test chart xpert i - home - thomson software solutions … · · 2014-09-23the phoropter...

Test Chart Xpert PHOROPTER INTERFACE

3Di

Thomson Software Solutions

131a Dixons Hill Road

Phone 01707 263195

EMAIL: [email protected]

WEB: www.thomson-software-solutions.com

T E S T C H A R T 2 0 0 0 X P E R T 3 D I P H O R O P T E R I N T E R F A C E

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PHOROPTER INTERFACE MODULE

Test Chart Xpert 3Di is available with an optional module for controlling the Nidek

RT5100 and phoropter.

This provides a single interface for the Test Chart and the phoropter allowing the

appropriate charts to be displayed when various lenses are selected and vice versa.

The module also provides a generic conduit for data to be passed between the

phoropter and patient management systems allowing previous prescriptions to be

dialled up in the phoropter at the click of a button and updated prescriptions to be

uploaded back into the database.

HARDWARE REQUIREMENTS

SCREEN SIZE AND RESOLUTION

The phoropter module requires a PC capable of supporting two monitors (see earlier

section). One monitor is used to display the test chart while the other is placed in

front of the practitioner to control the phoropter interface. The minimum resolution

for the practitioner’s monitor is 1280 x 1024. A larger/higher resolution is

advantageous because it allows other windows to be viewed simultaneously on the

screen.


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NB. The vertical resolution of the monitor must be 1024 or greater in order to

accommodate the control window. Widescreen formats such as 1680 x 768 are not

suitable.

SERIAL INTERFACE

A serial interface is required to link the PC to the phoropter control unit. Few PCs now

have a serial interface and therefore a USB to serial converter will probably be

required. These are readily available from computer suppliers or can be ordered

through Thomson Software Solutions.

USB to serial converter available from Lindys.

Plug the USB to serial converter into a USB port of the computer. After a few seconds

the “Found new hardware” wizard should appear. Insert the CD supplied with the

USB to serial converter and follow the on-screen instructions. When the driver has

been installed successfully a message should appear to confirm that the hardware is

now ready to use.

The USB to serial converter will appear as a serial (COM) port in the hardware

configuration of the computer. To check this, select Control Panel … Device Manager.


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Expand the Ports node and the USB to serial device should be listed along with the

COM port to which it has been assigned (e.g. COM 5). Make a note of this port as you

will need this information when configuring the phoropter interface in Test Chart

XPert 3Di.

You will also need a cable to connect from the USB to serial converter to the

phoropter control unit. This will be supplied by Nidek along with instructions about

how to connect this to the control unit.

INSTALLING AND SETTING UP THE SOFTWARE

The software is supplied on a CD with a Dongle and installed in exactly the same way

as the standard Test Chart Xpert 3Di software.

Before the phoropter interface can be used the interface needs to be configured and

enabled as follows: Select Setup from the menu at the top of the screen and select

the Remote and Phoropter tab.


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Select the phoropter type from the pull down list and ensure that Enable phoropter is

checked. Select the appropriate Com port using the information recorded from the

Device manager (see above). Click on OK to record the settings.

If you have not already done so, select Show floating window on desktop from the

Windows positioning page of the Setup window.

This will display the Floating window on your primary display. By default this will

show the thumbnail display as shown below.


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Select the Phor icon from the toolbar at the bottom of the screen. This will display the

phoropter interface as shown below.

By default, the interface will include three windows: the phoropter interface, the test

chart thumbnail and the Rx memory windows. The Rx memory can be swapped with a

Programmes window by selecting the Progs icon on the toolbar at the bottom of the

screen. Various options for the phoropter interface can be set by clicking on the Opts

icon in the toolbar. Each window will be described in detail below.

PHOROPTER INTERFACE

The phoropter interface has been designed to be as intuitive as possible. To achieve

this, the interface includes a visualisation showing exactly which lenses and filters are

being presented at any moment in time. This is particularly useful for those upgrading

from a trial frame.

SELECTING SPHERE/CYL LENSES

To dial up a prescription in the phoropter, simply click on the Sph, Cyl or Axis boxes

for the corresponding eye. The box will then be highlighted as shown below. To

change the lens, rotate the mouse wheel (located between the two mouse buttons).


