SIRIUS Phoenix - 4 - 1 - 3 - 0 - Ed - 04-2023

COSTRUZIONE STRUMENTI OFTALMICI
PHOENIX 4.1.3.0
INSTRUCTIONS FOR USE
Via degli Stagnacci 12/E | 50018 Scandicci (FI) | ITALY

Phone: +39 055 722191 | Fax: +39 055 721557
cso@csoitalia.it | www.csoitalia.it
04/2023
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EN
Phoenix 4.1.3.0 | IFU311EN00 - 04/2023
Table of contents
1 INTRODUCTION ............................................................................................................................... 3
1.1 DISCLAIMER ...................................................................................................................................................... 3
1.2 WHAT'S NEW .................................................................................................................................................... 5
2 INITIALIZATION ............................................................................................................................. 12
2.1 FIRST INSTALLATION AND STARTUP ...................................................................................................................... 12
2.2 SOFTWARE ACTIVATION AND REGISTRATION .......................................................................................................... 17
2.3 DATABASE CONVERSION .................................................................................................................................... 19
2.4 SOFTWARE UPDATE .......................................................................................................................................... 21
3 MANAGING PATIENTS AND EXAMINATIONS ................................................................................ 22
3.1 MENU AND TOOLBAR ....................................................................................................................................... 22
Instruments ............................................................................................................................................................ 23
3.2 PATIENT SEARCH PANEL..................................................................................................................................... 24
Advanced Search .................................................................................................................................................... 25
3.3 PATIENTS/EXAMINATIONS LIST ........................................................................................................................... 26
Patients/Examinations Toolbar .............................................................................................................................. 26
Add Patient Menu .................................................................................................................................................. 27
Patient Contextual Menu ....................................................................................................................................... 28
Examination Contextual Menu ............................................................................................................................... 29
Patient creation ...................................................................................................................................................... 30
3.4 REFRACTION EDITING ........................................................................................................................................ 31
3.5 RIGHT AND LEFT EYE GALLERY ............................................................................................................................. 31
Tags ........................................................................................................................................................................ 32
3.6 SETTINGS ....................................................................................................................................................... 33
Language................................................................................................................................................................ 33
Database ................................................................................................................................................................ 34
Miscellaneous......................................................................................................................................................... 35
Dicom ..................................................................................................................................................................... 35
Connectivity............................................................................................................................................................ 36
Maintenance .......................................................................................................................................................... 36
3.7 IMPORT/EXPORT EXAMINATIONS AND TESTS.......................................................................................................... 38
3.8 EXPORT INDICES .............................................................................................................................................. 39
4 EXAMINATIONS ............................................................................................................................. 42
4.1 ABERROMETRY ................................................................................................................................................ 42
Acquisition .............................................................................................................................................................. 42
Menu ...................................................................................................................................................................... 44
Settings .................................................................................................................................................................. 45
Printing ................................................................................................................................................................... 46
4.2 DYNAMIC ACCOMODATION ............................................................................................................................... 47
Acquisition .............................................................................................................................................................. 47
Settings .................................................................................................................................................................. 49
Analysis .................................................................................................................................................................. 50
Printing ................................................................................................................................................................... 52
4.3 FUNDUS CAMERA IMAGING ............................................................................................................................... 52
Acquisition .............................................................................................................................................................. 52
Analysis .................................................................................................................................................................. 56
Printing ................................................................................................................................................................... 61
4.4 MEIBOGRAPHY ................................................................................................................................................ 62
Acquisition .............................................................................................................................................................. 63
Analysis .................................................................................................................................................................. 64
4.5 AS-OCT BASED CORNEAL TOPOGRAPHY .............................................................................................................. 68
Calibration .............................................................................................................................................................. 68
Acquisition .............................................................................................................................................................. 70
Menu ...................................................................................................................................................................... 72
Settings .................................................................................................................................................................. 75
Ring/Pupil/Limbus editing ...................................................................................................................................... 77
Sections editing ...................................................................................................................................................... 79
Printing ................................................................................................................................................................... 83
Copyright © 2021 by CSO Srl. All Rights Reserved.

Phoenix 4.1.3.0 | IFU311EN00 - 04/2023
4.6 AS-OCT SINGLE SECTION ANALYSIS .................................................................................................................... 84

Acquisition .............................................................................................................................................................. 84
Menu ...................................................................................................................................................................... 86
Analysis .................................................................................................................................................................. 87
4.7 AS-OCT LENS BIOMETRY ANALYSIS .................................................................................................................... 89
Acquisition .............................................................................................................................................................. 89
Menu ...................................................................................................................................................................... 90
Data Editing ........................................................................................................................................................... 91
4.8 PLACIDO BASED CORNEAL TOPOGRAPHY ............................................................................................................... 92
Calibration .............................................................................................................................................................. 92
Acquisition .............................................................................................................................................................. 94
Menu ...................................................................................................................................................................... 96
Settings .................................................................................................................................................................. 98
Ring/Pupil/Limbus editing .................................................................................................................................... 100
Printing ................................................................................................................................................................. 102
4.9 PUPILLOGRAPHY ............................................................................................................................................ 103
Acquisition ............................................................................................................................................................ 103
Menu .................................................................................................................................................................... 104
Edit ....................................................................................................................................................................... 105
Printing ................................................................................................................................................................. 106
4.10 SCHEIMPFLUG BASED CORNEAL TOPOGRAPHY ..................................................................................................... 107
Calibration ............................................................................................................................................................ 107
Acquisition ............................................................................................................................................................ 108
Menu .................................................................................................................................................................... 110
Settings ................................................................................................................................................................ 112
Sections editing .................................................................................................................................................... 117
Printing ................................................................................................................................................................. 119
4.11 SLIT LAMP IMAGING ....................................................................................................................................... 120
Calibration ............................................................................................................................................................ 120
Acquisition ............................................................................................................................................................ 121
Analysis ................................................................................................................................................................ 123
4.12 TEAR ANALYSIS ............................................................................................................................................. 125
Acquisition ............................................................................................................................................................ 126
Analysis ................................................................................................................................................................ 128
4.13 TOPOABERROMETRY ...................................................................................................................................... 130
Calibration ............................................................................................................................................................ 130
Acquisition ............................................................................................................................................................ 132
Menu .................................................................................................................................................................... 134
Printing ................................................................................................................................................................. 135
Settings ................................................................................................................................................................ 136
4.14 VIDEOKERATOSCOPY....................................................................................................................................... 140
Acquisition ............................................................................................................................................................ 140
Analysis ................................................................................................................................................................ 143
5 GENERIC TOPICS.......................................................................................................................... 145
5.1 PRINT PREVIEW ............................................................................................................................................. 145
5.2 CONIC EQUATION .......................................................................................................................................... 146
5.3 TEAR MENISCUS ............................................................................................................................................ 146
5.4 DRY EYE REPORT (DER) ................................................................................................................................. 147
OSDI questionnaire (Ocular Surface Disease Index) ............................................................................................. 149
5.5 DICOM ...................................................................................................................................................... 150
Configuration ....................................................................................................................................................... 150
Send to PACS ........................................................................................................................................................ 154
Import from PACS ................................................................................................................................................. 155
Modality Worklist ................................................................................................................................................. 157
This document is the property of CSO Costruzione Strumenti Oftalmici srl.

Any reproduction, even partial, it is prohibited.
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1 INTRODUCTION
This manual has been written in accordance with the COMMISSION REGULATION (EU) No.
207/2012, of 9 March 2012, concerning electronic instructions for use of medical devices.
1.1 DISCLAIMER
Each device manufactured, marketed and / or otherwise placed on the market -
directly and / or indirectly by CSO is made in accordance with the provisions and
regulations in force in their user manuals contain the necessary information to ensure
intended use and to identify the manufacturer, whilst taking into account the training /
experience and knowledge of its intended users.
This information, including that contained in the accompanying manuals for our
products and our technical advice, whether verbal, in writing or by way of demo and
experiment, is provided on the basis of our best knowledge.
However, they must be considered as information without any binding effect,
including those with respect to any industrial property rights of third parties, and do
not exempt the customer from checking the current versions of our advice and
suggestions, in particular of our material safety data sheets, instruction manuals and
technical information, and products supplied by us, in order to estimate their
suitability for the intended purpose and processes.
The application, use and processing of our products and the products manufactured by
the customer on the basis of our technical advice and / or maintenance activities occur
outside of our control and fall, therefore, entirely under the customer’s own
responsibility, for which CSO assumes no responsibility as set out below. The technical
results and / or data resulting from handling or use of our devices must be analyzed by
experienced professionals in various fields of application of the specific product being
otherwise compromised the correct reading and analysis of data.
The sale of our products is governed by our General Conditions of Sale and Delivery as
amended.
The software provided by us in conjunction with our products or otherwise made
available for download on your computer or for use online are the exclusive property
of CSO which disclaims any responsibility for the accuracy of the results obtained with
the programs or algorithms used by the programs themselves or liability resulting from
the incorrect use of the software.
For data security, please refer to the management of Windows security. It is
recommended to enter a password to access the account used.
Before performing an upgrade of the application or the archive, and / or at least before
any maintenance operation, we advise to make a backup of the complete patient
database. It is also recommended you periodically (every week at least) make a backup
on a different medium of the one normally used (e.g. CD-ROM or DVD). CSO srl bears
no liability for loss of data due to improper handling of the archive.
All measured data, calculated and interpreted and subsequently displayed to the user
must be considered subject entirely to customer's responsibility. CSO remembers that
any data and / or information arising from the use of the above software must
necessarily be compared and verified with results from other devices in order to verify
the exact calibration of the instruments and their proper functioning according to the
specific parameters provided by the customer.
It should be noted, more specifically, that the indices of keratoconus screening provide
mere indications which however are not sufficient for assessing either instrument
calibration status nor the patient's clinical situation. Therefore, these indices are

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considered tools that the user can use to provide a diagnosis but cannot be considered
themselves a diagnostic interpretation of keratoconus. Therefore, we recommend the
user to exercise caution in evaluating these values and to correlate with other indices
of screening tests and the clinical picture of the patient.
CSO does not assume any responsibility for damage of any kind howsoever arising and
especially the application of the results of the IOL Summary in the software, including
those arising from an incorrect calculation of the IOL. The user of the program must
verify by plausibility considerations that the proposed values do not contain gross
mistakes.
CSO assumes no responsibility and makes no guarantee of accuracy, calibration and /
or exact measurements provided by the Products and / or software with which they
operate even if provided by the CSO itself. Consequently, CSO will not and cannot be
held responsible in any way or for any reason for any direct, indirect, consequential in
general, of image, or profit loss, or moreover of any kind or species whether they are
persons, property or other equipment or products that the customer complaints as a
direct or indirect consequence of the use of our products and our software.

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1.2 WHAT'S NEW

V. 4.1 (4.1.3.0)
- Phoenix: Updated User Interface
- Phoenix: Live preview
- Phoenix: Live acoustic feedback restored
- Phoenix: Fast process all
- Phoenix: Maintenance tools for network speed evaluation
- All exams: Printable measurements
- Pupillometry: Improved outlier rejection algorithm for “Dynamic” acquisitions
- MS-39: section grouping based on the scan mode
- MS-39: OCT sections and anamorphic display comparison
- MS-39, Sirius+, Antares+, Modì: Essential print-out
- MS-39, Sirius+: IOL database update via UpdateManager
- MS-39, Sirius+: Visual Axis \ Centration printout
- MS-39, Sirius+: Introduced N-T indicator on section thumbnail
- Biomicroscopy: support for new magnification set
- Osiris, OsirisT: Toric pIOL assistant
- DICOM: Multiple IODs to single exam association
- DICOM: Introduced support to these SOP Classes:
- Corneal Topography Map Storage
- Ophthalmic Tomography Image Storage
- Autorefraction Measurements Storage
- Keratometry Measurements Storage
- Minor bug fixes
V. 4.1 (4.1.1.5)
- Phoenix: Plugin management and centralized update of the contents
- Phoenix: MySQL database setup improvement
- Phoenix: several performance fixes and optimizations with big databases
- Phoenix: fixes for database conversion and management tools + performance boost
- Phoenix: Samples database available on clean install
- Sirius and Sirius+: keratoconus classification
- MS-39: epithelial thickness map enhancements
- MS-39, Sirius+, Antares+, Modì: 3D chart
- MS-39, Sirius+, Antares+, Modì: Chart 0°-360°
- MS-39, Sirius+, Antares+, Modì: Pupillography integration in CT
- MS-39, Sirius+: Visual Axis \ Centration printout
- Pupillography: new UI
- Osiris, OsirisT: Geometric PSF implementation in defocus curve
- Dicom: Added support for saving DICOM data into file, Added Bcs file into Raw Object
IOD
- Minor bug fixes
V. 4.1 (4.1.0.7)
- Added support for Antares+
- Added support for Mizar
- Added support for Win11 OS
- Phoenix: enhanced plugin management
- Phoenix: enhanced analysis UI
- Phoenix: redesigned UI of settings

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- Sirius+: enhanced section processing

- MS-39, Sirius, Sirius+, Antares, Modì, Osiris, OsirisT: enhanced export of indices
- MS-39, Sirius, Sirius+: enhanced keratoconus Follow-up
- OsirisT: Tear film analysis implemented
- Osiris/Osiris+: Dynamic accommodation exam implemented
- DICOM: Introduced support of ISO_IR 100
- DICOM: Added "PropagateDailyAccessionNumber" option
- Bug fixes
Known issues
- Missing keratoconus classification for Sirius and Sirius+
V. 4.0 (4.0.1.8)
- Added support for Osiris
- Added support for OsirisT
- Phoenix: Help On Line integration
- Phoenix: On Line SW activation
- Phoenix: Added anonymization on Patient export
- Phoenix: Enhanced double-click in Phoenix gallery
- Phoenix: Added PL language
- MS-39: Added 360° Δ 10° modality
- MS-39, Sirius+, Cobra, Slit-lamp: Image magnifier enhancements
- MS-39, Sirius, Sirius+, Antares, Modì, Osiris, OsirisT: Unified Rx control management on
Optical Quality Summary
- MS-39, Sirius, Sirius+: Keratoconus Follow-up implemented.
- MS-39, Sirius, Sirius+, Antares, Modì, Osiris, OsirisT: Added several printouts in specific
summaries.
- Antares, Modì, OsirisT: Redefined indices printout.
- MS-39, Sirius, Sirius+, Antares, Modì, Osiris, OsirisT: Export of indices
- DryEye report: improvements
- IOL calculation: toricity inversion displayed
- Bug fixes.
Known issues
- Missing keratoconus classification for Sirius and Sirius+
- Missing help on-line integration for OsirisT
V. 4.0 (4.0.0.57)
- Added support for Modì2
- Added support for Sirius
- Added support for Sirius+
- Phoenix: database path sharing among different users
- Phoenix: merging tool for different patients
- Phoenix: Fixed low quality videos
- Phoenix: Favorite acquisition managed from each specific modality
- Phoenix: Added support for BCS anonymization
- MS-39: Added support for scleral lenses
- MS-39: Added support for cornea geometric model
- MS-39 impoved compatibility with Sophos antivirius
- MS-39: improved 6xMap printout
- MS-39: Fixed wrong representation for Hchtilt indexes
- MS-39, Sirius, Sirius+, Antares, Modì: improved 6xMap printout.
- MS-39, Sirius, Sirius+, Antares, Modì: improved differental maps.

