PTS1000 automated perimeter - Canon Globaldownloads.canon.com/medical/Manual-PTS1000.pdf · PTS1000 automated perimeter is a diagnostic devices used for examining visual field. It

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PTS1000 automated perimeter

Instruction manual

ver.4.1

revision C

PTS1000 Instruction Manual

2

CONTENTS

1. Introduction ...................................................................................................................... 4 2. Technical data ................................................................................................................... 4

2.1. Minimum system requirements ............................................................................................... 5 3. Unpacking and installation ............................................................................................... 6

3.1. Safety standards ....................................................................................................................... 8 3.2. Software installation and configuration ................................................................................... 9

3.2.1. Software installation and configuration in Windows XP ............................................ 9 3.2.2. Software installation and configuration in Windows VISTA .................................... 14 3.2.2.1. Compatibility of PTS1000 and Windows VISTA ..................................................... 14 3.2.2.2. Drivers and software installation ............................................................................... 14 3.2.2.3. Running PTS1000 application on Windows VISTA as Administrator ..................... 19 3.2.2.4. Running PTS1000 application on Windows VISTA with UAC turned off............... 20

3.3. Finalize work with PTS1000 ................................................................................................. 23 4. PTS1000 maintenance .................................................................................................... 24

4.1. Blown fuses replacement ....................................................................................................... 24 5. System and PTS1000 program startup ........................................................................... 25 6. Program structure ........................................................................................................... 26 7. Main tab .......................................................................................................................... 27

7.1. Fast search mechanism .......................................................................................................... 27 7.2. Registering new patients ........................................................................................................ 28 7.3. Editing patient's personal data ............................................................................................... 30 7.4. Unregistering patients ............................................................................................................ 30

8. Examination tab .............................................................................................................. 31 8.1. Static examination ................................................................................................................. 31

8.1.1. Field selection ............................................................................................................ 32 8.1.2. Strategy selection ....................................................................................................... 33 8.1.2.1. 3-zone strategy ........................................................................................................... 33 8.1.2.1.1. 3-Zone testing using extended field ....................................................................... 34 8.1.2.2. Screening strategy...................................................................................................... 34 8.1.2.3. Threshold strategy ..................................................................................................... 35 8.1.2.4. Fast threshold strategy ............................................................................................... 35 8.1.2.5. BSV strategy .............................................................................................................. 36 8.1.2.6. Flicker strategy .......................................................................................................... 36 8.1.2.7. BDT strategy.............................................................................................................. 37 8.1.3. Reduced field ............................................................................................................. 37 8.1.4. Rarification of tested points ....................................................................................... 37 8.1.5. Neurological field reduction ...................................................................................... 38

8.2. Kinetic examination ............................................................................................................... 39 8.2.1. Kinetic strategy ......................................................................................................... 39

8.3. Correction lens ....................................................................................................................... 40 8.4. Examination parameters setup ............................................................................................... 41

8.4.1. Fixation selection ....................................................................................................... 43 8.5. Performing examination ........................................................................................................ 43 8.6. Stages of examination for Threshold, Screening, Fast threshold, 3-Zone strategies: ............ 46

8.6.1. Examination without digital fixation control. ............................................................ 47 8.6.2. Examination with digital fixation control .................................................................. 48 8.6.2.1. Active patient's attraction mechanism ....................................................................... 48 8.6.2.2. Possible problems with digital fixation control ......................................................... 48 8.6.3. Manual pupil diameter calculation ............................................................................ 49 8.6.4. Field retest ................................................................................................................. 49 8.6.5. Examination with BSV strategy ................................................................................ 50


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8.6.6. Examination with Flicker strategy ............................................................................. 51 8.6.7. Examination with BDT strategy ................................................................................ 52

9. Results review tab ........................................................................................................... 53 9.1. Visualization options ............................................................................................................. 53 9.2. Visual field analysis .............................................................................................................. 55 9.3. Analysis of results ................................................................................................................. 57

9.3.1. Absolute results graph ............................................................................................... 58 9.3.2. Age norm deviation graph ......................................................................................... 58 9.3.3. Total deviation graph ................................................................................................. 58 9.3.4. HOV deviation graph ................................................................................................. 59 9.3.5. Pattern Deviation graph ............................................................................................. 59 9.3.6. Three dimensional visualization ................................................................................ 60 9.3.7. Comparing results ...................................................................................................... 61 9.3.8. Pupil movement graph ............................................................................................... 62 9.3.9. Examination parameters panel ................................................................................... 63 9.3.10. Bebie curve graph ...................................................................................................... 67 9.3.11. Defects progress analysis ........................................................................................... 69

9.4. Patient‟s examinations list ..................................................................................................... 70 9.4.1. Filtering of an examinations list ................................................................................ 70 9.4.2. Data Export/Import .................................................................................................... 70

9.5. Printing results ....................................................................................................................... 72 9.5.1. Inserting new map ..................................................................................................... 72 9.5.2. Editing map ............................................................................................................... 73 9.5.3. Deleting map from printout ....................................................................................... 74 9.5.4. Changing printout options ......................................................................................... 74 9.5.5. Printing and saving results in printout manager ........................................................ 75 9.5.6. Results compare printout ........................................................................................... 76 9.5.7. Sample printout.......................................................................................................... 77

10. Setup tab ......................................................................................................................... 78 10.1. Language selection ............................................................................................................ 78 10.2. Database tab ....................................................................................................................... 79

10.2.1. Examination results transfer ...................................................................................... 80 10.3. Backup ............................................................................................................................... 81

10.3.1. Backup on CD ........................................................................................................... 81 10.3.2. Recovering data from backup copy ........................................................................... 82 10.3.2.1. Recovering whole database ................................................................................... 82 10.3.2.2. Inserting backup copy database into existing database ......................................... 83 10.3.2.3. Recovering database from auto backup file ........................................................... 84

10.4. Application settings ........................................................................................................... 85 10.4.1. Field editor ................................................................................................................. 86 10.4.2. Appearance adjustment .............................................................................................. 87

11. Multiuser access in computer network environment ...................................................... 88 11.1. Program configuration as database server ......................................................................... 88 11.2. Program configuration as database client .......................................................................... 89 11.3. Program limitations on Client computer ............................................................................ 90 11.4. Sharing PTS data base on Windows VISTA computer in Local Network ........................ 90

12. Data exchange interface .................................................................................................. 95 12.1. Optomate data exchange interface ..................................................................................... 96

13. Solving problems ............................................................................................................ 96 14. Symbol information ........................................................................................................ 98 15. Storing conditions ........................................................................................................... 99 16. Service ............................................................................................................................ 99 17. Utilization ....................................................................................................................... 99


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1. Introduction

PTS1000 automated perimeter is a diagnostic devices used for examining visual field. It enables to

diagnose many eye diseases including glaucoma.

PTS 1000 series introduces some new concepts of perimetry:

Kinetic strategy allows detecting visual field losses in central and paracentral areas for patients,

who have problems with static examination.

Stimuli projection method offers all Goldmann standard stimuli sizes I-V.

Four stimuli colors: white, green, blue, red.

Digital algorithms implemented in system enable to detect any defects in patient‟s visual field.

Patient reaction time is measured automatically and examination speed is adjusted. It enables to

shorten duration of examination without rushing patient.

PTS1000 has a special DEMO function, which enables the patient to get familiar with perimeter.

Computer controls fixation quality by using Heijl-Krakau method or by digital image analysis,

which enables to continuously monitor fixation.

Live eye preview enables to position patient‟s head precisely and to observe patient‟s behavior

during testing.

Electronic adjustment of chin rest height.

Flicker (Critical Fusion Frequency) measurement strategy.

Blue on Yellow (Short Wave Automatic Perimetry) examination mode.

BDT (Binocular Drivers Test) strategy – enable Esterman score calculation.

Self diagnostic system.

2. Technical data

PTS 1000:

Dimensions 693 x 585 x 444 mm ±2mm

Outer diameter of bowl 550 mm ±2mm

Height of center of bowl 381 mm ±2mm

Height of chin rest 280 do 328 mm ±2mm

Weight 19 kg ±0.5kg

Power supply 100-250 V, 50-60 Hz

Power consumption 110 VA

Stimulus type projected

Stimulus colors white, green, blue, red

Maximum stimulus intensity 10000 asb ±20%

Minimum stimulus intensity 0.03 asb ±20%

Number of intensity levels 16

Exposition time 0.1 to 9.9 s

Number of predefined fields 10 + user defined

Number of strategies 9

Stimulus size I-V Goldman

Background illumination 10 asb (white) ±20%, 31.5asb (white),

314asb (yellow)

Dynamic range 45dB


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2.1. Minimum system requirements

Processor Intel 1600 MHz

RAM 256 MB

Operating system MS Windows XP/ VISTA

Hard disk 50 MB free space

CD-ROM 4x

Graphic card 800 x 600, 24 bits of color depth (True color),

3D accelerator supporting OpenGL

Communication sockets 1 x USB 1.1


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3. Unpacking and installation

Standard set of PTS1000 consists of the following elements:

Eye-Band Installation CD-ROM

Trial Lens Set with Box Patient‟s Reaction Stick Examination Bowl

Power Supply Cable USB Communication Cable Perimeter Box

Dust Cover

Bottom Foam Top Foam Chin Rest Adapter Holder for Patient‟s

Reaction Stick


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Important!

We suggest you should wait at least one hour after it has been delivered to you before plugging

in the device for the first time. Big temperature changes in short time are not healthy for

electronic equipment.

Assembly procedure:

PTS1000:

1.Unpack examination bowl and place it on a table. The table should have electrically or manually

controlled height.

2.Connect examination bowl with computer using USB communication cable.

3.Connect patient's reaction stick to examination bowl.

4.Connect power supply cable of examination bowl.

After the set is unpacked, please make sure no component is missing. Make some

visual check for any mechanical damage. In case of any damage, don`t plug the

device in and contact your local distributor.

Forehead support

Examination Bowl

Trial lens holder

Chinrest

Patient‟s reaction stick


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3.1. Safety standards

PTS1000 series automated perimeter can only be connected to power supply socket equipped

with properly connected grounding pin.

PTS1000 series automated perimeter complies with requirements of directive 93/42/EEC (MDD

- Medical Devices Directive).

PTS1000 series automated perimeter is usually part of larger Medical System (containing other

medical and non medical devices). This Medical System as a whole and each device separately must

also be compliant with MDD standard. Therefore the distributor or manufacturer of all other

devices included in the Medical System must assure that those devices comply with MDD rules.

PTS1000 is connected to computer via USB cable. USB cable is electrically separated from

perimeter. This gives additional protection when the PTS1000 and the computer are connected to

different power supply sources with different ground level potential.

Electrical connections of PTS1000 medical system

Warning ! 1) If PTS1000 device and the whole Medical System have been installed by the

Manufacturer, the Manufacturer guarantees the proper installation and compliance with

MDD rules.

2) In case the PTS1000 automated perimeter and all later added instruments are

connected in a different way than in this instruction or the installation was NOT made by

Manufacturer, the Manufacturer takes no responsibility for the violence of the relevant

safety standards.

3) Any computer system or device attached to PTS1000 series perimeter must be MDD

compliant.

4) Manufacturer of PTS1000 series automated perimeters takes no responsibility for any

incorrectly diagnosed examination results and any problems caused by wrong diagnosis of

examination results.

Warning ! All activities that demand removing main body housing may be performed by qualified

personnel only.

Ignoring or disregarding the statements above may lead to danger of death or serious

injury.

CCD

cameraTRAFO

Microprocessor

PCB board

MAINS

FILTER

USB

220V/230V50Hz

PTS 910 Optical separation Computer

system

PC computer, printer, monitor, etc.

(Must comply with IEC-601:

Medical Electrical Systems

and MDD directive)

110/230 V

50 or 60 Hz

PTS1000


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3.2. Software installation and configuration

3.2.1. Software installation and configuration in Windows XP

First step is installation of perimeter bowl drivers (only for PTS1000 model):

1.Turn the computer on (Windows operating system will be loaded). Insert PTS1000 series

installation CD into CD-ROM drive (usually drive D: or E:).

2.Turn the examination bowl on (according to PTS1000: make sure the bowl is connected to

computer by means of USB cable, and connected to power supply).