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The software will wait until the mouse wheel stops moving and then dial in the new

lens in one rotation (rather than changing the lenses in 0.25 steps). This makes it very

much quicker to make large changes in lens power. The lenses selected will be shown

in the visualisation exactly as they would appear in a trial frame.

To change the lenses for the right and left eye together, click on the box between the

two lenses, For example, if you wish to change the power of the sphere in front of

both eyes simultaneously, click on Sph.

You will note that both the right and the left Sphere boxes are now highlighted as

shown below.


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If the mouse wheel is now rotated, both spheres will be changed simultaneously. To

return to single lens control, simply click on a box.

The value in the Sph and Cyl box can be zeroed by right clicking in the corresponding

box. Right clicking on the Axis box sets the axis to 90 or 180 degrees.

SELECTING A NEAR ADD

When in distance vision mode, the Add boxes are greyed out. Clicking on one of the

Add boxes will cause these boxes to be highlighted and the distance Rx to be greyed

out as shown below. The phoropter will also automatically be adjusted to the near PD

and the near chart illuminators will be switched on. By default, the Add for both eyes

will be highlighted which means that rotating the mouse wheel will add the same

reading addition to each eye. Clicking on one of the Add boxes will remove the

highlighting from the other eye and allow the Add for each eye to be adjusted

independently.


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Clicking on any of the Sph, Cyl or Axis boxes will put the phoropter back into distance

vision testing mode.

ADDING PRISMS

To add prisms, click on the Prisms button. This will display the prism rack as shown

below.

To add a prism, click on the appropriate prism box and rotate the mouse wheel. The

base direction is shown automatically.

The prism can be adjusted monocularly or binocularly by clicking on the button

labelled Monoc / Binoc. When in binocular mode, the prisms for the right eye will be

changed together in opposite directions so as to increase the combined prismatic

power. For example, changing the horizontal prism will add Base In or Base Out prism

to both eyes. For vertical prism, Base Up will be added to one eye and Base down to

the other.

NOTE: The prism will not be incorporated into the phoropter until the Incorporate

button is pressed. In addition to the button being highlighted, “PRISM


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INCORPORATED” is included on the visualisation as shown below. This allows prisms

to be incorporated instantly in front of both eyes if required.

The prism can be removed from the phoropter by pressing the Incorporate button

again and the prism rack can be hidden by pressing the Prisms button again.

AUXILLARY LENSES

The Nidek phoropter includes a variety of auxiliary lenses for use with specific tests.

To include an auxiliary lens, select the Aux lenses button. This will display the auxiliary

lens rack as shown below.


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To select one of the available lenses, simply click on the corresponding button. A

representation of the lenses inserted will be displayed on the visualisation as shown

below.

The auxiliary lenses can be linked to specific test chart screens by selecting Show

associated chart when lens is selected option from the Miscellaneous phoropter

options (see later).


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To remove all auxiliary lenses, select None. To hide the auxiliary lens rack, click on

Aux lenses again.

CROSS CYL TESTING

To perform a Cross Cyl test, select Cross Cyl. This will display the cross cyl rack as

shown below.

The three types of cross cyl (+/-0.25, +/-0.50 and Auto[if available]) can be inserted by

selecting the corresponding button in the rack. Likewise, the cross cyl mode (axis or

power) is selected by clicking on the corresponding button. The cross cyl is spun

(except for auto mode) by clicking on the Spin Cross Cyl button.

A representation of the cross cyl is presented in the visualisation. The red and black

dots represent the plus and minus axes of the cross cyl respectively.

When in Power mode the axes will be automatically set at 0 and 90 degrees from the

current cylinder axis. When in Axis mode the axes will be placed at 45 degrees from

the current cylinder axis. The orientation of the cross cyl will be adjusted

automatically as the cylinder axis is changed.

The red and green boxes can be used to change the cyl power and axis automatically

by simply clicking on the colour of the preferred cross cyl (shown as a red or green

rim to the cross cyl).


