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Haag Streit LENSTAR® - Operation


Haag Streit Lenstar

Biometry


Click on images to enlarge for better viewing.

General Precautions:

Lenses with a dense cataract absorb and widely scatter the measuring beam, sometimes making it impossible to measure axial eye length and lens thickness.

The dilatation status of the pupil has no bearing on the measurement of the various dimensions, other than with respect to pupillometry.

Examination:

Preparation

Before a measurement operation can begin, an existing patient must be selected or a new one created. This is done by clicking on the Patients button on the (left) side bar. The following screen will appear:

Patient Data LENSTAR Biometry

  1. Click on the Patient data tab to select an existing patient from the database or create a new one.
  2. To create a patient from scratch, click on New or on the plus sign + beside the search field above the patient list. You may now enter the patient data in the respective fields. Mandatory input fields are highlighted in green.
  3. In order to search for an existing patient, enter a search criteria e.g. patients firs name or date of birth in the search field above the patient list or use the Sort button below the patient list. To select an existing patient simply click on the name in the list.
  4. Only after a patient has been selected the biometry application becomes available form the side bar on the left.

Measurement Interface

The measurement interface screen is displayed after clicking on the button for the biometry application on the side bar. The sample shows the measurement surface in the middle of measurement session.

Mesaurement Screen Overview LENSTAR Biometry

  1. Side bar with the biometry application selected
  2. Patient details
  3. The measurement screen is split into two tabs the Measuring tab and the Results Overview tab. Before a Measurement has been done only the Measuring tab is available. During a measurement session you may switch between the two tabs by using the Finish button on the measurement screen and simply clicking on the Measuring tab to go back.
  4. The left side of the screen shows the details of the right eye (OD) and, the right side, details of the left eye (OS)
  5. Selection of A-scan measuring modes for OD and OS independently: phakic, aphakic, pseudophakic (default, PMMA, acrylic, silicone), silicone oil-filled (phakic, aphakic, pseudophakic). Phakic is the default setting.
  6. Display range for individual measurement readings
  7. Single measurement
  8. Graphic display of the A-Scan based on the filter selected
  9. Details of a single measurement reading obtained, classified by A-scan and keratometry:
    • Axial eye length (the axial length reading displayed by the LS 900 has been balanced with respect to the IOLMaster, i.e. the axial length displayed by the LS 900 is the distance between the front surface of the cornea – including the tear film – and the inner limiting membrane.)
    • Cornea thickness (indicates the average radius/refractive power of the cornea)
    • Aqueous depth (the aqueous depth indicated by the LS 900 - AD = Aqueous Depth - is the distance between the corneal endothelium and the front of the lens. The anterior chamber depth ACD is the distance between the front surface of the cornea – including the tear film – and the front of the lens)
    • Lens thickness (indicates the thickness of the lens)
    • Flat meridian and its axis position (indicates the greater main corneal radius)
    • Steep meridian and its axis position (indicates the lesser main corneal radius)
    • Astigmatism in plus (default) or minus cylinder notation (positive value for plus cylinder notation displaying the axis position of the steep meridian, negative value for minus cylinder notation displaying the axis position of the flat meridian). 
  10. Filter designed to display individual readings instead of a summary as shown in the example. The following filters are available:
    • Overall view
    • Cornea
    • Aqueous depth
    • Lens (indicates lens thickness)
    • Retinal thickness
    • Axial eye length
    • Flat meridian
    • Steep meridian
    • Astigmatism (indicates corneal astigmatism)
  11. The middle portion of the screen guides you through the measurement procedure

Measuring Procedure

Step 1: Selection of A-scan measuring mode

Measurement Mode LENSTAR Biometry

The measuring mode should normally be established before the first measuring operation. If this step is overlooked, the measurement can still be evaluated later in "Results" view in the correct measuring mode. The measuring mode should not be altered while a series of measurement readings is being taken.

Click on the "Measurement Mode" displayed just beside the eye identifier OD and OS.

A-Scan Measuring Mode selection window opens.

Cross-sectional of the eye highlights the parts that are different from normal, the example displayed is a normal phakic eye.

Aqueous depth menu is currently not selectable (no measurement mode more anterior chamber lenses)

Lens menu allows the selection of the properties of the lens supported modes are:

  • Natural (patient with natural lens)
  • None (aphakic patient)
  • Standard IOL (pseudophakic patient, if IOL material is not known)
  • PMMA (pseudophakic patient with PMMA lens)
  • Acrylic (pseudophakic patient with of an acrylic lens)
  • Silicone (pseudophakic patient with of a silicone lens)

Vitreous body menu allows the selection of the properties of the vitreous body, supported modes are:

  • Normal (patient with natural vitreous body)
  • Silicone oil-filled (patient without vitreous body, but with silicone oil filling)

Ophthalmologic Desc. displays the selection made. This is also displayed in the main screen besides the eye identifier OD and OS.