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- Test OSDI import (Marco Version)

- IOL calculation: option to adjust AL
- IOL calculation: toricity inversion displayed
- MS-39, Sirius, SL, Cobra: Added SaveImage feature
- DICOM: Added Ophthalmic Photography 8bit Image IOD support for ASOCt Section Exam
- Bugfix: Fixed 2D elevetion chart inverted
- Bugfix: Fixed diameter in advanced elevation
- Bugfix: Fixed altimetric difference issue at maximum diameter
- Bugfix: fixed language problem with decimal separator
- Minor bug fixes.
V. 4.0 (4.0.0.39)
- Phoenix: changed from x86 to x64.
- Phoenix: Access database discontinued in favor of SQLite or MySQL.
- Phoenix: Architecture changed from single-application into multi-application to increase
robustness and modularity.
- Phoenix: Improved patient search.
- Phoenix: Renewed GUI.
- Phoenix: Compatibility with Sirius+ Scheimpflug camera.
- Phoenix: One-to-One relationship between Exams and Groups turned into One-to-Many.
- All lives: SS-MM (Single Start – Multiple Modality) to speed-up clinical practice.
- All lives: Completely new GUI, unified for each live program.
- All lives: Parallel process acquisition.
- AS-OCTLive: Use of GPU to speed-up processing.
- AS-OCTLive: Modality reported into the thumbnail image.
- AS-OCT: Restored Klyce scale
- AS-OCT: Two-sided scales.
- AS-OCT: introduction of Posterior Gaussian Curvature map.
- AS-OCT: introduction of Pattern deviation maps.
- AS-OCT: updated bilateral keratoconus screening and indices.
- AS-OCT: updated AS-OCT Image container control.
- AS-OCT: comparison between AS-OCT Images.
- Scheimpflug camera: Restored Klyce scale.
- Scheimpflug camera: Two-sided scales.
- Scheimpflug camera: introduction of Posterior Gaussian Curvature map.
- Scheimpflug camera: introduction of Pattern deviation maps.
- Scheimpflug camera: updated bilateral keratoconus screening and indices.
- Scheimpflug camera: updated Scheimpflug Image container control.
- Scheimpflug camera: comparison between Scheimpflug Images.
- Corneal topography: Restored Klyce scale.
- Corneal topography: Two-sided scales.
- Corneal topography: updated bilateral keratoconus screening and indices.
V. 3.7 (3.7.0108)
- OCT topography 12x5x10 mm: increased image depth to include lens and iris
- OCT topography: edge detection improved
- OCT topography: fixed minimum acceptance distance for both 16mm and 10mm
acquisition modes
- Dry Eye Report: meibography can be graded using a grading scale directly in the report
- Dry Eye Report: osmolarity examination panel can now be hidden in the report screen
- Dry Eye Report: ocular redness and tear meniscus height can now be acquired with slit-
lamp

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- Dry Eye Report: optimized thresholds in Dry Eye Report

- Dry Eye Report: minor bug fixing
- Corneal topography: conic fitting for principal meridians
- Support for Nidek slit-lamp magnification set
- Fixed a bug that caused KLive.exe to crash with old firmware versions
- Meibography can now be graded using a grading scale instead of marking the glands
- Added 'export to external application' feature for studies and single images
- Movie preview in gallery can now be disabled in the settings window
- New graphics for instrument icons
- Major and minor bug fixing
V. 3.7 (3.7.0018)
- OCT topography: averaged modalities (2x12x16mm / 5x12x10mm) added
- OCT topography: epithelial edge detection improved
- OCT topography: epithelial indices added
- OCT topography: sector representation in pachymetry
- OCT topography: stromal thickness and elevation maps added
- OCT topography: live acquisition control and feedback added
- OCT topography: angles measurement optimized
- OCT section: Modalities (x2, x4, section, raster) added
- OCT section: Placido control allowed
- Dry eye report added
- TearX compatibility added
- Scheimpflug topography: sector representation in pachymetry
- GDPR features added
- Software usage under not-Admin rights
- Bug fixing
- Improved integration User manual
V. 3.6 (3.6.0061)
- Improved integration User manual
- Improved handling of examination move from one patient to the other
- Extended save image to desktop for all examinations
- Added Cartesian Grid
- Keratoscope: image quality improvement in Tear film analysis examination
- FUNDUS Various improvements and fixes for Fundus Camera "Plus"
- FUNDUS Mosaics are now imported into gallery automatically after acquisition
- FUNDUS Mosaic preview can be enabled/disabled by default at Live startup
- OCT Added Refractive Analysis indices
- OCT highly improved accuracy in epithelial maps
- OCT added scleral spur detection and AOD/TISA measurements for irido-corneal angles
- OCT manual editing for corneal surfaces
- OCT added movie recording (16mm and 8mm)
- OCT general improvements in surfaces detection
- OCT Epithelial map scale
- OCT BUGFIX Placid Disk turned on before end scanning
- OCT Distance from center on cursor
- OCT Flap Measurement
- OCT Biometry AC prediction
- OCT / OSIRIS Added Tear Film analysis
- OSIRIS Added refractive map to differential analysis
- OSIRIS Added WF movie

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- BUGFIX Sub-models distinction between Aberrometer and TopoAberrometer, Fundus

camera and Fundus camera 'Plus'
- BUGFIX Printout PWRs, PWRf, c30/LSA, PWRs, WRf and HVID*
V. 3.4 (3.4.0073)
- Added favorite image on gallery
- Windows 10 Full support
- New instrument: AS-OCT (Anterior Chamber OCT)
- Enhanced instrument: Cobra “Plus”
- Tear-analysis eye blink missed detection fixed
- Optimized white balance in Keratoscope and Slit lamp
- Software activation fixed for SW upgrade ("P-?" in license field)
- Startup crash "Cannot draw overlay when LiveControl property is not set" fixed
- Improved movie recording for Slit Lamp and Keratoscope movie modes
- "Reprocess all acquisitions" feature introduced for Scheimpflug, Keratoscope, OCT,
(Topo)Aberrometer
- Missed optical cup-disc detection fixed
- Updated online support
- Fundus Camera acquisition improved, max number of mosaic tiles was increased from 7
to 9
- Speed up mosaic creation
- Added function for “best image”, contro-lateral navigation
- Tight integration with user manual (CHM format)
- Aligned statistical analysis for topographic acquisitions
- Quality indices for (Topo)aberrometer
- Epithelial indices OCT
- Toric IOL assistant (Topoaberrometer, Scheimpflug camera)
- Added NTSI on topographic and wavefront maps
- Visualize c40, K1ref, K2ref
V. 3.2 (3.2.1020)
- Web activation: simplified online registration
- Added smartcard support for data entry
- Pupillography contro-lateral comparison
- Lens DB update
- Schwind bugfixes
- Bugfixes (#775)
- Fundus Camera: Enhanced mosaic generation algorithm
- Fundus Camera: Added support 5Mpx USB3
- Slitlamp: Updated USB3 support
- Slitlamp: Re-introduced Cup-to-Disc measurement
- Topographers: Graphic for tearfilm Breakup time
- Topographers: Added mean BuT
- Topographers: Tear analysis comparison
- Topographers: added acquisition tear meniscus
- Topographers: Added scale steps
- Aberrometer: various enhancements
- Print: Enhanced report functionality (print update)
- Print: Customized print for various follow-up functions
- (keratoconus, refractive surgery, acquisition stats)
- New example DB
- Linear calibration onboard on device

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- Enhanced ICRS
- Added PTI Graph
- Added indices for lens rise / lambda intercept
- Further PMS integration
- DICOM handling patient’s without first name
V. 3.1 (3.1.1031)
- Slitlamp USB3 support
- Tearfilm analyzer adjustable timeline
- Quality statistics (Scheimpflug, Keratoscope, Aberrometer)
- Added follow-up for keratoconus and refractive surgery
- Updated statistics LSA / OPD Normality
- Optimized ZCS import (multiselect)
- Changed ordering main gallery (identifier X-Y)
- Configurable BCS Export
- Optimized visualization of high-res images
- Optimized measurements
- Optimized printing features Cobra
- Optimized color quality for Cobra
- Bugfixes (#744, #765, #766, #767, #768, #769)
V. 3.0 (3.0.1021)
- New Instrument: (Topo-)Aberrometer (USB3)
- New Instrument: Color Keratoscope (USB3)
- New instrument: Tearfilm analyzer
- Advanced printing fundus
- A/V Ratio analysis on Cobra
- Toric IOL handling improved
- Enhanced handling of meibography
- Enhanced driver and firmware installation GUI
- Added exam description
- Enhanced main gallery performance
- Added layout functionality
- Added language Chinese
- Show refraction on main gallery
- Bugfixes (#704, #722, #730, #735, #736, #737, #738, #740)
Known issues
- It is not possible to configure storage commitment on the DICOM configuration (#745). It
might lead to missed echo requests, when the configured partner actor tries to ‘back-ping’
on the local port. Workaround is to set the local port to 0.
V. 2.6 (2.6.4000)
- Changed PDF creation (using proprietary virtual PDF printer)
- Updated 64-bit drivers
- Enhanced mosaic handling on fundus acquisitions
- Auto-focus on Cobra acquisition
- Enhanced Web Service access
- Added Shortcut to calibration procedure for Keratoscope and Scheimpflug camera
- Bugfixes (#672, #677, #695, #697, #699, #700, #701, #703, #707)
- Capture 64-bit acquisition
Known issues

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- Install configuration for Capture, in combination with Sirius or Cobra:

- Install Capture, and disconnect once installed;
- Install Sirius / Cobra;
- Reconnect Capture
This is caused by a driver conflict between the Sirius/ Cobra driver and the Capture driver [Bug
#694]

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2 INITIALIZATION
2.1 FIRST INSTALLATION AND STARTUP
In order to install the software please follow the instructions below.
- Run the software executable file ".exe" and wait for the installation procedure to start.
- Select the language to be used during the setup.
Language selection
- Accept the "License Agreement" by clicking on "I accept the agreement" option.
- Click Next to continue.
- Select the destination file path for software installation and click Next. We recommend
not changing the default displayed path.
Select Installation folder
- Select the start Menu folder: "Phoenix4" folder is selected by default.


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- Select the components to be installed. By selecting/deselecting "Examples database", a

database with example cases will be installed/not installed together with the application.
Components selection
- Click "Install" to start the installation.
Confirm installation

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- A message appears on the screen asking if the user wants to download the samples
database from the internet.
- To download the samples database, click Yes. An internet connection is required to
download it. Otherwise, the installation procedure ends.
The samples database is created in C:\DBPhoenix. If another DBPhoenix folder is already
present in the path, the demo database will not be installed.
- The application can be now executed using the shortcut displayed on the desktop.
- Click Finish button to end the setup process.
- The application can be now executed using the shortcut displayed on the desktop.
Warning: In order to be executed, the application requires operating system
user with local machine administrative privileges: if this requirement is in
conflict with user internal security policy, please contact support to evaluate
possible solutions.

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As software opens, the first time, the software updates its prerequisites:
- If "Microsoft Visual C++ 2010 x64 Redistributable is not installed on the PC, the "Microsoft
license agreement" screen will be displayed. Mark the checkbox to accept the licensing
conditions [1], press the "Install" button [2] and wait for the installation complete.
- If "Microsoft Visual C++ 2008 Redistributable is not installed on the PC, the "Microsoft
license agreement" screen will be displayed. Mark the checkbox to accept the licensing
conditions [1], press the "Install" button [2] and wait for the installation complete.

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- If a "Windows security" window appears asking the user to install the "Alkeria" software,
press the "Install" button [3].
Windows security window
- In case of first execution (without connected devices) please refer to Software activation
and registration procedure.
- After registration procedure you need to connect with the working database by the "Setup
Database Configuration Dialog". If a previous installation is detected, the software ask to
proceed with the database conversion. A new empty database is created otherwise.
Database path
- The application is now ready to be used, please refer to Managing patients and
examinations for more detail.

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2.2 SOFTWARE ACTIVATION AND REGISTRATION

Licensing
Every software installation requires a license.
There are 2 license modules available.
- DEFAULT: includes all basic features for all instruments.
- Sirius IOL: includes all basic features for all instruments and IOL calculation.
Check the instrument's Serial Number: all instruments released from 2016 contain their own
license on-board, so that the software will auto-activate as soon as the instrument is plugged
to the USB/Firewire port. The software will launch without asking for activation and a pop-up
appears at the bottom of the screen showing license type, P-number and Serial Number found
on the instrument(s).
Please note that the software becomes inactive when the instrument is unplugged from the
PC port.
You may ignore the following section if your instrument has completed the auto-activation.
Find and enter the "P-number"
- If the instrument was released before 2016 or there are no instruments plugged in, the
Activation form appears every time the software is launched.
- Click Use free trial to start the software in DEMO mode, which includes the same features
as PUPIL license, but can be run 60 times before preventing the software to launch again.
The activation form requires a P-number input, which is a software license identifier usually
printed on a gray label stuck on the instrument, or transmitted by your distributor.
- Input the P-number then click Next.
- A 24-digit request code is produced. Take note of this code and send it to your support
contact to claim the activation key.

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- Upon receiving an activation code, enter it in the activation form. The request code is
shown also in this form, in case it wasn't noted during the previous step.
- Insert the 24-digit activation code to complete the activation process.
- If something went wrong in the activation process, click Renew request to get back to the
P-number form and start a new activation request.

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Find and enter the "P-number" (Online activation)

If the PC is connected to the internet, it will be possible to activate the software online through
a "smart" procedure.
- Input the P-number then click Next.
- Upon receiving an activation code, enter it in the activation form to complete the
activation process.
2.3 DATABASE CONVERSION

"Convert a database from previous software version" start the process to convert a database
.mdb to a database .db3 (the current version).

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Step 1: Select DB to convert

Select a database file from previous software version (with extension .mdb) by clicking
icon. After selecting the path press "Continue" button.
Step 2: Select destination path

Select a path destination for the converted database file (with extension .db3) by clicking
icon. After selecting the path press "convert to SQLite file". The conversion process
will be start.
Step 3: Conversion
A green bar shows the progression of the conversion. Conversion will be successfully
completed once the message "Conversion complete" is displayed.

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2.4 SOFTWARE UPDATE

The software checks for available updates when it is connected to the internet.
The green circle on the right system tray indicates that the system is online.
When an update is available an alert is displayed in the bottom-right corner on the main
screen: .
- Select "Click
here to
download" to
start
downloading
the update.
- When
download is
complete,
select "Click
here to install"
on the update
window.
- The software
is closed and
the update
process
begins.

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3 MANAGING PATIENTS AND EXAMINATIONS

Main screen
When the program is launched, the Main Screen is shown. This first screen allows the user to
manage the patient database and the associated examinations. It is made up of various
sections and menus:
- [1] Menu and Toolbar

- [2] Patient Search panel
- [3] Patient/Examination edit/modify
- [4] Patients/Examinations list
- [5] Patient/Refraction information
- [6] Right and Left eye galleries
- [7] Tags panel
- [8] Acquisition preview
- [9] Info panel
- [10] Software online status/update
In case of first execution please refer to First installation and start-up procedure.
3.1 MENU AND TOOLBAR
A menu and a toolbar are displayed at the top of the screen: a short description of the
functionalities and options associated to its items follows.
Import from PACS Allows the user to retrieve previously sent exams from the
configured PACS. ("Import from PACS" icon is visible only if
DICOM is active.)
Modality Worklist Allows the user to open the Modality worklist window and
start exam. ("Modality Worklist" icon is visible only if
DICOM is active.)

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Instrument Allows the user to manage the instrument.
Export indices Allows the user to export indices. This button will be
visible if in the settings tab "Miscellanea" the option
"Show indices export button" will be checked.
Settings Allows the user to select the software language, manage
database, export indices and other settings. This menu
always accessable.
Manual Allows the user to show software manual.
Information Shows information on the software release.
Quit Exits the application after confirmation of the warning

message.
INSTRUMENTS
To proceed with an automatic setup of all the instruments to be used, connect all the
instruments to the PC.
The button allows the user to manage the instruments to be used.

A window with the instruments installed will be shown:
- [1] The Device's Serial Number.
- [2] If the device needs a calibration click the icon to start the calibration procedure.
- [3] A list of available exams for the current installed instrument.
Instrument dropdown menu

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- By clicking on a specific exam's button (i.e. "AS-OCT Corneal Mapping"), a device/exam

status window will be visible.
- It is possible to enable/disable the exam's status to add/remove the exam from the list
and/or set an exam as favorite.
- If the instrument is correctly powered but the software does not recognize the correct
power supply, follow the steps below:
- Open the instrument dropdown menu, go to "No power" and press the "Verify device
status" button.
- A window will open: press the button to refresh the device status.
Verify device status: dopdown menu
Verify device status: refresh button
3.2 PATIENT SEARCH PANEL
Patient search panel

Each patient is identified by Surname (Last Name), First Name, and an Identification Code.
A patient already listed in the database can be selected by Surname, Name or ID.
- Typing part of the Last Name, First Name or ID string, a list of patient names meeting the
criteria will be displayed. For instance, you may display all the patients whose names begin
with a given letter, or who have the same last name, or who have the same last name and
the same first-name initial, etc. As the letters or numbers are typed, the pull-down list will
display patients meeting the criteria.

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- Press the Empty Patient List icon to empty the contents of the window in which the
patient list is displayed (this will not delete the patients from the database) or the
Advanced Search button to perform a search by gender, date of birth, examination

date, instrument, or tags.
A patient archive may be expanded by clicking the patient found to show the list of associated
examinations. An unlimited number of examinations may be associated with each patient; the
examinations are defined on the basis of the instrument used and the date of creation.
ADVANCED SEARCH
Advanced search
Click the icon in the Patient Search panel, to access the advanced search function.
For each of these categories, checking the button shows the boxes for entering search criteria:
- by instrument: a list of possible

examination capture instruments (for
example, Aberrometry, Corneal
Topography, Pupillography, Scheimpflug
Corneal Mapping, Tear Film Analysis, AS-
OCT Section)
- by examination date: start and end dates

of the interval to be searched
- by tags: a list of the tags created
- by date of birth: start and end dates of

the interval to be searched
- by gender: male, female or other
Once the Patients/Examinations list is filled

according to the current search parameters
the Patient Search panel changes as follows:
- The standard search for name or

identification code is disabled.
Advanced search window

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3.3 PATIENTS/EXAMINATIONS LIST

The Patient/Examination list shows every patient and examination matching a standard or an
advanced search.
The fist level shows the patient list in the format Surname, Name (Identification code).
Once a patient has been selected, click the patient's line or press Enter or double-click with the
mouse to open the list of examinations associated.
To select a previously-stored examination, use the mouse or scroll with the ↓↑ keyboard
arrows to highlight one examination after another and, for each, view the relative images in
the window on the right-hand side of the screen.
After an examination is created the Right eye and Left eye gallery is filled up with the
acquisitions belonging to the current examination.
Patient search panel
PATIENTS/EXAMINATIONS TOOLBAR
Patients/examinations list
A toolbar is displayed at the top of the screen: a short description of the functionalities and
options associated to its items follows.
Add Patient Allows for the creation of a new Patient.
After a new patient is created, an examination will also be
created.
Add Exam Allows for the creation of a new Examination: if working with a
single instrument, the image capture mode will be automatically

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accessed. Otherwise, if at least two instruments are used, the

window shown below will open.
Select the instrument to be associated with the examination:
after selection, the capture mode is accessed.
Each examination is filed by date of creation and instrument
type.
Edit Exam It allows for the Refraction editing associated to a given
examination. This becomes active when an examination is
selected.
It is also possible to delete or export the exam
Acquire It permits the selected instrument to capture the exam and
accessing the capture environment. This icon becomes active
when a new exam is created or when a daily exam is selected.
Contextually to what is selected (Patient or Examination) a menu is associated to the right click
on the list.
ADD PATIENT MENU
Add Patient dropdown menu
Edit Patient It reopens the patient data window for editing the last name,
first name, date of birth, and/or gender.
Delete Patient Allows for the patient deletion after confirmation of the
warning message.
Warning: deleting a patient also deletes all the examinations
associated with that patient and the relative images.
Import patient Import a .zc2 or .zcs files containing the patient information
and all the examinations belonging to the patient to be re-
imported in another software program.
Export selected patient Export a single .zc2 file containing the patient information
and all the examinations belonging to the patient to be re-
imported in another software program.
Export selected patient Export a .zc2 file containing the examinations belonging to
(Anonymous) the patient to be re-imported in another software program.

