elektron eye technology Henson 9000 User Manual

Henson 9000

Elektron Eye Technology Ltd.

HENSON 9000

Elektron Eye Technology Ltd.

All rights reserved. No parts of this work may be reproduced in any form or by any means - graphic, electronic, or mechanical, including photocopying, recording, taping, or information storage and retrieval systems - without the written permission of the publisher.

Products that are referred to in this document may be either trademarks and/or registered trademarks of the respective owners. The publisher and the author make no claim to these trademarks.

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: May 2018 The HENSON 9000 is manufactured in the United Kingdom by Elektron Eye Technology Ltd.

Broers Building J.J. Thomson Avenue Cambridge Cambridgeshire CB3 0FA Tel : 01223 371 000 Email: info@elektroneyetechnology.com

at our manufacturing site in South West London. Elektron Eye Technology Ltd. 29 Central Avenue West Molesey Surrey KT8 2RF

Table of Contents

3Contents

Part I

............................................................................................................... 81

............................................................................................................... 92

............................................................................................................... 103

............................................................................................................... 124

............................................................................................................... 135

Part II

............................................................................................................... 151

............................................................................................................... 162

............................................................................................................... 173

............................................................................................................... 184

Part III

............................................................................................................... 201

............................................................................................................... 372

Welcome

Elektron company notices Im portant warnings Revision history Help/Manual information Acknowledgements

Quick start

Smart Supra Single Stimulus test Smart Supra Multiple Stimulus test ZATA Threshold test Esterman Binocular Driving test

Visual field tests

Smart Supra tests

Multiple Stimu lu s

Pa tient instructio ns Presenting and selecting different multiple st imulus

pattern s Missed stimu li in multiple stimulus suprathreshold test

Single Stimu lus

Standard a nd Mu lti-s ampling Algorithms Pa tient instructio ns

Settin g the test in tensity

Single Stimu lus a lgo rithm

Multiple Stimu lu s algorithm Test O pti on s Exten din g th e test Adding and correctin g presentations Changin g the supra-th reshold increment Analysing the res ults Toolbar

ZATA Threshold test

Blind spot Exten din g th e 24-2 test Fovea mea su remen t Global In dices

Mean D efect

Standard Deviation

Hemifield Test Outpu ts

Threshold/gray sca le

Total Deviation

Pa ttern Deviation Prin tou t

25 26 27

28 29 30

41 42 43 44

45 46 47 48

Henson 9000 Perimeter User Manual 4

............................................................................................................... 603

Part IV

............................................................................................................... 661

............................................................................................................... 702

............................................................................................................... 713

............................................................................................................... 724

............................................................................................................... 735

............................................................................................................... 746

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............................................................................................................... 768

............................................................................................................... 779

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............................................................................................................... 8012

............................................................................................................... 8113

............................................................................................................... 8214

Pro gression: Rate o f chang e

GSS II

Prin tin g Pa tient instructio ns Stimulus locatio ns Entering patien t details ZATA con trols

Esterman Binocular Driving tests

Pa tient Instruction s Options Stimulus locatio ns

General information

Preparing the patient

Ali gn in g th e patient Pa tient Instruction s Refractive correction

Auto timing Catch trials Changing eyes Demonstrating the test Entering patient data Entering the patient's date of birth Fixation targets Help facility Help Rx Printing the results of a field test Response button Saving visual field data Video camera

51 53 54

Part V

............................................................................................................... 841

............................................................................................................... 862

............................................................................................................... 873

............................................................................................................... 884

............................................................................................................... 895

............................................................................................................... 906

............................................................................................................... 917

............................................................................................................... 928

............................................................................................................... 939

Part VI

............................................................................................................... 961

............................................................................................................... 972

............................................................................................................... 983

Options program

Tests Computer Database Backup Video setup Integration PDF Save/Cancel Registration and licencing

Database program

Backup copy of the database Changing the active database Deleting a record from the database