  • Click on OK to confirm selection or Cancel to exit without saving the changes made

The measured axial eye length depends on the measuring mode selected. Depending on the measuring mode selected, the LS 900 adds or subtracts a predetermined constant value to or from the axial eye length that the LS 900 would have measured if the user had selected phakic measuring mode. These constants are as follows:

  • Pseudophakic standard IOL: +0.11 mm
  • Pseudophakic PMMA: +0.11 mm
  • Pseudophakic acrylic: +0.10 mm
  • Pseudophakic silicone: +0.12 mm
  • Aphakic: +0.21 mm
  • Phakic, silicone oil-filled: -0.74 mm
  • Pseudophakic standard IOL, silicone oil-filled: -0.75 mm
  • Pseudophakic PMMA, silicone oil-filled: -0.75 mm
  • Pseudophakic acrylic, silicone oil-filled: -0.76 mm
  • Pseudophakic silicone, silicone oil-filled: -0.74 mm
  • Aphakic, silicone oil-filled: -0.86 mm

Step 2: Taking the Measurements

The user guidance in the middle of the measurement screen is guiding you through the measurement process:

Measurement Screen Overview LENSTAR Biometry

The complete measurement process is controlled by clicking on the button at the joystick of the cross slide. The Measurement is divided in 4 Steps.

  • Step 1: Place the Patient in front of the device and adjusting table / chair and head rest height to get the eyes aligned with the black line marks on the head rest columns and create a convenient seating position for the patient. Press the button on the joystick to proceed.
  • Step 2: The screen changes and the user sees now a live image of the patient's eye. Please advice the patient to look straight into the red blinking light the patient is now seeing. Adjust the position of the device until you see two rings of 16 markers each in focus and the central reflex of the measurement is centred in the cross hair. It is the easiest to adjust the position of the device if you hold the joystick straight with one hand and adjust the base position with the other until you reached a good coarse positioning of the device. Press the button on the joystick to proceed.
  • Step 3: Do now the fine alignment using just the joystick to move the unit. As soon as you reached the measurement position a green circle is displayed and arrows are pointing in the direction you may want to move the device to reach the middle position of the measurement range. Press the button on the joystick to start the automatic measurement procedure.

Measurement Fine Alignment LENSTAR Biometry

Comparing the three adjustment factors:

  • Left image: Measuring position reached but could be improved by moving the LENSTAR towards the patient
  • Middle image: Optimum measuring position
  • Right image: Measuring possible but positioning could be improved by moving the LENSTAR away form the patient

Whenever a green circle is displayed a measurement can be taken. Even if the device is not positioned in the middle of the measurement range, perfectly good measurements can be taken.

The progress of the automatic measurement procedure is indicated by a grey cycle closing clock wise. If the patient looses fixation, the measurement procedure is stopped and continues automatically after the patient regains fixation. At the end of the measurement procedure you are asked to advice the patient to blink a few times but remain stable in the head rest.

Measurement Progress LENSTAR Biometry

Repeat the measurement procedure until you reached the desired number of repetitive measurements per eye. It is recommended to take five measurement per eye and patient (default settings). If less measurements are taken a dialog is displayed asking you to take more measurements. The default setting for this dialog can be adjusted in Preferences for Biometry.


Hints to easily achieve good measurements

  • Use both hands to adjust the device position. One on the cross slide for the coarse alignment and one on the joystick for the fine alignment.
  • Do not move the device in between the measurements. Keeping the device in the measurement position in between the repetitive measurements allows you to dramatically improve the speed of the measurement procedure as the alignment is already close to perfect when a 2nd, 3rd, ... measurement is started
  • If a patient is suffering of dry eye, allow him to blink during the measurement procedure. Doing so the measurement procedure may take a little longer but the results will be better. If the tear film is constantly breaking, apply some artificial tears before the measurement.
  • Keep the patient stable in the headrest between repetitive measurements. This again improves the measurement speed as the alignment does not have to completely redone in between measurements.

Possible error messages

Fidgeting patient / bad measuring position

If the patient moves excessively during the measuring process, or if the user fails to maintain a sufficiently good position, the colored circle disappears from the cross hairs and the progress indicator stops. If the circle is not displayed again within a certain period, a user message appears to indicate that the measuring operation has been canceled.

Low-lying eyelashes

The patient's eyelashes may, if they are low-lying enough, make it difficult for the device to calculate keratometry readings. This caused by the fact that the lashes prevent the light from the LEDs being reflected by the eye. A user message is likewise displayed if this occurs.

