN To Axial Power ye Image Z Carte
44. em is added to the Explorer pane under the current patient You can save more than one exam if you wish To view the Exam Results select the Exam in the Data pane and the View Mode see Analysing and Viewing Exam Results on page 23 Capturing Video 20 The E300 can capture video at frame rates of up to 25 frames per second fps Click on the Home gt New Exam gt Corneal Topography button to display the E300 Capture View see Figure 7 The red illumination rings inside the E300 cone should turn on Navigate to Home gt Capture Mode gt Video Figure 10 Make your selection for the number of maximum frames and the frames per second from the two spin boxes If previous video images were captured the Start button will be greyed and you must press the Home gt Exam gt Clear button to prepare for the next capture sequence Ready the patient as before When focussing and centring are correct press the F9 key on the keyboard or click Start to start the capture sequence The E300 will continue capturing until it has either captured the set number of images or the F9 key or Home gt Video gt Stop button Mis pressed again Medmont E300 Corneal Topographer Testing a Patient Max Frames 100 Nora Start Frames Per Sec 25 Capture Mode Video Video Settings Figure 10 Video capture controls While the software does not set a hard upper limit on the number of frames to capture captured images are written to memory an
45. es Idealized Eye displayed under Patient nodes in the Tree and E300 panes This represents an idealized symmetrical toric ellipsoidal surface derived from one or more actual eye exams Contact Lens displayed under Patient Exam or Idealized Eye nodes in the Tree pane View Items The E300 component adds the following items above the patient tree in Medmont Studio note the items are only visible when an appropriate item is selected in the Explorer pane Details displays the details for the selected E300 Exam and allows you to edit them see Editing Exam Details on page 63 Map displays a color contour map or 3D perspective map of up to four selected E300 Exams see Setting the Exam View Mode on page 24 Combination displays four different views of the selected E300 Exam see Setting the Exam View Mode on page 24 Compare displays a contour map of the difference between two selected E300 see Setting the Exam View Mode on page 24 Home Tab Items The E300 component activates the following menu items for the Medmont Studio Home tab Corneal Topography displays the E300 Capture screen Contact Lens creates a new Contact Lens for the selected Patient see Fitting Contact Lenses on page 58 Medmont E300 Corneal Topographer 69 Menu and Icon Reference Configure Tab Items The E300 component activates the following items in the Medmont Studio Configure tab Instrument Set
46. facturers as required a Contact Lens Design Selection Contact Lens Manufacturers O Contact Lens Centre Australia New Ze O CooperVision O Essilor O Eyoon Lens Laboratories O GelFlex O Ledaperm Figure 41 Contact Lens design selection dialog Selecting the Lens Design The Contact Lens Design dialog see Figure 42 allows you to select the lens design to use When a new design is selected from the drop down selection box the recommended parameters for the design are automatically calculated based on the eye geometry The simulated fluorescein pattern is computed and displayed The dialog also allows you to specify the manifest refraction that the software uses to calculate the required contact lens power For a new lens this will be set by default to the current refraction values for the patient from the Patient Management system Medmont E300 Corneal Topographer 59 Fitting Contact Lenses The dialog is displayed when creating a new contact lens You can also use it to change the design or refraction for an existing contact lens by clicking on the Display gt Design gt Change amp button fi Contact Lens Design mem Design ee y Manufacturers Spectacle Refraction Sphere Cylinder Axis Vertex 0 00 000 Hi X 0 1112 came ok _ Figure 42 Contact Lens Design dialog Several of the lens designs will display a lens designer dialog box to allow manipulation of design settings specifi
47. gt Add Attribute gt Pupil button You can define the iris by clicking on the Annotate gt Add Attribute gt Iris button The Pupil is a curved area annotation the Iris is a circle annotation When you create Iris and or Pupil annotations the system automatically adds a number of attributes including default text You can edit these as shown below Editing and Deleting Annotations You can move and edit any shape or text For shapes point and click anywhere on the shape outline and it will change color and show small white circles at all vertexes Left click anywhere on the outline except on a vertex and you can move the entire shape Alternatively you can click and drag the central cross For Area annotations click on a vertex and you can move that vertex independently of the others For Circles Squares etc this will re scale the annotation The lines joining the vertex will automatically follow To edit a Text annotation double click on the annotation or click on Annotate gt Selection gt Edit and the editor will be displayed allowing you to change the text or attributes You can move text by clicking and dragging using the mouse To delete an annotation select the annotation by clicking once on it and then clicking on the Annotate gt Selection gt Delete button You can also right click the mouse button and select Delete Annotation Medmont E300 Corneal Topographer 53 Analysing and Viewing Exam Results
48. he Display ribbon bar tab In each case the images are of the same exam no Axial Curvature Map Displays the curvature of the surface in mm with respect to the keratoscope axis Axial Power Map Displays the paraxial power of the surface in Diopters with respect to the keratoscope axis Tangential Power Map Displays the local paraxial power of the surface in Diopters Elevation Map Displays the distance from a specified best fit sphere to the surface in microns Positive values indicate the surface is above the best fit sphere Medmont E300 Corneal Topographer e Analysing and Viewing Exam Results 28 Height Map Displays the distance along the axis from the apex of the eye to the surface in microns Height Map Zernike Fit A decomposition of the height data in terms of the Zernike components These can be added or removed from the display by selecting the Data Setting button underneath the Map drop down list Medmont E300 Corneal Topographer meamon m Analysing and Viewing Exam Results Height Map Zernike Residual A decomposition of the height data in terms of the Zernike components These can be added or removed from the display by selecting the Display gt Map Type gt Data Setting button underneath the Map drop down list Selecting Show Residual will display the Zernike Residual This measures the error in fitting the height using Zernike functions Residual