3.Windows will detect new hardware connected to USB socket and you will see the following

screen. Click on the “Next >” button.

4.Select “Search for the best driver for your device. (Recommended).” option and click on the “Next

>” button.

5.Mark “Specify a location:” option and select the “Browse” button to browse the directory:

“D:\Drivers” from your installation CD. Note! Replace D: with the drive letter of your CD-

ROM drive if necessary. Click on the “Next >” button.

Click `Next`

button

Select this

option

Click `Next`

button


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6.Click on the “Next >” button.

7.Prepare Windows installation CD-ROM (only if Windows 9x is used).

8.Click on the “Finish” button.

Digital camera installation is performed in the same way.

After having installed the drivers, one has to install PTS1000software:

1.From PTS 1000 series installation CD-ROM run SETUP.EXE.

2.If Language window will appear select installation language. Language window will appear only

if operating systems default language is not supported by PTS software.

3.Click on the “Next” button to continue.

4.Select the folder you would like Setup to install PTS1000 program. If you want to use default

folder, click “Next >” button.

Mark this

option

Browse

'D:\Drivers'

directory

Click `Next`

button

Installation process can be little different, depending on the used version of

Windows operating system.

Click `Next`

button


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5.Select the start menu group to install PTS1000 shortcut. If you want to stay with default group,

click “Next >” button.

6.Choose the option of creating shortcut on screen panel and click “Next >” button.

7.Click on the “Install” button.

8.Click ”OK” to install Borland Database Engine.

9.Click on the “Yes” button to confirm specified directory.

9. Click on the “Finish” button.

Installation process can be little different, depending on the version used of

Windows operating system.

Click `OK`

button

Click `Yes`

button

Select the folder

Click `Next`

button

Click `Next`

button

Select start

menu group


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Manual selection of

communication port

in case of problems

in connecting device.

Now one has to configure the software:

1.Run PTS1000 application. (details are explained in “5. System startup” and “6. Program

structure” parts of this manual)

2.Click on the “Setup” button and go to Setup Window.

3.Choose “Microsoft WDM Image Capture Version: 5.” video source. If marked USB mode

option is visible, it is not necessary to specify communication COM port. Click on the

“Format” button.

Click `Setup`

tab

Choose `Microsoft

WDM Image

Capture Version:5.`

video source

Click `Format`

button

Mark this box to

enable video

preview


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4.Choose camera resolution of “352 x 288” pixels and “RGB 24” bits of color depth (True

Color). Click on the “OK” button.

PTS1000 software requires screen resolution of 800 x 600 pixels or better and 24 bits

of color depth (True Color) or better.

1. Click right mouse button on the Windows desktop and select “Properties”.

2. Select “Settings” tab and adjust settings.

Choose

`352 x 288`

resolution

Choose

`RGB 24`

color depth

Click `OK`

button

Select 'Settings'

tab

Adjust

resolution Choose

color depth


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3.2.2. Software installation and configuration in Windows VISTA

3.2.2.1. Compatibility of PTS1000 and Windows VISTA

PTS1000 software is compatible with Windows Vista with some restrictions because of UAC

(User Account Control) - new idea of user rights and user accounts implemented by Microsoft. The

differences appear if there are more than one user accounts which are used to run PTS1000

application on the computer. If the PTS1000 application is used only from administrator‟s account,

the only thing which is required for full functionality is to run application “as administrator”.

In Windows Vista only users with administrator privileges are allowed to run applications which

fully access system registry. PTS1000 uses registry indirectly via BDE component during database

integrity check. Therefore this option requires elevation of user rights and PTS application to be run

„as administrator‟.

Contrary to previous versions of Windows OS, Windows Vista with UAC turned on creates

copies of databases for each user separately. Hence, there can be a problem with maintaining

integrity of database if PTS1000 application is used from different users‟ accounts. Every user

would have own data base and different users would not be able to review the same results.

There are two ways to cope with above changes. One of them is running PTS1000 application as

administrator. This solution is described in section 3.2.2.3 of this document. Another solution is to

turn off UAC and manage users account like it was in Windows XP. This method is described in

section 3.2.2.4 of this document. In both solutions all users can see and edit the same patients‟ data

base.

3.2.2.2. Drivers and software installation

At first USB components drivers have to be installed.

1.Turn the computer on and wait for Windows to start. After Windows has started plug in USB

cable from PTS, “Found New Hardware” window will appear. This means that the Windows

found new hardware installed and will search for drivers. Select „Locate and install driver

software‟

Click ‘Locate and

install driver’


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2.Insert PTS1000 Setup disk into CD ROM and press “Next”.

3.Windows will display warning about verification of the publisher. Select “Install this driver

software anyway”.

4.Now Windows will install driver files for the device.

5.At the end there will be a window displayed, with information about successfully installed

drivers: “PTS1000 Automated Perimeter”. Click „Close‟ button.

6.Now “USB Camera” driver will be installed. Steps 2-5 will be repeated. Follow on-screen

instructions. Click „Next >‟ to continue.

Click ‘Next’

Click ‘Install this driver software anyway’

Click ‘Close’


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7.After that, following Windows message about successful installation will appear:

Next step is PTS1000 software installation

1. Insert PTS1000 installation CD into CD-ROM drive. Click 'My computer‟ and open CD-ROM

drive (usually D: or E:) and run SETUP.EXE file. After a message is displayed click „Next >‟

2. Select the destination folder where PTS1000 application will be installed and click „Next >‟ (the

default destination folder is: C:\Program Files\PTS1000)

Click ‘Next’

Click ‘Next’

Select destination folder


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3. Select menu start group where PTS1000 icons will be placed (default: PTS1000). Click „Next >‟.

4. Mark checkbox if you wish program to create desktop icon and press „Next‟

5. Click „Install‟

Click ‘Next’

Click ‘Install’

Select Start menu group name

Click ‘Next’


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6. After the software is installed, click „OK‟ to install BDE

7. If directory is not already present system will display massage. Click „Yes‟.

8. At the end of installation installer will ask for system restart. Select „Yes, restart the computer

now‟ and click „Finish‟

Click ‘OK.’

Click ‘Yes’


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3.2.2.3. Running PTS1000 application on Windows VISTA as Administrator

In this method of running PTS1000 application, make sure to RUN PTS APPLICATION AS

ADMINISTRATOR. Best way is to set properties of shortcut on the desktop to always run in

administrator mode for all users. To do that:

1. Click right mouse button on the PTS1000 shortcut on the desktop.

2. Select “Run this application as administrator” in „Privilege Level‟ box.

3.Click OK.

IMPORTANT! After above changes, „Standard User‟ with standard rights, who will attend to run PTS1000

application, will have to enter password of one of system‟s administrators. Make sure that

PTS1000 software is used by responsible person who will use password only to run PTS1000

software.


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3.2.2.4. Running PTS1000 application on Windows VISTA with UAC turned off

In this method of running PTS1000 application you need to reconfigure Windows VISTA.

There two actions that need to be performed.

Turn UAC off

Grant access to PTS1000 folder to all users which will be using PTS1000

TURNING UAC OFF

1. Log on to computer using account with administrator rights.

2. Go to Control Panel and open „User Accounts‟ window

3. Select “Turn User Account Control on or off”

4. Unmark “Use User Account Control (UAC) to help protect your computer” checkbox and click

“Ok”

5. System will ask you to restart computer. Select „Restart Later‟ and go to the next point.


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6. Go back to Control Panel and open „Security Center‟.

7. Select “Change the way Security Center alerts me” link.

8. Choose the option that suits you. If you do not want to have any alerts select third option. If you

want to have only red shield icon in status bar select second option. If you want to be noticed every

time about UAC turned off select first option or press „Cancel‟.

9. Turn off Control Panel and restart the system.


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GRANTING ACCESS TO PTS1000 FOLDER TO ALL USERS WHICH WILL BE

USING PTS1000

1. Open Computer folder and navigate to place, where your PTS1000 software is installed (by

default C:\Program Files\PTS1000). Click right mouse button and select „Properties‟

2. In security properties tab press „Edit...‟.

3. In next window under groups and users table press „Add..‟.


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4. Type names of users which you wish to grant the full access to PTS1000. You can type

„Everyone‟ to grant access to all users. Press „Check Names‟ to verify if entered users exist.

Then press „OK‟

5. Next select added users from the list and grant them „Full control‟ rights. Click „OK‟

Now all users will be able to use PTS1000 software and manage one integral database.

3.3. Finalize work with PTS1000

To avoid operating system malfunctions shut down operating system first and then turn off

PTS1000 Compact device.

After turning off PTS1000 device wait few second to turn it on again.


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4. PTS1000 maintenance

Warning!

All cleaning procedures can only be performed when PTS1000 series device is turned off and

unplugged from power socket.

During its life span PTS1000 series device doesn't require any special treatment. All surfaces of

the bowl should be kept tidy and free of dust. Use only mild solvents for cleaning. Make sure water

or any other liquid doesn't break into the interior of the bowl. Periodically check if the bowl is not

mechanically damaged. Make sure the plugs didn't get loose.

For hygienic reasons, after each examination the chinrest and forehead rest should be disinfected.

Warning!

To facilitate cleaning procedures, it is possible to detach chinrest from the bowl as per the picture

below.

4.1. Blown fuses replacement

When examination bowl is not acting after being turned on (there are no stimuli changing in

colors and sizes in the center of the bowl) you should check electric fuse in power supply socket. If

any fuse was damaged you must exchange it for a new one.

Type of used fuses: AC.250V, F3.0A, 5x20mm.

Warning !

No user serviceable parts inside device. Removing covers forbidden.

Fuse

Power supply socket


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5. System and PTS1000 program startup

After Windows has started, you can run PTS1000 software. Click “Start” button and find proper

folder containing PTS1000 application. Click PTS1000 icon. The program will be started.

If you are using this computer only for PTS1000 you can make PTS1000 start

automatically. Details are explained in the next parts of this manual.

PTS1000

folder

Click PTS1000

icon

Click `Start`

button


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6. Program structure

PTS1000 software is designed to make it as easy as possible for the user. All buttons are big and

ergonomically located on screen and logically grouped.

When using this application you have to remember some basic rules of data entering, cursor

movement, etc. These rules apply to all other Windows programs.

Small arrow located on the screen is mouse cursor. Mouse cursor is used to click buttons, and

also to place keyboard cursor for entering data from keyboard.

Keyboard cursor has a shape of vertical line. Each character entered from keyboard will appear

in place of this cursor.

When left mouse button is clicked, keyboard cursor is placed in the same place as mouse cursor

(If keyboard cursor is allowed to be placed there).

Switching between different controls can be done using mouse cursor or TAB key; and choosing

active control is confirmed by pressing ENTER key.

PTS1000 application is divided into four main tabs. You can jump freely between them.

Main tab – basic window visible just after program startup. It enables user to operate the database,

register new patients, edit patient's data, etc.

Examination tab – contains all controls that are used to conduct a new examination.

Result review tab– is used to review examination results.

Setup tab – is used to configure the whole application and to perform some database operations

(like backup, data recovery, etc.).

Keyboard cursor


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7. Main tab

Main tab appears on the screen just after the application is started. It enables user to control patient's

database:

register new patients,

remove patients,

edit patient's personal data,

enter some remarks concerning selected patients.

All controls located on main window are shown below:

7.1. Fast search mechanism

If you find it difficult to locate your patient, just go to fast search control and patients filter.

Enter first few letters of patient's name to quickly locate patient in patients list. Program will

automatically search for the closest match.

You can also use patients filter. It can be used to display only these patients who have been

examined during last n days/months/years or who have not been tested in a given period.

Fast search mechanism –

enter first few letters to

automatically find patient

Filter modes

Fast search

mechanism

Click to register

new patient

Click to view

examination

results

Click to go to

setup window

Click to quit the

program

Click to edit

patient's

personal data

Click to

unregister patient

Current

patient`s data

You can enter

your remarks

here

Software version

and ID number

Click to

conduct new

examination

Mark to see data

Exchange

patients only

(look chapter 12)

Here enter desired

number of days, months,

years


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7.2. Registering new patients

In order to register new patient, click “New patient” button. You will be able to enter all personal

data that are required. You have to enter last name, first name and date of birth (date should be

entered in a format YYYY-MM-DD). You can also enter patient‟s address and add some of your

remarks.