The measurement operation is canceled in both cases, and the process must be repeated.

Maximum number of measurements

Max Measurement Dialogue LENSTAR Biometry

The maximum number of measurements per measurement session and patient is limited to six (6) measurements. If you try to perform more measurements, EyeSuite is going to display the dialog above. If you want to perform more measurements on this patient, you may do so, but you have to start a new measurement session. The number of measurements per day, eye and patient is almost unlimited (eight hours of constant measuring or max. 600 measurements whatever is reached first).


Step 3: Review of interim results

As soon as the readings have been calculated, the corresponding values for the left or right eye are displayed in the overview table as described at the beginning of this chapter.

EyeSuite is checking the measurement quality and plausibility of the individual measurements. If the quality of a measurement does not fulfil the requirements a exclamation sign Exclamation Sign LENSTAR Biometry is displayed in front of the measurement. This does not mean that the respective measurement is not valid but it should be reviewed in detail.

If a measurement is recognized as not plausible it is going to be marked in red. Such a measurement should be deleted. Select the respective measurement and either press Del on the keyboard or press the right mouse button and select Delete. It a such a measurement is not deleted a warning dialog will inform you about the measurement featuring not plausible results.

High Standard Deviation Dialogue LENSTAR Biometry

If the measurements of one eye defer a lot form the other the respective measurements are marked with a  Unequal Sign LENSTAR Biometry. If this sign is displayed the respective results should be reviewed in detail. Such a condition may be caused by e.g. anisometropia caused by different eye length, unilateral LASIK, ... Beside of the sign with the measurement that differ from each other you are being warned by the following dialog when finishing the measurement session.

Unequal Dialogue LENSTAR Biometry


Step 4: End/cancel measurement process

To end finish the measurement process click on Finish on the bottom left of the measurement screen. EyeSuite automatically switched to the Result Overview tab of the measurement screen. If you did not perform the minimum number of measurement repetitions defined in the Biometry Preferences, a dialog is going to inform you about this. Still the measurement process may even be finished after a single measurement but it is recommended to perform five repetitive measurements per eye and patient.

Not Enough Measurements Dialogue LENSTAR Biometry

When leaving the Measuring tab you may return to add measurements to this session by simply clicking on the Measuring tab again.

If you click on Cancel you are leaving the measurement procedure without saving the measurements just taken. A dialog is going to warn you about it.

Measurement Cancel Dialogue LENSTAR Biometry


Result Overviews and Detail Evaluation

Result Overview

Once the measurement is complete, the software automatically switches to the Result Overview tab. This screen provides you with quick overview of the individual measurement parameter readings obtained. If the "display standard deviation" option has been selected in the Biometry Preferences, the corresponding standard deviation is displayed along with the average value of every measurement obtained.

Clicking on an individual measurement result allows you to access the detailed result view of the respective measurement.

Result Overview LENSTAR Biometry

The measurements are displayed in two columns one for the right and one for the left eye. On the right side of the tab a schematic cross-sectional and a frontal overview of an eye is displayed to show the location of a measurement as you are moving the mouse pointer over a measurement. Just below of the schematics details on the measurement analysis, the measurement session and on the used device might be found.

First block of results: Axial dimensions

Measuring mode - phakic, aphakic, pseudophakic (default, PMMA, acrylic, silicone), silicone oil-filled (phakic, aphakic, pseudophakic)

Axial length - measured form the corneal tear film to the inner limiting membrane

Corneal thickness - measured form the corneal tear film to the corneal endothelium

Aqueous depth - measured form the corneal endothelium to the anterior surface of the lens

Lens thickness - measured form the anterior to the posterior surface of the lens. Specifically in pseudophakic condition, measurement of implanted lens is not always achievable (e.g. due to light lens tilt and the non light scattering properties of an implant).

Retina thickness - measured only manually by adjusting the measurement gate in the A-scan from the inner limiting membrane to the retinal pigment epithelium. This function is not available for users of the LENSTAR within the USA.

Second block of results: Corneal curvature

Flat meridian - displayed as K1 in Diopters if the display option Power has been chosen in the Biometry Preferences or displayed as R1 if the display option Radius has been chosen in the Biometry Preferences. The curvature is displayed with its axis position

Steep meridian - displayed as K2 in Diopters if the display option Power has been chosen in the Biometry Preferences or displayed as R2 if the display option Radius has been chosen in the Biometry Preferences. The curvature is displayed with its axis position

Astigmatism - displayed in Diopters either in plus or minus cylinder notation dependent on the display option chosen in the Biometry Preferences

Keratometric index - displays the keratometric index chosen for this measurement to convert corneal curvature into corneal power

Third block of results: White to White

White to White measurement may only be analyzed if the option Take red free image for White to White measurements has been chosen in the Biometry Preferences. To get the result of the measurement you have to click on the Analyze button when you first enter the Result overview tab.