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Using this type of export, the patient's information will be

eliminated (only the identification codes remain)
Export all patients Export multiple .zc2 files containing the patients actually in
actually in list list (after an advanced search or all patients in the database).
The software will allow the user to choose the path of the
destination folder of the .zc2 files
PATIENT CONTEXTUAL MENU
Patient contextual dropdown menu
Edit Patient It reopens the patient data window for editing the last name,
first name, date of birth, and/or gender.
Delete Patient Allows for the patient deletion after confirmation of the
warning message.
Warning: deleting a patient also deletes all the examinations
associated with that patient and the relative images.
Export patient Save a .zc2 file containing the patient information and all the
examinations belonging to the patient to be re-imported in
another software program.
Export selected Export a .zc2 file containing the examinations belonging to the
patient patient to be re-imported in another software program. Using
(Anonymous) this type of export, the patient's information will be eliminated
(only the identification codes remain)
Send to PACS Send all the acquisitions belonging to the selected Patient to a
PACS in DICOM format.
"Send to PACS" icon is visible only if DICOM is active.
Create new Dry Eye Allows for the creation of a new patient Dry Eye Report.
Report

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EXAMINATION CONTEXTUAL MENU
Examination contextual dropdown menu
Edit Examination It reopens the edit exam windows for editing the Refraction
associated to a given examination, the data and the time of
acquisition.
Delete Examination Allows for the deletion of the current examination from the
database after confirming the deletion request warning
message. Warning: deleting an examination also deletes all the
images associated with it.
Export test Save a .zc2 file containing the patient information and the
current examination to be re-imported in another software
program.
Export a .zc2 file containing the examinations to be re-
Export test imported in another software program. Using this type of
(Anonymous) export, the patient's information will be eliminated (only the
identification codes remain).
Update Maps Allows the user to simultaneously update the maps of the
acquisitions in the exam folder (superficial reprocessing).
Reprocess All Allows the user to simultaneously reprocess the acquisitions in
the exam folder (total reprocessing).
This function is only active for the exams of: AS-OCT Corneal
Mapping, Corneal Topography, Scheimpflug Corneal Mapping
and TopoAberrometry
Send to PACS Send all the acquisitions belonging to the selected Patient to a
PACS in DICOM format.
"Send to PACS" icon is visible only if DICOM is active.

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PATIENT CREATION
To enter a new patient in

the database, click the
icon on the
Patients/Examinations
list
Last name, First name,
Date of birth, and gender
must be entered on the
input window.
It is possible to insert
Optional data like
Telephone #1, Telephone
#2, E-mail, Address,
Comments.
Date of birth must be

entered in accordance
with current windows
settings: entering an
invalid date will cause a
warning icon to be
displayed.
Entering a patient whose
data are identical to Patient creation panel
those of another patient
already contained in the
database will likewise
open a window
containing a warning
message.
The identification code is
automatically entered by
the system unless a
different option is
selected from the
Settings menu.
- Click the icon to merge two patients: all tests and images from current patient will
be assigned to a select patient. The current patient will be deleted.
- Click the icon to open a drop down menu to select text formatting: (no rules),
(uppercase) and (first capital letter).

- To confirm new patient entry, press OK button. To cancel, click Cancel.
Whenever a new patient is created, an examination associated with that patient is also
created.

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3.4 REFRACTION EDITING
To edit an exam click the

icon on the Patients/Examinations
List.
Refraction of right eye (OD), left
eye (OS), date and time must be
entered on the input windows.
Enter the values of the sphere in
diopters (Sph), the cylinder in
diopters (Cyl), the cylinder axis in
degrees (Ax), and the distance to
test eyeglass in mm (@) in the
relative fields.
Once the refraction is a valid one
the system calculates the
refraction at the corneal vertex.
If the data is incomplete, the color Refraction editing
of text will be red. If the data are
correctly entered, the color of text
will be grey.
The patient's natural visual acuity is entered in the UCVA (Uncorrected Visual Acuity) box; the
maximum visual acuity attainable with correction is entered in the BCVA (Best Corrected Visual
Acuity) box.
The Cancel button closes the window without saving the changes. To save the entered data,
click the OK button.
3.5 RIGHT AND LEFT EYE GALLERY
When an exam previously stored in the Gallery on the right-hand side of the main screen is
selected the gallery will show the images relative to each exam that is selected.
The images are subdivided by OD (right eye) and OS (left eye).
Examinations gallery

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Images are browsable by selecting one of the thumbnails in the gallery: when selected it
displays a preview of the summary of the selected examination in the middle portion of the
screen.
- Click the icon to add a tag (or multiple tags) in a single examination.
The caption of the thumbnail can be edited in order to insert comments and notes by clicking
icon.
It is possible to set a favorite exam by clicking icon.

Double-clicking an image opens the processed image summary, according to the exam type.
TAGS
Tags dropdown menu on the main screen
A type tag may be associated to each eye of each examination: cataloging the examinations by
homogeneous type tags is useful as a search aid.
Click the icon to open the pull-down menu of the entered new tags or select one of the
existing tags.
The pull-down menu opens a text box in which to enter the name of the new group.
Advanced tags management
Advanced tags management
The icons opens Advanced tags management .

This window shows the number of exams that are present for each tags.
- Right click the mouse to edit or delete a tag and search exams by tag.
After clicking icon, it's possible to filter the list of thumbnails in the gallery by selecting
one of the tags.

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3.6 SETTINGS
To open the settings' window click the icon in the toolbar.
Main screen toolbar: Settings button

LANGUAGE
Allows the selection of language to be used by the software.
Settings: Language tab

Available choices are:
- German
- English
- Spanish
- French
- Italian
- Dutch
- Polish
- Portuguese
- Chinese

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DATABASE
Warning: this section should be handled with caution. Editing database management could
result in loss of all patient data and existing examinations.
Default database path and options should never be changed unless there is a real need (for
example connecting to a database file located on a remote server).
- Click the icon to change database

paths. Click the to create a new
database.
Database path: Sets the path for the

Database .db3 file. This file contains all
data related to patients, examinations,
groups etc.
Image folder: Sets the path for the image
root file. Such file consists in a position-
marker, meaning that the directory that
contains this file is used to store all the
images acquired by the software. Please
note that images are not stored in the
database .db3 file as they require a stand-
alone directory in the hard drive.
Database backup folder: Sets the path
where to backup the .mdb file. Images will
not be backed up automatically.
Convert a database from previous
software version: Start the process to
convert a database .mdb to a database
.db3 (the current version).
In order to use MySQL you must indicate

the Server location path, Port, Username
and Password of the database.

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MISCELLANEOUS
It is possible to change preferences about "Job Scheduler", "Display confirmation questions",

"Singleton policy", patient list limit and "show indices export button".
If the button is blue the option will be enabled. If the button is grey the option will be disabled.
It is possible to set a start-up password also.
DICOM
This section enables the setup interface for DICOM.

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CONNECTIVITY
"External OSDI Test spooling path" is used to import .xml file to personalize OSDI Dry Eye
Report. It is necessary to indicate the external OSDI Test spooling path by pressing button.
"BCS Save" it is allowed to select swap files to run the customizable Plug-in.
MAINTENANCE
Warning: the use and the setup of tools and settings descripted on this paragraph is indicated
for advanced users.
Settings: Maintenance tab

"Fix and compact database (SQLite only)" it is allowed to regenerate and fix some database
issues.
"Advanced database management" allows the user to merge databases.
"Convert a database froom previous software version" allows to import and use an older
database on the new software version (from *.mdb to *.db3).

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"Save/Load database configuration" allows to export/import a file *.ini which describes all the
information of the database in use. The use of this setting is highly reccomended for network
administrators.
It is possible to open the Software's logs folder by pressing "Open logs folder” link.
It is possible to manage and/or upgrade the license by click on "Upgrade license".
"Updates Manager" allows to download and install external software's components: BcsSave,
BcsEyeLite, BcsKatt. BcsEasyFit, BcsIAssort, Manual EN, Lenses Database. After selecting
"Updates Manager" the application will be closed and a screen will open where it will be
possible to install updates.
Screen: Updates Manager
"Get TeamViewer" allows the user to download and launch TeamViewer to start a
support session.
Settings "Maintenance": Get TeamViewer

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3.7 IMPORT/EXPORT EXAMINATIONS AND TESTS
To export a single exam or a

patient, right-click on the
corresponding line of the
Patients/Examinations list panel
and click the icon or select

Add patient  Export patient 
Export selected patient

icon.
To export multiple exams or a
patients select Add patient 
Export patient  Export all
patients actually in list Export procedure

icon.
After indicating the path of the
export file confirming and a file
will be created with extension
zc2.
To import an existing zcs or zc2

file, drag and drop the file into
the Patients/Examinations list
panel or select Add patient 
Import patient icon in the

main screen.
Import procedure

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3.8 EXPORT INDICES
To open the export indices window click the icon in the toolbar.
Step 1:
Allows the selection of exam typology to be exported.

Available choices are:
- Cornal Topography
- Scheimpflug Corneal Mapping
- Aberrometry
- AS-OCT Corneal Mapping
To choose the indices to export click on "Configure" button (Step 1a).
Click on "Next" button to "Define filters" (Step 2).
Step 1a:
Allows the selection of indices to be exported.

For each of exam typology there are different combination available. Click on "Ok" button to
confirm the selection.

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Step 2:
Allows the selection of the filters by tags and by exam date.

Click on "Next" button to "Select export path" (Step 3).
Step 3:
Allows the selection of the .csv export file path.

Click on "Start" button to start the export.

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Exporting:
This windows shows the duration and info of the export in real time. Click on "Cancel"
button to stop the export.
Click on "Hide" button to continue the export in background.
Click on "Pause" button to stop momentary the export (Pause/Resume Export).
Pause/Resume Export:
If the export is paused it is possible to resume it by clicking icon

on the Main screen toolbar.
Click on "Yes" button to resume the export.

Click on "No" or "Cancel" buttons to end the export.

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4 EXAMINATIONS
4.1 ABERROMETRY
ACQUISITION
The icon on the main screen becomes active when a new examination is created or when
an empty exam is selected. Clicking the icon starts the image capture process. The instrument
will automatically set to the image capture mode and a live capture window opens.
Acquisition
Centering and focusing

To correctly center the instrument, position the cross-hair target between the reflected white
spots. To obtain the correct position move the joystick right or left to perform horizontal
movements, or turn the joystick clockwise-counterclockwise to perform vertical movements.
Once the instrument is centered focus the image of the iris by moving the joystick back and
forth.
Acquire
When the instrument is centered and focused at the correct distance, press the button on the
joystick and wait the device to perform the full aberrometry capture. Once the images is
captured a thumbnail is shown on the left or right side of the screen according to the
acquisition laterality.
If the Fogging buttons was set as active the last step of the acquisition will be a fogging
procedure else the fogging will be skipped.
Image storage and preview
It is possible to manage the images in the gallery, by selecting whether an acquisition have to
be saved or deleted. By left-clicking on the small thumbnail of the acquisition on the gallery a
preview is shown instead of the live panel. A double left click on the thumbnail will set the
relative acquisition as "to be deleted", the thumbnail will be marked with a litter bin, and will
be not saved once the live session is over.

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Settings
To access to the acquisition settings click on the icon.
Aberrometry settings
It will be possible to choose which map to display in overlay (OPD, refractive error
representation or nothing), or to choose the number of acquisitions per session (1, 2 or 3) and
the number of frames per acquisitions (10, 20 or 30). It will also be possible to enable or disable
the saving of the captured video by selecting the "Movie recording" button.
Once all the images needed have been captured, the capture environment may be closed
pressing the button; the program returns to the main screen.

Select one of the captured images to process it and access the Optical Analysis Summary.
Device measurement check
To check the correct device measurements, create a test patient and examination, then
acquire some images of the test eye.
Click on icon and select the Aberrometry examination.

Press the combination CTRL+T on the keayboard to activate the "TestEye" mode.
"TestEye" modality acquisition must be used only with the Aberrometric Calibration tool
(matched with device).
Aberrometry - Test Eye modality: must be activated with Ctrl+T keyboard sequence and must be used with
Aberrometric Calibation Tool.
After acquiring the images, press the button and reprocess the acquired examinations.
Open the acquisitions and verify the displayed values.
The target value is reported on the back side of the test eye; measured value should match
target value +/- 0.125D.

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MENU
A menu is displayed at the top of the screen: a short description of the functionalities and
options associated with the icons follows.
File
Save screen- Opens a window from which the current screen-capture can be saved in
capture as image various image formats.
Print screen- Opens a window to set-up printing parameters and to print the current
capture screen-capture.
Print screen- Directly prints the screen-capture.
capture
(Immediate)
Print Print report of the aberrometric examination session, in graphics form
Print (Immediate) Directly print.
Menu Toolbar
Summary Opens up the default overview summary, containing information on
aberrometry and refractive error.
Optical Quality Opens up a summary report showing patient's quality of vision.
Summary
Images Displays the image of the iris and pupil at acquisition time
Movie If present, displays the video of the iris and pupil at acquisition time
Compare Wave- Allows for a comparison of 2, 3 or 4 different acquisitions

Fronts
Compare OD-OS Allows comparison of the current eye and the fellow eye.
Subtract Shows the difference-map between 2 acquisitions.
Export Exports for external program (.csv)
Favorite Allows you to set an acquisition as a favorite
Settings Set-up user preferences for the display.
Close Closes the current analysis environment and returns to main page.
Quit Exits the application after confirmation of the warning message.
Fellow eye Switch to the fellow eye.
Instruments Toolbar
Pupil diameter Allows you to set pupil diameter to be analyzed in a range from 2 mm to
5 mm or max diameter.

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SETTINGS
Settings screen is displayed by choosing Settings from the menu toolbar.

User preferences for the way the representation of measured information is displayed can be
changed here.
Settings: Scales
Coordinate system
- Polar/Cartesian: Each point position will be expressed in ρ (distance from center) and @
(position in degrees) or in x (horizontal distance from center) and y (vertical distance from
center).
Zernike coefficients units
- Measure unit: Micron or Eq. D will be used as measure unit.
Wave-Front maps representation
- WFE/OPD: Displays the WFE (WaveFront Error) or the OPD (Optical Path Difference). OPD
and WFE relate as follows:
- OPD(x,y) = -WFE(x,y)

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Cylinder notation
- Negative/Positive: Negative or Positive notation will be used as cylinder notation.
Refraction
- Pupil diameter: choose beetwen 3mm and 4mm.
- Vertex distance can be changed
- Seidel correction
Scales
Settings Scales screen is displayed by clicking with right mouse button on every single scale
displayed in the main screen.
Three different color scales are available to choose from:
- Klyce/Willson
- Schwind
- American style
- ANSI Z80.23
It is possible to set the scales range value: ±2μm, ±5μm, ±10μm, ±20μm, ±50μm.
PRINTING
Print screen capture

You can access the print functionality through Print and Print screen under the menu File.
With reference to the print preview, it is possible to check the report preview, adjust print
settings and add an optional header.
Print (Quick) and Print screen (quick) functionality, also under the File menu, allows you to
print without preview.

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4.2 DYNAMIC ACCOMODATION

ACQUISITION
Acquisition
an empty exam is selected. Clicking the icon starts the image capture process. The instrument
will automatically set to the image capture mode and a live capture window opens.
movements, or turn the joystick clockwise- counterclockwise to perform vertical movements.
forth.
Dynamic accommodation settings

Acquire
joystick and wait for the device to perform the full dynamic accomodation acquisition process.
Once the images are captured, thumbnail images are displayed on the left or right side of the
screen depending on which eye was measured.

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Acquisition modalities
Generally, the device target is presented to the patient at the dark focus (unless otherwise
specified) and moves closer, providing an accommodative stimulus.
Once the images is captured a thumbnail is shown on the left or right side of the screen
according to the acquisition laterality.
Three main acquisition modalities are available:
- Square wave:
The patient optical target postion is represented by a square wave curve repeated twice. The
amplitude of the stimulus and ground level are adjustable:
- FF (Far Focus) level: it represents the far position of the stimulus and can be set up
either in Auto mode (DF, i.e. dark focus) or in Manual mode from -6 D to +4D with
0.5 D steps.
- Amplitude: it represents the accommodative step request and can vary from 1 D to 6
D with 1 D steps.
- ΔT: it represents the duration of the step and can vary from 1s to 5s.
- Discrete ramp:
The patient optical target position is represented by a step ramp wave curve. The amplitude
of the stimulus is 1 D and the ground level are adjustable:
- FF (Far Focus) level: it represents the far position of the stimulus and can be set up
either in Auto mode (DF) or in Manual mode from -6 D to +4 D with 0.5 D steps.
- ΔT: it represents the duration of the step and can vary from 1s to 5s.
Compression rate
In order to reduce to the processing time and the file size in the database it is possible to
set up a compression factor.
Possible options are:
- 1:1: No compression factor
- 4:1: 1 sample out of 4 is saved and stored
- 9:1: 1 sample out of 9 is saved and stored
- Accommodation Chart: only the chart is saved and stored but the aberrometries are
discarded
preview is shown instead of the live panel. A double left click on the thumbnail will set the
relative acquisition as "to be deleted", the thumbnail will be marked with a litter bin, and will
be not saved once the live session is over.
Select one of the captured images to process it and access the Dynamic Accomodation
Analysis.