Click “Enter” to complete registration of a new patient. Program will check entered data. If you

didn't specify some important data you will be asked to fill missing data. If data are correct program

will automatically jump to examination tab.

Important!

Remember to correctly enter patient's name. It will protect you from any further problems with

finding patients.

If program finds out that the patient is already registered in database you will receive a warning

message:

Last name, first name and date of birth are required fields and have to be filled in.

Address and Remarks are optional – you don`t have to enter them.

Enter first name

Enter date of birth

Enter address (optional)

Enter remarks(optional)

Enter last name


29

When program finds the patient with the same last name and first name, but different

date of birth you will receive a warning message: “There is a patient with the same

name already registered”. After that you should check patient's personal data in

database because the same patient could have been registered before with incorrect

date of birth.

Choose “Yes” to register patient. “No” when you want to correct these data.


30

7.3. Editing patient's personal data

To edit some incorrect data, select the patient from patients list and press “Edit” button. A

window will appear and you will be able to enter proper data. After the data are entered the program

will check the new data and they will be saved in database

7.4. Unregistering patients

To unregister a patient select patient from patients list and press “Remove” button. A warning

message will appear:

When you choose “Yes” a second and last warning message will appear:

When you chose “Yes” again the patient and his examination results will be unregistered and

deleted.

Once deleted patient cannot be restored. Make sure you are

unregistering proper patient.


31

8. Examination tab

Examination tab is used to perform new examinations and to control examination parameters. It

is possible to conduct static or kinetic examination. Choice is made by clicking proper tab at the top

of the window. By default static examination window is selected.

8.1. Static examination

Picture of “Examination tab” is printed below:

During Examination additional information is shown:

Current strategy,

click to change Current field Current patient,

click to change Click to change

field

Mark this if you

want to check

neurological defects

Click to set

cylindrical lens

value

Click to change

examination

parameters

Click to select

the other eye

Status bar and

progress bar

Eye preview window

Click to begin

examination

Click to run DEMO Blind spot location

Click to set

spherical lens value

False negative

errors information

Number of exposed

stimulus points

Patient's average

reaction time

Fixation errors

information (digital

image analysis system)

Test duration

False positive

errors information

Fixation errors

information (Heijl-

Krakau method)

Current pupil

diameter


32

8.1.1. Field selection

To select proper field range click “Field” box from Examination window. A small tab will be

opened showing you all available fields. Select one by clicking mouse cursor. Available fields:

Full (50° in every directions)

Central (30° in horizontal axis and 22° in vertical axis)

Glaucoma (30° with extend up to 50° in nose direction)

Peripheral (from 30° to 50°)

Macula (up to 10°)

Extended (special field for drivers examination – 50° in nose direction; 80° in temple direction)

Fast (up to 30° with scarce points)

User (up to 50° user defined)

Binocular Drivers Test(up to 80° in horizontal axis, up to 50° in vertical axis)

30 (30° in horizontal and vertical axis, points placed on square basis)

24 (24° in horizontal and vertical axis, extended to 30° in nasal direction)

50 40

30 22 15 10 3 6 3 6 10 15 22 30 40 50 40 70 80

60

0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 80

70 60 50 40 20 30 10 10 20 30 40 50 60 80 70

0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0

Extended field

BDT field

Full field Central field Glaucoma field

Macula field Peripheral field Fast field

3o

6o

10o

15o

22o

30o

40o

50o

3o

6o

10o

15o

22o

30o

40o

50o


33

8.1.2. Strategy selection

In order to select desired strategy click “Strategy” box. A small tab will be opened showing all

available strategies. Select proper strategy using mouse cursor.

There are five available strategies:

3-Zone

Screening

Threshold

Fast Threshold

Flicker

BDT (Binocular Drivers Test)

8.1.2.1. 3-zone strategy

In 3-Zone strategy each point is tested maximum 3 times. First exposition is made at 6dB below

HOV level (stimulus is brighter than expected). If patient reacts, the point is no more tested and

marked as NO DEFECT (a small dot appears on screen ),

If there is no reaction the point is exposed with maximum intensity (0dB). If there is no reaction

for maximum intensity, the point is no longer tested and marked as ABSOLUTE DEFECT (filled

square appears on screen). If there is reaction for maximum intensity, the point is tested again

6dB over expected HOV level. If there is no reaction the point is marked as RELATIVE DEFECT

(small empty square appears on screen □), otherwise the point is marked as NO DEFECT.

Below there‟s a schematic drawing of that process.

As it can be observed 3-Zone strategy can be used for locating defects of visual field without

measuring the depth of those defects.

N

N

N N

Y

N

Y

Y Y

Y NReaction No reaction

HOV level

AD RD No defect

30

10o

20o

30

0o 10o

20o

30o

0o

24 (right)

10o

20o

30

0o 10o

20o

30o

0o


34

8.1.2.1.1. 3-Zone testing using extended field

Unlike all other fields, extended field enables to test visual field up to 80 degrees. It can be

achieved by shifting fixation point 30 degrees left or right. Examination consists of a few stages.

In the first stage, normal 3-Zone test is performed (just as for all other fields). After a certain

number of points are tested, fixation point is shifted.

Patient should be instructed to look in the new fixation target. When the doctor makes sure that

patient‟s position is correct, examination can be resumed.

Make sure that patient looks at new fixation point and click “OK” button to continue.

8.1.2.2. Screening strategy

Screening strategy gives more accurate results. It not only locates defects but also measures the

depths of those defects.

First stimulus exposition is made 6dB over expected HOV level. If patient‟s reaction is

observed, current intensity is assumed as measured sensitivity for this point and it is no longer

tested. If there is no reaction, the intensity is increased in 6dB steps until the patients reacts for the

point or if maximum intensity is reached. If maximum intensity is reached the point is marked as

absolute defect and no longer tested (X mark is displayed on the screen).

If patient reacts, the stimulus intensity is decreased in 3dB steps until stimulus is invisible to

patient. The value of visible-not visible intensity is assumed as measured sensitivity.

Extended field can be tested only using 3-Zone strategy

After moving the fixation point, it is impossible to retest the blind

spot.


35

Below there‟s a schematic drawing of that process:

As can be seen from the graph above screening strategy can detect defects deeper than 6dB. It

doesn't detect areas that are more sensitive than expected – it doesn't test actual eye profile, it

detects defects only.

8.1.2.3. Threshold strategy

Threshold strategy is the most accurate strategy. It tests exactly the whole eye profile, but

duration of examination is longest.

First exposition is made at HOV level. Than the intensity is increased or decreased (depends on

reaction or no reaction from patient) in 6dB steps. Intensity is changed until sensitivity edge is

reached, then stimulus intensity is reversed in 3dB steps. This double check enables to determine

very precisely sensitivity level for each point.

This process is shown below.

Threshold strategy gives the most accurate results, but takes longest time. It not only locates

defects, measures depths of those defects but also measures exactly shape of visual field.

8.1.2.4. Fast threshold strategy

Fast threshold strategy is very similar to threshold strategy. The difference is in the duration of

examination. After calibration, initial levels of stimuli intensity are additionally modified on the

basis of measured sensitivity points in previous examinations of a given patient which are registered

in database, in order to minimize examination time. The examination consists of two stages.

In first stage points are tested using ordinary threshold strategy. After collecting half of the data,

program calculates expected sensitivity levels for the rest of points that haven‟t been tested yet. In

second stage program verifies those calculated values by means of screening strategy.

As a result Fast threshold strategy gives almost the same accuracy as threshold strategy but in a

lot shorter time (the examination takes 30%-40% less time).


HOV level

N

N

NN

Y

Y

HOV level

Actual

sensitivity

level

Actual

sensitivity

level


Calculated

HOV level

N

N

NN

Y

YActual

sensitivity

level

Actual

sensitivity

level

YY

N

Calculated

HOV level


36

8.1.2.5. BSV strategy

Examinations that use Binocular Single Vision strategy are performed in a different way than all

other examinations. BSV strategy is used to diagnose diseases related to common eyes movement

coordination and for diplopic diagnosis.

During the examination patient observes the examination bowl with both eyes opened, having his

head placed centrally using special chinrest adapter. The device will expose stimuli with maximum

intensity at different places of examination bowl. Patient should follow the stimuli with his eyes and

react on the reaction stick. If patient sees a single point, he should press the button once. If he sees

two points, then he should press the button twice.

Each of the examined points can have one of three possible values:

- it means normal single vision,

X - it means total no reaction,

- it means dual vision.

Detailed description of how to perform examinations using BSV can be found in chapter 8.6.5.

of this instruction manual.

8.1.2.6. Flicker strategy

Flicker strategy is used to measure patient‟s Critical Fusion Frequency (CFF). In this strategy

examination is performed in a different way than in other strategies. Exposed stimuli are not static,

they are blinking with different frequencies. Instead of measuring the brightness sensitivity

threshold in each point, we measure the frequency where the patient can see the blinking. Each

stimulus is presented with maximum intensity and maximum frequency. During examination, the

frequency is decreased until patient can see the flickering. Patient should be instructed to press the

button only if flickering point is visible. Stimuli are exposed in random places of examination field

by 3 seconds each. During exposition, frequency of stimulus decreases from 60 Hz with step 4 Hz

until patient reacts or exposition time ends. Minimum flicker frequency is 3 Hz.

In this strategy results are in Hz. If flicker frequency reaches value of 3 Hz and still there is no

reaction, point is marked as “X”.

Detailed description of how to perform examinations using Flicker strategy can be found in

chapter 8.5.6. of this instruction manual.

Frequency [Hz]

Time [s]

60

0 3 6

Initial level

Actual frequency level

reaction


37

8.1.2.7. BDT strategy

Examinations that use Binocular Drivers Test strategy are performed in a different way than all

other examinations. BDT strategy is binocular test measuring full field of vision for drivers (by

default suits III4e Goldmann stimuli).

During the examination patient observes the examination bowl with both eyes opened, having his

head placed centrally using special chinrest adapter. The device will expose stimuli with the same

intensity for all points at different places of examination bowl. Intensity can be set in settings

window. Patient should look at the fixation point by both eyes and react on the reaction stick when

he sees any appears points.

Each of the examined points can have one of two possible values:

- seen point,

- missed point

Detailed description of how to perform examinations using BDT can be found in chapter 8.5.7.

of this instruction manual.

8.1.3. Reduced field

After starting new examination, program searches its database for previous examination of the

patient. If those examination results are found – program searches for absolute defects in those

examination results („X” marked). If absolute defects are found, program asks if the new

examination should be performed without testing absolute defect areas. If reduced field is not used,

the whole field is tested. Otherwise absolute defect areas are excluded from examination. Not

concern 3-Zone, BSV, Flicker and Blue on Yellow strategies.

8.1.4. Rarification of tested points

There is a possibility to reduce time of examination by decreasing number of examined

points. There are 2 options of field rarification:

- Rarified – number of examined point is halved

- Auto – in the middle of examination program checks which point lie between defective

points and require testing.

Click 'Yes' if you want

use reduced field

Click 'No' if you want

continue examination

without reduced field

Select „Whole‟ if you

want to examine all

points in a field

Select „Rarefied‟ if you want to examine

every second point in a field

Select „Auto‟ if you want

program to decide which

points to examine in the

second part of

examination


38

8.1.5. Neurological field reduction

PTS1000 automated perimeter has the ability to shorten the duration of examination drastically

by using neurological reduction. If the neurological option is “On", after the process of calibration,

program analyses the four calibrated points. If none of them is marked with “X”, then there is no

neurological reduction, and examination is continued. If one or more are marked as “X”, additional

three points are exposed at maximum luminance at the selected quadrants. If patient doesn't respond

to any of those stimuli at current quadrant, the whole quadrant is marked “X” and excluded from

further examination.

Neurological reduction cannot be turned on when using 3-Zone and Flicker

Click 'Yes' if you want use

neurological field

reduction

Click 'No' if you want

continue examination

without neurological

reduction

Mark checkbox to use neurological

defect option


39

8.2. Kinetic examination

Screen from kinetic examination is presented below:

8.2.1. Kinetic strategy

In kinetic strategy patient concentrates on a fixation point and tracks stimuli moving from

peripheral towards center of visual field.