White to White - measured as the horizontal diameter of a best fit circle to the iris boarder

Iris barycenter - provides information of the shift of the iris center relative to the apex in X and Y coordinates

Fourth block of results: Pupillometry

Pupillometry is measured at ambient light condition. LENSTAR and EyeSuite do not collect any data on the actual lighting condition present at the time of the measurement.

Pupil diameter - measured at the diameter of a best fit circle to the pupil boarder

Pupil barycenter - provides information of the shift of the pupil center relative to the apex in X and Y coordinates


Detailed views

The Results Overview screen is divided into 5 sections:

  • A-scan
  • Keratometry
  • White-to-white
  • Pupillometry
  • Display images

Left-click once on a measurement reading to display the corresponding details.


A-scan detailed view

User interface

A-scan Details Overview LENSTAR Biometry

  1. Toolbar
  2. Details of patient/examination/evaluation/eye
  3. Graphic display of A-scan
  4. Overview of single measurement readings obtained, listed horizontally by the 5 single measurements and vertically divided by measuring parameter
  5. Key to column heading
  6. Clicking on OK/Cancel causes the software to jump back automatically (with or without saving) to Results Overview

The toolbar commands allow you to control the most important general functions. These are, from left to right:

  • Save: Maintain function
  • Print: Print out current screen/overview
  • Reset all: The changes that have been made remain reversible right up to final confirmation
  • Zoom scan: Zoom in on sections of scan
  • Fit scan in window: Shrink the zoom view back to normal size
  • Re-evaluate data: The measurement readings (with constant measuring mode) are recalculated. All modifications that have been made are now cancelled or returned to their default state
  • Re-evaluate data: The data are re-evaluated accordingly after a change of measuring mode

A-scan description

A-scan Details Description LENSTAR Biometry

  1. Signal strength scale
  2. Front surface of cornea
  3. Rear surface of cornea
  4. Front of lens
  5. Rear of lens
  6. Inner retinal limiting membrane
  7. Retinal pigment epithelium

The cursor (cross hair) marks the point of intersection between the average value of the 5 measurement readings (along the optical axis) and the topmost point at which the single measurement readings lie on the A-scan curve. The software adjusts this cursor automatically. The colors in the table correspond to those of the A-scan.

Notes concerning the retina thickness (RT): The cursor of the inner retinal limiting membrane is set automatically 0.200 mm in front of the cursor of the retinal pigment epithelium. This sets the retinal thickness (= distance between the inner retinal limiting membrane and the retinal pigment epithelium) automatically to 0.200 mm. A retinal thickness of 0.200 mm is a typical value. The retinal thickness may be changed by the user with the help of the manual cursors of the inner retinal limiting membrane or the retinal pigment epithelium. The change of these manual cursors change the axial length (AL) and therefore the results of the IOL calculation. This feature is not enabled for US-installations of EyeSuite Biometry


Displaying, filtering and sorting single measurements

These 3 functions, which are the same for all 4 detailed views (with the exception of viewing images), are fully explained here.

A-scan Details Filtering LENSTAR Biometry

  1. Click on the single measurements in the Overview table to mark them in dark blue in the table and highlight them in the graph. These measurement readings appear both in the table (column 1) and in the graph, highlighted in the corresponding colors (red, yellow, blue, green and orange).
  2. The user can, for whatever reason and at any time, filter out entire measurement operations or individual readings so that they have no bearing on the calculation of the average. Left-click with the mouse to mark entire individual measuring operations (all measuring parameters) with a tick and exclude (disable) them. The average value is automatically adapted accordingly. Three single measurements are required for a meaningful evaluation; otherwise small yellow warning symbols will appear next to the corresponding average values. At least 2 single measurements are required for the calculation of standard deviation.
  3. If you wish to filter out individual readings only, right-click on the values concerned and select the Include/Exclude menu item
  4. Click on the arrows next to the column headers to sort the single measurements in ascending or descending order.

Enlarge Section

A-scan Details Zoom LENSTAR Biometry

  1. Click on the Zoom Scan icon to convert the mouse cursor into a horizontal two-headed arrow
  2. Establish the start point of the zoom area (by left-clicking and holding down the mouse button)
  3. Without releasing the mouse button, drag the cursor to the other extreme of the view, then release the button.
  4. The enlarged view of the zoom area will be displayed
  5. Click on the Fit scan in window icon to return the display to its previous state

Adjust Cursor Manually

If you prefer not to let the software establish the average value automatically, the cursor can be displaced manually. It is advisable in such cases to start by enlarging the desired zone. As soon as the mouse passes into the graph area of the A-scan, the pointer takes on the form of a cross. If the mouse pointer (cross) is placed over the cursor (cross hair), the cross acquires an arrowhead at each of its 4 points. If the left mouse-button is now clicked and held and the mouse displaced, the cursor can be moved.