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SELECTING THE RIGHT OR LEFT EYES

To swap between the eyes when performing a cross cyl test, click on the R or L boxes

as shown below.

If already in cross cyl mode, the cross cyl will be removed from the other eye and

inserted in front of the selected eye at the correct orientation and in the same mode.

The other eye will also be occluded automatically.

To remove the cross cyl lens, click on the Cross Cyl button again.

OCCLUDING THE EYES

To occlude an eye, either click on the Cover RE or Cover LE buttons or click directly on

the visualisation. The corresponding eye will be occluded in the visualisation as

shown below. To uncover the eye, click on the button or the visualisation again.

FOGGING THE EYES

A fogging lens can be presented in front of the eyes (without changing the main

sphere power) by selecting the Fog RE or Fog LE buttons. This is displayed as an

additional “flipper lens” in the visualisation as shown below.


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The power of the fogging lens can be selected from the phoropter options window

(displayed by selecting Opts on the toolbar at the bottom of the screen).

To change the default power of the fogging lens, select the Fogging tab and then

select the required power from the pull down list.

RETINOSCOPY LENSES

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


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The power of the retinoscopy lenses can be selected from the phoropter options

window (displayed by selecting Opts on the toolbar at the bottom of the screen).

To change the default power of the retinoscopy lenses, select the Fogging tab and

then select the required power from the pull down list.

“FLIPPER" LENSES

It is often convenient to offer a patient a small adjustment in the spherical power of a

prescription. For example, is it any clearer with -0.25DS, is it any worse with +0,25DS.

This can be achieved by simply selecting the Sph value and changing the power using

the mouse wheel. However, the flipper offers a rather more convenient solution.

To display the flipper rack, click on the Flipper button in the top toolbar. This will

display a flipper rack for each eye as shown below.


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To change the spherical power in one eye, simply select the lens power from the rack.

This power will then be added to the current prescription. For example, to offer a +/-

0.25 lens, simply click on the +0.25 then -0.25 lens in the rack. To remove the

additional lens, select None.

To present the same powered lens to both eyes simultaneously (binocular flipper),

select the Monoc/Binoc button on either of the flipper racks.

ADJUSTING THE PHOROPTER CD (PD)

To adjust the centration distance of the phoropter to match the patient’s PD, select

the PD box as shown below.


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Selecting the box will turn on the eye illuminator LEDs and insert a cross-hair

alignment lens in front of each eye. The centration distance is changed by simply

rotating the mouse wheel until the lenses are aligned with the centre of the pupils.

To remove the alignment crosses and turn off the eye illuminators, click on any other

box, e.g. Sph.

RESET

To remove all lenses and filters from the phoropter and set the centration to 64mm,

click on the Reset button.

The phoropter can take up to 10 seconds to fully reset.


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OPTIONS

The phoropter interface can be customised by selecting Opts from the toolbar at the bottom

of the floating toolbar. This will display the Phoropter Options window which has four tabs.

CYL OPTIONS

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

PLEASE NOTE: The lenses in the Nidek phoropter are actually in minus cyl format which means

that when working in plus cyl format, both the sphere and cyl in the phoropter need to be

changed. This results in a “double clunk” and is rather slower than working in minus cyl

format.


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Selecting Automatically adjust sphere with cyl changes will automatically increment the

sphere value by +0.25 for every -0.50 change in cyl power thus keeping the mean sphere

constant.

By default, cyl axis changes in 5 degree increments. However, for higher cyls it may be

desirable to specify the cyl axis to the nearest degree. This is achieved by selecting the 1

degree option under Cyl axis increment.

Please note: the 1 degree increment option is not yet available for the tablet interface.

FOGGING

The power of the lenses use for fogging and retinoscopy can be selecting from the fogging tab

as shown below.

MISC OPTIONS

Selecting the Misc tab display the options shown below:


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Selecting Use IR remote to control phoropter allows the standard IR remote control to be used

to change various phoropter values.

