Elektron Henson 9000 User Manual

Henson Perimeter User Manual

Henson 9000

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While every precaution has been taken in the preparation of this document, the publisher and the author assume no responsibility for errors or omissions, or for damages resulting from the use of information contained in this document or from the use of programs and source code that may accompany it. In no event shall the publisher and the author be liable for any loss of profit or any other commercial damage caused or alleged to have been caused directly or indirectly by this document.

Printed: April 2017

The Henson 9000 is manufactured in the United Kingdom by

Elektron Technology UK Ltd. Broers Building J.J. Thompson Avenue Cambridge Cambridgeshire CB3 0FA Tel : 01803 407 700 Fax : 01803 407 724 Email: info@elektron-healthcare.com

at our manufacturing site in Torquay. Elektron Technology Woodland road Torquay Devon TQ2 7AY

Table of Contents

3Cont ent s

Part I

............................................................................................................... 81 Ele ktro n co mp a ny no tice s

............................................................................................................... 92 Impo rta nt w arnin gs

............................................................................................................... 103 Re visio n hist ory

............................................................................................................... 124 He lp /Man ua l info rma tion

............................................................................................................... 135 Ackn ow led ge me nt s

Part II

............................................................................................................... 151 Sin gle s timu lu s te st

............................................................................................................... 162 Multip le s timulus te s t

............................................................................................................... 173 ZATA th e s hold t es t

............................................................................................................... 184 Drive rs te st

Part III

............................................................................................................... 201 Sup ra -th re sh old te st s

............................................................................................................... 392 Za ta t hres ho ld te st

Welcome

Quick start

Visual field tests

Presenting and selecting different multiple stimulus patterns

21Multiple stimulus

23Patient instructions

24 25Missed stimuli in multiple stimulus suprathreshold test

26Single stimulus

28Patient instructions

29Setting the test intensity 31Single stimulus algorithm 32Multiple Stimulus algorithm

33Test status indicator

34Extending the test

35Adding and correcting presentations

36Changing the supra-threshold increment

37Analysing the results

38Toolbar

41Blind spot

42Fovea measurement

43Global Indices 44Mean Defect 45Standard Deviation 46Hemifield Test

47Outputs 48Threshold 49Gray Scale 50Defect 51Pattern defect

53Print Out

54Progression: Rate of change

Henson P erimet er User Manual4

............................................................................................................... 643 Drive rs te sts

56GSS2 58Printing

59Patient instructions

60Stimulus locations

61Using existing patient details

63ZATA toolbar

65Patient Instructions

66Options

67Stimulus locations

Part IV

............................................................................................................... 711 P re pa ring t h e p atie nt

............................................................................................................... 752 Aut o t imin g

............................................................................................................... 763 C atch Tria ls

............................................................................................................... 774 C han ging e yes

............................................................................................................... 785 De mon stra tin g the t es t

............................................................................................................... 796 En te rin g t he p atie nt's da te o f b irth

............................................................................................................... 807 Fixa tio n t arg e ts

............................................................................................................... 818 He lp fa cilit y

............................................................................................................... 829 P rint ing th e re sults o f a fie ld te s t

............................................................................................................... 8410 Re spo ns e bu tto n

............................................................................................................... 8511 Sa ving visu al fie ld d ata

............................................................................................................... 8712 Vid eo ca me ra

Part V

............................................................................................................... 891 Add re ss

............................................................................................................... 902 Te s ts

............................................................................................................... 913 C omp ute r

............................................................................................................... 924 Da ta ba se

............................................................................................................... 945 Ba ckup

............................................................................................................... 966 Vid eo Se tup

............................................................................................................... 977 Int eg ra tio n

............................................................................................................... 988 P DF

............................................................................................................... 999 Sa ve /C ance l

General information

Options program

72Aligning the patient

73Patient Instructions

74Refractive correction

Part VI

............................................................................................................... 10 31 Ba cku p co py of th e da ta ba s e

............................................................................................................... 10 42 Cha nging th e a ctive d ata ba se

............................................................................................................... 10 53 De le ting a re co rd from t he d ata ba se

............................................................................................................... 10 64 Ed itin g d ata in th e da ta ba se

............................................................................................................... 10 75 Find ing a re co rd in th e d a ta ba se

Database program

100

............................................................................................................... 10 86 Mo vin g t hro ug h t he d ata ba se

............................................................................................................... 10 97 Ima ge file s