A-scan Details Manual Gate LENSTAR Biometry

  1. Cursor position determined by software
  2. Cursor position adjusted manually (marked by finger)
  3. The average value in the table changes accordingly, and is assigned a *. The * indicates that the value has been changed. The individual measurement readings are displayed greyed-out.
  4. Click on the Reset all icon to cancel the displacement operation.
  5. The user is asked to confirm this operation

Change Measuring Mode

The user can subsequently change the measuring mode and recalculate the data accordingly. This is done by clicking on the icon at the end of the toolbar. A selection window is now displayed, identical to the one that appeared at the start of the procedure and likewise used to establish the measuring mode.

A-scan Details Reevaluate Dialogue LENSTAR Biometry

The following message appears once a selection has been made and confirmed with OK:

LENSTAR Biometry

A progress indicator appears briefly after confirmation with OK. The values are then adapted accordingly in the Overview table under the graph (for exact details of values, see "Selection of measuring mode" at the start of this section). In order to ensure that the different evaluations can be arranged in order, the software assigns a unique number to each one.

A-scan Details Measurement Mode Changed LENSTAR Biometry

  1. The selected measuring mode is displayed
  2. The value for Axe length (AL) is adapted
  3. As the natural lens has been replaced with an IOL in this example, the software no longer takes into account the measurement readings, which are displayed along with the corresponding warning symbols
  4. In order to ensure that the different evaluations can be arranged in order, the software assigns a unique number to each one. This number increases by a value of one each time

The measuring mode can be changed at any time.


Detailed Consideration of Keratometry

User Interface

K Measurement Details Overview LENSTAR Biometry

  1. Toolbar
  2. Details of patient/examination/evaluation/eye
  3. Image of keratometry points
  4. Overview of single measurement readings obtained, listed horizontally by the 5 single measurements and vertically divided by measuring parameter
  5. Key to column heading
  6. Clicking on OK/Cancel causes the software to jump back automatically (with or without saving) to Results Overview

The toolbar commands allow you to control the most important functions. These are, from left to right

  • Save: Maintain function
  • Print: Print out current screen/overview
  • Reset all: The changes that have been made remain reversible right up to final confirmation

The single measurements are flagged in color, both in the table (column 1) and the top, left-hand corner of the screen. See the section on the A-scan function for a detailed description of the display, filtering and sorting of individual measuring operations.


Detailed Consideration of White-to-White Function

User Interface

White to White Details Overview LENSTAR Biometry

  1. Toolbar
  2. Details of patient/examination/evaluation/eye
  3. White-to-white distance screen
  4. Overview of single measurement readings obtained, listed horizontally by the 5 single measurements and vertically divided by measuring parameter
  5. Key to column heading
  6. Key to command overview
  7. Clicking on OK/Cancel causes the software to jump back automatically (with or without saving) to Results Overview

Description of White-to-White Screen

The screen shows the white-to-white distance. The iris diameter evaluated by the software is marked with a circle. The centre of the iris is also marked with a cross. The table lists 3 values:

  • Diameter of the evaluated white-to-white distance (horizontal expansion is the decisive factor in this respect)
  • Distance in a horizontal direction from the center of the iris to the center of the reflected measuring beam (Apex)
  • Distance in a vertical direction from the center of the iris to the center of the reflected measuring beam (Apex)

Handling Procedures

The toolbar commands allow you to control the most important functions. These are, from left to right

  • Save: Maintain function
  • Print: Print out current screen/overview
  • Reset selected measuring: The changes that have been made remain reversible right up to final confirmation
  • Fit image in window: The entire ocular section is adapted to the size of the window (default setting)
  • Fit iris in window: The iris is adapted to the size of the window
  • Re-evaluate on green light image: The measurement readings are recalculated. All modifications that have been made are now cancelled or returned to their default state

The single measurements are flagged in color, both in the table (column 1) and the top, left-hand corner of the screen. See the section on the A-scan function for a detailed description of the display, filtering and sorting of individual measuring operations.

White to White Details Measurements LENSTAR Biometry

If the mouse pointer is in the screen section, you can move the image by clicking and holding down the right mouse button. The same result can be achieved by moving the scroll bar.

If the mouse pointer is in the screen section, press Crtl and turn the mouse wheel at the same time to alter the screen view.