49. her shall be certified to EN IEC60950 It must be powered by an isolation transformer compliant to the medical standard EN IEC 60601 1 UL2601 or CSA22 2 601 1 see Optional System Accessories available from Medmont on page 4 Disposal The expected service life of E300 equipment is 8 years For disposal at the end of the product life cycle please follow national regulations Medmont E300 Corneal Topographer 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 If a third party installer is commissioned by the customer only a qualified PC technician should perform the hardware and software installation The basic tasks associated with installing the E300 are e Setting up the Instrument in a suitable environment e Installing the Medmont Studio Software PC and Associated Equipment Requirements When acquiring a PC for the Medmont E300 please observe the minimum requirements as given in the Medmont Studio User manual Use only a PC and associated equipment that has been certified to the Standard EN IEC60950 Information CAUTION Technology Equipment and the Standards for Electromagnetic Emissions CISPR22 EN55022 If used within a patient environment power the PC and associated equipment with an EN IEC60601 1 compliant isolation transformer e g TR2450 230 240V Cover a
50. ht Instrument 30120 Calibration 23 Nov 1998 2 08 37 PM KI Analysis Type Normal Categories 4 Practice Sample Practice id id Clinician Sample User Comments Figure 14 Patient details view Map View Click on the Gl button at the top of the patient tree This displays up to four different selected Patient Exams with the same Map Type see Map Type on page 27 and Color Key see Setting Up the Color Key on page 37 Select multiple exams by first holding down the Control key then click and drag the mouse over the subject exams Use the View mode to display full screen color map images of a single exam or to display images of multiple exams 24 Medmont E300 Corneal Topographer Analysing and Viewing Exam Results Combination View Click on the Ba button at the top of the patient tree This view displays four separate views of the selected Patient Exam see Figure 15 The Map Type and settings for each image can be controlled independently Use this view for an overview of the corneal data L Wong John Left 4 Dec 1998 1 15 34 PM Axial Power Figure 15 Combination View Compare View Click on the 89 button from the top of the patient tree This view displays two selected Patient Exams and the difference between them Use this view to observe changes over time and healing patterns Medmont E300 Corneal Topographer 25 Analysing and Viewing Exam Results
51. id 11 Software Installation ssh nn nina eininreiennee 12 Running the Software 13 Connecting the E300 instruments Ahead 13 Connecting the USB Video Converter box 13 Checking the E300 instrument is connected 13 Resistere Hee 300 ses Re oe oa Mathai 14 Disconnecting the E300 instrument ccc cccsesssesseesesseeeeeeeceeeeeeeeenaas 15 Disconnecting the USB Video Converter box 15 Disconnecting from the Mains Power outlet 15 Medmont E300 Corneal Topographer 11 TES TENG A PATIENTS nas annee Patent Selon chair Ah dre ch h Positioning the Patents crc vic cccacsitecisaasitiieeshdsassniaipcaeaawaciseeiaiecastcsaens Capture Patient EXAMS ra noise Savile The IS CS Tid Ce gas seis slay en tee a Capture Vid o sus in Ai ins Nina Alternate Methods of Patient Selection ANALYSING AND VIEWING EXAM RESULTS ssesssssmeeseeee Selectine the PXAamMReSUITS sn See nn Sette the xa View MOSS na Ne ee Details View Map View Combination View Compare View Changing the View SOINS SELS Ne nr es nn Map Types Axial Curvature Map Axial Power Map Tangential Power Map Elevation Map Height Map Height Map Zernike Fit Height Map Zernike Residual Ray Error Map Refractive Power Map Tangential Curvature Map Wavefront Error Map Wavefront Error Map Zernike Fit Image Color Map Cartesian Grid Polar Grid Keratometrics Cross Section Attributes Annotations Readout Text Data Blocks Sim K e Eccentricity e Values p Values Q Asphericity Me
52. inrest and put her forehead firmly against the forehead rest She should then push her chin forward on the chinrest If the patient has deep set eyes instruct her to move her head back from the headrest This rotates the eye away from the eyebrow and eyelashes and produces better coverage and fewer interruptions of rings on the upper cornea Adjust the eye height to the level marks on the chinrest Ask the patient to look into the centre of the green fixation target and keep her gaze on this target The target centre point together with the centre of the ring pattern on the eye defines the Video Keratoscope axis VK axis the reference axis to which the axial radius power is calculated the values for tangential radius power are less affected by the fixation If the patient is fixating on the target the VK axis is aligned with the line of sight When an image is taken with the patient not fixated on the target the axial power is not referenced to the line of sight but to an arbitrary axis which may not be reproducible in future exams and may not represent the visual refractive properties of the patient s eye In most cases examining the position of the centre of the pupil easily identifies this For images with good fixation the pupil centre is aligned with the centre of the VK axis centre of the Polar and Cartesian grids If unsure re capture the image and view the difference between the two images Axial power maps are identical for fixated
53. label and line pointing to the selected anchor location A dialog similar to Figure 36 1s displayed to allow you to enter the text for the annotation Shape Annotations The Annotate gt Add Annotations ribbon bar group includes a number of shapes you can use to delineate areas in the image These are Circle Ellipse Rectangle and Square with an additional three tools for drawing polygonal Areas The shapes are shown in the Medmont Studio user manual You can Medmont E300 Corneal Topographer Analysing and Viewing Exam Results also draw a ruler that resembles a Callout annotation where the callout is automatically the current length of the ruler in mm The Area drawing tools all work in a similar way to each other The Annotate gt Add Annotations gt Polygon tool draws a straight line between each point you define by pressing the left mouse button Press the right mouse button to automatically close the polygon boundaries The Annotate gt Add Annotations gt Curved tool does the same only it passes a smoothing curve through the defined points The Annotate gt Add Annotations Freehand tool is just that click and hold the left mouse button and draw the shape you want Annotation Attributes The system will automatically attempt to define the pupil and this is visible as a black polygon if the Display gt Hide Show gt Annotations checkbox is ticked see Figure 17 You can re define the pupil by clicking on the Annotate
54. lipse annotations Rectangle create rectangle annotations Square create square annotations Polygon create polygon area annotations Curved create curved area annotations Freehand create freehand area annotations Edit edit the selected annotation Delete delete the selected annotation Save save the selected annotations Undo undo the most recent annotation Pupil allows you re compute the pupil Iris allows you to define the iris Medmont E300 Corneal Topographer 73 Glossary of Terms 12 Glossary of Terms 74 Analysis The process by which the Placido rings or segments thereof are identified on the image and from their distortions as much of the corneal surface as possible is reconstructed Calibrate The process in which an optimal calibration is obtained such that the overall error in reconstructing the surfaces for the calibration images is minimized Calibration A set of parameters used during the analysis of an image to compensate for small variations in the manufacture of the instrument Calibration object A small reflective ball of known radius Calibration images A set of currently 5 images of a Calibration object Categories A set of clinician provided descriptions that may be used to describe a particular eye Examples would be pre op post op corneal graft Color key An on screen column of colors with their corresponding value listed