............................................................................................................... 11 08 Prin tin g a da tab as e re co rd

............................................................................................................... 11 19 Sa vin g re co rd s in d a ta ba se

............................................................................................................... 11 210 P ro gre ss io n An alysis

............................................................................................................... 11 811 Imp ort from s pre ad sh ee t

5Cont ent s

113Progression Screen 115Glaucoma Staging System: GSS II 117Printing

Part VII

............................................................................................................... 12 01 Op en ing a n e xis t ing vis ual fie ld d ata ba se

............................................................................................................... 12 12 Cre a tin g a n ew vis ua l fie ld d ata ba se

............................................................................................................... 12 23 Cop ying a vis ual fie ld d ata ba se

............................................................................................................... 12 34 De le ting a re co rd

............................................................................................................... 12 45 Me rg ing d ata ba se s

............................................................................................................... 12 56 Tra ns fe rring re co rd s b e tw e en da ta ba se s

............................................................................................................... 12 67 Imp orting d ata fro m a He ns on 5/60 00 Da ta ba se

Part VIII

Utilities program

Appendix 1 - 9000 Technical specifi cation

Part IX

Appendix 2 - 9000 Connection details

Part X

Part XI

Appendix 3 - Instal lation

Appendix 4 - Maintenance and warranty

............................................................................................................... 13 51 Reg ular ins pe ctio n an d ma int ena nce

............................................................................................................... 13 92 Up grad in g t he s oftw a re

............................................................................................................... 14 03 Cle an in g

............................................................................................................... 14 14 Preve nta tive main t en ance

............................................................................................................... 14 25 Rep la ce me nt pa rts

............................................................................................................... 14 36 Rep airs a nd re ca libra tio n

............................................................................................................... 14 47 Wa rra nty

119

127

130

131

134

Part XII

............................................................................................................... 14 61 Ba ckg ro und o ut of to le ra nce

............................................................................................................... 14 72 Bow l e rro r

............................................................................................................... 14 83 LE D e rro r

............................................................................................................... 14 94 Chinre st

............................................................................................................... 15 05 Key vio la tio n

............................................................................................................... 15 16 Dat ab as e e rro rs

Appendix 5 - Troubleshooting

145

152Test Not recognised

Henson P erimet er User Manual6

153Database Backup not available

Part XIII

Part XIV

Part XV

Appendix 6 - License file

Appendix 7 - Networking

Appendix 8 - Practice management Integration

Index

154

155

156

159

7Welcome

To find out more about the Henson range of perimeters visit:

http://www.elektron-healthcare.com

or scan the QR code opposite.

Welcome

Henson 9000 Perimeter

Henson Perimeter User Manual

1. 1

Elekt ron company not ic es

The Henson 9000 is manufactured in the United Kingdom by

Elektron Technology Uk Ltd., Broers Building, J.J. Thompson Avenue, Cambridge. CB3 0FA

The Henson unit must be used in accordance with the operating instructions.

Please read the instructions before attempting operation.

The instructions in this guide are to be view ed as an accompaniment to correct training on this equipment.

Contact your sales agent for details of on-site training or contact the manufacturer for details of training videos and webinar training sessions.

The results of a test are only to be analysed by a suitable qualified person, and it is the responsibility of the practice manager/owner to ensure that only suitably trained personnel are operating this equipment.

The only warranties for Elektron Technology UK Ltd. products and services are set forth in the express warranty statements accompanying such products and services. Nothing herein should be construed as constituting an additional warranty.

This symbol on the product or on its packaging indicates that to preserve the environment, this product must be recycled after its useful life as required by law and must not be disposed of with your household or commercial waste. It is your responsibility to dispose of your waste electrical and electronic equipment by handing it over to a designated collection point for the proper recycling of such equipment. The separate collection and recycling of your waste equipment at the time of disposal will help to conserve natural resources and ensure that it is recycled in a manner that protects human health and the environment. For more information about the authorized collection location nearest to you, please contact your local city office, your household waste disposal service or the agent from whom you purchased the product.

9Welcome

This unit must be connected to an earthed mains supply

Hazardous voltages are present inside this unit. No user-serviceable parts inside

No modification of this equipment is allow ed

This equipment is not suitable for use in an oxygen rich environment

The instrument is not suitable for operation in environments where handling of fluids is normal use.