You also have the possibility of changing the iris diameter and position manually. To do so, start by left-clicking inside the window displayed. A fine frame will appear. To change the diameter, press the corresponding "+" or "-" key on the number keypad. The change is displayed both graphically and in the table. The centre of the circle remains unchanged.

In order to be able to displace the center of the circle horizontally and vertically, you must first left-click again in the displayed window. The centre of the circle and now be displaced using the four arrow keys. The change is displayed both graphically and in the table. The diameter of the circle remains unchanged.

Alteration of the circle's diameter and position can also be carried out with the mouse. If the mouse pointer is in the screen section, you can enlarge the image by clicking and holding down the left mouse button. When the cursor is hovered over the circle, the mouse pointer adopts the shape of a two-headed arrow. Click and hold the left mouse-button to change the diameter of the circle. When the cursor is hovered over the center of the circle, the mouse pointer adopts the shape of a four-way arrow. Click and hold the left mouse-button to reposition the center of the circle.

Whenever values have been changed manually, this is indicated by an asterisk (*) after the value concerned. This asterisk (*) will also appear in the Results overview. If values are altered to such an extent that standard divergence is too large, a yellow warning symbol is displayed next to the average value.


Detailed Consideration of Pupillometry

User Interface

Pupillometry Details Overview LENSTAR Biometry

  1. Toolbar
  2. Details of patient/examination/evaluation/eye
  3. Pupil screen
  4. Overview of single measurement readings obtained, listed horizontally by the 5 single measurements and vertically divided by measuring parameter
  5. Key to column heading
  6. Key to command overview
  7. Clicking on OK/Cancel causes the software to jump back automatically (with or without saving) to Results Overview

Description of Pupil Screen

The pupil appears on the screen. The pupil diameter evaluated by the software is marked with a circle. The centre of the pupil is also marked with a cross. The table lists 3 values:

  • The pupil diameter evaluated by the software
  • The horizontal distance between the center of the pupil and the center of the reflected measuring beam (Apex)
  • The vertical distance between the center of the iris and the center of the reflected measuring beam (Apex)
Note: This screen shows that the software has already automatically excluded readings from the evaluation on grounds of insufficient plausibility.

Handling Procedures

The toolbar commands allow you to control the most important general functions. These are, from left to right

  • Save: Maintain function
  • Print: Print out current screen/overview
  • Print out all measurement readings: The changes that have been made remain reversible right up to final confirmation
  • Adapt image to size of window: The entire ocular section is adapted to the size of the window (default setting)
  • Adapt pupil to window size: The pupil is adapted to the size of the window
  • Re-evaluate on infrared picture: The measurement readings are calculated. All modifications that have been made are now cancelled or returned to their default state

The procedure for manually altering pupil diameter and pupil position is similar to that described in the detailed consideration of the white-to-white function. See the section on the A-scan function for a detailed description of the display, filtering and sorting of individual measuring operations.


Detailed Consideration of Images

This function allows the user to see the images generated during the measuring operation.

User Interface

Details Overview LENSTAR Biometry

  1. Toolbar
  2. Details of patient/examination/eye
  3. Eye screen (at top left, corresponding to the number/color of the single measurement. See also white-to-white function and pupillometry)

The toolbar commands allow you to control the most important general functions. These are, from left to right

  • Save: Saves the displayed image in bitmap (bmp), portable network graphics (png) or joint photographic experts group (jpg) image file format.
  • Scroll: Forward / backward to previous / next image
  • Fit: Fit image to window
  • Full scree: switch to full screen mode
  • Load images: reload infrared images / reload green light images

Settings

The parameters for eye measurement can be adjusted using the Tools - Preferences menu item.

Keratometry

Settings Keratometry LENSTAR Biometry

This function lets you adjust the refractive index for the cornea. A keratometry index of 1.332 is normally used in Europe, a keratometry index of 1.3375 is normally used in the USA. The following alternative values are also available: 1.3315, 1.336, 1.3375 and 1.338. Please note if you want to enter K-Values form an external source, make sure LENSTAR and the external source are set to the same keratometry index.

You can also decide whether the corneal radii should be shown in measuring and evaluation mode as a radius (in millimeters) or as refractive power (in diopters).

Further more you can choose whether you want to have the astigmatism displayed in plus or minus cylinder. Plus cylinder are commonly used for the implantation of toric IOL.

In plus cylinder the astigmatism is displayed in a positive diopter value in combination with the axis location of the steep meridian.
In minus cylinder the astigmatism is displayed in a negative diopter value in combination with the axis location of the flat meridian.

Default configuration:

  • Display: Refractive power [dpt]
  • Keratometry index: 1.3375
  • Cylinder notation: + Cylinder

Pupillometry

Pupillometry Settings LENSTAR Biometry

The user can enter the iris depth in this screen.