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SETTINGS

changed here.
Dynamic accommodation settings

Coordinate system
center).
Zernike coefficients units
- Measure unit: Micron or Eq. D will be used as measure unit.
and WFE relate as follows: OPD(x,y) = -WFE(x,y)
Cylinder notation
- Negative/Positive: Negative or Positive notation will be used as cylinder notation.
Refraction
- Pupil diameter: 3 mm or 4 mm.
- Vertex distance: allows to set manually the desired vertex distance.
- Seidel correction: allows to use/not use the Seidel correction.

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Scales
Settings: Scales
- Klyce/Willson
- Schwind
- American style
- ANSI Z80.23
It is possible to set the Range value for following scales.
ANALYSIS
Dynamic accomodation (Square): analysis screen

This display shows an overall analysis of the accommodation.
- A OPD/WFE map is shown on the left side.
- A Refractive error map is shown on the right side.

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Dynamic accomodation: square chart

At the bottom, a chart shows the accommodation and the pupil size trend over time:
- The blue line shows the patient accommodation over time.
- The red line shows the target position (stimulus).
- The green line shows the pupil diameter over time.
It is possible to choose if hide/unhide the three lines by clicking the buttons associated.
A vertical grey line will be visible by clicking with the mouse's left button over the
accomodation chart.
During this operation the OPD/WFE and Refractive error maps will change according to the
time.
Dynamic accomodation: scale chart

On the right panel from top to bottom are shown:
- Miscellaneous information on the patient and the acquisition.
- The decomposition of the wavefront error in terms of Zernike polynomials on the Zernike
pyramid is shown;
The pupil diameter can be chosen on the left side of the screen in a range from 2 mm to 5 mm
(or max diameter).
A set of 36 Zernike coefficents are used for the decomposition of total aberration; the results
of the analysis are reported in the summary as numerical indices and graphic representations.

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PRINTING
Print screen capture screen

You can print the analysis screen by clicking on Print screen capture or Print screen capture
(immediate) under the menu File. With reference to the print preview, it is possible to check
the report preview, adjust print settings and add an optional header.
4.3 FUNDUS CAMERA IMAGING

ACQUISITION
an empty exam is selected. Clicking the icon starts the image capture process.
Image capture and alignment
Position the patient in the chinrest using the canthus mark to get them correctly postioned.
Ask them to look directly at the orange fixation point inside the instrument. Then starting far
away from the patient's eye, view the pupil on the screen, it appears as a very bright and clear
spot. Move slowly towards the pupil, trying to keep it as centered as possible in the middle of
the screen. Raise or lower the instrument if needed, using the joystick. Always make sure the
patient is looking directly at the fixation.
Once the pupil is centered, continue to move in, very slowly, until the patient’s retina becomes
visible. If necessary, focus the image by turning the upper knob on the side of the instrument.
If enabled, the focus assistant will provide visual feedback showing improvement/worsening
of the focus, as described in the section below.

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Stabilize the image making sure

the patient is steady and check
that the light does not flicker.
The image must be uniformly
illuminated. Do not move in
further when the image is
clear; too close a proximity
could generate undesired
reflections.
To capture the focused image
press the white button on the
joystick. The captured image
will be saved in the OD (right Optimal centered acquisition
eye) or OS (left eye) gallery,
depending on which eye was
photographed.
Focus assistant
The software provides two different approaches to provide support in determining when the
image is optimally focused. The focus knob located on the superior side of the instrument's
joystick should be used to adjust the focus once the fundus becomes visible during the
alignment and centering phase.
The focus assistant should be considered reliable only when the image is stable and bright and
the patient is not moving.
Focus assistant slider in neutral position
Exposure trackbar
Sometimes clinical conditions of the patient's fundus include hyper-reflecting areas which are
over-saturated by the camera flash light of the instrument (i.e. implanted retinal microchips).
The result is an image where interesting details are over exposed as white saturated spots.
Lowering the exposure value using the Exposure Trackbar lowers the cameras response to the
flash light, making such details perfectly visible while the rest of the fundus layer might become
much darker.
Exposure Trackbar

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Checking the acquisition

Once the image has been captured a thumbnail image pops-up in the respective OD/OS gallery.
Click the thumbnail to view the image, then click anywhere in the screen to get back to the
image capture process. Right click on the thumbnail to view the acquired infrared image, or
choose Delete to cancel the image from the gallery.
Implanted microchip with hyper-reflecting metallic parts
MultiFix functions
Advanced MultiFix functions are available only on MultiFix Fundus Camera models.
MOSAIC PREVIEW MODE
Mosaic preview window

Mosaic preview mode will be automaticaly activated when the fixation point is changed.
disabled after laterality change. Mosaic preview mode will be automatically disabled after
laterality change.
Please note that software version v3.4 and superior provides the mosaic function enabled by
default.

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Please note that the purpose of Mosaic preview mode is to provide live support when acquiring
images for mosaic construction. Any images can be used for mosaic creation later in the
Mosaic creation window, even if they were taken with the Mosaic preview mode deactivated.
When mosaic preview mode is enabled, anytime a new retinal image is acquired the system
tries to insert it in a mosaic preview.
When the new picture matches correctly, a mosaic preview window pops-up at the bottom of
the screen showing all the matching pictures merged together.
The purpose of mosaic preview mode is to show a preview of how the acquired images are
currently matching a mosaic. When the examination is complete all the images are available
for the final mosaic composition, so the mismatching pieces can still be inserted manually even
if they don't currently match the mosaic in the live preview.
Tip: always compose the mosaic starting from the center (a retinal image with the optical nerve
centered in the image, or at least present in the image), then acquire all the peripheral images
in any order.
MULTIFIX FUNDUS CAMERA
MultiFix models provide extra functions in addition to the standard Fundus Camera features.
MultiFix Fundus Camera is provided with 9 fixations leds which can be switched during the
examination in order to capture a complete mosaic of the fundus.
The MultiFix interface allows for rapid switching between central (C), superior (S), inferior (I),
temporal superior (TS), temporal inferior (TI), nasal superior (NS), nasal inferior (NI), nasal (N),
temporal (T) fixation.
Fixation selection interface
- Click the desired fixation to change the active led.

- Alternatively, use the numeric keypad or arrows on keyboard to move the fixation cursor
on the checkerboard.
Every fixation position displays a "preview" of what the acquired area of retina should look
like. The preview changes according to the current laterality.
When a picture is taken, the preview is replaced with the real image and, if the picture fits the
actual mosaic, it is merged into a mosaic preview.

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ANALYSIS
This section describes the advanced functions and tools which are available only for Fundus
camera images.
MENU
File
capture
(Immediate)
Print Print report of the fundus camera imaging examination session, in
graphics form
Filters
This set of image filters provides different levels of interpretation for a single fundus image.
No filter allows you to view the captured image without filter
IR filter allows you to view the image acquired with the addition of the IR filter
Red filter allows you to view the captured image with the addition of the red filter
Green filter allows you to view the captured image with the addition of the green
filter
Red free filter allows you to view the captured image with the addition of the red free
filter
Blue filter allows you to view the captured image with the addition of the blue
filter
Menu Toolbar
Compare Compares two or more fundus camera images into a single screen.
Merge mosaic Allows you to create a mosaic by selecting a maximum of 9 single fundus
camera acquisitions
Previous Switch to the previous acquisition.
Next Switch to the next acquisition.
Settings Allows the user to show patient's info on image and select the units of
measurement (millimeters or microns).
Manual Provides access to the software manual.

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Close Closes the current analysis environment and returns to main page
Fellow Eye Switch to the controlateral eye.
Settings
Measure unit Changes measurement unit between microns and millimeters. This
action is possible only if the picture was acquired with a calibrated
instrument, otherwise only pixel unit measurement is available.
Show on image Show or hide patient's info
INSTRUMENTS TOOLBAR
A instruments toolbar is displayed at the right of the screen: a short description of the
Zoom mode If selected the "Ctrl key + mouse wheel" combination will change the
image zoom.
Distance Allows for measurement of a distance between two points on the image.
measurement Click to mark the starting point and click again to mark the end point. To
delete the latest measurement, press Del or Backspace key.
Define Allows for measurement of a distance between two points on the image.
(type 2) delete the latest measurement, press Del or Backspace key.
Angular Allows to draw and measure an angle. To draw the angle, click to mark
measurement once the vertex and two times to indicate both sides of the angle. To
Horizontal angular Allows you to draw and measure a horizontal angle. To draw the corner,
click to mark the vertex and click again to indicate the width of the
corner. One side of the corner is by default horizontal the other side is
selected by the examiner. To delete the last measurement, press the
Delete or Backspace key.
Vertical angular Allows you to draw and measure a vertical angle. To draw the corner,
corner. One side of the corner is by default vertical the other side is
Area meauseremnt Allows you to measure an area. To draw a polygon click with the right
mouse button on 3 or more points of the image, to close the polygon
click with the left mouse button. To delete the last measurement, press
the Delete or Backspace key.
Optical disk This tool provides manual setting of the Cup-to-Disc ratio measurement
marker on the image
Draw arrow Allows to draw arrow on the acquisition's image.
Draw rectangle Allows to draw rectangle on the acquisition's image.
Draw text Allows to draw a text box on the acquisition's image.

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MOSAIC
The mosaic or panoramic mode, can be used to extend the field of view for the fundus camera.
The software matches single images and provides the User with an overview of the central and
peripheral areas of the retina.
Please note that Mosaic preview mode can be activated during image acquisition in order to
provide live support in acquiring well-matching mosaic images.
- From the Analysis menu, click the icon to access the Mosaic mode. This mode can be
accessed from any acquisition in the study, then all other acquisitions will be
automatically added to the mosaic, up to a total of 9 acquisitions.
Step 1: click on Mosaic icon on the menù toolbar

- If the study contains more than 9 acquisitions, the Image Selection window is presented
to select the desired acquisitions until the maximum allowed number is reached.
Step 2: double-click to select single Fundus camera acquisition, confirm the selelction by press "Ok" button
Step 3: software is creating the mosaic

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Step 4: mosaic is created (Mosaic mode)

The mosaic is shown as a set of fixed overlapping images and the global image can be moved
and zoomed in or out using the mouse and mouse wheel. Single mosaic images cannot be
moved or rotated here.
Single image Allows you to exit mosaic mode and return to a single fundus camera
acquisition
Edit mosaic Every single mosaic image is now selectable (circled in red) and can be
dragged using the left mouse button or rotated using the mouse wheel.
While being dragged the mosaic image becomes transparent to make
manual linking easier.
This way any issue due to the automatic reconstruction can be fixed
manually.
Right-clicking on a single image brings up a pop up menu that enables you
to remove that image from the mosaic. Removed images are placed in a
gallery on the bottom of the screen. All images that were not selected for
the automatic reconstruction process are also placed in this gallery. They
can be re-inserted manually in the mosaic by double-clicking them from
the gallery.
Step 5: edit mosaic (Manual edit mode)

Merge mosaic This button finalizes mosaic creation as it merges all overlapping images
together in a single image, excluding all the pictures that have been
placed in the discarded gallery.

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All image edges are smoothed and image transitions combined in a more
uniform image.
Save mosaic The composed mosaic is saved as a stand-alone acquisition and becomes
available in the examination gallery.
CUP-TO-DISC RATIO
- Click Optical disk marker icon to start a manual measurement.
Optical disk marker measurement requests 6 points to create circular cup and disc.
- Click the icon from the Tools Menu in the main image interface to start this
measurement.
- First mark three points on the image to set the external optical disk circle, then mark
another three internal points to set the cup. Cup/Disk Area ratio is displayed inside the
measurement for immediate evaluation once the operation is complete.
Cup and disk areas marked this way are two perfect circles set by the three points.
- It is possible to modify the position and the radius of the circles by moving the 6 points
previously created using the left mouse button.
Manually edited optical disc with reliable cup

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PRINTING
You can access the print functionality through Print and Print screen capture under the File
menu.
Print (immediate) and Print screen capture (Immediate) functionality, also under the File
menu, allows you to print without preview
Fundus camera printing preview

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4.4 MEIBOGRAPHY
The purpose of Meibography is to evaluate the health of meibomian glands.
Such examination can be performed by scheimpflug camera, keratoscope or fundus camera
using the instruments’ IR (infra-red) illumination source, since meibomian glands cannot be
spotted using standard visible light illumination.
After the IR images of meibomian glands have been acquired using the Live acquisition
environment of the selected instrument, they have to be manually processed by the operator
in order to calculate the gland health score and save it for further patient evaluation.
As a principle, the glands’ health tends to decrease as its area becomes smaller inside the eye-
lid: while a healthy eye presents the inside of upper and lower eye-lids completely filled with
meibomian glands, a suffering (dry) eye presents a surface of “eroded” meibomian glands. So
the main idea is to calculate the ratio between the area covered with glands and the total eye-
lid area. A low ratio determines a high probability of suffering dry eye.
Meibomian glands examination involves acquisition and further analysis.

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ACQUISITION
Meibography images can be acquired by scheimpflug camera, keratoscope and fundus camera.
Please note that there could be some major differences in images acquired with the different
instruments due to the individual optical engineering adopted in each of them. Meibography
examination should indeed be considered as a secondary examination type which takes
advantage of the infra-red illumnation capalibilies of the mentioned instruments, whilst they
have been developed for completely different primary tasks.
When acquiring with scheimpflug camera it is highly advisable to place a 4x Lens in front of the
instrument, otherwise the image cannot cover the whole glands area due to a reduced field of
view.
The acquisition procedure explained below is very simple and is replicable using every
supported device.
- Start the acquisition and prepare the patient by exposing the upper-lid and lower-lid
meibomian glands, in any order.
- Center the glands on-screen and focus the image moving the instrument forwards or
backwards (or using the focus handle in case of fundus camera).
- Take the picture using joystick button. Acquired picture will be shown on screen as a
thumbnail. Acquire at least one image for the upper-lid and one for the lower-lid.
- After a satisfactory amount of images has been acquired, exit Live acquisition.
After the acquisition is complete, exit the live environment and open the examination to start
the analysis.
Meibography acquire form

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ANALYSIS
Enter the meibography examination gallery in the main screen and double-click on the desired
image to start meibomian glands evaluation. The procedure is computer-assisted but requires
manual tracing of glands points.
Select the eye-lid (Step 1)
First of all, use the buttons on the top-left of the screen to select the evaluation for upper-lid
and lower-lid, respectively: the example described above shows a case where the lower lid
evaluation is selected.
The same buttons can be used to delete the evaluation measure and restart the process at any
time. Deletion is preceded by a confirmation message.
Deleting the measurement means that all control points currently displayed will be lost.
Fig 1. Upper / lower eye lid selector

Trace eye-lid boundaries (Step 2)
Four (4) control points must be set in order to define a very raw bound of the eye-lid’s area of
interest.
Place the blue points in order to build a trapezoidal shape. Exclude lid areas that are not
completely reverted, since they are not useful for the computation.
One point (in the example case the left-most one) should be placed near the tear punctum,
while the opposite side points (the right-most ones) should be placed on the end-fold of the
eye-lid or, as stated before, where the eye-lid is not completely reverted anymore. All the
control points that have already been set can still be canceled until the last point is set by
hovering the mouse on them and left-clicking when the white cross appears.
The bounds (red lines) do not need to be very precise in this phase, since they will be adjusted
automatically in the next phase.
Fig 2. Correctly selected eye-lid area. The red cross indicates the area that should not be selected since the eye-lid is
not completely reverted there.

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Adjust the boundaries (Step 3)

Use the all yellow points to adjust the red shape. Try to move the points (including the 4
manually set points) and see how their movement affects the global shape.
The yellow points at the end of the yellow lines can be stretched, such as to modify the
curvature of the red shape.
The mechanism is very intuitive anyway: try to approximate the eye-lid shape, but remember
that there is no need to be too strict in this approximation.
Fig 3. Adjust the boundaries by moving the yellow control points
Trace the glands points (Step 4)

Highlight the glands area by left-clicking on the upper glands bounds (or lower bounds, in case
of upper eye-lid meibography).
Every click adds a green gland-point: the more points are set, the more accurate the gland area
is. It is also possible to keep the mouse button clicked, then moving the mouse to draw the
glands bound: green points will be automatically set.
Avoid crossing lines or creating loops or complex paths.
It is not possible to create gland points outside of the red bounds: a mouse-click outside the
red borders will result in the adding of a gland point on the nearest red bound.
Fig 4. Marked green gland-points

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Edit the glands points

Defined points can be removed by left-clicking the mouse; a white cross appears on the point
when the mouse passes over the point. Right-click on a single point pops up a context menu
which allows removing the single point or all the gland points defined so far.
New points can also be set between existing ones in order to refine the green line shape. Just
move the mouse between points to obtain a preview of the new point’s influence, then left-
click to add it to the points set definitively.
Fig 5. Edit existing glands points

Switch between zoom mode and trace mode
Sometimes it is necessary to zoom in the image to obtain more precision in tracing gland
points.
If selected the "Ctrl key + mouse wheel" combination will change the image zoom.
Fig 6. Zoom mode

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Finalize meibography examination

Once all gland points have been placed, click the icon to end the editing phase.
Healthy gland area will be drawn in green, while loss area will be red.
Area of loss score is calculated together with a pre-established degree in the meibomian scale.
Score and degree are printed and visible directly on the image, while a detailed review of the
attributed score is available in a separate window which appears on the left of the main form.
Meibography score is automatically calculated even if the flag-button is not pressed and edit
mode is closed by clicking the quit button.
The updated image can now be printed (alone or compared with other processed or
unprocessed meibographies), saved in pdf format etc.
It is possible to delete the evaluation measure and restart the process at any time by clicking
the "select the eye-lid" icon on the top-left corner of the main form (step 1).
The examination is always editable after re-entering it in the future.
Fig 7. Complete examination

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4.5 AS-OCT BASED CORNEAL TOPOGRAPHY

CALIBRATION
Calibration is essential for obtaining accurate measurements: to calibrate correctly, follow the
step-by-step instructions on the screen and carry out all the captures needed, with the
calibration standards requested in a dark environment, similar to the one used for normal
acquisition.
The steps in instrument calibration are the following:
- Make sure the sphere on the calibration tool is clean and not damaged (do NOT clean with
solvents).
- Place the supplied calibration tools in front of the device.
- Open the instrument menu in the toolbar and click the calibration button.
- Carry out the curvature calibration as described below.
AS-OCT device menu in the toolbar

The entire procedure must be carried out carefully. Please check device steadiness before start
the procedure.
It is highly recommended to calibrate the instrument and check the curvature of the test sphere
at least once a month.