5Contents

............................................................................................................... 994

............................................................................................................... 1005

............................................................................................................... 1016

............................................................................................................... 1027

............................................................................................................... 1038

............................................................................................................... 1049

............................................................................................................... 10510

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Part VII

............................................................................................................... 1111

............................................................................................................... 1122

............................................................................................................... 1133

............................................................................................................... 1144

............................................................................................................... 1155

............................................................................................................... 1166

Editing data in the database Visual field chart Finding a record in the database List/Tree views Im port records Moving through the database Im age files Printing a database record Saving records in database Progression analysis

Glaucoma Staging System: GSS II

Utilities program

Opening an existing visual field database Creating a new visual field database Copying a visual field database Merging databases Transferring records between databases Im port Henson 6000 records

109

110

Part VIII

Appendix 1 - 9000 technical specification

Part IX

Appendix 2 - 9000 connection details

Part X Appendix 3 - Installation

Part XI Appendix 4 - Maintenance and

warranty

............................................................................................................... 1281

............................................................................................................... 1322

............................................................................................................... 1333

............................................................................................................... 1344

............................................................................................................... 1355

............................................................................................................... 1366

............................................................................................................... 1377

Regular inspection and m aintenance Upgrading the software Cleaning Preventative maintenance Replacement parts Repairs and recalibration Warranty

Part XII Appendix 5 - Troubleshooting

............................................................................................................... 1391

............................................................................................................... 1402

............................................................................................................... 1413

............................................................................................................... 1424

............................................................................................................... 1435

Background out of tolerance Bowl error LED error Chinrest Key violation

117

120

121

127

138

Henson 9000 Perimeter User Manual 6

............................................................................................................... 1446

Part XIII

Part XIV

Part XV

Database errors

Test n ot recognised Database B ackup not ava ilable

Appendix 6 - License file Appendix 7 - Networking Appendix 8 - Practice

management integration

Index

145 146

147

148

149

153

7Welcome

To find out more about Henson perimeters visit our website:

http://www.elektron-eye-technology.com

or scan the QR code opposite.

Welcome

Henson 9000 Perimeter

E le k tr o n E ye T ec h n o lo g y 2 0 18

Henson 9000 Perimeter User Manual

1. 1

Elektron company notices

The Henson 9000 is manufactured in the United Kingdom by Elektron Technology UK Ltd., Broers Building, J.J. Thomson 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 viewed 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 Eye 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 authorised 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.

E le k tr o n E ye T ec h n o lo g y 2 0 18

9Welcome

This unit must be connected to an earthed electricity supply

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

No modification of this equipment is allowed

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 an external hard drive, or other suitable removable media, to avoid any possibility of data loss.

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

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.

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Release

Date

Change

Version 1.0

August 2013

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 1.3

October 2014

Updated information on supra threshold tests, database operations and general formatting.

Version 1.4

May 2015

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

Version 1.5

November 2015

Added Progression information to coincide with Version 3.4 Software release

Version 1.6

April 2017

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

Version 1.7

May 2018

Changes for Version 4.0 Software release - new GUI for all test programs, changes to suprathreshold programs. Elektron Eye Technology branding applied.

Henson 9000 Perimeter User Manual

1. 3

Revision history

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

E le k tr o n E ye T ec h n o lo g y 2 0 18

To send Feedback, click the feedback button and enter details in the box. Pressing send will generate an email with the files attached.

Information for the software Versions after the 3.5 release

The release version of software called 3.5 contained some important changes to the way the software 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.

The image stored is now 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.

11Welcome

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 )

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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 9000 Perimeter User Manual

1. 4

Help/Manual information

Many of the images in this help 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.

permission of Elektron Technology UK Ltd. is prohibited, except as allowed under copyright laws.

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.

E le k tr o n E ye T ec h n o lo g y 2 0 18

13Welcome

1. 5

Acknowledgements

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.

