Adam,Rouilly AR403 User manual

Instrucon Manual
DIGITAL EYE EXAMINATION/
RETINOPATHY TRAINER
AR403/AR403-B

2
Adam,Rouilly’s already successful AR303 Eye Renopathy Trainer has been completely
redesigned to use the latest in high resoluon digital screen technology - enhancing realism
and the training experience.
Our new AR403 Digital Eye Renopathy Trainer includes 36 diabec, common and less
common renal condions to oer excellent ‘hands-on’ experience in examinaon of the
eyes and the use of an ophthalmoscope.
Skills
Features
Thank you for purchasing this AR403 Digital Eye Renopathy Trainer.
Please read this instrucon manual carefully and retain it for future reference.
Contents
Parts
- Supplied With
4
5
Before Use
- Using the Included Power Adaptor
- Using Baeries
- Power On and Selecng Condions
- Using the Examinaon Cover
7
7
9
9
During Use
- Ophthalmoscope Use
- Sleep Mode
- Low Baery Indicaon
11
11
13
Aer Use
- Using the Supplied Rigid Carrying Case 13
Descripons of Condions 14
• High Resoluon Digital Display
• Easy to use, digital control for each eye
• Examinaon cover
• Baery or Worldwide Mains Compable
• Sleep mode to conserve power

3
Safety and Precauons
The trainer contains sensive electronic parts. Do not store near heat or
where it may experience extremes in temperature, humidity or magnec
elds.
Use only the low-voltage power mains adaptor supplied. Use of other
adaptors may damage the model, and invalidate your guarantee.
Use only 4x AA baeries (not included) in the baery compartment as
indicated. Do not aempt to use any other type or size of baery. Other
baery sizes may damage the model, and invalidate your guarantee.
Please treat the trainer with the same care you would a paent.
Re-chargeable baeries may be used to power the trainer. Please note
however that the mains adaptor will not re-charge baeries.
Do not use the adaptor if the low voltage cable is damaged. The cable
cannot be repaired, the adaptor must be replaced.
Do not power down and leave or store the trainer with baeries sll
installed for prolonged periods. Always remove baeries before storage.
Do not exert excessive force on the buons or place the trainer upside
down. Doing so could cause damage and will invalidate your guarantee.
The trainer contains no user serviceable parts. Do not aempt to open or
disassemble the trainer. Doing so could cause damage and will invalidate
your guarantee.
The digital images of eye condions supplied are the copyright of
Adam,Rouilly Limited. They are for sole use with the AR403 Digital Eye
Renopathy Trainer. These images may not be extracted, copied, sold,
displayed, projected or reproduced in any format without the prior
consent of Adam,Rouilly Limited.

4
Parts
ab
c
e
f
d
g
h
i
j
Front
Rear

5
Supplied With
Right paent eye
a
d
cPower switch (with green indicator light)
bLe paent eye
e
Baery compartment (on base) for 4x AA baeries (not included)
f
Le eye LED condion number indicator
g
Le eye Up (+) and Down(-) buons
Right eye Up (+) and Down(-) buons
h
Right eye LED condion number indicator
i
j
Examinaon cover
Low voltage power jack
Low voltage power adaptor with world plug xings
S403/7 Blue baery compartment opening tool
S403/3 Rigid carry case
If you require replacement parts please contact our Sales Department, quong
codes where applicable.

6
Before Use
1a 1b
1c
2a 2b
1d

7
1a
1b
1c
Before rst use, rst select the appropriate plug xing for your local mains
supply from those included.
Insert the plug xing into the adaptor with the large catch at the base of the
adaptor rst.
Align the small rectangular groove on the top of the xing and press this into
the adaptor so that it clicks into the spring lug.
1d Plug the low voltage cable from the adaptor into the power jack at the rear of
the model.
Plug the low voltage adaptor into the mains outlet.
The simulator is now ready for use.
Alternavely, the model may be powered by 4x AA baeries (not included).
2b Install 4x AA baeries (not included) as indicated on the diagram in the baery
compartment.
Ret the compartment door.
The simulator is now ready for use.
2a Open the baery compartment at the base of the simulator by inserng the
supplied blue tool into the small slot on the side of the compartment door.
Ensure the work area is clean and dry.
Place the trainer on a stable, at surface.
Using the Included Power Adaptor
Using Baery Power
Use only 4x AA baeries (not included) in the baery compartment as
indicated. Do not aempt to use any other type or size of baery. Other
baery sizes may damage the model, and will invalidate your guarantee.
Re-chargeable baeries may be used to power the trainer. Please note
however that the mains adaptor will not re-charge baeries.
Do not power down and leave or store the trainer with baeries installed
for prolonged periods. Always remove baeries before storage.

