Test Chart XPert 3Di Phoropter Manual

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PHOROPTER INTERFACE MODULE Test Chart Xpert 3Di is available with an optional module for controlling the Nidek RT5100 and phoropter.

This provides a single interface for the Test Chart and the phoropter allowing the appropriate charts to be displayed when various lenses are selected and vice versa. The module also provides a generic conduit for data to be passed between the phoropter and patient management systems allowing previous prescriptions to be dialled up in the phoropter at the click of a button and updated prescriptions to be uploaded back into the database.

HARDWARE REQUIREMENTS SCREEN SIZE AND RESOLUTION The phoropter module requires a PC capable of supporting two monitors (see earlier section). One monitor is used to display the test chart while the other is placed in front of the practitioner to control the phoropter interface. The minimum resolution for the practitioner’s monitor is 1280 x 1024. A larger/higher resolution is advantageous because it allows other windows to be viewed simultaneously on the screen.

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NB. The vertical resolution of the monitor must be 1024 or greater in order to accommodate the control window. Widescreen formats such as 1680 x 768 are not suitable. SERIAL INTERFACE A serial interface is required to link the PC to the phoropter control unit. Few PCs now have a serial interface and therefore a USB to serial converter will probably be required. These are readily available from computer suppliers or can be ordered through Thomson Software Solutions.

USB to serial converter available from Lindys. Plug the USB to serial converter into a USB port of the computer. After a few seconds the “Found new hardware” wizard should appear. Insert the CD supplied with the USB to serial converter and follow the on-screen instructions. When the driver has been installed successfully a message should appear to confirm that the hardware is now ready to use. The USB to serial converter will appear as a serial (COM) port in the hardware configuration of the computer. To check this, select Control Panel … Device Manager.

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Expand the Ports node and the USB to serial device should be listed along with the COM port to which it has been assigned (e.g. COM 5). Make a note of this port as you will need this information when configuring the phoropter interface in Test Chart XPert 3Di. You will also need a cable to connect from the USB to serial converter to the phoropter control unit. This will be supplied by Nidek along with instructions about how to connect this to the control unit. INSTALLING AND SETTING UP THE SOFTWARE The software is supplied on a CD with a Dongle and installed in exactly the same way as the standard Test Chart Xpert 3Di software. Before the phoropter interface can be used the interface needs to be configured and enabled as follows: Select Setup from the menu at the top of the screen and select the Remote and Phoropter tab.

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Select the phoropter type from the pull down list and ensure that Enable phoropter is checked. Select the appropriate Com port using the information recorded from the Device manager (see above). Click on OK to record the settings.

If you have not already done so, select Show floating window on desktop from the Windows positioning page of the Setup window. This will display the Floating window on your primary display. By default this will show the thumbnail display as shown below.

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Select the Phor icon from the toolbar at the bottom of the screen. This will display the phoropter interface as shown below.

By default, the interface will include three windows: the phoropter interface, the test chart thumbnail and the Rx memory windows. The Rx memory can be swapped with a Programmes window by selecting the Progs icon on the toolbar at the bottom of the screen. Various options for the phoropter interface can be set by clicking on the Opts icon in the toolbar. Each window will be described in detail below. PHOROPTER INTERFACE The phoropter interface has been designed to be as intuitive as possible. To achieve this, the interface includes a visualisation showing exactly which lenses and filters are being presented at any moment in time. This is particularly useful for those upgrading from a trial frame. SELECTING SPHERE/CYL LENSES To dial up a prescription in the phoropter, simply click on the Sph, Cyl or Axis boxes for the corresponding eye. The box will then be highlighted as shown below. To change the lens, rotate the mouse wheel (located between the two mouse buttons).

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The software will wait until the mouse wheel stops moving and then dial in the new lens in one rotation (rather than changing the lenses in 0.25 steps). This makes it very much quicker to make large changes in lens power. The lenses selected will be shown in the visualisation exactly as they would appear in a trial frame.

To change the lenses for the right and left eye together, click on the box between the two lenses, For example, if you wish to change the power of the sphere in front of both eyes simultaneously, click on Sph. You will note that both the right and the left Sphere boxes are now highlighted as shown below.