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Curvature Calibration
Curvature calibration is necessary to permit the program to correctly measure the curvatures
and is composed of two steps. Position the instrument as illustrated and follow the instructions
as reported on the windows.
Curvature calibration Step 1/2
Curvature calibration Step 2/2
If the calibration procedure is performed correctly, a confirmation message will appear on

screen. After having successfully calibrated you should do an AS-OCT Topography exam of the
8-mm sphere (eye test modality) to verify correct instrument calibration. If the processed
measurements are not found to be reliable, repeat the entire calibration procedure.

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Last image represents the acquisition summary for a sphere after a correct calibration
procedure.
Acquisition of a 8mm calibration sphere
Device calibration check

Click on icon and select the Corneal topography examination.

Press the combination CTRL+T on the keayboard to activate the "Test Eye" mode.
Open the acquisitions, on the Settings panel select "millimeters" as unit of measurement.
Verify the displayed values: the measured radius on "Tangential Anterior" map should be 8
mm +/- 0.03 mm.
ACQUISITION
an empty exam is selected. Clicking the icon opens the window for selecting the instrument
with which to capture an image.
The window displaying the live images of the capture process shows images from two cameras:
- ASOCT Camera: this camera shows the 0° corneal profile (lower part of the screen) and
permits setting the instrument to the correct distance.
- Central Camera: this camera (upper part of the screen) permits correct centering of the
instrument and monitoring of the tear film.
In order to conduct the examination at the correct distance from the corneal vertex, move the
joystick forward and backward until the corneal vertex is within the green rectangle (ASOCT
Camera). When the joystick is moved forward, the profile of the cornea displayed on the
monitor moves upward; when the joystick is moved back, the profile of the cornea moves
downward. The instrument is centered when the reflected white fixation point, in the middle
of the reflected rings, is inside the aiming cross-hair target (Central Camera). To move the cross
to the left and right, move the joystick to the left and right. To move the cross up and down,
rotate the joystick clockwise and counterclockwise.

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Both distance and centering is incorrect
Distance and centering are correct
AS-OCT Corneal mapping acquisition: schematic correct allignment

Capture and preview
When the instrument is centered and at the correct distance, press the button on the joystick
to capture the image. This action starts the capture procedure (all the reference elements
become grey), at the end of which all data are saved. After each acquisition the OD/OS gallery
are populated; using mouse buttons over each gallery element you can: remove the acquisition
(double-click with left button), check the preview (hold down right mouse button). Once all the
data needed have been captured, the capture environment may be closed; the program
returns to the main screen.

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The 3 scan modes available are: 25x1 (16 mm), 12x2 (16 mm) and 12x5 (10 mm) where: the
first number identifies the meridians acquired, the second number the amount of scans
performed for each meridian and the third number identifies the scans width.
Select one of the captured images to process it and access the Summary.
Right click on gallery thumbnail to get preview
Scan mode selection

Test eye mode
In order to validate instrument calibration you can activate the eye test acquisition modality
(8-mm sphere acquisition) typing CTRL+T and proceed as already described. "TestEye"
modality acquisition must be used only with the Calibration tool (8-mm sphere).
Quit
Once all the data needed have been captured, the capture environment may be closed; the
program returns to the main screen. Select one of the captured images to process it.
MENU
A menu is displayed at the top of the screen: a short description of the available functionalities
and options follows.
File
capture (quick)
Print Opens a window to set-up printing parameters. The final printout is
screen dependent.
Print (quick) Directly prints.

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Edit
Ring/Pupil/Limbus Opens the environment for the editing of reflected Placido rings, of the
editing pupil and of the limbus edge.
Edit sections Opens the environment for the editing of front and back corneal
surfaces, of the iris and of the crystalline lens.
Reprocess Reprocess all OCT images and the keratoscopy.
Summary
Standard Summary Opens up the default overview summary, containing information on
pachymetry, curvature and elevation.
Multimap The screen can be displayed as follows:
(customizable)
- 2x Display 6 maps chosen by the user with the possibility to
customize the summary name.
- 2x Display 4 maps + indices chosen by the user with the
possibility to customize the summary name.
- 2x Display 4 maps + sections chosen by the user with the
Rename summary Allows to customize the summary name.
Sections
Sections Displays the OCT images.
Applanation-like Allows you to smooth out the cornea by flattening the anterior surface.
cornea This modality can be used just for 12x10mm scan mode.
AS Model Displays schematized OCT images.
Single Map
1 map Displays a single map to permit detailed analysis.
IOL
IOL Displays an overview dedicated to IOL calculation.
Keratoconus
Keratoconus Displays a detailed summary of keratoconus.
Wave-front
Zernike summary Displays an overview dedicated to the corneal wavefront analysis.
Optical Quality Opens up a summary focused on the patient quality of vision.

Summary
Other
Advanced Displays a screen for the elevation analysis of anterior corneal surface.
Elevation
(anterior)

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Advanced Displays a screen for the elevation analysis of stromal surface.

Elevation (stromal)
Advanced Displays a screen for the elevation analysis of posterior corneal surface
Elevation
(posterior)
Glaucoma Displays an overview dedicated to the analysis of the anterior chamber,
summary for glaucoma screening.
ICRS summary Displays an overview dedicated to the intra-stromal rings surgery
planning.
Compare
Compare maps Allows comparison of up to 4 different maps.
OD/OS Allows comparison of the current eye and the fellow eye.
Compare Allows comparison of 2 different corneal wavefront maps
wavefront
Subtract
Subtract Show the difference-map between acquisitions (up to 3).
Wavefront Show the difference/map between wavefront maps.

differential
Toolbar
Export Exports for external program (.xyz, .csv, .xml, BCS file)
Settings Set-up the user preferences for the display of topography.
Fellow Eye Switch to the fellow eye.

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SETTINGS

Preferences on the representation of the measured information can be changed here.
- Coordinate system: Polar/Cartesian. Each point position will be expressed in ρ (distance

from center) and @ (position in degrees) or in x (horizontal distance from center) and y
(vertical distance from center).
- Curvature measure unit can be expressed in Millimeters [mm] or in Diopters [D]
according to this setting.
- Cylinder notation: Negative/Positive. Negative or Positive notation will be used as
cylinder notation.
- Asphericity: the asphericity measurement can be set as p, e, SF(E), or Q.
- W-W: when set to "Adjusted" correct the value of W-W with a fixed bias.
- Best-fit type: The reference surface can be spherical, aspherical or asphero-toric
according to the preference and the samples used for the best-fit calculation.
- Best-fit diameter: The reference diameter can be 8 mm, 9 mm or 12 mm.
- Indices printing: By this menù it is possible to choose how many indices display in the
print file: Comprehensive is the standard mode, Essential is the "reduced" modality. It is
also possible to choose to include or not the keratoconus screenig indices.

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Scales
Settings: Scales
- Klyce/Willson
- Schwind
- American style
- ANSI Z80.23
It is possible to normalize scale by clicking icon.
It is possible visualize adjust scale graph by clicking icon.
Settings: Adjust scale

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RING/PUPIL/LIMBUS EDITING
To access the Rings/Pupil/Limbus editing functions select Rings/Pupil/Limbus editing from the
Edit menu.
RINGS EDITING
The software automatically recognizes the keratoscopic ring positions reflected off the cornea,
detecting dark-to-bright or bright-to-dark transitions. The rings detection is emphasized on the
screen as alternating green and red circles.
Irregularities, corneal opacity or shadows from eyelashes or the nose may cause mistakes on
the identification of the rings correct position: it is important to check the correct detection of
the rings before starting the analysis of the topographic maps. The software offers the
possibility to fix the detected rings by manually editing them.
The window contains a set of buttons identifying rings on keratoscopy, and five buttons that
allow editing of the rings.
Rings editing
Selecting a ring
To select a ring move the mouse cursor onto the ring to be selected and right-click or press the
button with the corresponding number on the screen.
When selecting a ring, points situated on the ring are joined by an orange line,the addition or
removal will only happen to this ring.
When selecting a ring, it is possible to select the previous or next ring by using the arrow keys
on the keyboard.
Deleting a ring
To delete points, press the Delete icon. Moving the mouse cursor over the keratoscopic
image and holding the left mouse button, a circular cursor appears: points below the cursor
will be removed. When you select a ring, you can remove only points belonging to that
particular ring. To delete an entire ring press the Del or Backspace key on the keyboard.

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Delete all rings and Recenter
Pressing the Delete all rings icon will erase all the detected points. After confirming the
alert message "Are you sure you want to erase all the rings?" press Recenter and the
program will let you choose a new keratoscopic center. Use arrow keys to find the correct
position of the center and confirm by pressing the Enter key.
Adding a ring
To add points press the Add ring icon and select the ring you want to complete. Then
press the left mouse button on a point that is part of the ring image.
Interpolating rings
To complete a missing part of a ring, just press the Interpolate rings icon.
PUPIL EDITING
After pressing the Edit pupil icon, the pupil is highlighted as a red circle with a red center,
bordered by three yellow crosses.
To change position and size of the pupil:
- Drag and drop the red circle representing the pupil in the right position.
or
- Drag and drop the yellow crosses that define the red circle.
Pressing the Delete pupil icon will delete the pupil.

Right-clicking on the image the corneal vertex will be assigned.
Pupil editing

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LIMBUS EDITING
When you open this editing window, the limbus is marked with two red semicircles.
To change the size of the limbus:
- Drag and drop the blue horizontal arrows and drag to resize the limbus.
- Drag and drop the blue vertical blue arrow to move the limbus vertically.
Limbus editing
SECTIONS EDITING
To access these functions select Edit sections from the Edit menu .
The software automatically recognizes the front and rear surface of the cornea as well as the
iris and the lens.
the edge identification: it is important to check the correct detection of the edges before
starting the analysis of maps. The software offers the possibility to fix the detected edges by
manually editing them.
By selecting one of the 5 tabs the user will be allowed to edit:

- front and rear corneal surface
- crystalline lens
- iris
- angles
- epithelial layer
Once selected, the corresponding surface will change color to yellow and will be ready for
editing.
The meridian to be edited has to be selected by using the mouse wheel: the screen opens on
the horizontal meridian.
By the CTRL button and using simultaneously the mouse wheel the magnification factor of the
image will change.

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OCT images editing

Corneal editing:
To edit the corneal surfaces it is possible to use the delete, the add surface and the smart edit
buttons, in addition to those indicated above.
Allows for deletion of a part of the selected surface: by left-clicking, the samples close to the
clicked point will be removed from the surface.
Allows addition of a part of the selected surface: by left-clicking on a point of the image the
closest edge will be selected, tracked and added to the current surface.
Smart edit: allows you to manually edit the curvature of a narrow segment of the corneal
edges.
Smart edit

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Crystalline lens editing:

To edit the front surface of the crystalline lens it is possible to drag and drop the three yellow
points by the left-clicking.
Cristalline lens editing

Iris editing:
To edit the iris surface it is possible to use the delete and the add buttons, in addition to those
indicated above.
Iris editing

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Angles editing:
to edit the angles it's possible to move the yellow point (SS) by left-clicking.
Angles editing
Epithelium editing:
to edit the epithelium surfaces it is possible to use the delete and the add buttons, in addition
to those indicated above.
Epithelium editing

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PRINTING
menu.
Print (immediate) and Print screen capture (immediate) functionality, also under the File
menu, allows you to print without preview.
Print preview

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4.6 AS-OCT SINGLE SECTION ANALYSIS

ACQUISITION
Focusing and angle selection
With this exam you can acquire a specific corneal section simply by selecting the desired
position and angle. In order to conduct the examination at the correct distance from the
corneal vertex, move the joystick forward and back until the corneal vertex is within the two
green lines (ASOCT Camera) When the joystick is moved forward, the profile of the cornea
displayed on the monitor moves upward; when the joystick is moved back, the profile of the
cornea moves downward. To move the central camera cross to the left and right, move the
joystick to the left and right. To move the cross up and down, rotate the joystick clockwise and
counterclockwise. The section angle can be changed simply rotating the wheel placed on top
to the joystick; angle selection status is highlighted by the presence of yellow reference lines.
During angle selection status the acquisition is disabled.
Photo capture
When the desired section is displayed at the correct distance press the button on the joystick
to capture the image. This action starts the capture procedure (all the reference elements
become red), at the end of which all data are saved. After each acquisition the OD/OS gallery
are populated. After each acquisition the data will be processed, the number of instances
currently under processing are indicated by an icon reporting this number (i.e.
). Application exit is disabled until processing is complete.
Movie capture
If you want to acquire an entire video of the corneal section you can switch to movie mode
selecting , proceed selecting the section angle and acquisition width desired and start
registering the movie pressing joystick button. You can stop the movie acquisition pressing the
joystick again. During this acquisition angle and width change are disabled.
Select scan mode
It's possible to select the preferred scan modality:
- x1: Allows to acquire a single section at any angle.
- x2: Allows to acquire 2 meridians (0°, 90) by a single joystick shot.
- x4: Allows to acquire 4 meridians (0°, 45°, 90°, 135°) by a single joystick shot.
- Raster: Allows to acquire parallel sections (N° = 3, 5, 7) ranging from 0.3 mm to 1 mm
distance.
- Sector: Allows to acquire multiple sections (N° = 3, 5, 7) ranging from 3° to 45° angular
distance.
- 0-360° Δ10°
Capture settings
Switch between High Definition acquisition mode and Raw acquisition mode.
Switch between Full Section (16 mm) and Epithelium Mode (10 mm) acquisition
mode.
Switch between movie and photo mode.

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Change placido light condition among: Scotopic (off), Mesopic, Photopic
Set acquisition preferences as default
Quit
Gallery
After each acquisition the OD/OS gallery are populated; using mouse buttons over each gallery
element you can: remove the acquisition (double-click with left button), check the preview
(hold down right mouse button). Preview will show photos and movies acquired.
Quit
Section aligning Setting section angle
Live Preview

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MENU
File
capture
(Immediate)
Print Print report of the AS-OCT Section examination session, in graphics form
Menu Toolbar
Scleral Lenses Allows you to identifies and measures the sagittal values useful for
setting up the scleral lenses.
AS model Allows you to measuring distances and angles on the section without the
effect of distortion.
Applanation-like
Allows you to smooth out the cornea by flattening the anterior surface.
cornea
Compare Set the screen for comparison with another section acquisition. This
button is also available in the toolbar of the main screen
Close Closes the current analysis environment and returns to main screen

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ANALYSIS
SINGLE SECTION IMAGE
Single section image exam can be used to show and make measurement of interesting cross-
sectional structures.
Single section image

The toolbar menu is located at the top of the analysis screen.
At the left side of the image a instruments toolbar can be found.
MEASUREMENT OF ANGLE-OPENING DISTANCE (AOD) AND TRABECULAR IRIS SPACE
AREA (TISA)
AOD and TISA measures

- AOD is calculated as the perpendicular distance measured from the trabecular meshwork
at 250 μm, 500 μm and 750 μm anterior to the scleral spur to the anterior iris surface.
- TISA is an area bounded anteriorly by the AOD, posteriorly by a line drawn from the
scleral spur perpendicular to the plane of the inner scleral wall to the opposing iris,
superiorly by the inner corneoscleral wall and inferiorly by the iris surface.
This function is enabled only for acquisitions made with the Full Section mode (16 mm).

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INSTRUMENTS TOOLBAR
Instruments Toolbar
A instruments toolbar is displayed at the right of the screen: a short description of the
image zoom.
Click to mark the starting point and click again to mark the end point. To
Define index It defines a custom refractive index to be applied to the previous distance
tool.
Angle Allows to draw and measure an angle. To draw the angle, click to mark
once the vertex and two times to indicate both sides of the angle. To
Magic wand When selected, clicking on a point of the anterior chamber, a line passing
through that point going from the corneal posterior surface to the iris or
to the lens will be drawn and measured. If the point is higher than the
anterior surface it will measure corneal sagitta, when lower than the
posterior surface, the anterior chamber depth is measured. The function
will not work outside of mapped zones. To delete the latest measurement,
press Del or Backspace key.
Magic wand with Similar to magic wand but adds an intermediate measure on the clicked
middle point position.
Iridocorneal angle Show iridocorneal indices: AOD and TISA.
indices

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4.7 AS-OCT LENS BIOMETRY ANALYSIS

ACQUISITION
- ASOCT Camera: this camera shows the 0° corneal profile (upper part of the screen) and
permits setting the instrument to the correct distance.
- Central Camera: this camera (lower part of the screen) permits correct centering of the
instrument
Using the central camera put the reflected white fixation point into the green cross. To move
the cross to the left and right, move the joystick to the left and right. To move the cross up and
down, rotate the joystick clockwise and counterclockwise.
Now maintaining the previous position on the central camera move the joystick forward until
the first eye lens surface is inside the upper green rectangle. When the joystick is moved
forward, the profile of the cornea displayed on the monitor moves upward; when the joystick
is moved back, the profile of the cornea moves downward.
Capture and preview
When the instrument is at the correct distance, press the button on the joystick to capture the
image. This action starts the capture procedure (all the reference elements become red), at
the end of which all data are saved. After each acquisition the OD/OS gallery are populated;
using mouse buttons over each gallery element you can: remove the acquisition (double-click
with left button), check the preview (hold down right mouse button). Preview will show the
estimated biometry lens thickness and anterior chamber depth for 0° and 90° sections. For
each acquisition there is a score index indicating the acquired data quality; we suggest to use
acquisitions with scores above 50%.
Exit
Section aligning Live Preview

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MENU
File
capture
(Immediate)
Print Print report of the lens biometry examination session, in graphics form
Toolbar
Save changes Saves the edited changes.