At the beginning the blind spot is tested to check if patient fixates properly. A first stimulus is

brighter than expected normal threshold value in the central part. If patient reacts, point is marked

as point with known sensitivity. Points where patient reacted are consequently marked on a plot.

These points joined with a line create one isopteran. After completing meridians with first intensity,

intensity is decreased by 3dB and test is repeated. A stimulus is decreased 3 times so after

examination there are 4 complete isopters on the map.

User has possibility to change color, size, speed and intensity of stimuli. The value of intensity is

selected for the first run of meridians testing. In the consecutive runs stimuli is decreased by 3dB

from initially selected value.

- Isopteran map – visual field is presented in form of a

graph with approximated isopterans. In this mode

isopterans join points with the same sensitivity covering

whole visual field.

Select Color, Size, Speed

and Intensity of moving

stimuli

Eye selection

Examination settings

Stimuli vectors

Stimuli vectors


40

8.3. Correction lens

PTS1000 automated perimeter is equipped with special lens holder. It enables to perform

examinations with correction lenses: spherical and/or cylindrical. The perimeter has possibility to

use spherical lens (SPH), cylindrical lens (CYL), or both lenses simultaneously.

If correction lenses are used, their diopter powers must be set by special keys in „Parameters”

panel. If no correction lens is used, parameter value should be set to „None” – which refers to

power 0D set by respective keys, or by pressing the left mouse button twice on a given field. If a

patient has spectacles on during examination, or correction lens is to be used, proper correction

value must be set in „Parameters” panel. When using correction lenses, it‟s only reasonable to test

area up to 15 . Wider test is useless, due to some distractions caused by correction lens itself.

That is why in the first stage PTS1000 tests only field area up to 15 . When all points in this area

are tested, program asks doctor to remove trial lens. Remove the correction lens, move the lens

holder aside not to interfere in further examination, and press OK button. Examination is continued

for the remaining part of a chosen field, without a correction lens.

Placing a spherical and cylindrical lens simultaneously is possible only in

perimeters equipped with a holder adapted to mounting two correction

lenses.

Set the value of SPH

correction lens (from -20D

to +20D, step 0.25D)

Double click in these

fields will change value

to zero.

Set the value of CYL

correction lens (from -6D

to +6D, step 0.25D)

Insert correction

lens to trial lens

holder and click

'OK'

Remove correction

lens from trial lens

holder and click 'OK'


41

8.4. Examination parameters setup

In order to set Examination parameters click “Settings” button. A window will be opened as

shown below:

Fixation errors – Heijl-Krakau

Randomly during examination blind spot points are exposed. If the reaction is negative (no

reaction), program continues examination. If patient reacts for the stimulus, another stimulus is

exposed into blind spot. If there is reaction again, program displays warning message and fixation

errors index increases. The examination can be assumed as reliable if fixation errors ratio is less

than 25%

Digital fixation control

Constantly during examination special algorithm analyses images from camera and controls

fixation. Digital system of image analysis allows following movements of patient‟s eyes during

examination. If the fixation is good, examination is preceded and no expositions to blind spot are

made (which allows speeding up the process). If patient tries to stare away from fixation point,

program notices it immediately. Exposition to blind spot is made – to make sure the fixation is

incorrect. If there is no reaction from patient‟s side, examination is continued. In case of reaction

for blind spot points, program increases number of fixation errors and turns on attraction

mechanism (more details about attraction mechanism will be explained farther in this instruction

manual). Digital fixation control is much more efficient and accurate than H-K method as it

continuously monitors fixation.

False negative errors

If this option is activated, randomly during the examination, exposition is made to a point that has

already been tested. The stimulus is 6dB brighter than previously tested sensitivity level. In case of

Flicker strategy that stimulus has maximum brightness and flicker with frequency 5 Hz. The patient

should respond for this stimulus. No reaction from patient is treated as false negative error. False

negative errors can‟t be turned on for 3-zone and BSV strategy.

Stimuli exposition level

for BDT strategy

False positive

errors on/off False negative

errors on/off Fixation monitoring

on/off (Heijl-Krakau

method)

Fixation control

on/off (using image

analysis system)

Initial test speed

Fixation target

Stimuli parameters

Exposition time

Reaction time

Exposition time for

BSV strategy

Pause between

expositions

Click to restore

default values

Double reaction time

for BSV strategy

Reaction time in

slow mode


42

False positive errors

If this option is activated, randomly during the examination no exposition is made at all. In case of

Flicker strategy stimulus is exposed, it has maximum brightness and flicker with frequency 60 Hz.

If the patient reacts (because of so called „learning effect”), number of false positive errors is

increased. False positive errors can‟t be turned on for 3-zone and BSV strategy.

Exposure time

It's the time, when stimulus is exposed. It concerns all strategies excluding BDT strategy.

Reaction time

It's the time when device waits for patient‟s reaction after stimulus is turned off. During

examination, this time is automatically adapted to patient‟s reaction speed. It concerns all strategies

excluding BDT strategy.

Pause

It's the time when the computer delays next stimulus exposure, after the patient releases reaction

button. It concerns all strategies excluding BDT strategy.

Iterpretation of times settings

Exposure time for BSV strategy

It's the time for BSV strategy, when stimulus is exposed.

Double reaction time for BSV strategy

It's the maximum time between patient's clicks, which are treated as double click.

BDT stimuli level

It is stimuli‟s exposure level for all points. Can reach values from 3 to 30 dB with 1 dB step.

It should be considered, that fixation errors, false positive errors and false negative errors can

increase duration of examination, due to the necessity of exposing additional stimuli.

Events

Time

reaction time

pause

time exposure

time

reaction

next

exposure

When reaction occures

Events

Time

reaction time

exposure

time

next

exposure

When reaction not occures


43

8.4.1. Fixation selection

PTS1000 series automated perimeters support two types of fixation targets. Default target is one

central orange-colored point. For some patients (especially those suffering from strong defect of

yellow spot) this point may not be visible. For those patients fixation target can be switched to the

so called large diamond target. It consists of four paracentral fixation diodes. In order to change

fixation target the doctor has to click on target icon:

8.5. Performing examination

To perform new examination, please follow the instructions below:

1. In the main Window select proper patient. You can use “Fast search” mechanism. If the patient

is not yet registered, click New patient button and register patient.

2. Click “examination” button to go to Examination Window.

3. Make sure you have selected proper patient. The name is displayed on a panel in upper left

corner of the screen. If you selected wrong patient, click patient's name. A list will be opened

and you should find the proper person.

4. Select Field range for the examination.

Field name Usage

Full Used in monitoring neurological changes in both central and peripheral areas

of visual field. All other fields are contained in full field (except for extended

field). Usually used with screening strategy.

Glaucoma Used in glaucoma diagnosis. It is the field extended nasally to 50 degrees. Any

defects in nasal area can suggest glaucoma treatment; e.g. central or macula.

Used mostly with Fast threshold and Threshold.

Central Used to monitor changes in the centre of visual field i.e. caused by glaucoma

after previous examinations performed using glaucoma field

Macula Used in macula diseases, to detect field loss in diseases n.II and others, and

monitor changes with field limited below 10 degrees. Usually used with Fast

Threshold and Blue on Yellow strategies

Peripheral Used to detect peripheral changes, can be used as a supplementary test aimed

to follow further field loss above 22 degrees.

Extended Used for drivers. Can be tested using 3-Zone strategy only.

Fast Used mostly as first examination of a new patient and also to do large

population tests. Usually performed using Screening or 3-Zone strategy or

Blue and Yellow strategies.

User User defined field can include any points in 50 degrees range

BDT Used only with BDT strategy to examine whole drivers field range. Includes

120 points in 80 degree horizontal and 50 degree vertical ranges

30 Field covering central 30 degrees – 76 points on square basis evenly spaced

every 6 degrees

24 Field covering central 24 degrees – 54 points on square basis evenly spaced

every 6 degrees

Fixation target

button


44

Select desired strategy of testing:

Strategy Usage

3-Zone The result of this strategy can be: no defect, absolute defect, relative defect. It

does not measure depth of defects, just the location. It is used to make

screening examinations and for detecting very deep and broad field loss.

Screening Can be used to detect defects deeper than 6dB and measure depth of those

defects. Duration of examinations is relatively short.

Threshold Detects sensitivity level in each tested point. Basic strategy advised to monitor

glaucoma. Can be used to detect both defects and areas of so called super

vision. Gives most accurate results but duration of examination is longest.

Fast threshold Detects sensitivity level in each tested point. It is advanced threshold strategy,

analyzing neighboring points and predicting threshold levels. Can be used to

monitor glaucoma. It is characterized by high accuracy (comparable to

threshold strategy) but reduces duration of examination by 30%-40%.

BSV Enables examination of both-eye-movement coordination. It's used to monitor

diplopy. It's usually used in connection with symmetrical fields (full, central,

peripheral)

Flicker Detects Critical Fusion Frequency (CFF) which is useful in glaucoma

diagnostic.

BDT Used only with BDT fields, enables binocular examination of visual field.

Examination is performed with constant intensity level and is used to drivers

checking with Esterman score.

Table below shows which fields can use which strategies:

Full Glaucoma Central Macula Peripheral Extended Fast User BDT 30 24

Threshold

Screening

3-zone

Fast

threshold

BSV

Flicker

BDT

5. Select fixation target best suitable for patient. Default fixation target is single central point. If

patient finds it difficult to focus on that point, select four paracentral fixation targets (look

If selected strategy does not match to selected field program, selected field and strategy will

flicker few times and change for matched.


45

chapter 8.4.1 of this manual).

6. Specify power of correction lenses (or no correction lens) and put lens/lenses in trial lens

holder. It is possible to use patient‟s own near vision spectacles. The frame can't be too loose or

too small (patent frames cannot be used), bifocal or progressive lenses cannot be used. Patient‟s

eyeglasses up to +6.0D can be used. With larger corrections you should remember about

possibility of optical artifacts. In this case using correction lens assures better parameters. With

correction 8D or higher, it is recommend to use contact lens. In case of examination using BSV

strategy, no correction lens can be mounted in lens holder.

7. Select tested eye (left or right). In case of BSV strategy you can't select tested eye (examination

is made for both eyes simultaneously).

8. If there is neurological defect suspicion (because of earlier examinations and doctor‟s

interview), you should mark this option in program (neurological option is inaccessible in 3-

zone, BSV, Flicker and BDT strategies).

9. Cover the other eye using eye-band supplied with perimeter. Patient should be informed that

during examination he must have both eyes opened, and can blink (it does not concern BSV

strategy). Keeping eyes half-open may significantly lower examination accuracy.

10. In case of BSV or BDT strategy, you should install chinrest adapter, which enables patient to

place head in central position.

11. Place patient's chin on chin-rest. Forehead should touch forehead-support. The height of table

should be set in comfortable position for patient.

12. Doctor should set patient‟s head height, using mouse cursor and clicks “up” or “down” button.

Patients pupil should be on horizontal line shown in preview window (look at below image).

13. Tell patient about the examination. Let him blink; explain what the examination is about and

what role patient plays in testing. Patient can pause the examination anytime by depressing

reaction button for about 3 seconds. Tell patient that in case fixation diode is blinking he must

look at it.

14. For inexperienced patients, having their eyes tested for the first time, it is advised to perform

DEMO program. It will allow the patient to get acquainted with the procedure, which will bring

out more credible results. When the patient is used to testing technique, DEMO program should

be cancelled.

15. There is eye preview window on the computer screen. Look at image from camera and set

patient's head height again. Patient's pupil should be on the horizontal line and inside the ellipse

(it does not concern BSV strategy – in BSV strategy height setting proceeds only according to

point no.13).

16. Ask patient if he is ready, and start examination using “Begin“ button.

The examination can be paused by the doctor using “Pause” button, but the patient himself can

pause the examination by pressing and holding reaction button for about 3 seconds. The

examination can be resumed using “Resume” button by doctor only.