The IR remote keys take on the following functions:

Vertical cursor keys: Move between Sph, Cyl and Axis

Horizontal cursor keys: Increment / decrement current value (Sph, Cyl, Axis, Add)

R/L: Select Right / Left eye respectively

Home / PgUp: Cover / uncover right and left eyes

U: Show cross cyl

I : Remove cross cyl

Test Option 1 / 2: Spin cross cyl

Test Option 3 / 4: Select Axis / Power mode for cross cyl

M: Select auxillary lens mode

Selecting Use keyboard to control phoropter causes the up/down cursor keys on the keyboard

to change the current phoropter values (instead of using the mouse wheel). This can be

useful when performing retinoscopy for example.

Selecting Show associated chart when lens is selected is the reverse of the previous option.

The corresponding lens is inserted when specific charts are selected.. For example, a cross cyl

lens is inserted when a cross cyl target is selected.


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Selecting Insert associated lens when chart is selected causes the corresponding test chart to

be displayed when specific lenses are selected. For example, a cross cyl target will be

displayed when a cross cyl lens is selected.

DATABASE LINK

Selecting the Database link displays the screen shown below.

This allows the location of the CSV file used to transfer the data between a database

and the Rx memory to be set (see section below).

RX MEMORY

The Rx memory module allows the practitioner to maintain up to seven different

copies of the patient’s prescription and rapidly transfer these between the phoropter

and memory.

The seven copies of the prescription are labelled:


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Old Rx 1

Old Rx 2

Focimeter

Autoref

Ret

Final 1

Final 2

Most refractions would commence with entering a copy of the patient’s Rx, either

taken from a previous prescription, their old prescription as measured with a

Focimeter or the reading from an Autorefractor. This can then be instantly

transferred to the phoropter for checking and fine-tuning. The new prescription can

then be transferred back into memory as the Final 1. If the patient needs a separate

prescription for intermediate vision for example, this can be transferred to Final 2.

These prescriptions can be saved in the simple patient database provided with the

system or transferred to a full Patient Management System such as Optix using the

generic prescription transfer protocol.

The Rx memory module is displayed by default when the phoropter module is

selected. However, if it is not displayed, select Rx mem on the toolbar at the bottom

of the screen.

The seven copies of the prescription are displayed by selecting one of the seven

buttons down the left side (Final 1, Final 2 … etc.). The prescription currently assigned

to this mode is shown in the grid to the right.

ENTERING A PRESCRIPTION

A prescription may be entered into the grid by simply clicking on each cell and

rotating the mouse wheel in the same way as for the main phoropter module.

TRANSFERRING THE PRESCRIPTION TO AND FROM THE PHOROPTER

The prescription shown in the grid can be transferred to the phoropter by clicking on

the green arrow above the word PHOROPTER. Likewise, the prescription currently

held in the phoropter can be transferred back to one of the Rx memories by clicking

on the red arrow.


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MOVING PRESCRIPTIONS BETWEEN MEMORY BANKS

It is sometimes useful to be able to move a prescription from one memory bank to

another. For example, you may want to shift the prescription stored under Old Rx1

(the Source) to the Final 1 (the Target). To do this, simply select the Rx that you wish

to move and drag the button on to the new memory bank. The mouse cursor will

change as you drag and the target memory bank will be highlighted as the cursor

moves over it (see below).

NOTE: The Source prescription will overwrite the Target prescription.

CLEARING THE RX MEMORY

To clear the Rx displayed, click on Clear Current. To clear all the Rx memory banks,

click on Clear all.

TRANSFERRING PRESCRIPTIONS TO AND FROM PATIENT MANAGEMENT

SYSTEMS

The prescriptions held in memory can be transferred to and from a Patient

Management System (PMS) such as Optix, using a generic CSV file. This is a text file

which is stored in a common directory on the PC. The PMS system must write the

prescription data in the prescribed format to this directory. The Rx Memory module

can then read these prescriptions and they can be transferred to and from the

phoropter as described above.

Having modified the prescription and saved it back to the Rx Memory, the data can

then be exported to the same CSV file and imported back into the PMS.

This allows a previous prescription stored in a PMS to be readily imported into the Rx

Memory, modified and then exported back to the PMS.

The name/ location of the CSV file used to transfer the data can be specified from the

Phoropter Options window shown below.