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DATA EDITING
After an acquisition this screen is shown first: it displays the 0° and 90° eye sections with the
data derived from processing each single image. The data showed are the Aqueous Depth (AD)
and Lens Thickness (LT). In order to get the Estimated Lens Equator Depth (ELED¹) follow the
reported instructions for each image:
- Place the upper lateral yellow crosses + over the upper left and right lens edge portions.
- Place the lower lateral yellow crosses x over the lower left and right lens edge portions.
- When the crosses are well positioned the fitting curves and equator line will appear.
- If needed try to adjust the previous crosses in order to fit the lens surfaces as better as
possible. During this task you can use zoom, hide and pan instruments as illustrated on
the toolbar.
- After the editing process you can save changes by clicking button.
ELED¹: is the distance between the lens equator and the back corneal edge at the corneal
vertex.
AD and LT measures shown before editing ELED measure after editing
Correct upper lens edge fitting example Correct lower lens edge fitting example

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4.8 PLACIDO BASED CORNEAL TOPOGRAPHY

CALIBRATION
instructions given step-by-step on the screen and carry out all the captures needed, with the
calibration standards requested in a dark environment.
The steps in instrument calibration are:

solvents).
- Open the instrument Keratoscope menu in the toolbar and click the calibration button;
The entire procedure must be carried out carefully.
It is highly recommended to calibrate the instrument and check the curvature of the test sphere
at least once a month.
Keratoscope instruments panel

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Curvature calibration is necessary to permit the program to correctly measure the curvatures.
Carefully acquire an image of the calibration sphere. If the acquisition is not satisfactory a
message will ask to repeat the procedure.
After having successfully calibrated you should capture some images of the calibration sphere,
creating a patient and a test exam to verify correct instrument calibration. If the processed
Focus-based devices calibration
To acquire an image press the joystick button and move the topographer slowly forward until
the image defocuses again. During this movement make sure that the cross remains near the
center of the rings. Passing through the focus the software captures the best image and the
calibration will be accepted by the software.
Focus-based oopographer: curvature calibration

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Triangulation-based devices calibration

Move the topographer forward or backward: when the device is too far or too close to the
calibration sphere vertex the slits appear disjoint or overlapping in the calibration sphere
periphery.
Instead, when the slits are aligned and overlapping in the center the device will be at the right
distance: make sure that the cross remains near the center of the rings and that the rings are
not corrupted and press the spacebar to grab the image.
Triangulation-based topoaberrometer: curvature Triangulation-based topographer: curvature calibration

calibration (correct alignment) (correct alignment)

Click on icon and select the Corneal topography examination.

Press the combination CTRL+T on the keayboard to activate the "Test Eye" mode.
mm +/- 0.03 mm.
ACQUISITION
an empty exam is selected.
Focus-based devices acquisition
Position the patient's head on the chin rest and move the topographer in front of the patient's
eye you want to acquire.
Adjust the height of the topographer until the cross is in the center of the rings.
Move the topographer forward or backward to find the best focus and then move the joystick
backwards to defocus the image.

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To acquire an image press the joystick button and move the topographer slowly forward until
the image defocuses again. During this movement make sure that the cross remains near the
center of the rings. Passing through the focus the software captures the best image and you
will see it in the gallery. The procedure will be finished when you hear a sound.
To force the acquisition press again the joystick button: the image with the best focus until
than, will be saved.
Acquire several images per eye to choose the best of these, deleting the unclear images.
To check the keratoscopy quality right-click on the thumbnail: the image will be shown on the
live area.
To select/unselect a keratoscopy left-click on its thumbnail: a check/cross icon will appear on
the side.
To process the images, exit the image capture process by pressing the button and select the
keratoscopy to be processed from the gallery images in the main screen.
Focus-based devices: correct acquisition

Triangulation-based devices acquisition
Position the patient's head on the chin rest and move the topographer in front of the patient's
eye you want to acquire. Adjust the height of the topographer until the cross is in the center
of the rings.
Move the topographer forward or backward: when the device is too far or too close to the
corneal vertex the slits appear disjoint or overlapping in the corneal periphery.
On the contrary, when the slits are aligned and overlapping in the center the device at the right
distance: make sure that the cross remains near the center of the rings and that the rings are
not corrupted by tears or eyelashes and press the joystick button to grab the image.
It is possible to manage the keratoscopies in the gallery, by selecting whether an acquisition

have to be saved or deleted. By right-clicking on the small thumbnail of the acquisition on the
gallery a preview is shown instead of the live panel. A double left click on the thumbnail will
set the relative acquisition as "to be deleted", the thumbnail will be marked with a litter bin,
and will be not saved once the live session is over.
To process the images, exit the image capture process by pressing the button and select the
keratoscopy to be processed from the gallery images in the main screen.

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Triangulation-based devices: (Wrong) Topografic Triangulation-based devices: (Correct) Topografic

acquisition. When the device is too far or too close to acquisition. When the device is at the right distance the
the cornea the half-slits appear disjoint or overlapping half-slits appear overlapping in the center
in the corneal periphery
Test eye mode

(8-mm sphere acquisition) typing CTRL+T and proceed as already described.
"TestEye" modality acquisition must be used only with the Calibration tool (8-mm sphere).
MENU
File
capture (quick)
screen dependent.
Edit
Edit Opens the environment for the editing of reflected Placido rings, of the
Ring/Pupil/Limbus pupil and of the limbus edge.
Reprocess Reprocess the acquisition.
Toolbar
Summary Opens up the default overview summary, containing information on

Elevation Displays a screen for the elevation analysis of anterior corneal surface.

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Zernike analysis Displays an overview dedicated to the corneal wavefront analysis.

Summary
CL fitting Accesses the contact lens simulation environment.
Compare
wavefront
Subtract
Subtract Wave- Show the difference/map between wavefront maps.

Fronts
Toolbar
Export Exports for external program (.xyz, .csv, .xyX)

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SETTINGS
Settings screen is displayed b choosing Settings from the menu

Settings
cylinder notation.
Scales
- Klyce/Willson
- Schwind

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- American style
- ANSI Z80.23
Settings: Scales

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Edit menu.
RINGS EDITING
Rings editing
Selecting a ring
When selecting a ring, points situated on the ring are joined by an orange line, the addition or
on the keyboard.
Deleting a ring

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Adding a ring
Interpolating rings
PUPIL EDITING
or

Pupil editing

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LIMBUS EDITING
Limbus editing
PRINTING

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4.9 PUPILLOGRAPHY
ACQUISITION
In the Pupillography environment, the user may make automatic measurements of the pupil
diameter and its offset from the corneal vertex in various controlled light conditions.
If we assume the light contribution from the environment to be null (for this reason, during
the Pupillography examination, the examination room must be completely dark, with the
Pupillograph as the only light source), three lighting conditions are available to the user:
- Scotopic, the only visible light source is the LED source (0.1 cd/m2).
- Mesopic, the disk is illuminated in such a manner as to bring ambient light intensity to
about 1 cd/m2
- Photopic, the disk is illuminated in such a manner as to bring ambient light intensity to
about 10 cd/m2.
- Dynamic, the capture is begun with the disk rings fully illuminated (100 cd/m2 ca.); it is
switched off at the moment capture begins. In this manner, it is possible to monitor pupil
dilation in conditions from photopic to scotopic conditions and analyze pupil size and pupil
offset instant by instant.
an empty exam is selected. Clicking the icon opens the acquisition environment for selecting
the instrument with which to capture.
Selecting light condition, centering and focusing
Correctly position the patient’s head on the chin rest and move the instrument to visualize the
selected eye in the live capture window. Before proceeding with the acquisition select the
desired light condition using mouse, Up/Down arrow keys or rotating the wheel placed on top
to the joystick. To correctly center the instrument set the crosshair target over the fixation
point. To obtain the correct position move the joystick right and left to perform horizontal
movements, or turn the joystick clockwise-counterclockwise to perform vertical movements;
once the instrument is centered focus the image of the iris.
Acquire
When the instrument is correctly centered, press the button on the joystick or keyboard space
bar to capture the image. For Dynamic acquisition a recording message is displayed, click a
second time in order to stop the acquisition. During the dynamic acquisition phase all
functionalities are disabled except for joystick and spacebar.
For acquisitions in static light conditions (scotopic, mesopic, or photopic), 3-5 seconds delay
between captures are generally sufficient, since the observable phenomenon should already
be established. In the case of dynamic acquisition we recommend continuing capture until the
pupil has assumed a dilation that may be reasonably considered to be the maximum for the
lighting condition.

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Acquisition Dynamic acquisition
Preview
Preview image (with perimeter and pupil center superimposed) can be displayed by keeping the mouse
left button pressed over the corresponding button as shown in Preview figure. For dynamic acquisition
the entire image sequence is displayed.
Preview Dynamic Preview
Exit
Once the images have been acquired you can complete the process using the button; in this
case the program return to the main screen from which you can proceed with the subsequent
analysis procedures of examinations stored.
MENU
options that are available follows:
File
Print Print report of the pupillography examination session, in graphics form.
Edit
Edit Pupil Opens the environment for pupil and corneal vertex editing (Scotopic,
Mesopic, Photopic, Dynamic).

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Reprocess The pupillography images are reprocessed from the top; any changes
made during pupil editing are lost.
Analysis
Single eye Sets the single eye analysis screen. This button is also available in the
toolbar of the main screen.
Compare Set the screen for comparison with the fellow eye. This button is also
available in the toolbar of the main screen.
Tools
Export Allows you to export .csv file of the acquisition.
Information Information about the acquisition device.
EDIT
The program automatically identifies the pupil border. The commands for correcting automatic
editing of the pupil are displayed at the top of the window. By selecting the number of the
image from the drop down menu in the upper right corner of the screen you can choose which
image to edit. The buttons and allow for ignoring the current frame from the
sequence of Pupillography, or to restore it to the sequence. The buttons on the left hand side
allow for the actual editing, as described in further paragraphs. Pressing the Ok button allows
for confirming the changes, and returning to the principal Pupillography screen. The Cancel
button closes the screen without saving the modifications.
Delete Once chosen, the Delete command allows you to remove the existing
Pupillary border by moving the mouse cursor over the border.
Add Once having deleted part of the pupil’s border it is possible to redraw the
border using the Add command.
Recenter To recenter the pupil, move the cursor with the arrow keys towards the
vertex and press Enter.
Interpolate rings You can interpolate the pupil’s border by clicking the button Interpolate
rings.

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Pupil Editing
PRINTING
menu.
Print (immediate) and Print screen capture (Immediate) functionality, also under the File
Print preview

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4.10 SCHEIMPFLUG BASED CORNEAL TOPOGRAPHY

CALIBRATION
step-by-step instructions on the screen and carry out all the captures needed, with the
calibration standards requested in a dark environment, similar to the one used for normal
acquisition.
solvents).
- Open the instrument menu in the toolbar and click the calibration button;
The entire procedure must be carried out carefully. Please check device steadiness before start
the procedure.
It is highly recommended to calibrate the instrument and check the curvature of the test
sphere at least once a month.
Scheimpflug camera under Instruments panel

Position the instrument as illustrated. Make sure to perform as follows:
- Center the cross for the frontal camera (the one on the lower part of the screen) in the
middle of the rings reflected by the 8 mm sphere.
- Place the instrument at the correct distance from the sphere. The correct distance is such
that the white arc, which is the reflection of the blue slit on the surface of the sphere,
touches the horizontal line displayed on the lateral camera (the one in the upper side of
the screen).
- Block the instrument, using the base screw.
If the calibration procedure is performed correctly, a confirmation message will appear on
screen. After having successfully calibrated you should capture some images of the 8-mm
sphere, creating a patient and a test exam to verify correct instrument calibration.

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If the processed measurements are not found to be reliable, repeat the entire calibration
procedure.
Curvature calibration Scheimpflug camera curvature calibration: schematic

correct alignment

Click on icon and select the Scheimpflug Corneal Mapping examination.

Press the combination CTRL+T on the keayboard to activate the "Test Eye" mode and select
x25 scans.
mm +/- 0.03 mm.
ACQUISITION
To capture a Scheimpflug corneal mapping image, select the icon. The instrument
automatically sets to the capture position and a live capture window opens.
one coming from the lateral camera (positioned in the upper part of the screen) this shows the
cornea in profile and permits setting the instrument to the correct distance, the other coming
from the central camera (lower part of the screen), which permits correct centering of the
instrument and monitoring of the tear film.
In order to conduct the examination at the correct distance from the corneal vertex, move the
joystick forward and back until the corneal vertex is within the two green lines. As long as the
corneal vertex is not at the correct distance, the horizontal lines will be red; when the apex is
between the two dashed lines, they will turn green. When the joystick is moved forward, the
profile of the cornea displayed on the monitor moves upward; when the joystick is moved
back, the profile of the cornea moves downward.

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The instrument is centered when the reflected white fixation point, in the middle of the
reflected rings, is inside the aiming cross-hair target.
To move the cross to the left and right, move the joystick to the left and right.
To move the cross up and down, rotate the joystick clockwise and counterclockwise.
The cross-hair turns green when the instrument is centered.
Both distance and centering are incorrect

Distance and centering are correct
Capture
to capture the image (or the spacebar).
This action starts the capture procedure, at the end of which the image is saved.
The 3 acquisition modes available are: x25 scans, x50 scans and x100 scans.
Once all the images needed have been captured, the capture environment may be closed; the
program returns to the main screen.
Select one of the captured images to process it and access the Summary.
Scheimpflug camera acquisition: schematic correct alignment

Test eye mode
(8-mm sphere acquisition) typing CTRL+T and proceed as already described.
"TestEye" modality acquisition must be used only with the Calibration tool (8-mm sphere).

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MENU
A menu is displayed at the top of the screen: a short description of the available functionalities and
options follows.
File
capture (quick)
screen dependent.
Edit
Ring/Pupil/Limbus Opens the environment for the editing of reflected Placido rings, of the
editing pupil and of the limbus edge.
Edit sections Opens the environment for the editing of front and back corneal
surfaces, of the iris and of the crystalline lens.
Reprocess Reprocess all acquisitions.
Summary
Standard Summary Opens up the default overview summary, containing information on
Multimap The screen can be displayed as follows:
(customizable) • 2x Display 6 maps chosen by the user with the possibility to
customize the summary name.
• 2x Display 4 maps + indices chosen by the user with the
• 2x Display 4 maps + sections chosen by the user with the
Rename summary Allows to customize the summary name.
Sections
Sections Displays the sections images.
Single Map
IOL
IOL Displays an overview dedicated to IOL calculation.

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Keratoconus
Keratoconus Displays a detailed summary of keratoconus.
summary
Wave-front

Summary
Other
Advanced Displays a screen for the elevation analysis of anterior corneal surface.
Elevation
(anterior)
Advanced Displays a screen for the elevation analysis of posterior corneal surface
Elevation
(posterior)
Glaucoma Displays an overview dedicated to the analysis of the anterior chamber,
summary for glaucoma screening.
ICRS summary Displays an overview dedicated to the intra-stromal rings surgery
planning.
Autofit Accesses the contact lens simulation environment.
Compare
wavefront
Subtract
Subtract Show the difference/map between wavefront maps.

Wavefronts
Toolbar
Export Exports for external program (.xyz, .csv, .xyX)

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SETTINGS
Settings screen is displayed by choosing Settings from the menu

Settings
cylinder notation.

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Scales
Settings: Scales
- Klyce/Willson
- Schwind
- American style
- ANSI Z80.23

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Edit menu.
RINGS EDITING
Rings editing

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Selecting a ring
on the keyboard.
Deleting a ring
Adding a ring
Interpolating rings
PUPIL EDITING
or


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Pupil editing
LIMBUS EDITING
Limbus editing

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SECTIONS EDITING
To access these functions select Edit sections from the Edit menu .
The software automatically recognizes the front and rear surface of the cornea as well as the
iris and the lens.
the edge identification: it is important to check the correct detection of the edges before
starting the analysis of maps. The software offers the possibility to fix the detected edges by
manually editing them.
By selecting one of the 5 tabs the user will be allowed to edit:
- front and rear corneal surface
- crystalline lens
- iris
- angles
Once selected, the corresponding surface will change color to yellow and will be ready for
editing.
The meridian to be edited has to be selected by using the mouse wheel: the screen opens on
the horizontal meridian.
By the CTRL button and using simultaneously the mouse wheel the magnification factor of the
image will change.
Corneal editing:
to edit the corneal surfaces it is possible to use the delete, the add surface and the smart edit
buttons, in addition to those indicated above.
Edit anterior surface Edit posterior surface

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Crystalline lens editing:

to edit the front surface of the crystalline lens it is possible to drag and drop the three yellow
points by the left-clicking.
Crystalline lens editing
Iris editing:
to edit the iris surface it is possible to use the delete and the add buttons, in addition to those
indicated above.
Iris editing

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Angles editing:
to edit the angles it's possible to move the yellow point (SS) by left-clicking.
Angles editing
PRINTING
menu.
Print (immediate) and Print screen capture (immediate) functionality, also under the File
Print preview

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4.11 SLIT LAMP IMAGING

CALIBRATION
The Slit lamp calibration procedure is required to enable calibrated measurements with
microns or millimeters instead of standard pixels.
Slit lamp calibration menu

- Select the Calibration button to start the process
- Acquire a graph paper (i.e. graph paper with 1-mm blocks) image with neutral
magnification
- Specify which magnification set is indicated on the slit lamp: 6/10/16/25/40x or
5/8/12,5/20/32x
- Adjust the red grid (5 mm x 5 mm) to match the graph paper reference beyond. Drag the
red grid with the mouse until the red squares match 1 mm x 1 mm real paper squares.
- When finished, click Ok on the calibration form then Yes to finally save the calibration.
Slit lamp calibration grid with 5mm x 5mm square: the red grid must be adjusted.
All the measurements placed on the images from now on will be available in microns or
millimeters.