Head too high – pupil above horizontal line Proper patient's head height


46

Below, the process of examination for the following strategies is described:

Threshold

Screening

3-Zone

Fast threshold

Examination process for BSV strategy is described in chapter 8.1.2.5

Examination process for Flicker strategy is described in chapter 8.1.2.6

Examination process for BDT strategy is described in chapter 8.1.2.7

8.6. Stages of examination for Threshold, Screening, Fast threshold, 3-Zone strategies:

Stage I – calibration

During this stage program automatically locates position and size of blind spot and measures the

sensitivity levels of four calibration points.

If the blind spot is not found, warning message is displayed.

You should then check patient‟s position and relocate blind spot.

During calibration process, it can happen that the calibrated HOV level will be much lower than

average value and below 18dB. This may be due to some defects which occur in/around calibration

point‟s area. The program detects that situation and displays warning message. Calibration level can

be then selected manually.

After sensitivity levels for all calibration points are tested, program calculates average sensitivity

by omitting two extreme values and by calculating an average value from the remaining two

figures. This average value is used to calculate a reference profile for all other field points,

according to the drawing presented below:

where X is the average sensitivity of 4 points for 10 degree ring calculated from calibration.

Sensitivity profile has a slope of 3 dB/10o for all strategies. Sensitivity profile height matches

average sensitivity of 4 calibration points for threshold and fast threshold strategies, while it is 6 dB

lower for screening and 3-Zone strategies.

If you give up with blind spot location, test will be performed without any

fixation monitoring, which will significantly affect credibility of the result.

Screening and 3-zone

strategy

10 o 10 o

0 o

Sensitivity [dB]

Angle

X

3dB/10 o

Threshold, Fast Threshold strategies


47

Important !!!

In case of BSV and BDT strategies the computer skips calibration and starts examination process

immediately.

Stage II – Testing

During this stage sensitivity levels are tested for each field point.

If fixation monitoring using Heijl-Krakau method is turned on, randomly there are expositions

made to blind spot location. If a patient reacts to two consecutive expositions of blind spot stimulus,

the computer increases number of H-K fixation errors.

If digital fixation is turned on, no expositions to blind spot are made when patient is fixating

well. Some expositions to blind spot are made only if program detects wrong fixation. If a patient

reacts to blind spot stimuli, the computer increases number of digital fixation errors.

Digital fixation control is a modern and a lot more reliable method than classic Heijl-Krakau

method. In digital fixation method, fixation is controlled continuously during testing. In case of

classic methods fixation tests are performed randomly, and they do not guarantee detecting all

moments of fixation loss.

Stage III – Final settings

After sensitivity levels for each point are measured, program displays final dialogue window

with a moving spiral informing patient that examination is over. The window with collection of

BASIC examination parameters is displayed on monitor screen. Doctor can enter some remarks

concerning examination. Examination can be saved to database or ignored, or printed.

8.6.1. Examination without digital fixation control.

If digital fixation control is off, program doesn't analyze images from camera. However the

image is displayed during the examination. Doctor can constantly observe patient's reactions. With

this setting, diameter of pupil is not measured automatically.

Click to save result to

database and go to result

window

Click to save result to

database only

Click to print the result

Click to ignore the result.

The result will not to be

saved to database

Click to measure

pupil diameter

Detailed information

about test

Enter your

remarks here

Click to retest field


48

8.6.2. Examination with digital fixation control

If examination is performed using digital fixation control, program automatically analyses

images received from the camera and locates the position of pupil. Pupil is marked with white dot

on the screen. Program measures the diameter of pupil and detects blinking.

If the patient is fixating well, the examination is conducted without expositions to blind spot. If

program notices, that the patient is trying to stare away from center, blind spot expositions are

made. It is aimed to verify, whether patient indeed has a wrong fixation. If the patient does not react

to blind spot stimuli, the examination is continued. If patient‟s reaction to blind spot stimuli is

detected, patient attraction mechanism is activated.

8.6.2.1. Active patient's attraction mechanism

Constantly during the examination program is monitoring position of pupil. If patient is not

fixating well, active attraction mechanism is turned on. The central fixation point starts to blink

rapidly. It causes patient to look at this point. When fixation is back to normal, the examination

continues.

8.6.2.2. Possible problems with digital fixation control

It can happen that in some special rare cases, program will not be able to locate position of pupil.

This happens very rarely, and can be caused by some pupil disease, mechanical pupil shape

distortions or bad lighting conditions in a room. In this case digital fixation control can be turned

off, using small button marked with x in upper right corner of camera image. Try also to arrange

examination room to avoid side lighting sources.

Wrong

fixation Marked centre

of pupil

Fixation

locator

Available eye

position range

Click to turn digital

fixation control on/off


49

8.6.3. Manual pupil diameter calculation

PTS1000 has a special system for automatic pupil diameter measurement. There is also a way to

measure the diameter of pupil manually. During examination some pictures of eye are collected.

Choose one of them and follow the instructions given in pupil analysis dialogue window.

8.6.4. Field retest

After examination is over, you can retest selected single points if necessary. When examination

is finished click “Field retest” button. Select stimulus points which you want to retest and click

“Retest” button.

During retesting procedures, apart from chosen points, also other points are randomly tested,

although measurement of these extra points is not taken into account. They are only used to

convince the patient that choice of retested points is completely random.

information how to

measure pupil diameter

Selected picture

Click to select

different picture

Selected points

Click to retest

selected points


50

8.6.5. Examination with BSV strategy

Examination with BSV strategy is completely different that other strategies. Before examination

doctor should place special adapter on the chin rest which enables to put head in central position

relative to device. Set chin rest height using “up” and “down” buttons (look chapter 8.6 point 13) so

the eyes are located on the same height as markers.

Doctor should inform patient that he must observe the bowl and click button once if he sees

single light point. If patient sees two points, he must click button twice. Exposition time of each

stimulus is much longer than in other strategies. Each stimulus has maximum brightness.

Simultaneously central fixation is turned off during examination.

BSV strategy examination result is field with marked defects. Point with dot (•) means single

vision. Point with X symbol means no reaction. Point with filled square means double vision.

Picture below shows example of examination result with BSV strategy.

Chinrest for binocular tests

Marker


51

8.6.6. Examination with Flicker strategy

Examination with Flicker strategy is different than other strategies. Stimuli are exposed with

maximum luminance, but they stimulus is not static. The stimulus is blinking (flickering) with

different frequencies. Patient should react only flickering stimulus is visible. If the patient can see

static stimulus or doesn‟t see any stimulus, he should not press the button.

Calibration stage is performed by similar way than in other strategies, computer examines 4

points at 10o decentration, calculates mean value („X‟ on graph below) and increases it by 12 Hz. It

is the initial level of stimuli flicker frequency examination. During calibration computer also detects

blind spot by presenting flickering stimuli with 5 Hz frequency in each blind spot point.

During examination every stimulus starts flickering with calculated initial frequency level and

then frequency is decrease with step of 4Hz until patient reacts or 3 seconds elapse. The frequency

is decreased until patient reacts (sees flickering point) or 3Hz level is reached. If 3Hz level is

reached and patient didn‟t react, the points is marked as absolute defect (red „X‟ on the map).

False Positive and Negative tests are performed for Flicker strategy (False positive – 60 Hz,

False Negative 5 Hz frequency used).

Measured flicker level

10 o 10 o

0 o

Flicker frequency [Hz]

Angle X

Initial flicker level

Frequency [Hz]

Time [s]

60

0 3 6

Initial level

Actual frequency level

reaction


52

8.6.7. Examination with BDT strategy

Examination with BDT strategy is completely different that other strategies. Before taking

examination doctor should place special adapter on the chin rest which enables to put head in

central position relative to device. Set chin rest height using “up” and “down” buttons (look chapter

8.6 point 13) so the eyes are located on the same height as markers.

Examination with BDT strategy can be performed only on BDT field. Doctor should inform

patient that he must observe fixation point and if he detects any appears point he should react by

patient‟s reaction button. Each stimulus has constant brightness which can be set in settings window

(see 8.5 chapter).

BDT strategy examination result is field with marked defects. Point with circle (o) means seen

stimuli Point with rectangle symbol () means missed stimuli. Picture below shows example of

examination result with BDT strategy. After test program adds below factors into examination

remarks:

Stimuli level: 10 dB

Points seen: 119/120 (number of seen points of all field/number of all points)

Points missed: 1/120 (number of missed points of all field/number of all points)

Esterman efficiency score: 99 (percentage value of seen points)

Chinrest for binocular tests

Marker


53

9. Results review tab

Results review tab is used to view and analyze examination results that are already saved in

database.

Result review tab with description of each function is shown below:

9.1. Visualization options

Results review window was designed to give operator view onto most important data

simultaneously. It is possible thanks to multi-window display.

Results review window is divided into four subwindows. One of them is surrounded by blue frame.

This subwindow is an active one. Any window can be activated by clicking inside it.

Below image shows controls used to change visualization status.

Click to choose

Results Comprasion

option

Visualisation

options

Click to select graph

type in active window

Click to select

analysis type in

active window

Examinations‟

filtering options

Click to view

next/previous test

result

Click to import

examination result

Click to print

the result

You can enter your

remarks here

Current patient. Click

to select different one

Active

window

Click to export

current examination

result

List of current

patient‟s

examinations

Click to delete an

examination result


54

Blocking all four subwindows to display results of one examination.

By default, in all four subwindows of results review screen images are related to one examination.

There is a possibility to display results of different examinations in different subwindows. In order

to do that it is necessary to turn off blocking of the windows. It is done by clicking the button with

padlock symbol.

- blocking turned on

- blocking turned off

Enlarging of the active window

It is possible to display contents of the active window enlarged onto results field. In order to

do that active subwindow should be double-clicked or enlargeing button pressed.

- 4 windows mode is active

- enlarged window mode is active

Restoring of the standard settings

To restore the standard settings, that is to display default maps in all 4 windows, “STD”

button is used. The default maps for each window can be selected in Setup/Appearance tab.

Both analysis type (ABS, HOV, AGE a.s.o.) and map style (dB, dot scale, grey scale, color

scale) can be adjusted according to preferences.

- Restore the standard maps in results review


55

9.2. Visual field analysis

PTS1000 automated perimeter offers four different graph types. Changing the graph types is

done by choosing one of the windows and selecting from the „Graph‟ list a required one.

Decibels field range is presented as a graph with values expressed in decibels of measured

sensitivity levels of field points.

Grey scale the result is shown as a grey scale with approximated values between tested points.

In this mode, the computer analyses and calculates sensitivity map for complete vision field,

based on point-measured sensitivity, and presents results in shades of grey. The darker the point,

the lower sensitivity.


56

Dot scale this graph is similar to grey scale, but sensitivity values are shown as small dots, for

easier recognition of areas with a given sensitivity level.

Color scale this graph is similar to dot scale, but pictograms are displayed in colors.

3-Zone and BSV results can be viewed only in decibel scale.


57

9.3. Analysis of results

PTS1000 series automated perimeters do not only collect the data during testing. It has some

special tools for analyzing results in order to easily detect all the defects. To change analysis type,

use the button named „Analysis‟

In order to change analysis tape, select one of the subwindows and then press analysis button.

- Absolute level Absolute level graph shows sensitivity levels expressed in decibels just

as they were tested. To select Absolute level analysis click “ABS” button.

- Age norm deviation / Total deviation This graph shows the deviation between actual

sensitivity of each point compared to pattern sensitivity calculated upon

patient‟s age. Negative number means, that the actual sensitivity is lower

than expected. Positive value means that the sensitivity is higher than

expected. To select Age norm deviation analysis click “AGE” button.

- HOV deviation / Pattern Deviation HOV - For each point of tested field this graph shows the deviation

between patient‟s actual sensitivity and the correct sensitivity. Correct

sensitivity is calculated on the basis of calibration and examination.

Negative number in each point means, that the actual sensitivity is lower

than expected. Positive value means, that the sensitivity is higher than

expected. To select HOV deviation analysis click “HOV” button.

Pattern Deviation – It is the Total Deviation map with removed general

depression bias. Therefore it shows deviations from the patient‟s ideal

profile and has a functionality of HOV deviation. General depression is

removed by zeroing 7th

best result from Total Deviation.

- 3D visualization This graph shows the 3-dimmensional visualization of a patient‟s Hill Of

Vision (HOV). It is based on HOV deviation.

- Examination details Shows information about selected examination. It contains: field type,

strategy, time of an examination, number of expositions, fixation errors,

MD and PD indexes.

