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Performing the Test
This paragraph explains how to operate the DRS to perform a complete test. When the unit is turned on and the boot process is over, the HOME screen shows up (See Figure 5),
Several options are available at this point, such as:
- adding a new patient
- selecting an existing patient from the list
- starting the image acquisition process without identifying the patient
Adding A New Patient
To add a new patient to the list, type the last name (mandatory), first name and date of birth in the corresponding boxes. Optionally, select the gender and type of Code of you choice. Then click SAVE.
Selecting An Existing Patient
To select an existing patient from the list click on the PATIEN LIST button: the complete list of stored patients will show up.
The following mechanisms are available to find a specific patient:
- scroll the list by dragging the screen up or down
- sort the list by one of the available field (the list can be sorted by last name, age, or date of last visit) by clicking on the corresponding arrows located at the header of the list (by default patients are sorted by their numeric ID, in ascending order
- search for a specific patient by typing the initials of the last name or first name in the SEARCH box.
Once desired patient has been identified in the list, click on the corresponding line to select.
Starting The Image Acquisition Process
Whether a new patient has been created or an existing one selected or none of the above (anonymous), it is possible to start the image acquisition process.Before proceeding, be sure that the patient received complete explanations concerning the test and what they are required to do. Then proceed as follows:
- Select OU to acquire images from both eyes (default), OD for the right eye inly and OS for the left eye only
- Select SINGLE FIELD to acquire one 45° image of the retina (default) or MULTI FIELD to acquire multiple fields at 45° per photo.
- Position the patient on the chin rest and head rest and use the CHINREST UP and CHINREST DOWN buttons to adjust the chin rest position, if needed. When the AUTOMATIC CHIN REST flag is selected from the settings menu, the chin rest is automatically adapted to the patient head characteristics.
- Press the START button to start the acquisition procedure.
NOTE: The START button is only enabled if the chin rest is engaged. Of the patient is not properly positioned on the chin rest, the START button will not be enabled and it will not be possible to start the acquisition process.
Once the START button is pressed, the DRS will automatically perform the following steps:
- Move the optical head to locate the patient’s pupil
- Move the optical head to center the patient’s pupil to the front lens; the system will also display the pupil current diameter and which eye is being acquired; the red circle in Figure 8 represents the pupil and becomes green when proper centering is achieved.
NOTE: IN case the auto-alignment module fails, manual alignment is possible
- Perform auto-focus (see figure 9)
- Capture an image, by flashing the retina. This step also involves automatic tuning of the flash level
- Store the image in the local hard drive (see figure 10)
- In case of acquisition of both eyes and/or multiple fields, the acquired images can be displayed before proceeding the next one, depending on the settings
NOTE: At any time during the above sequence it is possible to stop the acquisition process by pressing the CANCEL button.
If, for some reason, the automated eye search fails, a message as in 9 shows up. Reasons for failure include: improper patient positioning, patient not fixating steadily, patient moving the head and/or the gaze during eye search.
NOTE: If any of the above situations applies, try to fix the cause (re-position the patient, instruct them to steadily fixation at the target and/or to not move before proceeding with the manual alignment.
Use the UP/DOWN/LEFT/RIGHT buttons to adjust the optical head position and align the patient’s eye to the instrument front lens. As soon as the eye is detected the automated procedure will restart.
The result of the overall acquisition process is one or more retinal image as the one shown below.
In order to shoot a focused image of the anterior part of the eye, the patient’s head must be placed on the chinrest but with a distance of 3-5cm (2-3 fingers) between the patient’s forehead and the instrument front rest (see figure 13).
Once started, the optical head moves in front of the selected eye for a rough alignment. When it reaches the optimal position, a live color view of the eye is displayed so that manual alignment and focus can be performed using the on-screen buttons. The fine manual positioning and focus setting is necessary in order to take a good quality picture. The live view can be toggled to full screen just by pressing it.
Once satisfied with the position and focus, press SHOOT to acquire the image.
If Stereo is selected prior to start the exam, two images of the Central Nasal Field will be shot one after the other, with automatic alignment and focus. A delay between the shots will be applied in order to let the pupil get back to its normal dimensions and have two images as much similar as possible in therms of brightness. The delay length can be set in the Settings page ( Exam >>Saving).
In order to perceive the 3D vision of the optic disk, the images must be watched with a couple of prismatic goggles that let each eye see only one of the two images. Alternatively, the “crossed-eye” format, which does not require goggles, can be toggled by clicking on the swap images button.
If the lens cap is on the frontal lens support when starting an exam, the message reported in Figure 16 will be shown. Pressing OK to exit and restart the exam, after having removed the cap. When the pupil of the patient – measured immediately before the snapshot – is smaller than 3.8mm, a warning message is sent to acknowledge the user about the possible low quality of the image (Figure 17).
Once the image(s) has (have) been acquired, the system will open the patient’s individual record and present a thumbnail view of all the available images (Figure 18).
Patient Record Screen
For each thumbnail, the following information is displayed:
- the eye (OD/OS) and field information, in the top-left corner
- the image number, in the top-right corner
- the acquisition date and time, in the bottom-right corner
Full Image Screen
There are two ways to review DRS data and images remotely from a PC or from some models of a smart phones. The first is attaching to an existing network (LAN) and the second is creating a private network even in absence of existing infrastructures. The DRS supports both wired and Wi-Fi connections in both exiting and private network mode.
NOTE: The DRS remote viewer uses standard Internet browsers and does not require installation of any software application on the remote PC. Supported browsers include: Microsoft Internet Explorer 8 (or later), Mozilla Firefix 3 (or later), Apple Safari, Google Chrome.
Remote Visualization Through a LAN
In order to use the remote viewer with an existing LAN proceed as follows:
- Connect the DRS to the LAN
- Connect the remote PC to the LAN
- In case the local area network does not provide automatic IP assignments, configure the DRS and configure the remote PC with a different IP
- Retrieve the DRS IP, as displayed in the Settings – Network screen
- Type the DRS IP in the URL box of the PC’s Internet browsers.
Remote Visualization Through Private Network
To use the viewer in wireless mode proceed as follows:
- Enable the wireless connection of your PC or smart phone (some models)
- Select wireless network created by the DRS that will be called “drs-s/n”
- Open the browser
- Digit http://drs in browser
To use the viewer in wired mode proceed as follows:
- Connect the DRS with a cable to your PC
- Open the browser
- Digit http://drs in the browser
Once the connection is established, the DRS patient list will show up on the remote PC or smart phone (some models). You might be required to type a password depending on the settings in the DRS users preferences. Available functions include:
- Patient list (same as figure 6)
- Patient record screen (same as Figure 18)
- Access to individual images (same as Figure 21).