55. lly once the software is unable to reduce the error any further over a number of consecutive calibration cycles If you select Full Recalibration then the calibration will complete the maximum number of Medmont E300 Corneal Topographer 67 Calibrating the E300 68 calibration cycles Full Recalibration is generally only required for new instruments done at the factory or for instruments where the capture device or other physical hardware has been changed E300 Calibration Wizard 31838 Error 0 109 Status Running Cycle 1 of Max 2000 Figure 50 Recalibrating the Instrument Calibration of the E300 involves analysing and adjusting over 80 software parameters to match the exact physical dimensions of the instrument Consequently depending on the speed of the PC Full Recalibration may take several hours A Quick Recalibration usually can be completed in under an hour and generally takes between 10 and 15 minutes The calibration process can be stopped at any stage and resumed later At the completion of calibration the verification screen is displayed again and the software recommends whether further calibration is required based on the calibration error Medmont E300 Corneal Topographer Menu and Icon Reference 11 Menu and Icon Reference The E300 software component adds the following types of icons to the Medmont Studio Explorer pane j E300 Exam displayed under Patient nodes in the Tree and E300 pan
56. mple showing the difference between an Absolute on the left and a Normalised Color Key Difference Color Keys There are three predefined difference color keys e Standard Power Difference Maps the axial tangential and refractive power differences in Diopters to color e Normalized Power Difference Maps the axial tangential and refractive differences in Diopters to a linear color scale using a maximum and minimum corresponding to the data being mapped e Standard Curvature Difference Maps the axial and tangential curvature differences in mm to color e Standard Height Difference Maps the elevation differences in microns to color The current Difference Color Key type is displayed at the bottom left of a Difference map display similar to a standard map view like Figure 22 The Custom Settings dialog is the same as shown in Figure 23 For difference views the result of normalising the color key will usually show a more dramatic change because the differences typically have a smaller range Figure 25 demonstrates on the left an Absolute color key with the expanded scale around zero and on the right a Normalized color key of the same image showing the color key re mapped from the standard 100 to 100 to cover just the image data range Note that the scale will always be symmetrical about zero even if the data is not Medmont E300 Corneal Topographer 41 Analysing and Viewing Exam Results ee G
57. n a tabbed window below the color map A white Section indicator line is displayed over the color map to indicate the source of the cross section The Section line has three handles which allow you to rotate and translate the line see Using the Section Display on page 43 Medmont E300 Corneal Topographer Reset Defaults Analysing and Viewing Exam Results Attributes Displays the attributes associated with this exam in a tabbed window below the color map Annotations Displays any annotations stored with the exam Readout Displays a readout marker a white cross over the color map The location of the readout marker relative to the keratoscope axis and the data values at that location are displayed in the bottom right hand corner of the image The values presented are in terms of the currently selected Map Type see Map Type on page 27 Clicking and dragging with the left mouse button moves the readout marker and updates the readout in real time Numeric Data Toggles on or off the display of numeric data at specific points on each 30 degree spoke The data displayed at each point will depend on the chosen map type Text Data Blocks On the left hand side of each image there is a Top and Bottom block of text data Two drop down controls allow content selection for these blocks If Section is enabled then clicking on the steep or flat text see Keratometrics above moves the Section tool see Using the Section
58. ntact lens fitting refractive surgery orthokeratology and general assessment of the corneal surface The E300 shall only be used as described in this manual and only for the intended purpose Figure 1 The E300 Instrument Power Connection A typical power connection between the various units is shown in Figure 2 2 Medmont E300 Corneal Topographer Intended Purpose Mains USB Video Power Converter box Mai ns Isolation Power Transformer Monitor Figure 2 Typical Power Connection For the diagnosis treatment or monitoring of a patient under medical supervision there are three area definitions Patient Environment Medically used room and Non medically used CAUTION room Each area demands different electrical safety requirements for your system Please make sure that your system is set up correctly in the right environment When used in a Patient Environment the PC and its Monitor if separate refer to Figure 2 must be powered via a protective isolation transformer compliant to the governing medical standard IEC60601 1 or UL2601 CSA22 2 601 1 for North America only A hospital grade power cord must be used to achieve reliable grounding Tthe Isolation Transformer must be certified either cULus or cCSAus for North America or UL for US market or CSA for Canadian market or meet National Electrical Regulations CAUTION Standard E300 Accessories e USB Video Converter box e Calibration Object R 8 00
59. nverter box to the mains power using the supplied mains power cable Do not switch the unit on Connect the USB Video Converter box to the PC using the supplied USB cable Connect the E300 Corneal Topographer 8 pin DIN plug to the USB Video converter box Turn on the USB Video Converter box Checking the E300 instrument is connected l 2 Open Device Manager Under Microsoft Windows 7 this can be done by selecting the Windows Logo in the bottom left corner of the main desktop window Next right click while hovering above Computer and select Manage from the popup menu When the screen titled Computer Management appears select Device Manager from the System Tools menu in the explorer pane left docked Expand imaging devices Medmont E300 Corneal Topographer 13 Installation 3 Ensure that the item MEDMONT E300 USB appear in the list of imaging devices as per the screen in Figure 1 r bojke a Device Manager File Action View Help i T amp 4 4 MELDSK2013 uy Acronis Devices B Bluetooth Radios 4 Computer gt jy Disk drives gt MM Display adapters 5 DVD CD ROM drives oe Human Interface Devices gt IEEE 1394 Bus host controllers 2 Imaging devices gt 2 Leutron Vision PicPort o 2 MEDMONT E300 USB gt KY Jungo gt ED Keyboards F Mice and other pointing devices s M Monitors gt Network adapters gt J Processors gt i Sound video and game controllers lt Sto