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If the mouse wheel is now rotated, both spheres will be changed simultaneously. To return to single lens control, simply click on a box. The value in the Sph and Cyl box can be zeroed by right clicking in the corresponding box. Right clicking on the Axis box sets the axis to 90 or 180 degrees. SELECTING A NEAR ADD When in distance vision mode, the Add boxes are greyed out. Clicking on one of the Add boxes will cause these boxes to be highlighted and the distance Rx to be greyed out as shown below. The phoropter will also automatically be adjusted to the near PD and the near chart illuminators will be switched on. By default, the Add for both eyes will be highlighted which means that rotating the mouse wheel will add the same reading addition to each eye. Clicking on one of the Add boxes will remove the highlighting from the other eye and allow the Add for each eye to be adjusted independently.

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Clicking on any of the Sph, Cyl or Axis boxes will put the phoropter back into distance vision testing mode. ADDING PRISMS To add prisms, click on the Prisms button. This will display the prism rack as shown below.

To add a prism, click on the appropriate prism box and rotate the mouse wheel. The base direction is shown automatically. The prism can be adjusted monocularly or binocularly by clicking on the button labelled Monoc / Binoc. When in binocular mode, the prisms for the right eye will be changed together in opposite directions so as to increase the combined prismatic power. For example, changing the horizontal prism will add Base In or Base Out prism to both eyes. For vertical prism, Base Up will be added to one eye and Base down to the other. NOTE: The prism will not be incorporated into the phoropter until the Incorporate button is pressed. In addition to the button being highlighted, “PRISM

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INCORPORATED” is included on the visualisation as shown below. This allows prisms to be incorporated instantly in front of both eyes if required.

The prism can be removed from the phoropter by pressing the Incorporate button again and the prism rack can be hidden by pressing the Prisms button again. AUXILLARY LENSES The Nidek phoropter includes a variety of auxiliary lenses for use with specific tests. To include an auxiliary lens, select the Aux lenses button. This will display the auxiliary lens rack as shown below.

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To select one of the available lenses, simply click on the corresponding button. A representation of the lenses inserted will be displayed on the visualisation as shown below.

The auxiliary lenses can be linked to specific test chart screens by selecting Show associated chart when lens is selected option from the Miscellaneous phoropter options (see later).

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To remove all auxiliary lenses, select None. To hide the auxiliary lens rack, click on Aux lenses again. CROSS CYL TESTING To perform a Cross Cyl test, select Cross Cyl. This will display the cross cyl rack as shown below.

The three types of cross cyl (+/-0.25, +/-0.50 and Auto[if available]) can be inserted by selecting the corresponding button in the rack. Likewise, the cross cyl mode (axis or power) is selected by clicking on the corresponding button. The cross cyl is spun (except for auto mode) by clicking on the Spin Cross Cyl button. A representation of the cross cyl is presented in the visualisation. The red and black dots represent the plus and minus axes of the cross cyl respectively. When in Power mode the axes will be automatically set at 0 and 90 degrees from the current cylinder axis. When in Axis mode the axes will be placed at 45 degrees from the current cylinder axis. The orientation of the cross cyl will be adjusted automatically as the cylinder axis is changed. The red and green boxes can be used to change the cyl power and axis automatically by simply clicking on the colour of the preferred cross cyl (shown as a red or green rim to the cross cyl). 12

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SELECTING THE RIGHT OR LEFT EYES To swap between the eyes when performing a cross cyl test, click on the R or L boxes as shown below.

If already in cross cyl mode, the cross cyl will be removed from the other eye and inserted in front of the selected eye at the correct orientation and in the same mode. The other eye will also be occluded automatically. To remove the cross cyl lens, click on the Cross Cyl button again. OCCLUDING THE EYES To occlude an eye, either click on the Cover RE or Cover LE buttons or click directly on the visualisation. The corresponding eye will be occluded in the visualisation as shown below. To uncover the eye, click on the button or the visualisation again. FOGGING THE EYES A fogging lens can be presented in front of the eyes (without changing the main sphere power) by selecting the Fog RE or Fog LE buttons. This is displayed as an additional “flipper lens” in the visualisation as shown below.