Default configuration: 3.7 mm

The indicated value defines the distance from the vertex of the front face of the cornea to the level (iris) used for evaluation of the pupil diameter.

White-to-White

White to White Settings LENSTAR Biometry

The user can enter the iris depth in this screen.

Default configuration: 3.7 mm

The indicated value defines the distance from the vertex of the front face of the cornea to the level (iris) used for evaluation of the white-to-white distance.

Overview

Settings Summary LENSTAR Biometry

This screen allows the user to decide whether the Results Overview window should display the standard deviations or not.

Default configuration: Inactive

Printouts

This screen allows the user to create manual and automatic print jobs for the biometry extension of EyeSuite

Settings Printouts LENSTAR Biometry

Activation

Sets the mode of the print job.

Automatic
The selected / defined print outs are generated whenever a new measurement is acquired or the user changes anything on an existing measurement.
Manual
The selected / defined print outs are only created if the print job button Settings Printjob Button LENSTAR Biometry is pressed within EyeSuite. The user may also create his own print job icon.
Disabled
Print job is not active.
Tool bar
Allows the user to name the print job and create a user defined print job icon. Click on the Settings Printjob Button LENSTAR Biometry to select the desired graphics (only PNG format accepted) to be fit on the print button displayed in EyeSuite. Please keep in mind that the print button is a small button (28x28 Pixel) when selecting a graphics.

Output and Naming

Printer
Select any installed Windows printer or the EyeSuite internal PDF generator or the EyeSuite internal Image Printer. The image printer generates a jpg image of the selected printouts.
File name
Is only active in the EyeSuite internal PDF generator or Image Printer has been selected. If no file name is defined, then they are created by EyeSuite as follows:
Selected printout AutomaticallyGeneratedFilenameExtension.xxx
Biometry Summary ID_NAME_FIRSTNAME_TIMESTAMPSTD_BIOMETRY.xxx
Biometry A-Scan Printout ID_NAME_FIRSTNAME_TIMESTAMPSTD_EYE_ASCAN.xxx
Keratometry Details Printout ID_NAME_FIRSTNAME_TIMESTAMPSTD_EYE_KERATOMETRY.xxx
Iris Details Printout ID_NAME_FIRSTNAME_TIMESTAMPSTD_EYE_IRIS.xxx
Pupil Details Printout ID_NAME_FIRSTNAME_TIMESTAMPSTD_EYE_PUPIL.xxx
e.g.: 205_Zoss_Christian_2010_11_23_16_24_13_BIOMETRY.pdf
Please note the Extension is added to any file name, also user defined ones, to identify the print created. All detail print-outs (A-Scan, Keratometry, Pupillometry and White to White) for a complete (left and right eye biometry) create two files one for the left (OS) and one for the right (OD) eye. If only one eye has been measured only one file for the measured eye is being created
.
The above mentioned file names are used as a post fix to any user defined file name. The user may define a fixed or a dynamic file name. A fixed file name is a simple text entered in the file name input field. A dynamic file name is built out of Patient and Examination details, using the Haag-Streit script language. The following script language tags may be used to create a file name, every tag has be be used in {} (e.g. {NAME} will return the patient's name) to be recognized by the system:
TAG Description
ID Patient ID
NAME Patient family name
FIRSTNAME Patient first name
BIRTHDAY Patient birthday in system format
BIRTHDAYSTD Patient birthday in standard format yyyy.mm.dd (for file names, "." and "spaces" are replaced by "_")
BIRTHDAYYEAR Patient birthday's year in the format yyyy
BIRTHDAYSHORTYEAR Patient birthday's year in the format yy
BIRTHDAYMONTH Patient birthday's month in the format mm
BIRTHDAYDAY Patient birthday's day in the format dd
TIMESTAMP Returns information when the exam was taken in the system format (dependant on the local settings of your PC operating system)
TIMESTAMPSTD Returns information when the exam was taken in standard format yyyy.mm.dd HH:mm:ss (for file names, "." ":" and "spaces" are replaced by "_"
YEAR Returns the year the exam was taken in the format YYYY
SHORTYEAR Returns the year the exam was taken in the format YY
MONTH Returns the month the exam was taken in the format MM
DAY Returns the day the exam was taken in the format DD
HOUR Returns the hour the exam was taken
MINUTE Returns the minute the exam was taken
SECOND Returns the second the exam was taken
Folder
Is only active in the EyeSuite internal PDF generator or Image Printer has been selected. Please select where EyeSuite should store the PDF or JPG of the printout. Use the Settings Browse Button LENSTAR Biometry to browse through the directory structure of your PC or to create a new output folder. It is even possible to use the scripting language to create dynamic folders.
Printouts
Allows the user to select the printouts are generated either automatically or manually by pressing on the generated print icon. Available are all print outs of biometry extension of EyeSuite.