60. ny open PC communication ports that have accessible conductors with dummy plugs if used in a patient environment Instrument Environment The E300 is highly precise measuring equipment and must be located in a suitable and clean environment The environmental requirements for the E300 are Room temperature 10 C to 40 C Relative humidity 10 to 80 Medmont E300 Corneal Topographer 11 Installation Keep the instrument away from direct sunlight and avoid unnecessary exposure to heat and light Avoid overly bright rooms to keep stray light level low Set up the instrument that any unavoidable bright light sources are opposite the cone opening Set up the instrument that all interface and power cables are easy to access Do not set up the instrument in proximity to devices with high electromagnetic emissions Temperatures too low may cause condensation on the optics while temperatures too high may result in de calibration of the instrument After such an event a calibration check is recommended Strong surrounding electromagnetic fields may affect performance and results of the E300 CAUTION It is recommended that the E300 be set up on the Medmont Automatic Table TE300 for optimum positioning flexibility and stability Customers using their own table should ensure the linear guides are assembled parallel and positioned as per Figure 3 and that the table is adequately secured DRILL l 5xi0 DEEP 4 PLCS fa ZELF TAPPER
61. o a pointed rectangular shape and wet slightly with optics cleaner The narrow end of the cone can easily be reached with the cotton applicators For the entrance area cloth or cotton gives a good result Calibration Object The calibration object has a delicate optical surface After use clean with isopropanol and a lint free cloth to prevent acid corrosion from fingerprints Use the same technique to remove any contamination prior to using the object again Lubrication All parts except the exposed horizontal shaft are permanently lubricated and do not require any additional lubricant The horizontal shaft should be cleaned from dust and old oil residues and oiled every few months This also protects the shaft from corrosion The oil used should be acid free fine instrument oil e g sewing machine oil Apply only a fine film with a lint free cloth Service 78 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 Medmont E300 Corneal Topographer Cleaning Maintenance and Service Troubleshooting The following guide is an aid for the user to help identify describe and remove certain errors No video image No video image No video image No video image No cone illumination 12V indicator light is OFF USB power indicator
62. o their default settings Map Type a drop down list box that allows you to select the type of image data to display Medmont E300 Corneal Topographer 71 Menu and Icon Reference 12 Data Settings Map options when the Elevation Height Zernike Fit and Wavefront Error Zernike Fit has been selected from the Map Type drop down list Colour Map Opacity Set the level of transparency for the Colour Map Perspective Scaling A spin control allows you to display 3D Perspective views with enhanced distortion Sim K units Allows the user to select the units of measurement for the resulting data in both the top and bottom data blocks when Zoned K or Sim K_ have been selected Options are mm millimetres D Diopters or Auto K which will automatically select the best unit of measurement based on the chosen map type Image Toggles on or off the raw video image leaving just the colour map Colour Map Toggles on or off the colour map leaving just the raw video image Numeric Data Toggles on or off the display of numeric data at specific points on each 30 degree spoke The data displayed at each point will depend on the chosen map type Cartesian Grid Toggles on or off a one millimetre rectangular grid centred on the keratoscope axes overlaying on the colour map Polar Grid Toggles on or off reference ring centred on the keratoscope axis overlaying the colour map Keratometrics
63. ohn 26 Aug 1961 Michele 6 Nov 1959 Fredericks Fred 13 Apr 1920 Joly Nick 26 Mar 1960 Jones Chris 18 Nov 1971 King Sue 19 Mar 1961 laua Carak AT Can ANTS Male Female Male Male Male Female 4 gt Figure 11 Patient Selection Dialog Select a patient from this list and click OK You can now save an exam against this patient 22 Medmont E300 Corneal Topographer Analysing and Viewing Exam Results 7 Analysing and Viewing Exam Results The E300 software provides a variety of ways in which to view exam results The Exam View mode controls how selected exams are displayed see Setting the Exam View Mode on page 24 For each of these modes you can set the type of data to display see Changing the View Settings on page 26 and the color mapping see Setting Elevation Map Options on page 36 Selecting the Exam Results The first step in viewing Exam Results is selecting the exam s to view To select the exam for a particular patient click on the exam symbol L or the date of the exam in the Medmont Studio Explorer pane To select multiple exams hold down the control key while clicking on the symbols Medmont Studio Standalone admin o x Home Configure Analysis Display Annotate Fifer Michele E Jolly Nick HIRR 6 Sep 1990 11 22 00 AM HBR 21 Apr 1992 7 14 00 AM HIR 14 Sep 1992 9 04 00 AM ER L 3 May 1993 7 58 00 AM HRR 23 Aug 1993 11 59 00
64. ols and Labels gt CAUTION gt NOTE 32 28 THIS EN TEC 60950 CERTIFIED EQUIPMENT IS USED WITHIN PATIENT ENVIRONMENT USE TOGETHER WITH AN ISOLATION TRANSFORMER OR ADDITIONAL TE EARTH TERMINAL TO PROTECTIV CAUTION SYSTEM GROUND lt PATIENT ENVIRONMENT ATTACH TO AFFECTED APPLIANCE Nm 7 IPX1 eR __ POWER COVER OPEN PC COM gt PORT IN PATIENT camo ENVIRONMENT Caution In event of user error or equipment fault condition there may be a serious risk to health or life of patients or operator or product damage or loss may occur Precaution Attention consult accompanying documents Alternating current Compliance with the EC Directive 93 42 EEC for medical devices here shown with Notified Body identification The date below this symbol shows the year and month of manufacturing The patient environment comprises a 1 5m radius around the area in which patient or some other person can touch parts of the medical system intentionally or unintentionally This label is to be attached in a visible position on any EN IEC 60950 compliant equipment used within the electro medical system of the E300 Protection against ingress of water Power Indicator on rear side of unit The E300 is powered if indicator is illuminated green unpowered if un illuminated This label is found on the PC port insulation plugs These plugs are for RS232 and Network ports and these ports ar