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Henson 9000 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 get more help on an item in the start-up screen click that item on the image below.

See Appendix 3 for installing and setting up the software.

121

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15Quick start

2. 1

Smart Supra Single Stimulus test

After selecting the test and entering the patient's date of birth you will be presented with the Smart Supra Single Stimulus test screen below.

To get m ore help on a test screen item click over the item in the im age below.

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Henson 9000 Perimeter User Manual

2. 2

Smart Supra Multiple Stimulus test

After selecting the test and entering the patient's date of birth you will be presented with the Smart Supra Multiple Stimulus test screen below.

To get m ore help on a test screen item click over the item in the im age below.

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17Quick start

2. 3

ZATA Threshold test

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 patient details or select the

specific patient's details from the database . Once this has been done you will be presented

with the ZATA Threshold test screen below.

To get m ore help on a test screen item click over the item in the im age below.

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Henson 9000 Perimeter User Manual

2. 4

Esterman Binocular Driving test

After selecting the relevant Group 1 or Group 2 test you will be presented with the test screen below.

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

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19Visual field tests

Visual field tests

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

Smart Supra Single Stimulus : Choose this test to screen large

25 25

numbers of patients. It is a fully automated test where the patient presses a response

button every time they see a stimulus.

Smart Supra Multiple Stimulus : Choose this if speed is important.

21 21

It is approximately twice as fast as the single stimulus strategy in patients with little or no defect. This is a Semi-Automated test.

ZATA Threshold (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.

Esterman Binocular Driving Test : 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.

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Henson 9000 Perimeter User Manual

3. 1

Smart Supra tests

There are two different Supra-Threshold tests provided with the Henson 9000 software, Single

25 21

and Multiple stimulus:

Both incorporate three levels of testing. Both can be run in an age-related (Total Deviation) or threshold-related (Pattern

Deviation) mode.

The flow chart below gives the different stages of a Supra-Threshold test.

Multiple Stimulus

The Smart Supra Multiple Stimulus test is used to rapidly screen the visual field. The test is semi-automated but requires more perimetrist involvement than the single stimulus equivalent. With a skilled perimetrist this can result in more reliable results with less variability.

The perimetrist should 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

69 66

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

1. After each presentation the patient tells the perimetrist how many stimuli they saw.

2. If the patient gives 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 an intensity that 95% of patients with no field loss should see. The test has 3 levels , it starts testing just 26 points. It can be extended to 54 and 86

32 32

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

To get m ore help on a test screen item click over the item in the im age below.

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Henson 9000 Perimeter User Manual

3.1 .1.1

Patient instructions

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 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.

Not all of the spots will be the same intensity.

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

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".

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23Visual field tests

3.1 .1.2

Presenting and selecting different multiple stimulus patterns

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

To present this pattern to the patient click or press the space bar. To go forward or back to another pattern click or press the left or

right arrow keys on the keyboard.

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

bottom of the screen:

To select a specific pattern click the pattern button. Each pattern button shows the number of stimuli in the pattern. The number on the button is initially green and turns 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.

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Henson 9000 Perimeter User Manual

3.1 .1.3

Missed stimuli in multiple stim ulus suprathreshold test

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 bowl as a clock face and to give the hour positions of the stimuli.

2. To mark a location as missed move the mouse to the missed location, click the left button and from the pop up select .

To correct mistakes (i.e. remove stimuli marked as missed) repeat 2 but select .

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25Visual field tests

3.1 .2

Single Stimulus

The Smart Supra Single Stimulus test is ideal for screening the visual field. The fully automated test 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 comfortable.

The test intensity is derived either from the patient's age or from a measurement taken

28 28

at the beginning of the test. There are two different test algorithms, Standard and Multi-sampling The patient responds to each seen presentation by pressing the response button . This test incorporates a number of false positive catch trails that help to discourage the

patient from predicting the next presentation. The test can be customised with the addition of extra stimulus locations.