This equipment should be kept dry at all times

1. 2

Important warnings

Backing up your data

It is strongly recommended that you regularly back up the database of patient records on a USB memory stick, or other suitable removable media, to avoid any possibility of data loss.

This simple procedure is described later in this manual in Database Backup .

103

Allergy advice

The chin and head rest pads are made from a low allergy Silicone, but you should check with the patient that the do not have an allergy to silicone before allowing them to touch the Henson.

Re lease

Dat e

Chan ge

Version 1.0

30/08/13

New version for V2.0 software

Version 1.1

May 2014

For version 2.1 onwards software

Version 1.2

July 2014

Additional Installation Information added

Version 1.4

May 2015

Changes to patient instructions in the first person. Additional formatting changes and corrections.

Version 1.5

Novembe

r 2015

Added Progression information to coincide with Version 3.4 Software release

Version 1.6

April

2017

Changes for Version 3.5 Softw are release - addition of integration, changes to Database images, additional language support.

Henson Perimeter User Manual

1. 3

Revision history

To determine the version of installed software, click ABOUT on the main menu.

Info rma t io n fo r th e Ve rs io n 3 .5 re le as e

The release version of softw are called 3.5 contains some important changes to the way the softw are operates. These may not affect your operation of the instrument if you do not use the database or have any practice management integration, but it is important that you understand them if you do.

The previous versions of the software stored a PDF copy of the printout alongside the database in an images folder and this has now changed to a jpeg picture file. The database will operate in the same way as before except that the 2 eyes plots (threshold tests) are shown on different tabs.

The quality of the jpeg picture file can be set in the options program.

If you currently use the PDF file for another reason, and the Jpeg file cannot be substituted then an additional PDF file can still be created when saving. The location for this can be set in the options program (PDF tab )

11Welcome

Consult manual

WEEE Directive

0 1

Power Off (0)

Power On (1)

Type B Applied Part

Hazardous voltage CE mark

USB

Protective earth AC Mains

Henson Perimeter User Manual

1. 4

Help/Manual informat ion

Many of the images in this manual have 'hot spots'. If you place the cursor over one of these and click then you will jump to a new page giving further information on a topic.

Some of the screen shots in this manual may differ slightly from the software installed on your machine.

The information contained in this manual is subject to change without notice.

Elektron Technology UK Ltd. shall not be liable for technical or editorial errors or omissions contained herein.

The following symbols are used in the manual and on the instrument.

13Welcome

1. 5

Ac knowle dgement s

Microsoft, Windows, Windows 7 and Windows 8 and Windows 10 are registered trademarks of Microsoft Corporation.

Adobe and Acrobat (R) reader(R) are registered trademarks of Adobe systems.

Henson Perimeter User Manual

Quick start

To start a visual field test or one of the menu bar items click over that item on the start-up screen.

To g et mo re h e lp o n a n ite m in th e s ta rt-u p s cre e n click th at ite m o n th e im a g e b elo w .

See Appendix 3 for installing and setting up the software.

131

15Quick start

2. 1

Single s timulus test

After selecting the test, and entering the patient's date of birth you will be presented with the Single stimulus supra-threshold test screen below.

To g et mo re h e lp o n a te s t s cre e n ite m click o ve r th e it em in th e ima g e b elo w .

Henson Perimeter User Manual

2. 2

Mult iple stimulus test

After selecting the test, and entering the patient's date of birth you will be presented with the Multiple stimulus supra-threshold test screen below.

To g et mo re h e lp o n a te s t s cre e n ite m click o ve r th e it em in th e ima g e b elo w .

17Quick start

2. 3

ZAT A theshold tes t

After selecting the test, you will be asked whether this is a new or an existing

patient . Depending on your response you will then either need to enter the

patient's date of birth or select a patient from the database . Once this

79 61

has been done you will be presented with the ZATA test screen below.

To g et mo re h e lp o n a te s t s cre e n ite m click o ve r th e it em in th e ima g e b elo w .

Henson Perimeter User Manual

2. 4

Driv ers test

After selecting a Drivers test you will be presented with the Drivers test screen below .

To obtain more help on a test screen item click over the item in the image below .

19Visual field tests

Visual field tests

The following visual field tests are available with the Henson 9000:

Multiple Stimulus Supra-Threshold : Choose this if speed is

important. It is approximately twice as fast as the Single Stimulus suprathreshold strategy in patients with little or no defect. This is a SemiAutomated test.