65. ons can be added to E300 exams using the options in the Annotate ribbon bar tab The Display gt Show Hide gt Annotations check box must be checked to enable annotations Annotations are stored with the exam and may be printed exported and imported Medmont E300 Corneal Topographer 51 Analysing and Viewing Exam Results 52 Annotations can also 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 Text Annotations Clicking on Annotate gt Add Annotation gt Text changes the cursor to allow you to place a text annotation on the image Click at the location to place the anchor for the annotation the left hand end of the text The Text Annotation dialog see Figure 36 is then displayed allowing you to enter the text to be displayed You can use the various controls to change the Font Background color no background color Transparent Text Color and Test alignment and Vertical position f TP Edit Annotation re Font Arial Bold 12 Point Background u Transparent Text Color Lv Text Alignment Left Z Vertical Position Top Zz Save as default Caneel Figure 36 Text Annotation Dialog Callout Annotations Clicking on Annotate gt Add Annotation gt Callout changes the cursor to allow you to place a text callout annotation on the image This consists of a text
66. r Color Monochrome CDROM or DVD burner Medmont E300 Corneal Topographer 81 Specifications Operating conditions 10 to 40 C max 80 relative humidity Isolation Transformer Compliance with EN IEC 60601 1 National electrical safety regulations Transport Storage Conditions 15 to 40 C 10 to 95 relative humidity 500 to 1060 hPa 82 Medmont E300 Corneal Topographer Representatives 15 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 is Medmont E300 Corneal Topographer 83
67. rage controllers JE System devices gt Universal Serial Bus controllers Figure 4 Device Manager showing a successful connection to the Medmont E300 Corneal Topographer If the E300 Corneal Topographer does not appear as per these instructions refer to the troubleshooting section in this manual for suggested solutions Registering the E300 You must register your E300 with the software before continuing Double click on the Medmont Studio desktop icon or Select Medmont Studio from the Windows Start gt Programs gt Medmont gt Medmont Studio 5 menu A banner with the Medmont Studio logo is displayed while the software loads To begin the registration process click on the Configure gt E300 gt Instrument Setup button Lx Click New to register the instrument You will be prompted to enter the serial number of your E300 instrument Enter the serial number the format should be E30X XX and press OK Next click the Import Calibration button to import the instruments calibration file You will be presented with a standard Windows file selection 14 Medmont E300 Corneal Topographer Installation menu Insert the CD ROM which contains the calibration file into your PC Once the CD has loaded browse to your CD ROM drive ensure the file with the ECF extension is highlighted and click Open From the Instrument setup window you can select edit to add a comment to the instrument and select delete to delete
68. re 40 Note the T and N letters denote the Temporal and Nasal orientation of the lens The fluorescein display is a simulation and should only be used as a guide to the expected fit Simulated fitting of lenses larger than the captured data area is based on extrapolated data and may therefore be less accurate A trial lens fitting should always be performed to confirm the simulation results NOTE v Standard Fluorescein j j i j RX Sphere 0 00 D BOZD 7 80 mm Radius 2 10 52 mm RX Cylinder 0 00 BOZR 7 52 mm RX Axis 0 Diameter 1 8 40 mm RX Vertex 12 Width 1 0 30 mm Calculated Lens Power 0 59 D Radius 1 8 72 mm Residual Astigmatism 7 72 D Diameter 2 9 00 mm Diameter 9 00 mm Width 2 0 30 mm HEL Modify _ Fe etre 58 Medmont E300 Corneal Topographer Fitting Contact Lenses Creating a new Contact Lens Before proceeding with contact lens fitting you should have captured exams for both eyes of the patient see Capturing Patient Exams on page 17 Select the Patient Exam on the Explorer pane and click on the Home gt New Exam gt Contact Lens button J This displays the Contact Lens Design dialog shown in Figure 42 Restricting the Available Designs If required you can restrict the set of available lens designs to better suit your practice Click on Manufacturers within Contact Lens Design dialog to display the lens design selection dialog shown in Figure 41 Check or uncheck the manu
69. red on zero for a circle Notes on Shape factors e e p and Q The shape factors are useful in partially quantifying aspects of the shape of the eye They are all derived from an ellipse that approximates a specific cross section of the eye typically the steep or flat axis How ts the ellipse approximated Medmont computes the unique ellipse that gives the same axial curvature at a specified chord and apical curvature as the actual eye In practice this method gives repeatable and reliable shape factor readings An alternative method uses height instead of axial curvature but it is more sensitive to noise hence less repeatable and less reliable Can you reconstruct height data from the shape factors While the original ellipse can be reconstructed mathematically from these parameters the height information thus obtained describes a crude approximation rather than the actual eye A better alternative is to use the height data obtained from the Height view directly Medmont E300 Corneal Topographer 35 Analysing and Viewing Exam Results Color Map Opacity Located at Display gt Options gt Color Map Opacity This spin control allows you to set the level of transparency of the color map when it is displayed over the raw video image A value of 0 0 makes the video image transparent A value of 1 0 makes the video image opaque Perspective Scaling Located at Display gt Options gt Perspective Scaling This spin con
70. rsal Standard Scale Normalized Power Custom Figure 22 Selecting the current Color Key Custom Color Keys You can customise the color key to highlight a particular aspect of an exam Drop down the Color Key selection box see Figure 22 and click on the Custom entry This will present the Custom Settings dialog shown in Figure 23 The Base Color Scale text box shows the base scale of the currently selected key and the three spin boxes show that key s parameters see Manual Conventions on page 1 Custom Settings ese Base Colour Scale RIME CARAT e EE m Absolute Normalized Min Value 30 00 Max Value 67 50 Step Size 1 50 Seveas Cancel Amy J ok Figure 23 Color Key Custom Settings dialog The radio buttons provide for switching between Absolute and Normalized versions of the current Color Key The Absolute setting displays the data in the current image mapped into a fixed range of colors that defines the selected Color Key The Normalized setting linearly re scales the current Color Key so that its upper and lower bounds correspond to the limits of the data in the image An example is shown in Figure 24 for the Universal Standard Scale key Medmont E300 Corneal Topographer Analysing and Viewing Exam Results Weare John Saght 4 Der 1996 1 14 58 PM Antal Poner Ly Wong Sahn Right 4 Dec 1999 1 14 58 P Axial Power Med mont 7 Ji Figure 24 An exa