Analysis for radial maps

Age norm is available only

for people examined with

green stimuli of size 3.

Analysis for 30 and 24

maps

Age norm is available

only for people examined

with green stimuli of size

3.

IMPORTANT!

Age norm is available only for people examined with green stimuli

of size 3 or white stimuli on maps 30 and 24.


58

- Defect progress This graph shows changes in values of a Pattern Defect and Mean Defect

indexes in time. It is based on previously taken examinations.

- Bebie curve It is a patient‟s vision quality graph organized as cumulative plot –

known as Bebie curve.

- Comparison It opens comparison window in which two different examination results

can be compared.

9.3.1. Absolute results graph

Selecting absolute results graph will show a graph with absolute values of sensitivity in decibels

(hertz‟s for Flicker strategy), grey, dot, or color scale. All points marked with “X” are absolute

defect points. It means that patient didn't react even to brightest stimulus (3 Hz for Flicker strategy).

9.3.2. Age norm deviation graph

After choosing “Age Norm Deviation” option, the screen displays values calculated as difference

between real sensitivity level and level fixed as pattern for a given age group. The pattern level for a

given age group is set on the basis of statistics reached upon approximately 50.000 examinations,

and specified according to patient age, as per the table below:.

Age HOV level at 10° ring

<45 24 dB

45-65 21dB

>65 18 dB

9.3.3. Total deviation graph

Total deviation graph is Age norm deviation equivalent for 30 and 24 maps. It is showing the

differences between patient‟s results and normal values for appropriate age group. Age groups are

as follows:

I <20 years old

II 20-30 years old

III 30-40 years old

IV 40-50 years old

V 50-60 years old

VI >60 years old

Positive numbers mean that patient‟s eye is more sensitive than the normal value and show how

much it is higher in dB. Negative number show how much is the patient‟s vision worse than the age

normal in given location.

IMPORTANT!


of size 3.


59

9.3.4. HOV deviation graph

After selecting HOV deviation, program calculates the desired eye profile for the patient – basing

on sensitivity levels of four calibration points and examination result. Then this calculated level is

compared with actual sensitivity level for each point. Number in each point shows depth of defect,

in decibels (Hertz‟s for Flicker strategy), grey scale or dot scale. When examination was taken

using Screening and Blue on Yellow strategies, defects that are 6dB or deeper are shown. For

Threshold and Fast Threshold strategies this bound is different for each ring. For 1o - 10

o rings this

bound is 4dB, for 15 o

ring its 6dB, and for rings 22o - 50

o its 8dB. For Flicker strategy points are

marked as defects if they are deeper than 8 Hz.

Points marked with mean no defect. Points with absolute defects are marked with „X‟. Setting

pattern levels is different in Screening strategy than in other strategies.

In case of Screening strategy, pattern level for each ring is set in the same way as during patient

examination (look Chapter 8.6 – Stage I – Calibration).

For Threshold, Fast Threshold, Blue on Yellow and Spatial sensitivity strategies, pattern level for

each ring is set by using interpolation of real examination result skipping deep defects.

For Flicker strategy, pattern level suits calibration level and is flat for whole field of

examination.

Considering result reference to correct state, deviation is easy to interpret, and serves as BASIC

interpretation graph for specifying defects of visual field.

9.3.5. Pattern Deviation graph

Pattern Deviation is the HOV deviation equivalent for maps 24 and 30. It highlights local

depressions (scotomas) by zeroing influence of general depression of Hill Of Vision. The base for

Pattern Deviation graph is Total Deviation graph. By zeroing seventh best value from Total

Deviation the general depression is diminished in visualization of result.

Considering result reference to correct state, deviation is easy to interpret, and serves as BASIC

interpretation graph for specifying defects of visual field.

IMPORTANT!

Total Deviation analysis is available for Threshold and Fast

threshold strategies on 24, 30 maps and white stimuli of size 3.


of size 3.

IMPORTANT!

Total Deviation analysis is available for Threshold and Fast

threshold strategies on 24, 30 maps and white stimuli of size 3.


of size 3.


60

9.3.6. Three dimensional visualization

PTS1000 series has been equipped with a special system to show the results as 3D graphs. Click

“3D” button to see visualization like example below:

The doctor can change the point of view of the 3D cone by pressing the left mouse button and

dragging the mouse over the 3D image. It is possible to change the scale of the image by pressing

right mouse button and dragging amuse up/down.

Basic idea of this type of graph is to explain the idea and interpretation of test to the patient.

Result like this is very easy for the patient to understand. Proper and easy presentation of

examination results improves relationship and trust between patient and doctor. 3D view enables

doctor to better determine place and size of defects and losses.

3D visualization shows HOV deviation of the results. It is available for Threshold,

Screening, Fast Threshold results.


61

9.3.7. Comparing results

After choosing „Result Comparison” option, Results Compare window is displayed. To compare

examination results you must click “Select” button. The current examination will be compared to

the one chosen from the list. If sensitivity difference in a given point is not higher than 6dB, the

point is marked with a small dot (•) meaning, that the difference is within limits. If the difference is

bigger, a number is shown specifying the difference in decibels between two results.

Current result

Result to compare

Click to see field

of vision map

Click to result

details

Click to select

result to compare

Select

examination

result to compare

Click 'Select'

button

The list shows only those examination results that can be compared with

currently selected result (the proper strategy and the same field)

Results Compare does not work with 3-zone and BSV.


62

9.3.8. Pupil movement graph

During examination performed with digital image analysis on, program automatically stores

movements of patient‟s eyes into memory. Data like this is very useful when determining the

reliability of examination. Sample graph is shown below.

The upper horizontal line marks 10-degree deviation from center. The above graph shows poor

fixation sample. Well fixating patient's graph is shown below:

Vertical bars represent eye deviation from centre. The higher the bar, the bigger deviation from

bowl centre. Bars below horizontal bottom line mark the moments, when the active attention

attraction system is turned on.


63

9.3.9. Examination parameters panel

This panel contains all pieces of information about currently viewed examination result:

Duration

Shows total time that the examination has taken. This time includes only effective examining,

without pauses and breaks. When examination is paused, this timer is paused too.

Number of expositions

Shows how many stimulus points have been exposed to patient in a ratio to total number of field

points. For example: 208/104 means that test includes 104 points and its 208 expositions – each

point was tested twice on the average.

HOV level

Patient‟s HOV level is calculated on the basis of fixed sensitivity level in four calibration points

placed on 10 degree ring, after omitting two extreme values and calculating average figure from

the remaining two. This value is a HOV value calculated during calibration.

Eye profile slope

Contains information about how steep the eye profile is. For screening strategy it is set by default

to 3 [dB/10°]. In threshold strategy the slope is calculated upon test result data. Calculated

profile slope should be in bounds between 1[dB/10°] to 4.5 [dB/10°]. If it's out of bounds one of

the values listed above is chosen.

Correction lens

This field contains information about trial lens used during testing. PTS1000 perimeters offer a

possibility to perform examination using two correction lenses simultaneously (sphere and

cylinder).

Date the test was taken Strategy of examination

Duration of test

Calibrated HOV level

at 10 degree

Trial lens information

Quality indexes

Statistical indexes

Tested field

Number of expositions /

number of total field points

Eye profile slope Pupil diameter

Stimuli size Stimuli color


64

Quality factors

MD index for radial maps (mean defect)

This parameter specifies loss of eye sensitivity calculated as a mean difference between „ideal”

profile calculated by computer for a given patient on the basis of his examination results, and age

norm appropriate for this patient. This factor does not take into account losses in visual field

(scotoma).

This index can only be calculated for examinations taken by threshold and fast threshold

strategies. This index can change in range -1 to +1. Value -1 on average means that sensitivity is

twofold lower in the whole field than expected for age norm of a given patient (e.g. if age norm

for a patient is 24dB for 10o ring, his real sensitivity will be 12dB for 10

o ring).

Warning level is marked with one exclamation mark „!” next to a given value, and limit for

every field is presented in the table below. It refers to the location of Bebie curve on bottom line

of tolerance path.

Alarm level is marked with two exclamation marks „!!” next to a given value, and limit for every

field is presented in the table below. It refers to the location of Bebie curve below its tolerance

path.

Field/Limit Full Central Glaucoma Peripheral Macula Fast

Warning

level (!)

0,25 0,25 0,25 0,25 0,25 0,25

Alarm

level (!!)

0,35 0,35 0,35 0,35 0,35 0,35

For extended field, MD index is not given, because this field is examined only by means of

3-zone strategy.

MD index for 30 and 24 maps (mean defect)

In case of 30 and 24 maps the explanation of MD is much simpler. Basically it is the average

value of points from Total Deviation graph. Hence this index shows how far is the patient‟s

visual filed deviated from the normal values.

PD index for radial maps (pattern defect)

This parameter gives information about smoothness of patient's eye profile. Generally, it

specifies quantity and depth of local defects (scotoma) as compared to pattern sensitivity. Zero

value means, that the profile is smooth, without any local defects. The bigger the value, the

deeper local defects are.

Warning level is marked with one exclamation mark „!” next to a given value, and limit for

every field is presented in the table below. It refers to 2 deep defects (sensitivity 0dB for 10o

ring).

Alarm level is marked with two exclamation marks „!!” next to a given value, and limit for every

field is presented in the table below. It refers to 5 deep defects (sensitivity 0dB for 10o ring).

Field/Limit Full Central Glaucoma Peripheral Macula Fast

Warning

level (!)

0,26 0,42 0,40 0,58 0,83 0,72

Alarm

level (!!)

0,64 1,05 1,01 1,46 2,08 1,81

For extended field, PD index is not given, because this field is examined only by means of

3-zone strategy.


65

PD index for 30 and 24 maps (pattern defect)

This parameter gives information about smoothness of patient's eye profile. Generally, it

specifies quantity and depth of local defects (scotoma) as compared to pattern sensitivity. Zero

value means, that the profile is smooth, without any local defects. The bigger the value, the

deeper local defects are.

PD value is calculated as average difference between values from Total Deviation graph and

MD index value. This way in case of general depression without localized defects PD will be

around zero with high MD value. In case of lots of scotoma and no depression both PD and MD

indexes will be significant.


66

Statistical tests

FIX (H-K) – fixation errors

This index specifies number of fixation errors detected for Heijl-Krakau method (blind spot

location analysis). This factor is calculated only in the case, when examination was conducted

when the system of digital analysis of eyeball location was switched off.

The factor is presented as A/B=C%, where A stands for the number of fixation errors, B stands

for the number of fixation controls, and C stands for the percentage value of fixation errors in

relation to total fixation tests.

Warning level is marked with one exclamation mark „!” next to a value higher than 15%.

Alarm level is marked with two exclamation marks „!!” next to a value higher than 25%.

FIX (CCD) – fixation errors

This index has a similar meaning to FIX index, however it's much more reliable. This factor is

calculated only in the case, when examination was conducted when the system of digital analysis

of eyeball location was switched on.

Program uses digital image analysis to calculate this index. Proper fixation is controlled

continuously during the test.

It is shown as a ratio A/B, where A stands for the number of fixation errors, B stands for the

number of situations in which the system suspected patient‟s bad fixation.

Warning level is marked with one exclamation mark „!”, and its value refers to FIX (H-K) factor

of 15% value.

Alarm level is marked with two exclamation marks „!!”, and its value refers to FIX (H-K) factor

of 25% value.

POS – false positive errors

This index informs about number of false positive errors committed by patient during the test

(ratio). Details are described in Chapter 8.4.

The factor is presented as A/B=C%, where A stands for the number of false positive errors, B

stands for the number of trials, and C stands for the percentage value of errors in relation to total

number of trials.



NEG – false negative errors

This index informs about number of false negative errors committed by patient during the test

(ratio). Details are described in Chapter 8.4.

The factor is presented as A/B=C%, where A stands for the number of false negative errors, B

stands for the number of trials, and C stands for the percentage value of errors in relation to total

number of trials.




67

9.3.10. Bebie curve graph

A Bebie curve enables to easily and efficiently estimate patient‟s visual field quality.