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ACQUISITION
an empty exam is selected. Clicking the Slit Lamp icon opens the acquisition environment.
Quick acquisition
to capture the image. Both pictures and videos can be acquired, depending on the selected
acquisition mode.
Acquisition mode can be switched from the toolbar, where the icon enables photo
acquisition mode (default), while the icon switches to video acquisition mode.
All the acquired images become available in the gallery. Click on the thumbnail to preview the
acquisition.
When a video is recorded, it can be played using the main program's video player from the
examination gallery.
Advanced camera settings are available in the Control Panel. Available acquisition tools and
modalities are described in the Toolbar section.
Acquire

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Zones of interest
Moving the mouse on the screen displays clickable zones of interest on the live image.
Selecting a zone adjusts the camera exposure on the underlying area. This feature is critical
when observing an image with different illuminated areas (for example iris and sclera), so that
exposure control can be adjusted dynamically while taking several shots.
Zones of interest selection grid
Acquisition toolbar
The toolbar provides useful functions to switch between different acquisition functions.
Photo mode Photo mode is enabled when this icon is selected in the toolbar.
Video mode Video mode is enabled when this icon is selected in the toolbar.
Screen adjustment Adjusts the camera output image to screen height, screen width, or just
keeps its original size (1624x1232) unmodified. Please note that portions
of the image might be cut off the screen depending on the effective
screen size and the chosen adjustment option. Try different options to
best-fit the screen size.
Default This option allows you to restore the acquisition default values
Hi Speed This option allows you to maximize FPS.

Low ligh This option allows you to acquire an optimal image in low light
conditions
Quit Exits the application and saves all acquired pictures and videos.
Control panel
The control panel is loaded by hovering the mouse on the label at the bottom side of the
screen.
Modifying any options have immediate effect on the live image.

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Camera control
Slide the trackbars to adjust different camera parameters.
Control panel
- Gain: controls camera light sensitivity without affecting exposure time.
- Shutter: when Autoshutter checkbox is unchecked this parameter controls camera
exposure time.
- Reference: when Autoshutter checkbox is selected this parameter sets the illumination
value which should be reached by the dynamic shutter adjustment algorithm.
- Restore defaults: when Restore defaults button is selected reference and gain parameters
will be restored with the defaults values.
ANALYSIS
This section describes the advanced functions and tools that are available only for Slit Lamp
acquisitions.
Slit lamp image viewing and editing window

File
Copy screen Allows to create a copy of screen capture to clipboard
capture to
clipboard
capture
(Immediate)
Print Print report of the pupillography examination session, in graphics form

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Toolbar
Menu Settings
Tools
image zoom.

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Set current Allows to set correct magnification of current acquisition's image.

magnification
4.12 TEAR ANALYSIS

The purpose of the tear film break-up analysis is to assess the integrity of the tear film spread
on the patient's anterior corneal surface over time. The layer is restored after every eyelid blink
and tends to get thinner and break-up in a few seconds, until the next blink. A very short time
interval between the eyelid blink and the first break-up may indicate an eye condition like, for
instance, contact lens-related eye disorder symptoms.
This test is performed through videokeratoscopy, the video recording of the Placido's disk ring
projection on the patient's cornea. The perfect reflection of the disk's rings is actually ensured
by the even distribution of the tear film on the anterior corneal surface: any distortion or
interruption of this surface causes one or more of the disk's reflected rings to deform or often
break, showing exactly when and where the break-up has occurred.
The system processes the video in real time and autonomously, also performing the
measurement without any need for the user to intervene, thus avoiding the elaborate manual
frame-by-frame checking of the film.
Tear Analysis examination involves acquisition and further analysis, whilst the following
paragraph describes the measurement units employed.

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NIF-BuT and NIAvg-BuT

NIF-BuT (Non Invasive First Break-up Time) is the time, expressed in seconds and tenths of a
second, that elapses between the moment the eyelid opens again after one or more blinks and
a) the very first tear film break-up, or b) the moment in which the following blink takes place.
It is the most relevant clinical measure since patients with tear film in optimum conditions
should not present any break-up for a time that varies between 10 to 17 seconds. Such
measurement, however, does not take into account any break-ups that may occur following
the first one, thus limiting the overall evaluation of the tear film health condition.
NIAvg-BuT (Non Invasive Average Breakup Time) introduces an auxiliary and complementary
measurement, i.e. the tear film break-up average time which is measured by averaging the
times of all the reflected disk's sections that actually broke-up throughout the examination.
Such value may be used arbitrarily to obtain a more accurate diagnosis, together with the NIF-
BuT.
For example: a NIF-BuT value of 3 seconds would indicate a tear film poor health condition,
since at least one sector of the film broke up within 3 seconds after the blink; however, if the
associated NIAvg-BuT value measured 10 seconds, this would indicate that -on average- the
other sectors degraded considerably later, therefore tempering the negativity of the
examination's results.
Concerning the above, it is important to associate to the numerical values described also the
overall Break-up map evaluation (paragraph 3.4 of the manual), that visually gives information
regarding the amount of sectors that have been damaged throughout the measurements.
To exemplify further, the NIF-BuT value of 3 seconds mentioned above would be irrelevant
from a clinical point of view if only one sector of the tear film map was damaged.
It is useful, moreover, to measure the same eye more than once, in order to obtain information
regarding the patient's break-up condition stability and repeatability.
As per the definitive evaluation of the patient's health conditions in relation to the lachrymal
film, it must be said that it depends on the subjective opinion of the specialist performing the
test: you must also take into consideration all the related variables and other factors connected
to the specific context.
ACQUISITION
an empty exam is selected. Clicking the Tear analysis tab opens the acquisition environment.
Step 1: Centering the rings
Start the tear film break-up analysis and position the patient on the chinrest. Focus the rings
(centering phase). The centering phase is extremely important as the final reliability of the
examination can be compromised by poor focusing. The figures on the right side show two
samples of out of focus and well-focused images, respectively.
The indicator on the right bottom of the screen gives a feedback in real time on the focusing
operation.
When the image is clear and focused, press the joystick button to start the measuring phase.

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Tear analysis acquisition screen Acquisition alignment
Step 2: Measuring
Tell the patient to blink twice, then the system automatically starts taking measurements.
During the measurement, the central target becomes red and the recording symbol appears
on the top right corner. It is important that the eye be very well centered and focused
throughout the acquisition.
The measuring and the filming automatically stop when the patient closes the eyelids again, or
when the joystick button is pushed again.
Step 3: Reviewing and Saving acquisitions
Each successful measurement completed will be saved in the gallery.
Results can be checked by clicking on the thumbnail in the gallery directly from within the
acquisition environment, without necessarily returning to the main patient management.
The meaning of the maps and of the numerical data is well explained in the Analysis section.
Notably, the maps shown in the live preview are the Break-Up graph to the left and the Break-
Up map to the right, which are described in the Analysis section.

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ANALYSIS
The Tear analysis summary displays several maps and graphs in the same screen.
Tear analysis summary

Break-up scale (1)
The Break-up chromatic scale provides an intuitive feedback to support the NIF-BuT and NIAvg-
But numerical values. It can be found both in the preview window of the acquisition
environment (which can be accessed by clicking on a thumbnail in the gallery) and in the main
software environment. In addition, the sectors' colors of the Break-Up maps described in this
paragraph refer to this scale.
Generally speaking, a tear film break up time that falls within a range of 0 and 4 seconds is to
be considered health condition for the patient. A time falling within a range of 4 and 10 seconds
can be considered below standard and therefore it must be assessed individually, taking into
account the other parameters for the patient. A time over 10 seconds generally indicates good
tear film conditions and may be attributed to a healthy patient. The maximum time allowed by
the software is 17 seconds, since tear film integrity time exceeding that amount of time are
not relevant from a clinical point of view and do not support the analysis in any way.
To the sides of the scale there are two indicators, the NIF-BuT one on the left and the NIAvg-
But to the right. The indicators are represented by red, yellow or green icons, according to the
category they belong to as described above
Media player (2)
The first quadrant displays an unaltered video of the videokeratoscopy as well as a set of
controls similar to MediaPlayer that move forward or rewind the video, that play it frame by
frame, and that display the first or the last frame of the video.
The recording starts the moment the patient blinks up to the action that determines the end
of the measurement (the successive blinking, a joystick button pressure, the end of the
maximum time allowed), and it therefore shows the actual degrading over time of the tear film
conditions.

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Zooming-in the break-up details in the movie quadrant
Map of the break-up flow (3)

The second quadrant map is dynamic and changes in real time according to the video that is
being played on its left. The purpose of this map is to highlight, frame after frame, in which
areas of the disk break-ups are occurring and the approximate extent of their severity.
The yellow color indicates a slight break-up, which is probably hardly visible to the naked eye;
the bright red color indicates a more sever break-up, probably an abrupt interruption of one
or more of the rings.
By clicking with the mouse on a point of the video or of the break-up flow map, it is possible to
enlarge in real time that area in order to observe the break-up in detail even while the video is
being played.
Zooming in the break-up details in the break-up flow quadrant

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Break-up graph (4)

The third quadrant displays a graph summarizing the examination timeline (X-axis is time in
seconds, Y-axis is break-up percentage). The graph line stays green until the first break-up
occurs, then turns to red and indicates the percentage of examined eye area that is actually
broken at the corresponding time. The black vertical lines indicate NIF-BuT and NIAvg-But,
respectively.
Break-up map (5)
The map located in the bottom right area is the most important of all, it being a summary of
the analysis outcome.
The map is divided in radial sectors and it shows the evolution over time of each sector in terms
of tear film integrity, according the following interpretation:
- the opaque and transparent sections show areas of the map that have not been
considered in the final measurement of the Break-up time, probably due to the fact that
they included areas of the eyelids, eyelashes or simply because they were not considered
sufficiently reliable.
- the green sections without numerical values, indicate those areas of the map in which the
tear film has remained intact throughout the examination.
- sectors containing numerical values indicate those areas of the map in which a tear film
has degraded or broken up: the numerical value shows the exact moment in time in which
the first deterioration of the sector occurred, and such value is marked red in case it
represents the sector that broke-up first in the map (First Break-up sector). To the
numerical value is, furthermore, associated a color that indicates the "severity" of the
break-up: a color shifting to green means that the break-up occurred in normal conditions,
i.e. after about 10 seconds from the beginning of the test. A color shifting to red indicates
that the break-up is more severe, i.e. that it occurred within few seconds.
The figure below is an example for a Break-up map: the sector measuring 2.1s was the first to
show a tear film break-up. The fact that it is red indicates that it is a severe break-up since it
occurred after such a short delay of time. The other sections "broke-up" respectively after 3.4s,
8.1s, 8.5s, 10.5s. The NIF-BuT time is obviously 2.1s, whereas the NIAvg-But time is 6.5s, i.e.
(2.1s + 3.4s + 8.1s + 8.5s + 10.5s) / 5 = 6.5s
Linked examinations (6)
It is advisable to take more than just one test per patient, since Tear film break-up analysis may
vary slightly from acquisition to acquisition. 3 consecutive acquisitions are the best option in
order to obtain the most reliable results.
When more acquisitions are taken for the same patients, the averaged data are shown here
and the other acquisitions are lined up as clickable hyperlinks. Clicking the link loads the
corresponding examination and closes the current one.
4.13 TOPOABERROMETRY
CALIBRATION
instructions given step-by-step on the screen and carry out all the captures needed, with the
calibration standards requested in a dark environment.
The steps in instrument calibration are:
solvents).

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- Open the instrument TopoAberrometer menu in the toolbar and click the calibration
button;
The entire procedure must be carried out carefully.
It is highly recommended to calibrate the instrument and check the curvature of the test
sphere at least once a month.
TopoAberrometer under Instruments panel

Carefully acquire an image of the calibration sphere. If the acquisition is not satisfactory a
message will ask to repeat the procedure.
After having successfully calibrated you should capture some images of the calibration sphere,
creating a patient and a test exam to verify correct instrument calibration. If the processed
Triangulation-based devices: curvature calbration (correct align)

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ACQUISITION
an empty exam is selected.
movements, or turn the joystick clockwise-counterclockwise to perform vertical movements.
forth.
Step 1: Aberrometry acquisition
joystick and wait the device to perform the full aberrometry capture.
If the Fogging buttons was set as active the last step of the acquisition will be a fogging
procedure else the fogging will be skipped.
Aberrometric acquisition

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Step 2: Keratoscopy acquisition

When the keratoscopy image grab starts the Placido disk and the blue slits light up. Move the
topographer forward or backward: when the device is too far or too close to the corneal vertex
the slits appear disjoint or overlapping in the corneal periphery. On the contrary, when the slits
are aligned and overlapping in the center the device at the right distance: make sure that the
cross remains near the center of the rings and that the rings are not corrupted by tears or
eyelashes and press the joystick button to grab the image. Once the image is captured a
thumbnail is shown on the left or right side of the screen according to the acquisition laterality.
Step 2: (Wrong) Topographic acquisition. When the Step 2: (Correct) Topographic acquisition. When the
device is too far or too close to the cornea the slits device is at the right distance the slits appear
appear disjoint or overlapping in the corneal periphery overlapping in the center

preview is shown instead of the live panel. A left click on the top left corner of the thumbnail
will set the relative acquisition as "to be deleted", the thumbnail will be marked with a litter
bin, and will be not saved once the live session is over.
Settings
To access to the acquisition settings click on the icon.

It will be possible to choose which map to display in overlay (OPD, refractive error
representation or nothing), or to choose the number of acquisitions per session (1, 2 or 3) and
the number of frames per acquisitions (10, 20 or 30). It will also be possible to enable or disable
the saving of the captured video by selecting the "Movie recording" button.

Select one of the captured images to process it and access the TopoAberrometry Summary.

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MENU
File
capture (quick)
screen dependent.
Edit
Edit Opens the environment for the editing of reflected Placido rings, of the
Ring/Pupil/Limbus pupil and of the limbus edge.
Reprocess Reprocess the acquisition.
Toolbar
TopoAberrometry Opens up the default overview summary, containing information on
summary curvature, elevation and Wave Front.
Corneal Opens up the default overview summary, containing information on
topography pachymetry, curvature and elevation.
summary
Ocular Wave-Front Opens up the default overview summary, containing information on
summary aberrometry and refractive error.
Elevation Displays a screen for the elevation analysis of anterior corneal surface.
Optical/Ocular Opens up a summary focused on the patient quality of vision.

Quality Summary

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CL fitting Accesses the contact lens simulation environment.
Toric IOL assistant Opens up a summary report for the management of toric IOL post
implant.
Compare
Compare Corneal Allows comparison of up to 4 different maps.
topographies
Compare Corneal Allows comparison of 2 different corneal wavefront maps
Wavefronts
Subtract
Subtract Corneal Show the difference-map between acquisitions (up to 3).
topographies
Subtract Show the difference/map between wavefront maps.
Corneal/Ocular
Wavefronts
Toolbar
Export Exports for external program (.xyz, .csv, .xml)
PRINTING

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SETTINGS

changed here.
Aberrometry and Topography settings

ABERROMETRY
Coordinate system
center).
- Zernike coeff. Units: Micron or Eq. D will be used as measure unit.
and WFE relate as follows: OPD(x,y) = -WFE(x,y)
cylinder notation.
- Pupil diameter: choose beetwen 3mm and 4mm.
- Vertex distance can be changed
- Seidel correction
TOPOGRAPHY
Coordinate system:
- Polar/Cartesian. Each point position will be expressed in ρ (distance from center) and @
center).
cylinder notation.

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SCALES
Settings: Scales
- Klyce/Willson
- Schwind
- American style
- ANSI Z80.23

Edit menu.
RINGS EDITING

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Rings editing
Selecting a ring
on the keyboard.
Deleting a ring
Adding a ring
Interpolating rings

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PUPIL EDITING
or

Pupil editing

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LIMBUS EDITING
Limbus editing
4.14 VIDEOKERATOSCOPY
ACQUISITION
an empty exam is selected. Clicking the Video icon opens the acquisition environment.
Quick acquisition
to capture the image.
When video acquisition mode is enabled press the button to start recording a video, press it
again to stop recording and save.
Both pictures and videos can be acquired, depending on the selected acquisition mode.
Acquisition mode can be switched from the toolbar, where the icon enables photo
acquisition mode (default), while the icon switches to video acquisition mode.
All the acquisitions become available in the gallery located at the sides of the screen.
Click on the thumbnail to preview the acquisition.
When a video is recorded, it can be played using the main program's video player from the
examination gallery.
Advanced camera settings are available in the Control Panel.