71. rve or diameter of the lens Click on the Apply button to display the simulated fluorescein pattern for the new parameters The Defaults button restores the default settings for contact lens designs based on the eye geometry Moving the Contact Lens The contact lens can be moved over the eye to determine how the fit varies as the lens moves Select the contact lens by clicking on the outside border or central dot You may need to move the section indicator first When selected the lens border and central dot are displayed in red Hold the mouse button down while dragging the lens to move it When you release the mouse button the lens is left at the current location and a new simulated fluorescein pattern is generated Contact Lens Parameters The software calculates the required lens power Calculated Lens Power by adjusting the manifest refraction to take into consideration the vertex distance for the refraction and any resultant tear film power The predicted residual astigmatism Residual Astigmatism is calculated by comparing the corneal and manifest refraction astigmatism These values and other design parameters are displayed in the Lens Parameters panel The visibility of the Lens Parameters panel is controlled by the Display gt Show Hide gt Lens Parameters checkbox Contact View Settings A number of parameters specific to the lens design are available on the Display gt Show Hide ribbon bar group as shown in Figure 44
72. s dynamically as the handles are dragged The vertical axis of the Section graph covers the same range as the current color key Note that the image may contain data that is outside the currently selected color key resulting in parts of the section graphic being clipped at the window edge s If you need to see the entire graphic use the Normalize button in the color key Custom Settings dialog see Custom Color Keys on page 40 Medmont E300 Corneal Topographer 43 Analysing and Viewing Exam Results If Keratometric values are displayed in a data block then click on the steep and flat values to move the section indicator and Section tool to the corresponding steep flat meridian Displaying Analysis Details 44 The Analysis Details dialog provides numerical readouts of various analysis parameters at a specified meridian and chord for the currently selected exam s Note that you can select more than one exam to analyse Click on the Analysis gt Show gt Details button to display the Analysis Details dialog see Figure 27 This displays the corneal height shape factor and apical curvature at the selected chord and meridian The Steep and Flat buttons set the meridian to the steep and flat axis respectively Analysis Details ARE 72 0 Meridian degrees Flat Steep 5 0 180 360 9 35 Chord mm 5 0 6 12 Exam Apical Curvat Weighted Ave e Values e Eccentricity Axial Curva gt
73. s Designs a inis Medmont E300 Corneal Topographer ill 10 11 12 13 14 15 1V MANAGING EXAMS AND CALIBRA TIONS sssssssssssssccccccccsesees Cine EX at DEAS deei e r a S Moving an Exam to a Different Patient Changing the Calibration Used for an Exam Categories Deleting Exams Prescriptions and Calibrations CALIBRATING THE E300 visscscscsscesiscisccacsasacenccdsancacsctacarssccascadsasaserccscawcaciess Choosing the Video SOULCE eiren a e aE Capture Calibration Iman ES sn ei nn Checking the Current Calibration sanaan Recaliorating the Iistruinie mts 23 en ns nus MENU AND ICON REFERENCE ccccssssssssssccccccsssscccecesscssesssssccees NIC WW TMS es de ne nid dd enr alse atinatsec Home DAS ASS eee ci mes COMM UTE ADE SR Rd en Analysis TaD ems aena ease eaaeeannene Display Pai Ie ris iss A nd ones Cit Fab MOIS E at nan GLOSSARY OF TERMS ss no tien it e eais CLEANING MAINTENANCE AND SERVICE see see oo 022200000000 000 0 Routine Hysien and Cl ment nn Cleaning of contaminated Optics cccccccccccccccceeeeeceesseeeesseseeeeeeeeeees Calbradon OD Ces RNA rene tn ane UTC AMO Mic as ccdeaiie av eenerdecteu a DE CS sent ets cae aes cme eos cmc ees emesis eee eee PEPOUDICSINOO GING ESS RTS ee Ne ne TS SPECIFICATIONS sn ER nn NN a lent tiens REPRESENTA MV ES nine nssitiiensnatetiienitnerate te ice Medmont E300 Corneal Topographer Manu
74. s reconstructed it is a line passing through the centre of the image roughly orthogonal to the surface Refraction Summary of the patient s current spectacle prescription Consists of sphere cylinder axis and vertex Score An automatic percentage rating of the quality of an image Three basic scores are computed for each image measuring the amount of movement how well centered the eye 1s and the distance from the eye to the ideal capture plane A total score which is the product of the three basic scores is also computed Sim Ks Simulated keratometer values measured along the steep axis and the flat axis see keratometric power Steep Axis The axis along which keratometric power is maximized Surface Asymmetry Index SAI The SAI is the centrally weighted average of the difference in power between corresponding points at the same chord 180 degrees apart on the eyes surface The weighting value used 1s Weight R r Where R radial distance from the keratometer axis Surface Regularity Index SRI This is a calculation of amount of local variation in the power of the eye within the average virtual pupil The predicted power at a point is calculated as the average of the values of its rectilinear neighbours The difference between the predicted power and the actual power is averaged over the central 4mm chord area The SRI is then given by SRI log ZERO _ POINT SCALING _FACTOR x avg abs Pr edictedP Ac
75. sian Grid 4 Readout Attributes ie O Planar WY Perspective 0 r 4 Colour Map Polar Grid Z Annotations Bottom Auto Sim K Units Numeric Data M Keratometrics Cross Section None Map Type Options Show Hide Data Blocks Figure 19 Combination View Settings dialog The set of image control options on the Display gt Show Hide ribbon bar group Figure 19 Combination View Settings dialog are summarised below Image Displays the raw video image The color map is displayed transparently over the image You can set the level of transparency with the Display gt Options gt Color Map Opacity spin box see Color Map on page 36 and Manual Conventions on page 1 Color Map Displays the color mapped data Disabling the color map allows you to examine the raw video image If you disable one or the other of the Image or Color Map checkboxes clicking on the checked box will flip the display between these two settings Cartesian Grid Displays a one millimetre rectangular grid centred on the keratoscope axes overlaying on the color map Polar Grid Displays a polar reference ring centred on the keratoscope axis overlaying the color map Keratometrics Toggles on and off the display of the Keratometrics The steep axis is calculated as the spoke with the highest average axial power whilst the flat axis is always set at 90 degrees from the steep axis Cross Section Displays a cross section of the displayed data i