Single Stimulus Supra-Thresho ld : Choose this test to

screen large numbers of patients. This is a fully automated test where the patient presses a response button every time they see a

stimulus.

ZATA (Zippy Adaptive Threshold Algorithm): This strategy replaces

the classic Full threshold algorithm. It is much faster than the Full and Fast Threshold programs and will normally be the program of choice for monitoring visual field loss. The ZATA program uses a Bayesian algorithm and adaptive terminating criteria to make the best use of prior data. This is a fully automated test where the patient presses a response button

every time they see a stimulus.

Drivers : The Drivers Test program is designed to see whether or

not a patient meets the UK DVLA visual field requirements for Group 1 and Group 2 driving. Again, this is a fully automated test where the patient presses a response button every time they see a stimulus.

Henson Perimeter User Manual

3. 1

Supra- threshold t est s

There are two different supra-threshold tests provided with the Henson 9000 software, single and multiple stimulus:

Both incorporate several levels of testing.

Both can be run in an age-related or threshold-related mode.

The flow chart below gives the different stages of a supra-threshold test.

26 21

Mu ltip le s timulus

Multiple stimulus supra-threshold tests are used to rapidly screen the visual field. Multiple stimulus tests are approximately twice as fast as a single stimulus test. The multiple stimulus tests are semi-automated and require more perimetrist involvement than the single stimulus tests. With a skilled perimetrist this can result in more reliable results with less variability.

Each presentation is composed of a pattern of 2, 3 or 4 stimuli.

1. The patient tells the perimetrist how many stimuli they saw .

2. If they give the wrong number then the perimetrist should repeat the presentation.

3. If on the second presentation the patient still reports the wrong number, the perimetrist asks the patient where the stimuli they saw were. Any missed stimuli are then marked as misses . It is often

useful when trying to establish which stimuli were missed to ask the patient to report the clock hour positions of the seen stimuli.

4. If on the second presentation the patient reported the correct number then the perimetrist should proceed to the next pattern. In this case it is assumed that the error in the first presentation was a false one.

5. If there is some doubt, the perimetrist can re-present the pattern. There is no limit to the number of times it can be presented.

Missed locations can be tested at higher intensity levels to quantify the

depth of any defect.

At the beginning of the test the threshold is determined. Stimuli are then

initially presented at 5dB above this threshold estimate.

The test has 3 levels , it starts testing just 26 points. It can be extended

34 34

to 68 and 136 locations.

The test can be customised with the addition of extra stimulus locations.

To g et mo re h e lp o n a te s t s cre e n ite m click o ve r th e it em in th e ima g e b elo w .

Henson Perimeter User Manual

3.1.1.1 Pa tie nt ins tructio ns

It is important that the patient understands what they need to do during the test.

Below is a set of instructions that we have found to work well.

The eye not being tested should be occluded and the test eye must be correctly aligned with the patient sitting comfortably.

Threshold set by age

The test is going to take about 2 minutes.

You must look at the central red light and keep your eye as still as possible

The technician is going to present patterns of 2, 3 or 4 light spots.

After each presentation he/she will ask you how many you saw.

The technician may ask you where you saw the lights.

Add when setting the threshold by measurement

23Visual field tests

To begin with the lights will be fairly bright.

They will then get dimmer and dimmer until they cannot be seen.

You should not guess. If unsure it is advisable to say "none".

Henson Perimeter User Manual

3.1.1.2 Pre se nt in g a nd s ele cting d iffere nt mu ltip le s timulus p att erns

The currently selected multiple stimulus pattern is displayed on the screen by the red circles.

To present this pattern to the patient click Present or press the space bar.

To go onto the next pattern click Fwd or press right arrow key on keyboard.

To go back click Bwd or press left arrow key on keyboard.

All the patterns within the current test level are represented by a line of buttons

along the bottom of the screen:

To go to a specific pattern click the pattern button.

Each of the pattern buttons gives the number of stimuli in the pattern. This number starts off in green and goes to black once the pattern has been presented. If there is a missed stimulus in the selected pattern then the number is shown in red.

When extending the test to a higher level , additional pattern buttons will

appear.

3.1.1.3 Mis se d s timuli in mu ltip le s timulus s upra thre sh old te st

It is not unusual for a patient with no visual field loss to miss the occasional stimulus. To differentiate between these and misses due to genuine field loss, the pattern should be presented a second time.