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Main screen
ACQUISITION TOOLBAR
The toolbar provides useful functions to customize the acquisition environment or switch
between different acquisition functions.
Toolbar items
Photo mode Photo mode is enabled when this icon is shown in the toolbar. Click the
icon to switch to video acquisition mode.
Video mode Video mode is enabled when this icon is shown in the toolbar. Click the
icon to switch to photo acquisition mode.
Zoom In Toggles a special lens which optically zooms in / out the image.
Zoom Out
White lights Allows you to enable or disable white lights acquisition mode.
Fluo mode Allows you to enable or disable fluoresceina acquisition mode.
Tear meniscus Allows you to optimize camera parameters for acquisition of the tear
mode meniscus. Acquired images can be analyzed in the Tear meniscus
analysis window in the main program.
Quit Exits the application and saves all acquired pictures and videos.

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CONTROL PANEL
The control panel is located at the bottom of the screen.
Modifying any options have immediate effect on the live image.
Camera control
Slide the trackbars to adjust different camera parameters.
Control panel (autoshutter enabled)
Control panel (autoshutter disabled)

Shutter: controls camera exposure time. When Auto-exposure checkbox is selected shutter is
calculated at runtime automatically.
Autoexposure reference: when Auto-exposure checkbox is selected this parameter sets the
illumination value which should be reached by the dynamic shutter adjustment algorithm.
ISO: controls camera light sensitivity without affecting exposure time.
Light source: allows to choose the light source to use during the acquisition between Placido
disk or White light (leds).
Placido intensity: adjusts placid disk light intensity. Very high values might be annoying for the
patient when used for a long time.

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ANALYSIS
This section describes the advanced functions and tools that are available only for
Videokeratoscopy acquisitions.
Videokeratoscopic image viewing and editing window

File
Copy screen capture to clipboard Allows to create a copy of screen capture to clipboard
Save screen-capture as image Opens a window from which the current screen-capture
can be saved in various image formats.
Print screen-capture Opens a window to set-up printing parameters and to
print the current screen-capture.
Print screen-capture (Immediate) Directly prints the screen-capture.
Print Print report of the pupillography examination session,
in graphics form
Toolbar
Menu Settings

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Tools
image zoom.

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5 GENERIC TOPICS
5.1 PRINT PREVIEW
This form lets you configure and preview the layout of your printout.
options available follows.
Generic printing form
Generic printing form: settings
Print Prints the form.
PDF The PDF button makes a print PDF file. It is necessary to choose whether
to save the file on desktop or keep it in the examination gallery.
Patient header Shows/hides the patient header on the printout. This header contains
demographic information of the patient.
Practice header Shows/hides the practice header on the printout. This header contains
information on the practice.
Edit practice Allows editing of the practice header.
header
Zoom In/Out Allows you to zoom in/out the print preview.

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5.2 CONIC EQUATION

The equation of a conic curve can be expressed as below:
where r is the distance from center, R is the apical radius, p is the asphericity in one of its
forms.
The apical radius is the local radius of curvature in r = 0, i.e. at the apex of the curve.
Asphericity can also be expressed as e, E and Q. Here below are the formulas for converting p
to e, E and Q.
For a circle, we have p = 1, e = 0, E = 0, Q = 0.

5.3 TEAR MENISCUS
Images acquired by SlitLamp and Videokeratoscopy can be subjected to advanced tear
meniscus analysis.
The purpose is to mark three or more points of interest in the tear meniscus in order to obtain
reliable statistic data about the average height and standard deviation.
Click on one edge of the tear meniscus, then move the mouse over the other edge to adjust
the marker's height and orientation, then click again to set the marker.
Hovering the mouse on an existing marker brings up the "delete measurement" menu.
All measurements are saved automatically when the tear meniscus analysis window is closed.
Tear meniscus main screen
Tear meniscus analysis

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5.4 DRY EYE REPORT (DER)

The Dry Eye Report (DER) is a collection of 5 examinations and a questionnaire (OSDI) assigned
to a single patient.
The main purpose of the report is to summarize all available examinations concerning the dry
eye condition and to ease its diagnosis.
With all examination previews and gradings collected together in a single page, it is much
easier to get an overview of the patient's condition.
Eventually a single DER can be graded by the clinic with an overall score ranging from Normal
to Severe.
Creating a new report / loading an existing report
The DER can be assigned to every single patient. It is not possible to assign more than one
report to a patient.
Right-click on the patient's name, then choose Dry Eye Report from the context menu.
If there are no reports available for the patient, an empty new report is created.
Opening the Dry Eye Report

Dry Eye Report screen
The DER main screen collects the following examinations and features.
Most of the examinations require the proper instrument in order to be acquired, as specified
below.
- OSDI questionnaire - can be compiled by asking questions directly to the patient.
- Ocular redness- requires the keratoscope or slit-lamp Video examination
- Meibomian glands loss - requires the keratoscope or scheimpflug camera Meibomian
glands examination
- Tear meniscus height - requires the keratoscope or slit-lamp Video examination
- NiBut - requires the keratoscope, scheimpflug camera or AS-OCT NiBut examination
- Osmolarity - requires external instruments, not supported
Each examination is contained in a control panel. There are two control panels for each type
of examination, one for OD and one for OS. The left and right columns in the DER screen
contain the OD and OS control panels, respectively.
Depending on the examination type, the control panel provides a range of possible actions:
- Acquire: starts the live acquisition for the examination. The last acquired picture / exam
will be set in the control panel. All other pictures will be available in the Open menu.
- Open: browses available existing acquisitions for the patient that are compatible with the
examination type. This is a simple and fast way to select an acquisition that was already
taken before opening the DER for the patient.

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- Reset: cleans up the control panel excluding the selected acquisition. The acquisition will
not be deleted and remains available under the patient's examination list.
- Grade: ocular redness and meibomian glands loss examinations can be graded directly
from the DER without opening and processing the acquisition. Click Grade to show the
grading scales, then choose a grade for the picture. Ocular redness requires grading for
conjuntival or limbal redness by Nathan Efron grading scale, while meibomian glands loss
requires Meibomian grading scale by Heilko Pult.
- Double click the image thumbnail to open the selected acquisition in order to allow
processing and reviewing. For instance the tear meniscus height acquisition must be
opened in order to mark the tear meniscus points, then the calculated TMH will be shown
in the control panel.
- Compile: available for the OSDI questionnaire only. Opens up the questionnaire.
- Import: available for the osmolarity examination only. The osmolarity value can be
imported from an external source only and cannot be measured using this software.
Type in the measured osmolarity value and press enter to insert it into the control panel.
Dry Eye Report screen
Examination control panel
Grading the DER

An overall score can be assigned to the report.
Select Normal, Trace, Mild, Moderate or Severe from the drop down menu in the bottom of
the report screen.
Options
Select Options from the top menu tho show available options.
- Show osmolarity: hides or restores the osmolarity examination panel. This may be useful
when the osmolarity values are never imported and should not be considered part of the
DER.
Printing
Select File -> Print or Print screen capture from the top menu to print the DER or save it as pdf
file.

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OSDI QUESTIONNAIRE (OCULAR SURFACE DISEASE INDEX)

The OSDI questionnaire is widely used in clinics all over the world and the Tear Film and Ocular
Surface Society (TFOS) Dry Eye Workshop (DEWS) suggested it should be primarily considered
in clinical assessing of DED symptoms. It is based on simple questions involving ailments and
fatigue due to typical dry eye symptoms in a form that can be easily recognized by the patient
since all questions concern everyday life. The OSDI score is calculated automatically with
respect to the arithmetic OSDI evaluation rules and its value is converted to the Dry Eye Report
normalized scale.
The OSDI standard questionnaire is implemented as an HTML web page, which can be easily
compiled by the patient while he/she is still waiting for the other examinations to begin.
When the questionnaire is complete click OK to return to the Dry Eye Report main screen.

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5.5 DICOM
This manual is intended to provide information about how to configure and use the Application
DICOM Module, for any other topic please refer to the document
"DICOM_Conformance_Statement_Phoenix4.pdf".
CONFIGURATION
In order to configure DICOM application proceed as illustrated below:
- Click on Settings icon on the main screen.
- Select the DICOM tab page.
- Ensure that "On/Off" toggle button is placed into the On position.
- Open Dicom configuration form by clicking .

Enable/Disable Used to enable/disable DICOM support into the application
Settings Run the DICOM settings panel.
Application path Used to change the DICOM application path.
Settings icon on the main screen.
DICOM Enable

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DICOM SETTINGS - AES

This page is used to configure all the involved application entities:
- Save on file: by enabling this feature DICOM files will be saved into the configured
destination folder. Files will be saved using this naming pattern: {Object GUID}.{SOP Class
Name}.dcm. During the saving procedure the file extension “.tmp” will be temporarly used
in order to help a polling procedure understanding when the action has been completed.
- PACS: configuration parameters related to the "Picture Archiving and Communication
System".
- PMS: configuration parameters related to the "Practice Management System". This entity
is used by DICOM module to retrieve the Modality Worklist.
- PPS: used to configure the entity in charge of the Performed Procedure Step service.
- Local AE and Port: local application entity name and port are used to authenticate the
local installation into the customer's DICOM environment. Local port is used by an internal
service, be sure that this port is not filtered by computer Firewall rules or is already used
by another service inside the local PC (where Software is installed).
In order to configure PACS and PMS, click the related button and proceed by filling in the
requested fields (AE Title, AE Host IP or Name, AE port). After each configuration has been
done the user can test it by clicking .
Settings It opens the AE Configuration window for setting the parameters of the
related Application Entity.
AE Verification It executes the Verification SOP class on the related Application Entity.
AEs AE Configuration
DICOM SETTINGS - GENERIC

This page allows the user to configure the general DICOM-related application behavior. Below
is reported a description about each configurable parameter:
- Auto-Send mode: used to configure how the exams should be sent to the PACS
- Disabled: auto-send mode is disabled, the exam should be manually sent by the user.
- Before entering into Exam: the exam will be sent immediately after the acquisition
phase has been completed.

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- After exiting from Exam: the exam will be sent after exiting from the related
processing module.
- Enable auto-send PDF: all the PDF reports generated during the exam analysis phase will
be sent immediately after exiting from the related processing window.
- Enable MPPS: Modality Performed Procedure Step messaging is enabled (please refer the
Conformance Statement document).
- Filter search by contained modalities: if checked, the study search inside the "Import from
PACS" window will be filtered using these contained modalities: "OP", "XC", "OPT",
"OPM", "AR", "OT".
- Filter MWL by Scheduled AE Title: if checked, the modality worklist will query only for
those entries targeting the current application entity title.
- Send images as ImplicitVRLittleEndian: if checked, the images contained in the exam will
be sent using the "Implicit Value Representation Little Endian" instead of "JPEG Baseline
(Process 1)".
- Propagate daily Accession Number: this feature is related to the MWL operating mode.
When checked the daily Accession Number received through the modality worklist item
will be propagated to the subsequent manually generated exams for that patient.
- Add BCS (Raw IOD): if checked, a private tag containing the BCS file will be added to the
Raw Data CIOD related acquisition.
- Enable "Series Level" search: if checked, the “Series Level” search will be enabled inside
the “Import from PACS” window. This kind of search shall be used in order to retrieve
acquisitions previously sent with the “Make importable” flag checked.
- Max number of results: maximum number of displayed results after search query.
- Retrieve mode: exam retrieve SOP class used during the "Import from PACS" procedure.
In case of CMOVE the PACS entity should be configured to send data properly to the
current application entity.
Generic

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IODS CONFIGURATION
Each exam can be encapsulated and sent using different DICOM objects at the same time.
The IODs configuration window allows the user to choose which DICOM IOD objects should be
sent to the PACS for a specific exam.
Starting from software version 4.1.3.0 the “Raw Data Object” is the only IOD enabled to be
subsequently imported. To exchange exams among different hosts where this application is
installed, be sure that this kind of IOD (“Raw Data Object”) has been selected.
IODs Configuration

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SEND TO PACS
Patient/Exam/Acquisition stored into the application database can be sent to the PACS by
opening the context menu associated to the desired object and by clicking the button .
Three types of send level are supported:
Patient level send Send all the exams and related acquisitions for this Patient to
the configured PACS.
Exam level send Send all the acquisitions contained in the selected Exam to the
configured PACS.
Acquisition level send Send the currently selected acquisition/report to the configured
PACS.
Patient level send
Exam level send
Acquisition level send

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After the send procedure has been started, a dialog box will appear on the screen indicating
the current sending status.
Send dialog box

IMPORT FROM PACS
The "Import from PACS" window allows the user to retrieve previously sent acquisitions from
the configured PACS; only acquisitions sent as "Raw data Object" are allowed to get imported.
To open the "Import from PACS" window, click the button located into application main
toolbar.
Import from PACS button
Import from PACS main window
The window is composed by three main areas:

- [1] Search Area: contains all the filters useful to run search queries. Search can be done
at Study, Series or Raw Data level by selecting the corresponding radio button. Each filter
can be included/removed from the current query by expanding /collapsing the
corresponding expander control (filters enabled are highlighted in green). Inside text
boxes wildcard character * is allowed ( the string *DOE* inside the "Name and Surname"
text box should return a list of results where the DICOM Patient's Name tag contains the
value DOE). Case sensitive search and support for wildcard character * depends on the
PACS implementation.
- [2] Results Area: contains the Study/Series/Raw Data CFIND results returned by the
previously run query.
- [3] Info Area: this area shows all the messages related to query and import activities. Error
conditions are highlighted with red color.

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Import selected Start to import the selected Study/Series/Raw Data into the local DB.
Study/Series/Raw
Data
Copy value Copy the content currently pointed by the mouse cursor.
Show related Query for all the series related to the currently selected study.
series
Show related Raw Query for all the Raw Data related to the currently selected study.
Data
Show Tags Show all the DICOM tags contained into the selected CFIND result.
Configure Open the configuration window.
Paste value Paste the previously copied value into the selected text box.
Study/Series/Raw Data context menu
Text box context menu

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MODALITY WORKLIST
The "Modality Worklist" window can be opened by clicking the button highlighted in red.
Modality Worklist button
Modality Worklist main window
The window is composed by four main areas:

- [1] Search Area: contains all the filters useful to run search queries. The filters can be
included/removed from the current query by expanding /collapsing the corresponding
expander control (filters enabled are highlighted in green). Inside text boxes wildcard
character * is allowed ( the string *DOE* inside the "Name and Surname" should return a
list of results where the DICOM Patient's Name attribute contains the value DOE) Case
sensitive search and support for wildcard character * depends on the PACS
implementation.
- [2] Results Area: contains all the modality worklist items returned by the previously run
query.
- [3] Details Area: this area contains specific data coming from the currently selected
modality worklist item; some of these data can also be changed by the user. Changes
made on these data are subsequently reported inside the corresponding generated IODs.
The "Scheduled AE" highlighted with yellow color means that the current selected item is
not scheduled for the current Application Entity (this situation occurs only when the
settings "Filter MWL by Scheduled AE Title" is unchecked).
- [4] Info Area: this area shows all the messages related to Modality Worklist activities.
Error conditions are highlighted with red color.
Search Send a query to the PMS using the previously configured filters
Start Start the Modality Worklist driven exam for the selected item
Edit patient Open the Edit Patient dialog
Save Save all the changes made inside the Details area

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Check tags When enabled, it allows to display all the missing tags that are
mandatory to start the selected modality worklist item
Copy value Copy the content currently pointed by the mouse cursor
Show related series Query for all the series related to the currently select study
Show Tags Show all the DICOM tags contained into the selected CFIND result.
Configure Open the configuration window
Paste value Paste the previously copied value into the selected text box
After the button has been pressed, the application will check if the selected modality
worklist item is referred to a patient that already exists inside the local database (similarity is
detected by using Name, Surname and Birthdate). When similar patients are detected, the user
will be able to choose, through the "Select Patient" dialog, whether to add the exam to a new
patient or to an existing one. The user can now proceed by selecting the desired exam through
the "Select Exam" dialog. When Modality Performed Procedure Step messaging is enabled the
application will send automatically all the messages related to the current procedure status to
the configured "Performed Procedure Step Service".
Modality Worklist context menu
Edit Patient dialog

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Select Patient dialog
Exam Modality selection dialog

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PHOENIX 4.1.3.0 | 04/2023

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COSTRUZIONE STRUMENTI OFTALMICI

COSTRUZIONE STRUMENTI OFTALMICI

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Copyright © 2021 by CSO Srl. All Rights Reserved.

4.6 AS-OCT SINGLE SECTION ANALYSIS .................................................................................................................... 84

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1.2 WHAT'S NEW

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- Sirius+: enhanced section processing

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- Test OSDI import (Marco Version)

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- Dry Eye Report: optimized thresholds in Dry Eye Report

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- BUGFIX Sub-models distinction between Aberrometer and TopoAberrometer, Fundus

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- Install configuration for Capture, in combination with Sirius or Cobra:

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Select Installation folder

- Select the start Menu folder: "Phoenix4" folder is selected by default.

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- Select the components to be installed. By selecting/deselecting "Examples database", a

- Click "Install" to start the installation.

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- Click Finish button to end the setup process.

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Windows security window

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2.2 SOFTWARE ACTIVATION AND REGISTRATION

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Find and enter the "P-number" (Online activation)

2.3 DATABASE CONVERSION

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Step 1: Select DB to convert

Step 2: Select destination path

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2.4 SOFTWARE UPDATE

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3 MANAGING PATIENTS AND EXAMINATIONS

- [1] Menu and Toolbar

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Instrument Allows the user to manage the instrument.

Information Shows information on the software release.

Quit Exits the application after confirmation of the warning

The button allows the user to manage the instruments to be used.

Instrument dropdown menu

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- By clicking on a specific exam's button (i.e. "AS-OCT Corneal Mapping"), a device/exam

Verify device status: dopdown menu

Verify device status: refresh button

3.2 PATIENT SEARCH PANEL

Patient search panel

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Advanced Search button to perform a search by gender, date of birth, examination