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The power of the fogging lens can be selected from the phoropter options window (displayed by selecting Opts on the toolbar at the bottom of the screen). To change the default power of the fogging lens, select the Fogging tab and then select the required power from the pull down list.

RETINOSCOPY LENSES Selecting the Ret button inserts plus lenses in front of both eyes as shown below.

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The power of the retinoscopy lenses can be selected from the phoropter options window (displayed by selecting Opts on the toolbar at the bottom of the screen). To change the default power of the retinoscopy lenses, select the Fogging tab and then select the required power from the pull down list. “FLIPPER" LENSES It is often convenient to offer a patient a small adjustment in the spherical power of a prescription. For example, is it any clearer with -0.25DS, is it any worse with +0,25DS. This can be achieved by simply selecting the Sph value and changing the power using the mouse wheel. However, the flipper offers a rather more convenient solution. To display the flipper rack, click on the Flipper button in the top toolbar. This will display a flipper rack for each eye as shown below.

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To change the spherical power in one eye, simply select the lens power from the rack. This power will then be added to the current prescription. For example, to offer a +/0.25 lens, simply click on the +0.25 then -0.25 lens in the rack. To remove the additional lens, select None. To present the same powered lens to both eyes simultaneously (binocular flipper), select the Monoc/Binoc button on either of the flipper racks. ADJUSTING THE PHOROPTER CD (PD) To adjust the centration distance of the phoropter to match the patient’s PD, select the PD box as shown below.

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Selecting the box will turn on the eye illuminator LEDs and insert a cross-hair alignment lens in front of each eye. The centration distance is changed by simply rotating the mouse wheel until the lenses are aligned with the centre of the pupils. To remove the alignment crosses and turn off the eye illuminators, click on any other box, e.g. Sph. RESET To remove all lenses and filters from the phoropter and set the centration to 64mm, click on the Reset button. The phoropter can take up to 10 seconds to fully reset.

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OPTIONS The phoropter interface can be customised by selecting Opts from the toolbar at the bottom of the floating toolbar. This will display the Phoropter Options window which has four tabs.

CYL OPTIONS

The Plus Cyl options tab is used to present the Rx in plus cyl format as shown below:

PLEASE NOTE: The lenses in the Nidek phoropter are actually in minus cyl format which means that when working in plus cyl format, both the sphere and cyl in the phoropter need to be changed. This results in a “double clunk” and is rather slower than working in minus cyl format.

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Selecting Automatically adjust sphere with cyl changes will automatically increment the sphere value by +0.25 for every -0.50 change in cyl power thus keeping the mean sphere constant. By default, cyl axis changes in 5 degree increments. However, for higher cyls it may be desirable to specify the cyl axis to the nearest degree. This is achieved by selecting the 1 degree option under Cyl axis increment. Please note: the 1 degree increment option is not yet available for the tablet interface.

FOGGING The power of the lenses use for fogging and retinoscopy can be selecting from the fogging tab as shown below.

MISC OPTIONS Selecting the Misc tab display the options shown below:

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Selecting Use IR remote to control phoropter allows the standard IR remote control to be used to change various phoropter values. The IR remote keys take on the following functions: Vertical cursor keys: Move between Sph, Cyl and Axis Horizontal cursor keys: Increment / decrement current value (Sph, Cyl, Axis, Add) R/L: Select Right / Left eye respectively Home / PgUp: Cover / uncover right and left eyes U: Show cross cyl I : Remove cross cyl Test Option 1 / 2: Spin cross cyl Test Option 3 / 4: Select Axis / Power mode for cross cyl M: Select auxillary lens mode Selecting Use keyboard to control phoropter causes the up/down cursor keys on the keyboard to change the current phoropter values (instead of using the mouse wheel). This can be useful when performing retinoscopy for example. Selecting Show associated chart when lens is selected is the reverse of the previous option. The corresponding lens is inserted when specific charts are selected.. For example, a cross cyl lens is inserted when a cross cyl target is selected.

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