Bebie curve is constructed by ordering the sensitivities of each tested point in descending order:

from highest sensitive point to lowest sensitive point. Because of the order, the curve has always

negative slope (always lowering).

radial maps, stimuli size 3, green

On the basis of statistical examinations performed by the manufacturer

of device on c.a. 50.000 examination results, there has been some margin

of tolerance applied. The area between the lines marked by B+ and B-

describes the area where 90% of healthy populations locate its Bebie

curves. The elevations, width, shape and inclination of the tolerance

margin depends on the examined field range and age of patient. Bebie

curve for a healthy visual field should be within the B+, B- lines (within

the tolerance margin). On the basis of Bebie curve shape (and additionally

PD and MD indexes) some very important information can be obtained.

Bebie curve is also helpful for estimating the reliability of examination results).

24, 30 maps, stimuli size 3, white

Normal Bebie curve shape is drawn on the basis of age norm defined for

normal patients of age groups: <20, 20-30, 30-40, 40-50, 50-60, >60.

Upper and lower margin is selected as +3dB and -3dB deviation from

norm. Scale on the left is adjusted to have zero dB value for the point in

the middle of normal Bebie curve.

Sample Bebie curve graphs and its meaning

The picture on the right shows a Bebie curve for a sample

examination result. It gives information about large and deep defects in

the visual field. Of course the Bebie curve gives no information about

the location of the defects. The larger part of Bebie curve is outside the

tolerance margin, the more extensive defects are. The part of Bebie

curve which is placed on horizontal axis reflects the points of absolute

defect (marked with X on visual field map). The part of the curve

within tolerance limits reflects the part of the field without defects. In

this sample case there will also be a high value of PD index.

The picture on the left shows a Bebie curve with characteristic

“peak” at the beginning of the curve. The rest of the curve is within the

norm. This “peak” tells the doctor, that there are no real defects in the

field, but the examination is not very reliable due to “trigger happy”

patient (patient pressed the button even if he didn't see the points).

Confirmation of the poor reliability will be

a high number of false positive errors made during examination.


68

Another picture on the right shows a Bebie curve of a visual field with

one or few small but quite deep defects. For this patient the MD index will

be quite normal (low) but PD index should confirm the existence of local

defects.

Another example on the left shows

a patient with very extensive shallow defect

covering almost whole visual field. This type of

defect is confirmed by the big value of MD

index, while the PD index should be normal (because of no local deep

defects).


69

Mean defect progress graph

Mean defect progress graph slope

Currently viewed result

Pattern defect progress graph

Pattern defect progress graph slope

Currently viewed result

9.3.11. Defects progress analysis

Defects progress analysis window shows two graphs: MD progress and PD progress. Those

graphs show MD and PD levels of all examinations for this eye ordered by examination dates from

oldest examination to newest examination.

Defects progress analysis also shows defects progress graph slope, the greater slope, the visual

field is worse.

On each graphs rectangles shows particular defects, interrupted line shows currently viewed

result.

Both graphs for a healthy visual field should have levels and slope near 0.


70

9.4. Patient’s examinations list

In the „Results review‟ window there is a list of all patients‟ examinations. Selecting of a different

examination can be done by clicking it on the list or by using arrows next to the list.

9.4.1. Filtering of an examinations list

In order to make searching of patient‟s examinations easier, program is equipped with filter. It can

be used to limit displayed examinations to that which satisfy filtering conditions: used field, used

strategy, examined eye and date period when the examination had been done.

To activate filter, it is necessary to select one of the filter conditions from the list. Adequate

condition switch will be automatically turned on. Clicking on the condition switch again will

deactivate it. Different conditions can be selected simultaneously to limit number of displayed

results.

9.4.2. Data Export/Import

PTS 1000 series Automated Perimeters have a mechanism for transferring single examination

results between different users/computers. Exported data can be saved in GDT format and then it

can be import to another computer. Exported data also can be saved as JPG image. Exported data

can be saved to hard disk (or other data storage) or sent by e-mail.

Cursors used to move along

examinations list.

List of conditions in filters

Filtering conditions

switches

Deleting an examination

Active

examination

Importing an

examination to list

Exporting an

examination to file

Printing an

examination result


71

Import

To import saved examination result click “Import” button, and next select source folder and

select GDT file in “Open” window.

Perimeter program will check validity of imported GDT file and insert it into database. If

imported result comes from older software version, message will appear.

Export To export current examination result click “Export” button, Export window will appear.

Mark type of exported file in “File mode” panel. Mark export operation in “Export mode” panel.

Click “Ok” button. If “Save file” mode is selected Save as window will appear, select destination

folder and enter file name (by default, the system will prompt „My Documents‟ folder and file name

as name_surname.gdt). Click “Ok” button to save file. If “Send by e-mail” mode is selected,

program will open New message window of default mail client installed on operating system with

exported file attached.

Sending exported file by e-mail is available only if e-mail client is installed and

mail account is configured.

Only GDT files can be imported.

Imported result derived from older software version can cause result review

errors.


72

9.5. Printing results

PTS software has a printout manager module. With its help, user can select from predefined

examination printout templates, create his own template, print examination result on a printer, save

it as PDF file or save it as graphic file. Click “Print” button to activate it. Main printout screen

looks as follows:

9.5.1. Inserting new map

To insert new map into printout, right-click anywhere in a printout preview. Choose „New‟ from

the list.

New map field will appear in the preview. Active field is always marked with grey color.

List of stored templates

Check to hide personal

data on the printout

Check to hide personal

data on the printout

Enter name of your own

template

Save your own template

Delete selected template

Print examination result

Save as a file

Close printout manager

Print preview


73

Select one of available maps. Title of map in the printout will be automatically added. If you

wish to change the title, put the mouse cursor over title area and click.

9.5.2. Editing map

If the map is present on the preview you can edit its position, size and contents. To do so, put the

cursor over any map that is present on the preview to mark it in grey.

To change the contents of the map unroll the list of available maps and select needed one.

To change the position of the map, press and hold left mouse button over the area of the

map. Move the map to desired position and then release left mouse button.

Click to unroll list of

available maps


74

To change dimensions of the map, place mouse cursor in the bottom-right corner of the map.

When cursor changes icon press and hold left mouse button. Moving the mouse on the

images diagonal while holding left mouse button will cause resizing of the map. Release left

mouse button if you finished resizing.

9.5.3. Deleting map from printout

To delete any mp from the printout, move mouse cursor over the area of the map which you want

to delete. Right-click to open pop-up menu. Select „remove‟ to delete map.

9.5.4. Changing printout options

In printout manager there are two additional options:

- Hide patient‟s personal data –this option removes patient‟s name and date of birth

from the printout

- Hide field for remarks and signatures – this option removes additional field for

remarks and signatures from the bottom of the printout.


75

Click to select

printer

Click to adjust printer

parameters

Mark this box to print

to file instead of printer

Click here to adjust

number of copies

Click here to cancel

printing

Click here to start

printing

9.5.5. Printing and saving results in printout manager

After clicking „Print‟ a window will appear, enabling to set the desired printer parameters:

After clicking „Save as‟ a window will appear, enabling to select file name and file type for

examination results:

Important !!!

It is recommended not to print earlier results while next examination is being performed. Printing

absorbs significant amount of computer resources, and together with examination may slow down

the whole system.

This window can have different shape and different controls – it depends on

type of printer you have installed.

Browse to desired

location

Enter filename

Select file format

Save printout

Cancel


76

9.5.6. Results compare printout

In order to print Compare result profile, click “Print” button in Results Compare window. A

Standard Print dialogue window will be opened (look point 9.4) and printout will be created.

Printout contains compared profile in decibels and dot scale, and two compared results with details.

Click to print

compare printout


77

9.5.7. Sample printout

Below you can see sample printout. All printouts are made in A4 format – it has been scaled for

this manual only. Below, there is printout of Fast threshold strategy.

Patients

personal data

Examination

details Info card

Absolute

level dot

scale

Blind spot

HOV

deviation

color scale

Statistical data

about

examination

and reliability

indices

Absolute

level decibels

HOV

deviation

graph

Eye

movement

monitoring

HOV

deviation dot

scale


78

10. Setup tab

This tab enables to set general parameters of the system, enables to control the state of database,

removing unused test results, etc. You can also perform backup process here – to secure against

data loss in case of operation system failure.

10.1. Language selection

PTS1000 software is multilingual. You can change application language by selecting it in

Language list box in Setup window.

Select application

language


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10.2. Database tab

It enables you to order database and make it in good condition. You can delete old examination

results or patients not examined during long time.

After pressing “Start” button, options marked on the left will be performed. If „Check

Database” is ticked, the software will check status of database and if necessary, the system will

repair it automatically.

Mark to check integrity of

database

Mark to automatically

unregister patients not

examined for last n years

Click to automatically

remove examination results

older than n years

Progress bar Select 'Database' tab

Click to use remote database

Remote database location

Click to transfer examination results

Click to start integrity check


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10.2.1. Examination results transfer

Sometimes there is a need to transfer single examination results between different patients in

database. Such situation can happen if the doctor performed examination and then found out that he

selected improper patient in the database.

Perimeter program enables to transfer examination results between patients in current database.

To transfer result click “Results transfer” button from “Setup” window. “Results transfer” window

will appear as shown below.

The window is divided into three parts. Two panels on the left side specify the source patient and

source examination results. Panel on the right specifies the destination patient. In order to transfer

examination result, do the following:

select patient in the left panel from which the examination should be transferred (source patient)

select examination result which will be transferred in left panel (source examination)

select patient in the right panel to which the examination will be transferred (destination patient)

click “>>>” button to move examination.

Select destination patients Select source patient

Select source patients result Click to transfer result


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10.3. Backup

This tab enables to create backup copy of the whole database. Click “Backup” button, Save as

window will appear. Select drive and destination directory. By default, the backup copy will be

created on hard drive in “C:\” folder with name “PTS-YY-MM-DD.zip”. However you can change

name and any location in save dialog window. The frequency of backup depends on the number of

examinations is done weekly. The more examinations are taken weekly, the more frequently backup

copy should be created.

It is advised to make backup copy at least once a week. It will secure against important data loss

in case of any system failure.

10.3.1. Backup on CD

PTS software have possibility to save database backup file directly on CD. To save backup on

CD click “Burn on CD” button. “CD burning” window will appear. If computer owns more than

one CD writer select proper drive, insert empty or multisession CD into drive and click “Burn”

button. Backup copy will be created with name “PTS-YY-MM-DD.zip

Select 'Backup' tab

Default

destination

folder Backup on CD

button


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10.3.2. Recovering data from backup copy

This tab enables user to recover all lost data from backup copy created on floppy disks or other

data carriers (hard disks, CD-ROMs etc.), it also enables to insert database from backup copy into

existing database.

10.3.2.1. Recovering whole database

In order to recover data from backup copy click “Recover” button. Make sure the option “Add to

current database” is not marked. Open window will appear, select source backup copy file to

recover. The program will display warning message: “Current database will be replaced with

database read from backup diskette”.

The program will replace all database files with the files from backup copy. In this way any

possible damages to database can be fixed.

Before performing recovery process one has to make sure the backup

copy was created using the same software version which is used when

recovering.

Use this option only in severe cases – when you lost all your data

from database. Contact your local distributor before performing

recover operation.

Select proper drive

Click „Burn‟ button

Saving backup file on CD is possibile only in computers applied with

CD writer

Click to recover database

from backup copy

Leave this option

unmarked


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10.3.2.2. Inserting backup copy database into existing database

PTS1000 offers possibility to add backup copy of database into existing database. This option is

used to join two databases into one part.

To add Database from backup copy to current database mark “Add to current database” option

and click “Recover” button. Open window will appear, select source backup copy file to add. The

program will display confirmation message and if you click “Yes” button database will be added to

current database.

In this mode, the recovered database can have any format (it can be created by earlier versions of

software) – it will always be converted to the current format.

This mode doesn't replace database files. Any existing damages to

database will not be fixed

If recovered database derive from older software version, message will

appear, and program will rebuild database.

Click 'Yes' to

recover database

Click 'No' to

cancel

Mark this option

Click to recover database

from backup copy

Click 'Yes' to

recover database

Click 'No' to

cancel


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10.3.2.3. Recovering database from auto backup file

PTS1000 software has “Auto backup” mechanism. Every day after closing PTS software,

database backup copy is created. Software archives 10 last auto backup copies which may be

recovered.