Exports

This screen allows the user to create manual and automatic export jobs for the biometry extension of EyeSuite. All measurement results may be exported in several formats to be used by EMR systems, third party IOL calculations programs, for incremental backup and more...

Settings Exports LENSTAR Biometry

Activation

Sets the mode of the export.

Automatic
The selected / defined export is generated whenever a new measurement is acquired or the user changes anything on an existing measurement.
Manual
The selected / defined export is only created if the export button Settings Export Job LENSTAR Biometry is pressed within EyeSuite. The user may also create his own export icon (as you can see form the screen shot above.
Disabled
Export is not active.
Toolbar
Allows the user to name the export and create a user defined export icon. Click on the Settings Export Job Button LENSTAR Biometry to select the desired graphics (only PNG format accepted) to be fit on the export button displayed in EyeSuite. Please keep in mind that the export button is a small button (28x28 Pixel) when selecting a graphics.

Export file

Format
Allows the user to select a file format for the export file, the available options are as follows
  • EyeSuite Template Exporter
Creates a user defined Export file based on a template created in script language by the user
  • EyeSuite ESX
Creates an export the measurements in EyeSuite exchange format, a proprietary data exchange format of all Haag-Streit EyeSuite applications (XML based, see section 11 EyeSuite Handbook for details).
  • No Export, only executable
Allows calling an other application form within EyeSuite Biometry without the creation of export data.
  • EyeSuite GDT Output
Creates a GDT examination result file. The GDT file created only contains patient information and information that a Biometry measurement has been taken and when. No measurement date is currently included as this has not been specified yet in the GDT norm.
  • Hoffer Programs Connector
Creates the Export file settings to directly connect EyeSuite to the Hoffer Programs in standard Installation, simply enable the export as manual Export and select the Hoffer Icon from file.
  • Holladay IOL Consultant Connector
Creates the Export file setting to automatically populate the measurement data for Holladay IOL consultant, simply enable the export as automatic export to complete the connection in eye Suite.
  • PacoOptics Connector
Creates the Export file settings to directly connect EyeSuite to the PhacoOptics Program in standard installation, simply enable the export as manual Export and select the PhacoOptics Icon from file.
  • System Interconnect Export
Creates an export of the raw measurement data optionally including the A-Scan and images form the K- and White to White measurement in a proprietary format. The export always consists of two files with the extensions OD for the right and OS for the left eye. If no specific file name is specified, then EyeSuite creates the file name as follows: ID_NAME_FIRSTNAME_YYYY_MM_DD_HH_MM_SS_of_the_exam.OD/OS
  • Okulix Connector
Creates the Export file setting to directly connect EyeSuite to the Okulix Program in standard installation, simply enable the export as manual Export and select the Okulix Icon from file.
Template
This field is only active if EyeSuite Template Exporter has been selected in the Format field. The user has to select a template for the export desired. Click on the Settings Browse Button LENSTAR Biometry button to browse for a template created by the user.
Filename
This field is only active if EyeSuite Template Exporter, EyeSuite ESX or System Interconnect Export has been selected. The file name may be created as described in section Printouts. If no file name is specified, then EyeSuite creates the file name.
Options
Options available depend on the format selected, click on the check box to select an option available.

Invoke external application This section allows the user to call a third party application directly form within EyeSuite.

Executable
Select the executable file to be called form within eye suite when this particular export is chosen. Use the Settings Browse Button LENSTAR Biometry button to browse for a executable file.
Working folder
Specify the working folder the executable file is called in. Usually it is the same folder the executable file is stored in. Use the Settings Browse Button LENSTAR Biometry button to browse for a folder.

Check gauge

Settings Test Gauge LENSTAR Biometry

This feature lets the user display the data/measurement readings corresponding to the device check gauge. These data also appear in the check gauge report supplied.

If the user ever needs to replace the check gauge, this screen can be used to enter the new values from the report.


Measurement

Settings Measurement LENSTAR Biometry

Number of single measurements desired for each eye:

This function lets you set how many single measurement operations are to be carried out on each eye, in order to be able to exit measuring mode without a warning message being displayed. The number of single measurements desired for each eye can be set to between 3 to 6 operations. It is always possible to enter a number of measurements per eye that is higher or lower than that shown here.

Default configuration: 5

Take red free image for White to White measurements:

This activates the optional green-light image recording function used for analysis of the white-to-white distance.

Default configuration: Selected


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East Valley Ophthalmology
5620 East Broadway Road
Mesa, Arizona 85206

Tel: +1-480-981-6111
FAX: +1-480-985-2426

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