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Select the Database link tab and then click on Browse … Navigate to the directory

where the transfer file is to be saved and create a filename (e.g. Phoropter.csv).

To transfer the prescriptions currently held in the Rx Memory to a PMS, click on the

red arrow above the word DATABASE (see below). If your PMS is compatible with this

interface, it will contain a similar button for importing the prescriptions in the file into

the PMS.

To import prescriptions from a PMS, first export the data to the temporary file then

read the prescriptions into the Rx memory by clicking on the green arrow above the

word DATABASE.

USING THE BUILT-IN DATABASE

If you do not use a PMS or your PMS does not include a suitable interface with the Rx

Memory module, prescriptions can be stored in the simple database included with

the software. To access this database, select the dBase icon in the toolbar at the

bottom of the screen.


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This will display the window shown. The first tab shows a list of the patients currently

stored in the database. The list can be sorted alphabetically according to First name,

Surname, Date of birth, Address or Postcode. The list can also be filtered to show a

subset of records. For example, entering “j” in the text box labelled First name will

filter the list to show just those records where the first name begins with “j”. Adding

an “s” in the family name text box will further filter the list to show those records

where the first name begins with “j” and the surname begins with ”s”. The list can

also be filtered by postcode. This allows records to be rapidly located from the list. To

select a record, double click on it.

To enter or edit the patient’s personal details, select the Patient details tab. To save

any changes, click on Save record.


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To enter or edit a patient’s prescription, select the Patient Rx tab. This will display the

window shown to the left.

Up to seven prescriptions may be stored for each patient and these are displayed by

selecting the corresponding tab (Final 1, Final 2, Ret …etc.).


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A prescription is entered by clicking on each cell and rotating the mouse wheel

(identical to the phoropter module). The name of the optometrist, notes and the type

of spectacles can be entered for each prescription.

Prescriptions can be transferred from one category to another by first selecting the

prescription to be moved (the Source) and then selecting the Target category from

the pull down list labelled Transfer Rx from ****** to.

A copy of the current prescription can be printed by selecting the Reports tab. To

change the size of the report preview click on the magnifying glass icon. To print the

report, click on the print icon.


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TRANSFERRING THE RX BETWEEN THE DATABASE TO THE PHOROPTER

To transfer an Rx between the database and the phoropter, simply click on the green

arrow at the bottom of the window. This will transfer the current record to the

transfer CSV file. This can then be imported into the Rx memory and then transferred

to the phoropter.

Likewise, a prescription held in the Rx memory can be exported to the transfer CSV

file and then imported into the database by clicking on the red arrow at the bottom

of the screen.

NOTE: The Rx will be imported into the current record, overwriting the current data.

Therefore it is important that the correct record is selected in the database when

importing the data.


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PROGRAMMES

Most eye examinations follow some form of set routine. For example, most

practitioners would commence an examination by measuring visual acuity and then

perhaps progress through checking the spherical component of the prescription,

cross cylinder, balancing etc.

Test Chart XPert 3Di includes a powerful Programmes module to allow the

practitioner to define one (or more) routines so that specific charts/test stimuli and

lenses can be selected with a single click. The greatly simplifies testing and can speed

up the routine.

To display a programme, click on Progs on the toolbar at the bottom of the screen.

This will display the screen shown below.

The Programmes window shows five columns:

Procedure: The name of the test

N: the order in the programme

Rx: the Rx to be transferred to the phoropter


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R Aux: The auxiliary lens to be placed in front of the right eye

L Aux: The auxiliary lens to be placed in front of the right eye

The procedure is implemented by simply clicking on an item in the list. For example,

clicking on Duochrome RE the list shown above would display the duochrome screen,

transfer the Rx currently held in Old Rx 1 to the phoropter and cover the left eye.

Selecting Cross cyl axis LE would leave the current Rx in place, insert the cross cyl in

axis mode in front of the left eye and occlude the right eye.

Each programme can include up to 30 procedures. The procedures can be sorted

according to any of the column headers (n, Rx etc) by clicking on the column header.

You may define an unlimited number of programmes to cater for different types of

patient and to suit each practitioner’s preference. The different programmes can be

selecting via the pull down list at the bottom of the Programmes window.