To recover auto backup file click “Recover auto backup file” button and confirm warning

message.

“Open auto backup file” dialog window will appear. Select which auto backup file you want to

recover and click “Open” button.

Click to open dialog

window

Click 'Yes' to add

database Click 'No' to cancel

operation

Click ‘Open’ to

recover selected

autobackup file


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10.4. Application settings

This tab allows the user to set some individual parameters of the system. It also contains

information about camera settings. It is advised to change camera settings by experienced staff only.

PTS 1000 software have implemented sound events mode. If computer is equipped with sound

card PTS software user can enable sound. If sound is enabled any messages and events will be

signalized by sound. For messages program uses default operating system sounds.

Also during stimuli expositions sound can be used and that sound can be defined by user – user

can load any wave file and use it as stimuli sound.

PTS software have 4 different types of sounds:

- stiuli exposition sound,

- events no need to any operator reactions sound (for example fix error)

- events needs operator reaction (for example examination paused etc.)

- finish examination.

To use sounds in software mark “Play sounds” checkbox in “Sound” tab of “Setup” window.

Set sounds volume and optionally load sound wave file form hadr drive to use as stimuli sound.

If you want to use defauld PTS stimuli sound click “Default”.

Below you will find the descriptions of the available options:

Auto turn off - if this option is marked the computer will be shut down automatically when user

quits the PTS1000 program. (In Windows 2000/XP, the user must have rights given by

Communication port

selection Mark it to enable

video preview

Video source

selection

Advanced camera

settings

Click to set

examination

parameters

Select

'Parameters' tab

Automatic

communication port

selection

Click to open

„Field editor‟

window

Set sound volume

Mark to use events sounds

Select wave file to load

Mark to use stimuli sounds

Click to apply loaded wave

file as stimuli sound Click to restore

default stimuli

sound Click to play selected

wave file

If computers sound card is not compatible with PTS software

„Sounds” tab will be invisible.


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Administrator to shut down the system).

Auto turn on - if this option is marked the PTS1000 software will be automatically started when

Windows is loaded.

Database synchronization - this option is valid only if there are two or more Optopol devices

installed on one computer. If this option is marked, the system will share the same patient

database.

Off line mode - if this option is marked, perimeter program is in off line mode, and it cannot do

examinations. This option is useful when program works with remote database.

10.4.1. Field editor

PTS software enables user to define own field to be examined. Thanks to implemented “Field

editor” user can define any field in range of 50 degrees in each direction, separately for each eye or

symmetric for both eyes. To define user field can use patterns matched implemented fields.

There is possibility to save defined field to a file and open defined field from file. Thanks to that

user can make collection of defined fields or send it to another user.

To define user field click “Field editor” button in “Setup” window. “Field editor” window will

appear as shown below.

Click to change defined eye

Mark to use symmetric

field

Click to select field pattern

Click to load defined field

from file

Click to save defined field

to file

Click to close field editor –

defined field will be applied

Click to close field editor

without defined field apply

Click to mark/unmark point

to be tested in user field


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10.4.2. Appearance adjustment

PTS1000 enables to individually set the color style used to display graph results. The colors can

be adjusted to suit individual taste of users. If “Angular ruler” is marked, there will be a ruler

displayed in each decibels graph on screen. You can select which analysis and what style of the map

will appear in results review as standard. This setup will be recalled after pressing STD button in

results review. Also info card and logo can be selected here.

3D disable - if this option is marked, 3D view in result review window is disabled. This option is

used to avoid software malfunctions with computers equipped with non compatible graphics card

(not supported OpenGL).

Click if you want back to

default colors set

Click to select item color

Mark this to display ruler

on graph

Click to unroll list of

available skins

Click here to select Logo

which appears on a

printout

Card editor. Enables to

design own card printed

on each printout

Select analysis method in

standard setup for each of

multiwindows

Select map style in standard

setup for each of

multiwindows


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11. Multiuser access in computer network environment

Starting from Automated perimeter PTS software version 3.3, databases can be accessed by many

users simultaneously by multiple users on using different computer. Thanks to network option, it is

a lot easier to perform examinations and make the diagnosis. The doctor can be in his office and

analyze examination result on his own computer; he doesn‟t have to go to another room where

examinations are done.

PTS1000 software is based on Client-Server model. It means that one of the computers in the

network is configured as Server (database files are stored on this computer), the rest of the

computers are Clients (they access the database located at Server).

To configure perimeter program for multi-user environment you have to:

a) install the same PTS software on all computers (both Clients and Server).

b) choose one of the computers as Server (in case of small local networks it is usually the computer

with direct connection to PTS, otherwise if its big network, server computer should be clearly

distinguished).

Important !!!

To let any of Client computers work with perimeter program, Server computer must be

turned on.

Following chapters describe program configuration on Server computer and on all of the Client

computers.

11.1. Program configuration as database server

a) The folder where PTS1000 application is located should be shared on the network for all Client

computers with full access rights (read+write+change). Default location: C:\Program

Files\PTS1000)

b) Run perimeter program, and go to Setup-->Database. Make sure that “Use remote database”

checkbox is unmarked. In this case content of field on the right (specifying the location of

remote database) is ignored.

c) If PTS1000 device is not connected directly to Server computer, one should mark “Off line

mode” in Setup-->Parameters. If PTS1000 device is connected to Server computer, “Off line

mode” should not be marked.


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11.2. Program configuration as database client

Following procedure should be conducted on all Client computers.

a) Run perimeter program, and go to Setup-->Database. Make sure that “Use remote database”

checkbox is marked.

b) In field at right specify network location of PTS1000 database on Server computer (for example

if Server computer has name SERWER, and database folder with access named PTS1000, one

should type location: \\SERWER\PTS1000)

Warning !!!

We suggest to use UNC format when specifying location of database (e.g.

\\COMPUTER\\folder). Optionally network disk mapping can be used.


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c) If PTS1000 device is not connected directly to Client computer should mark “Off line mode” in

Setup-->Parameters tab. If PTS1000 device is connected to Client computer, “Off line mode”

should not be set.

11.3. Program limitations on Client computer

Perimeter program configured as Client computer (using remote database) have some functional

limits, which do not apply to Server computer. On Client computer the following options are

blocked:

Patients removing,

Results deleting,

Database backup,

Database recovering,

Database ordering,

Results transferring.

Additionally, on all computers with turned on “Off line mode” Examination window is blocked

(it isn‟t possible to make examination).

11.4. Sharing PTS data base on Windows VISTA computer in Local Network

Sharing of the PTS data base on Windows Vista computer is similar to Windows XP but

requires some additional configuration. Following points show how to configure PTS database

sharing.

1. Go to Control Panel and „Network And Sharing Center‟

2. First of all turn the „Network discovery‟ on then apply changes.


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3. Windows will show two possible choices. You can select whichever you want. If you use only

private network choose first option.

4. Next turn on „File sharing‟ and apply changes.


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5. Turn off „Password protected sharing‟ and apply changes.

6. Now change type of the network to private. Press „Customize‟ next to unidentified network

7. You can name this network or leave it unidentified. Select „Private‟ and click „Next‟.

8. Now you need to share the PTS1000 folder on the network. Select Computer from Start menu

and explore to your PT1000 folder (by default C:\Program Files\PTS1000). Right click on it and

select „Share...‟


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9. In next window select „Advanced Sharing..,

10. Select „Share this folder‟ and enter name under which it will appear in the network.

11. Next configure share permissions. You should specify users which will have network access to

PTS1000 folder. Grant them „Full Control‟. You can select „Everyone‟ if you wish to grant

access to everyone.


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12. Click „OK‟. Now you can share PTS1000 data base from different computers in the network.


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12. Data exchange interface

PTS software has possibility to exchange data with any medical system. Data exchange is

performed using data exchange files which can be loaded and saved in exchange folder localized on

computers hard drive. Files saved by medical system and opened by PTS software (PTS_IN files)

includes data of patients which may be examined. After ordered examination PTS software saves

PTS_OUT files with examinations data to data exchange folder.

To enable data exchange interface set data exchange folder location and mark “Data exchange”

checkbox in “Parameters” tab of setup window.

When data exchange interface is enabled, PTS system automatically detects if any PTS_IN files

appears in exchange folder. Message dialog will appear and if you confirm patients import program

will import new patients to examination. Ordered examination description will appear in imported

patient‟s remarks. You can display only imported patients by marking “Data exchange only”

checkbox in “Main window”

Data exchange patients

examination remarks

Mark to enable data

exchange interface

Set data exchange

folder location


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After imported patient‟s examination, PTS program automatically saves PTS_OUT files into data

exchange folder and deletes PTS_IN file. Patient and examination from data exchange interface

stays in current PTS database.

To get information what medical systems can collaborate with PTS software contact with PTS

device distributor.

12.1. Optomate data exchange interface

PTS software is able to connect to Optomate medical system. To enable connection to Optomate

medical system mark “Link to Optomate” checkbox in “Data exchange” tab of “Setup” window.

13. Solving problems

In case of any malfunctions follow the procedure below:

Problem Cause Solve

Message:

“Examination bowl

not connected to

computer. Check

cables!”

No physical connection between

computer and examination bowl on

selected communication port.

Check cable connection between

examination bowl and computer. If

computer ask “Perform automatic

ports search ?” click “Ok” button

Message: “I can't

establish

communication with

testing bowl”

No communication between

computer and examination bowl.

Check if power supply cable is

connected. Check if examination

bowl is turned on.

Message: “Backup

process hasn't been

performed for at least

xx weeks”

Backup of your database hasn‟t been

performed for at least xx weeks. You

can lose your patients‟ data when

computer or Windows crashes.

Create backup copy of the whole

database. Read chapter 10.2.

Message: “I can't

establish connection

with CCD camera”

Camera drivers are not installed

properly, wrong camera source is

selected or camera damaged.

Check if USB cable is connected

properly. Read chapter 3.2 and

reinstall camera drivers. Make sure

proper drivers are selected.

No video preview in

“Examination

window”

Camera drivers are not installed or

video preview disabled.

Check if video preview is selected

in 'Setup' window. Check if camera

source is selected properly. Read

chapter 3.2 and 10.5 for these

options.

Mark to enable

Optomate medical

system connection


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Problem Cause Solve

Message: “Not

supported DIB

format”

Wrong camera configuration. Read chapter 3.1to configure

camera.

After turning on

examination bowl is

not illuminated, there

is no central fixation

point

Examination bowl has no power. Make sure the bowl is connected to

power supply socket with proper

parameters (230V, 50Hz or 60 Hz)

and turned on. If green light on the

power button is not lighting then

turn off power and check fuses.

Message: “Critical

database damage”

Database files got damaged or

backup has been done from older

version of program.

Close program and reboot system.

If problem appears again use

backup diskette to recover database

or reinstall PTS1000 software. Look

Charter 10.2 for database repair.

Message: “I can't open

communications port”

Selected COM port is used by

another application.

Select different COM port or quit

the application that uses the COM

port.

No 3D visualization in

results review on

Windows VISTA

No actual drivers for graphic card Download and install latest drivers

for you graphic card

Consumable spare parts:

fuses type: WTA-F, AC.250V, F3A, 5x20mm - 2 pcs.

(Other fuses can be used, but they must have the same electrical parameters and F,M

characteristics, or T characteristics according to IEC standard)


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14. Symbol information

WARNING - Consult accompanying documents

WARNING – Risk of electric shock

Indicates a fuse is present near this symbol

On / Off

Type B Applied Parts

Date of manufacture

Manufacturer

Electrical and Electronic Equipment waste. Do not throw the product away

with a normal household waste at the end of its life.

Conformity with 93/42/EWG


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15. Storing conditions

Temperature: 10 – 40 °C

Relative humidity: 60 – 80 %

Atmospheric pressure: 860 – 1060 hPa

16. Service

In case of problems contact your local distributor.

17. Utilization

It is recommended to contact with local distributor after device usage duration period is over – to

agree upon the way of utilization (plastic, epoxide resin, polyurethane foam, metal, etc.)

Windows is a registered trademark of Microsoft Corporation. Pentium is a registered trademark of the Intel Corporation. All other trademarks are

properties of their respective companies.

Edition date: February 2008;

Verification date: June 2008;