To get m ore help on a test screen item click over the item in the im age below.

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Henson 9000 Perimeter User Manual

3.1 .2.1

Standard and Multi-sampling Algorithms

Smart Supra test algorithms define what the patient has to do for a test location to be marked as seen or missed.

The single stimulus test offers two different algorithms, Standard and Multi-sampling. When your machine was installed one of these algorithms would have been set as the default

within the Options program. You can change the test algorithm at the onset of a test by clicking

Standard algorithm

In this algorithm the patient has to miss a flash at each test location twice, or see it once, before it is marked as missed or seen. Having to miss the stimulus twice before the location is marked as a miss reduces the number of false positives misses. This algorithm has been part of the Henson software for many years.

Multi-sampling algorithm

In this algorithm the patient has to miss a flash at each test location twice, or see it twice before it is marked as seen or missed. This algorithm is new to the Henson 9000 and takes a little longer, as there are more presentations, but is more robust to response errors and is less variable.

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27Visual field tests

3.1 .2.2

Patient instructions

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.

Not all of the flashes of light are the same intensity.

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.

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Henson 9000 Perimeter User Manual

3.1 .3

Setting the test intensity

The Smart Supra tests present stimuli at intensities that are above the patients estimated threshold. It uses one of two techniques to establish the patient's threshold:

Age related (Total Deviation). The level is 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 (Pattern Deviation). 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 within the Options program.

You can change the method at the onset of a test by clicking the Test Options button which presents the following options form.

The perimeter will revert to the default method for the second eye or when starting a new

patient.

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29Visual field tests

3.1 .3.1

Single Stimulus algorithm

The threshold sensitivity is measured at four test locations, one in each quadrant. The locations are displaced 9 degrees from the vertical and horizontal meridians.

At each location a repetitive bracketing algorithm (1dB steps, six presentations) is undertaken.

The average intensity of the last four presentations, at each of the four test locations, is then taken as the threshold. To guard against the inclusion of data from locations where the threshold is abnormally depressed, the algorithm excludes data from locations where the average of the last four presentations is below the 95% confidence limits of the expected age setting. If all test locations are excluded, the threshold is set at 4dB below the age setting.

Ten demonstration presentations are made prior to the collection of data.

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Henson 9000 Perimeter User Manual

3.1 .3.2

Multiple Stimulus algorithm

Perimetrist task.

1. Present the current pattern by clicking Present .

2. Ask the patient how many stimuli they saw, the pattern can be repeated if necessary.

3. Click either or depending on whether or not they saw any stimuli.

4. Keep repeating 1-3 until the threshold has been established when the test will automatically jump to the Supra-Threshold testing mode.

Notes:

The algorithm starts by presenting a pattern that should be easily seen. At each subsequent presentation it reduces the intensity until the patient reports (twice) that none are seen.

If none were seen on the first presentation then the algorithm increases the test intensity. It is important to tell the patient what is going to happen, i.e. that the patterns are going to get

dimmer and dimmer until they cannot see any of the stimuli. This helps to put the patient at ease when the stimuli get too dim to see.

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+ 125 hidden pages

elektron eye technology Henson 9000 User Manual

Specifications and Main Features

Frequently Asked Questions

User Manual

Welcome

Elektron company notices

Important warnings

Revision history

Help/Manual information

Acknowledgements

Quick start

Smart Supra Single Stimulus test

Smart Supra Multiple Stimulus test

ZATA Threshold test

Esterman Binocular Driving test

Visual field tests

Smart Supra tests

Multiple Stimulus

Patient instructions

Presenting and selecting different multiple stimulus patterns

Missed stimuli in multiple stim ulus suprathreshold test

Single Stimulus

Standard and Multi-sampling Algorithms

Patient instructions

Setting the test intensity

Single Stimulus algorithm

Multiple Stimulus algorithm