CHANGING THE PROGRAMME ORDER

The order of the procedures in the programme can be changed by simply dragging

any procedure to its new position. For example, to move Unaided vision RE to

position 12 in the list, click on Unaided vision RE and keeping the mouse button

pressed, move the cursor down to position 12. The list will automatically be updated

to show the new order.

ADDING TO OR EDITING AN EXISTING PROGRAMME

To change an existing programme, select the programme from the pull-down list and

click on Edit. This will display the window shown below.


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To add or change a procedure in the programme, select the Procedure no (1-30). You

may then edit the Procedure label to describe your new procedure.

To select the Rx that you wish to be dialled up in the phoropter, select one of the

options in the pull down list. These correspond to the prescriptions currently held in

the Rx memory.

To select the auxiliary lens to be placed in front of each eye, select the lens form the

corresponding pull-down list.

To record the test chart that you wish to display for this procedure, select the

required chart in the normal way and then click on Record current chart selection.

The chart currently displayed will then be automatically reproduced when this

procedure is selected.

Click on Save to record any changes that you make to the programme.

CREATING A NEW PROGRAMME

You may create an unlimited number of programmes to cater for different types of

patients and each practitioner’s personal preference.

To create a new programme, click on New. This will display the window shown below.

Enter the name for the new programme (e.g. “Optometrist 1 adult”) and then click on

OK. A new blank programme will be created and the new programme will be added

to the list of programmes. Add the required procedures to the new programme as

described above.

COPYING EXISTING PROGRAMMES

The programmes are stored in a subdirectory of the main program directory called

Presets.


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This directory will contain a series of files with the same name as the Programmes

that have been defined. If you wish to use these programmes on another computer,

simply copy these files into the corresponding directory on the new computer and

they will automatically appear in the list of programmes.


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USING THE PHOROPTER INTERFACE ON A TABLET

The phoropter control can be displayed on a tablet allowing the practitioner to

perform a refraction without being tied to a computer.

Details of how to link a tablet to a PC using Air Display are contained in the Test Chart

XPert 3Di manual.

Having connected the tablet and PC, ensure that Enable tablet is ticked under the

Windows positioning tab of the Setup screen. Also ensure that Show floating window

on desktop or Show floating window on tablet is selected as shown below.

If you have selected Show floating window on desktop, the phoropter control screen

will initially be displayed on the desktop. However, it can be transferred to the tablet

by selecting the Tablet button at the bottom of the screen. If you have selected Show

floating window on tablet, the phoropter control window will be displayed on the

tablet screen by default.

The phoropter control screen is automatically modified when displayed on a tablet

screen (see below).


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Due to the space constraints, the Rx Memory and Programme screen are not

displayed alongside the phoropter control screen. Instead, they are displayed in front

of the phoropter control screen as shown below.

You will also notice that the “flipper” controls are not displayed.


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As it is not practical to use a mouse in conjunction with a tablet, a scrolling table

control has been implemented. To use this control, simply tap on the parameter that

you wish to change (Sph, Cyl, Axis, Add or PD) and an appropriate scrolling table will

appear showing the complete range of values available. For example, selecting Sph

will generate a scrolling table with values between -20.00 and +20.00. To select a Sph

value, simply “slide” the table up or down until the required value is centred in the

blue rectangle in the centre. The Sph value will then automatically change to this

value. The scrolling table will appear on the left or the right depending on which eye

is selected.

To change Cyl power, Axis, Add or CD, select the corresponding box and follow the

same procedure. The screen below shows a -2.25 cyl being selected for the left eye.


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All other aspects of the phoropter control interface work in the same way as

described for the desktop interface.

HELP AND SUPPORT

If you require any help setting up the phoropter interface, please contact our helpline on

01707 263195. It is generally easier if we can log in to your computer to resolve any issues.

To do this, your computer will need to be connected to the internet and yow will need to

download a copy of Teamviewer from www.teamviewer.com.

We are always keen to hear your suggestions about how we might improve the software.

http://www.teamviewer.com/

test chart xpert i - home - thomson software solutions … · · 2014-09-23the phoropter...

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