76. t Add Attribute gt Pupil button Click on the Analysis gt Create gt Composite Eye button The software aligns the axes of each of the selected exams with most central exam the exam with the pupil closest to the instrument axes and creates a composite exam by combining the aligned exam data Creating an Idealized Eye The Lo Create Ideal Eye function allows you to create an idealized symmetric toric ellipsoidal surface based on the average values of the currently selected exam s This can be useful when fitting some contact lens designs that are based on a symmetric ellipsoidal model of the eye It creates a new exam which also allows you to compare the real surface with the best fit toric ellipsoid surface to visualize higher order visual defects Select the exams you wish to base the idealized eye on click on the Analysis gt Create gt Ideal Eye button The software calculates the average steep and flat angles of the selected exams and creates a toric ellipsoidal surface based on the average height values at a set chord along these axes The chord used is that set for measuring shape factors in the E300 Options dialog see Setting Elevation Map Options on page 36 Note that unlike the Composite Eye function the selected exams are not aligned to a common axes before being averaged The Ideal Eye function should therefore only be used on a single exam or exams where the pupil is aligned Adding Annotations Graphical annotati
77. the currently selected exam Some examples are e Score a computed number that combines the measurements of how well centred the captured image was how well focused the captured image was and of how much movement there was in the captured image 1 0 optimal e The Flat Angle and Steep Angle are the angles of the flat and steep keratometric axes e The Surface Asymmetry Index SAI which increases with increasing asymmetry in corneal power distribution e The Surface Regularity Index SRI which increases as central corneal irregularity increases e BFS Radius the radius of the best fit sphere note that this is affected by the current Elevation Fitting Radius see Setting Elevation Map Options on page 36 e IS Index this is a measure of the difference between the average inferior and superior power in the eye e HVID this is a measure of the horizontal visible iris diameter You will need to manually define an iris for this attribute to be defined Pupil Centre X 0 1 mm Pupil Circumference 12 9 mm Pupil Centre Y Pupil Height Score Total SS Recalculate LT Arrange Figure 31 E300 attributes window Arrange Attributes The Arrange Attributes dialog shown in Figure 32 controls which attributes are displayed and the order in which they are displayed 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
78. trol allows you to display 3D Perspective views with enhanced distortion The deviation of the eye surface from the best fit sphere is multiplied by the scaling factor and added to the original surface A value of zero produces a true 3D Perspective Sim K units Located at Display gt Options gt Sim K units this allows the user to select the units of measurement for the resulting data in both the top and bottom data blocks when Zoned K or Sim K have been selected Options are mm millimetres D Diopters or Auto K which will automatically select the best unit of measurement based on the chosen map type Setting Elevation Map Options When the Elevation map type is selected the Display gt Options gt Data Settings button is displayed to allow elevation related settings to be changed This is shown in Figure 20 i A 9 o To Elevation 50 Colour Map Opacity 7 Image Cartesian Grid 4 Readout Z Attributes R e Eccentricity 7 Planar WY Perspective 0 Z Colour Map M Polar Grid Z Annotations Bottom Data Settings Auto Sim K Units Numeric Data M Keratometrics M Cross Section Sim K Reset Map Type Options Show Hide Data Blocks Defaults Figure 20 Elevation map view settings dialog showing the additional Elevation Settings button Clicking on the Display gt Map Type gt Data Settings button displays the Elevation Settings dialog shown in Figure 21 This has additional controls for manip
79. ttings Elevation Fitting Annulus D 00 Inner Radius 6 00 Width Hevation Fitting Sphere J Use Best Fit Sphere 800 Radius Cancel OK Figure 21 Elevation Settings dialog Setting Up the Color Key The color keys control the mapping of data values to colors There are two types of Color Keys Standard used to convert data values into colors and Difference used to convert the difference between data values into colors Difference color keys are always balanced about zero i e the minimum color key value is the negative of the maximum value and zero difference is always the same color light green Standard Color Keys The E300 provides a number of predefined color keys for each map type Medmont E300 Corneal Topographer 37 Analysing and Viewing Exam Results Map Type Available Color Keys Axial Power Standard Power Normalized Power Universal Standard Scale K Scale Tangential Standard Power Normalized Power Universal Power Standard Scale K Scale Axial Curvature Standard Curvature Normalized Curvature Tangential Curvature Standard Height Normalized Height Refractive Standard Power Normalized Power Universal Power Standard Scale K Scale Standard Elevation Normalized Elevation Color Key Descriptions Standard Curvature Normalized Curvature There are seven standards based Color Keys Three apply to the Map types medmonti Standard Power The standard Medmont E300 color
80. tualP Medmont E300 Corneal Topographer 75 Glossary of Terms 76 Where PredictedP Predicted Tangential Power based on the average power of the rectilinear neighbours Actual P Actual Tangential Power SCALING_FACTOR 10 0 ZERO_POINT 0 90 Note SCALING_FACTOR and ZERO_POINT values are chosen to given equivalence with the original TMS SRI values Tear Film Clearance TFC The distance between the surface of the eye and the contact lens at a point Medmont E300 Corneal Topographer Cleaning Maintenance and Service 13 Cleaning Maintenance and Service To maintain the life of the components and the accuracy of the instrument regular maintenance 1s required in the form of lubrication and cleaning Routine Hygiene and Cleaning All surfaces coming in contact with patients need regular disinfecting Standard instrument grade disinfectant diluted with 50 water may be used on all external surfaces Wipe surfaces with a damp cloth only to avoid liquid entering delicate parts and optics Do not use strong oxidising agents or solvents as they could damage surface coatings Do not use any aerosols or sprays that could contaminate the optics Use soft non abrasive cloth only Special care of the inside of the cone is required and is described in the section below Cleaning of contaminated Optics The following optics are externally accessible and subject to contamination from dust residues from evaporated liquids
81. ulating the elevation Fitting Annulus and Best Fit Sphere The Elevation Fitting Annulus inputs allow you to specify the boundaries of the annulus used by the software to calculate a best fit sphere The calculation is based only on the eye surface contours covered by this annulus The Inner Radius defines the size of the annulus inside diameter and thus defines how much of the central eye surface will be ignored The 36 Medmont E300 Corneal Topographer Analysing and Viewing Exam Results Width sets the annulus width and defines how much of the eye surface outside the inner diameter is used in the computation The best fit sphere is the one passing through the eye surface defined by the annulus and minimising the surface elevations on either side For example to view changes induced by surgery or Ortho K to the central zone of the eye set the inner radius to 3 mm and the width to 1 mm The sphere will be fitted to the data in the 3 4 mm radius zone which will not change significantly before and after surgery thus providing a stable baseline for comparison By default the software uses the best fit sphere when calculating elevation data However you can force it to calculate the elevations from a sphere of a radius you specify by deselecting the Use Best Fit Sphere option Being able to specify a fixed radius can be useful when displaying elevation differences to ensure that both exams use the same baseline elevation le Elevation Se