If the incorrect number is given twice then establish which stimuli were missed by:

1. Asking the patient where they saw stimuli. It is often helpful at this stage to tell the patient to consider the bow l as a clock face and to give the hour positions of the stimuli.

2. With the Miss button selected (down) click over the location of the missed stimulus, or click the right mouse button when the cursor is over the missed location.

To correct mistakes (i.e. remove stimuli marked as missed) make sure the Rmv

25Visual field tests

button is selected (down) and touch or click over the mistake.

Stimuli missed at a 5dB increment should be tested at a higher intensity level.

Henson Perimeter User Manual

3.1.2

Sin gle s timu lu s

The Single Stimulus Supra-threshold test is ideal for screening the visual field.

The test is fully automated and requires no intervention other than to instruct

the patient on what to do, ensure that they have the correct refractive

correction in front of their eye and that they are correctly positioned and

74 71

comfortable.

The initial test intensity is set to 5dB above the patient's threshold. The

threshold is derived either from the patient's age or from a measurement

taken at the beginning of the test.

Stimuli that are not seen by the patient are presented a second time at the same intensity.

If missed on both occasions, the stimulus is marked as a miss and presented at 8dB above the threshold estimate.

If missed at 8dB it will be presented at 12dB above the estimate. A gray scale indicates the depth of defect (5, 8 or 12dB).

The patient responds to each seen presentation by pressing their response

button .

This test incorporates a number of false positive catch trails . These help to

discourage the patient from predicting the next presentation.

The test can be customised the with the addition of extra stimulus locations.

To g et mo re h e lp o n a te s t s cre e n ite m click o ve r th e it em in th e ima g e b elo w .

27Visual field tests

3.1.2.1 Pa tie nt ins tructio ns

Henson Perimeter User Manual

It is important that the patient understands what they need to do during the test.

Below is a set of instructions that we have found to work well.

The eye not being tested should be occluded and the test eye must be correctly aligned with the patient sitting comfortably.

Threshold set by age

The test is going to take about 2 minutes.

You should press the response button when you see a light flash.

Some presentations are deliberately blank so do not press the button unless you are sure you saw a light flash.

You must keep looking at the central red light and keep your eye as still as possible.

If you want to take a break, you can hold down the response button. The test will pause until the response button is released.

The first few presentations are a demonstration, so do not worry if you make a mistake at the beginning.

Add when setting the threshold by measurement

At the beginning of the test the light will be very dim.

Do not worry if you do not see many lights

Only press the button when you are sure.

The lights will brighten up later on.

29Visual field tests

3.1.3

Se ttin g t he te s t int ens it y

The Supra-threshold tests present stimuli at intensities that are above the patients estimated threshold. It uses one of 2 techniques to establish a patients threshold:

Age related. The level is simply set by the age of the patient. This is

the fastest method but can lead to errors when a patient's threshold departs from the average value for their age, e.g. when there are media opacities.

Threshold related. The level is set by a series of measurements

taken at the onset of the test. The algorithm is different for Single and Multiple stimulus tests.

When your machine was installed one of these techniques would have been set as the default method, i.e. the method first selected when a suprathreshold test is undertaken. You can change the default method within the

Options program.

You can also opt to change the method at the onset of a test. For example, you might want to regularly use the age setting method but then for a particular patient, maybe one who has a cataract, want to set it according to their threshold.

To select a different method at the onset of a test:

1. Click on the tool bar.

2. Select a method from the popup screen, see below, and then click OK.

No tes:

Henson Perimeter User Manual

You can set the threshold to a given value. You might want to do this to match a previous setting.

The perimeter will revert to the default method when swapping to the next eye or starting a new patient.

+ 131 hidden pages

Elektron Henson 9000 User Manual

Specifications and Main Features

Frequently Asked Questions

User Manual

Welcome

Elekt ron company not ic es

Important warnings

Revision history

Help/Manual informat ion

Ac knowle dgement s

Quick start

Single s timulus test

Mult iple stimulus test

ZAT A theshold tes t

Driv ers test

Visual field tests

Supra- threshold t est s

Mu ltip le s timulus

3.1.1.1 Pa tie nt ins tructio ns

3.1.1.2 Pre se nt in g a nd s ele cting d iffere nt mu ltip le s timulus p att erns

3.1.1.3 Mis se d s timuli in mu ltip le s timulus s upra thre sh old te st

Sin gle s timu lu s

3.1.2.1 Pa tie nt ins tructio ns

Se ttin g t he te s t int ens it y