82. up Opens the E300 instruments window which allows you to setup delete and calibrate E300 instruments Calibrate Instrument allows you to check the accuracy of the current calibration and recalibrate if required see Calibrating the E300 on page 65 System Settings allows you to configure to adjust the Eccentricity and Shape Factors the height and Wavefront errors which affects the attribute values Analysis Tab Items 70 The Analysis tab is added by the E300 component It is only displayed when a Patient Exam is selected Ds ie arrra ae Reset clears the analysis of the selected E300 Exams This forces the software to re analyse the selected exams Export creates a set of text files containing raw E300 Analysis data for the selected E300 Exam see Exporting the Analysis on page 56 Details displays numerical readouts for apical curvature sagittal height and shape factor etc calculated at a specified meridian and chord diameter for the selected E300 exams see Displaying Analysis Details on page 44 Ideal Eye creates an idealized symmetric toric ellipsoidal surface based on the average values of the currently selected exams Edit Allows you to edit the E300 exam to highlight and remove artefacts Remove Selected Removes a point s that have been highlighted as an artefact for removal Medmont E300 Corneal Topographer Menu and Icon Reference Display Tab Items
83. ure 46 Medmont E300 Corneal Topographer 63 Managing Exams and Calibrations FL Citizen John Left 3 Dec 1998 4 11 03 PM Patient Citizen John Change Exam Date 3Dec 1998 04 11 03 PM fy Eye Left Right Instrument 30120 Calibration 23 Nov 1998 2 08 37 PM Q Analysis Type Normal Categories Practice Sample Practice K Clinician Sample User Comments Figure 46 Exam Details dialog Deleting Exams Prescriptions and Calibrations You can delete exams prescriptions and calibrations but keep the following in mind e Deleting a calibration also deletes all of its calibration tests e You cannot delete a calibration that is used by a patient exam In general it is not a good idea to delete calibrations Select the item s to be deleted in the Explorer pane Then click on Home gt Exam gt Delete 64 Medmont E300 Corneal Topographer Calibrating the E300 10 Calibrating the E300 The accuracy and repeatability of exam results is dependent on ensuring that the E300 is correctly calibrated The instrument is supplied with a calibration object which is calibrated to the National Standard Handle and maintain this object with care Do not touch scratch or dent the object surface it is a nie delicate optical device The calibration object should be verified and re calibrated every two years as stated on the calibration label either by Medmont or a Certified Measuring Laborator
84. with the eraser tool The point will once again be included in the colour map To apply changes made with the eraser tool click on Analysis gt Data Points gt Remove Selected button The colour maps and statistics are recalculated excluding the selected points If needed you can always reset the analysis back to its original form on the Analysis menu by clicking Reset Printing the Exam Results Select the Patient Exam s you wish to print then select the View see Setting the Exam View Mode on page 24 and Map Type see Map Type on page 27 Select the printer and paper size to print by clicking on the Application button and selecting Print and then clicking on the Settings button Click on the Application button and select Print to print the displayed exams immediately or alternatively select the Print Preview to adjust titles and margins and view output before printing see the Medmont Studio documentation for more detail Printing to a color printer provides a concise summary of the exam see Figure 39 Medmont E300 Corneal Topographer 53 Analysing and Viewing Exam Results Sample Practice Page 1 Citizen John Right 3 Dec 1998 4 09 17 PM Axial Power 1005 e Eccentricity medmont 0 44 120 955 0 52 20 505 8 8 2 gt 8 3 g STE HE OU Ete ea ee TE ME IN ee Pow 43 1 D so 44 30 30 Dis 9 00 mm AK 7 7D Ang Fist Angle Ste2o Angl
85. xam Figure 5 shows the Medmont Studio initial display with a patient selected in the explorer pane EE m Medmont Studio Standalone admin mi x Home Configure CRMoveTo OR L i Wg Add 8CopyTo Digita Corneal act Perimetry YW Organise Find New Delete Image Topography Exam Patient Exam New Exam Favorites Peridata Tree q FE King Sue Sort exams by Date v Dese n 3 Sample Practice Citizen John H Fifer Michele af Fredericks Fred H Jolly Nick Hf Jones Chris LE L R 2 Dec 1998 9 27 23 AM L L 2 Dec 1998 9 28 20 AM amp King Sue LR 15 Dec 2010 3 10 22 PM H Love Sarah H Mills Karen H Peterson Margaret H Smith Sandra LastName King HE Wong John H Wright Sally FirstName Sue General Clinical Comments Title Mrs Middle Name Date of Birth 19 Mar 1961 wy External Record Male Sex Female S al 12 found 4 Tree Pati s0v2_ 630 m70 Figure 5 Patient selection Positioning the Patient In order to capture good quality and accurate images some precautions should be followed in positioning the patient correctly While these are well known and standard practice for corneal topography examinations here we reiterate the most important points as they apply to the E300 16 Medmont E300 Corneal Topographer Testing a Patient The patient should sit comfortably in the chair Ask the patient to put her chin onto the ch
86. y If any surface defects are identified the object must be replaced to ensure the best calibration result You should check the calibration of the instrument e After installation or moving the system to another location e Ona monthly basis To calibrate the installed instrument navigate to Configure gt E300 gt Instrument Setup Then from the E300 Instruments window click on the installed instrument and click Calibrate to run the Calibration Wizard which allows you to check the current calibration and optionally recalibrate the instrument The following sections describe the Calibration Wizard steps Choosing the Video Source The first step of the calibration wizard is to specify the device used to capture video from the E300 topographer see Figure 47 The first option is Leutron PCI Capture Card choose this if your topographer connects to a PCI card using a long flat D shaped connector The second option is USB Video Converter Box choose this if your topographer connects to a grey box using a round 8 pin connector which then connects to the PC with a USB cable If you are upgrading from Leutron to USB now is the time to change the Video Source device doing so requires a full factory calibration which may take several hours to complete Medmont E300 Corneal Topographer 65 Calibrating the E300 E300 Calibration Wizard 30118 Select Video Source Select the type of device used to capture video from the E300 Instrument

MEDMONT E300 - The Contact Lens Laboratory of South Africa

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