8
Before Use
3a 3b
3c
4

9
Aer a short delay, the le eye LED and right eye LED condion number
indicators will both display a “1”, indicang that Condion 1 is being displayed
on both paent eyes.
3a
3b
3c
4
Power on the model using the power switch.
The green indicator light on the switch will illuminate.
Both the le eye LED and right eye LED condion number indicators may be
hidden if required, e.g. under examinaon condions.
To use, simply li the hinged examinaon cover unl it rests over the LED eye
condion displays.
Power on and Select Condions
Using the Examinaon Cover
If the model fails to power on, check the baeries are ed correctly and
have sucient power, or check the low voltage cable is aached correctly
and the mains supply is turned on.
Whenever the model is powered o and then on again, both eye condions
will automacally default to Condion 1.
Any of the 36 condions may be set independently for each paent eye,
at any me.
To set a condion, simply press the Up (+) or Down(-) buons for each paent
eye unl the desired condion number is displayed on the LED condion
number indicator.
For detailed descripons of each condion, please refer to page 14.

10
During Use
5
6a
6b

11
5
6a
6b
An ophthalmoscope (not included) may be used to view each condion.
The model has an automac sleep mode which turns o all displays to
conserve power.
This is funconal if either baery power or mains power is used.
Aer a period of approximately 8 minutes of no new condions being
selected, the main internal display and LED condion number indicators will
switch o.
The green power indicator light on the power switch will ash, indicang that
sleep mode is operaonal.
To wake, simply press any Up (+) or Down(-) Buon once.
Aer a short delay, both LED condion number indicator displays will
show a “ ” and then resume to the numbers of the condions which were last
selected for each eye.
The model is ready for use again.
Ophthalmoscope Use
During sleep mode, the last condions selected on each eye are stored.
For best clarity of display of the condions, we recommend seng the
ophthalmoscope light to “o”.
Sleep Mode

12
During Use
Aer Use
7
8

13
7If baery power is insucient for the model to funcon correctly, low baery
indicaon will display.
Four “ ” will appear on the LED condion number indicator displays.
Switch the model o and replace the baeries.
Low Baery Indicaon
Do not power down and leave or store the trainer with baeries installed
for prolonged periods. Always remove baeries before storage.
8Aer use, or before transportaon, the model should be placed upright in the
supplied Rigid Carrying Case.
Using the Supplied Rigid Carrying Case
The trainer contains sensive electronic parts. Do not store near heat or
where it may experience extremes in temperature, humidity or magnec
elds.

Condion 2 This view is of the opc disc and temporal rena
The main clinical features are:
• Mulple hard exudates in the macular area,
some are circinate
• Haemorrhages and Microaneurysmse
This diagnosis is consistent with:
DIABETIC MACULOPATHY (with visual acuity ≤ 6/12)
Comment:
The visual acuity may be reduced depending on the locaon and macular oedema. Circinate
hard exudates oen have Microaneurysms at their centre. The haemorrhages in the inferior
temporal arcade are linear (ame-shaped). Along the vascular arcades the hard exudates
are linear around the central macular area. These are key features of grade 3 hypertensive
renopathy. Hypertension is an important risk factor for Diabec Renopathy. The darker
renal appearance is normal in an Asian or Afro-Caribbean paent.
Condion 1 This view is of the opc disc and temporal rena
The main clinical features are:
• Blot haemorrhages in the nasal macular
area and superior temporal arcade
• Hard exudates along the inferior temporal
arcade
• Microaneurysms (MA) in the macular area
• Circinate exudates along the inferior tempo-
ral arcade
This diagnosis is consistent with:
BACKGROUND DIABETIC RETINOPATHY AND DIABETIC MACULOPATHY
(if Visual Acuity ≤ 6/12)
Comment:
The macular area, as dened by a circle area centred on the fovea with its radius extending
to the edge of the opc disc, has exudates in it. This makes the condion Maculopathy. If the
visual acuity was normal and there were Microaneurysms and haemorrhage only, then this
would be background diabec renopathy alone. Normal VA is usually dened as beer than
6/12. Microaneurysms are dened as round red dots less than the diameter of a vein at the
opc disc margin. Other red lesions are usually haemorrhages.
Condions and Diseases of the Rena
Diabec Renopathy: Condions 1 - 8 (Condions shown for Right Eye)
14

Condion 4 This view is of the central fundus with the opc disc
The main clinical features are:
• New vessels on the disc (NVD) and else-
where (NVE) along the vascular arcades
• Haemorrhages
• Hard exudates
• Pre-renal brosis
This diagnosis is consistent with:
ADVANCED PROLIFERATIVE DIABETIC RETINOPATHY
Comment:
On-going ischaemia and increase in vaso-proliferave factors. The New Vessels grow into
the vitreous and are fragile leading to haemorrhage. As the haemorrhage organises, brous
ssue reacon occurs oen resulng in traconal renal detachment.
Condion 3 This view is of the opc disc and temporal rena
The main clinical features are:
• Mulple dot and blot haemorrhages
• Coon wool spots (CWS)
• Intra-renal micro-vascular abnormalies
(IRMA)
• New Vessel formaon on the disc (NVD)
This diagnosis is consistent with:
PRE-PROLIFERATIVE DIABETIC RETINOPATHY
Comment:
Pre-proliferave Diabec Renopathy is characterised by renal ischaemia. Coon
Wool Spots represent areas of focal renal ischaemia and Intra-renal micro-vascular
abnormalies are a pathological aempt at micro-revascularisaon. Intra-renal micro-
vascular abnormalies are at and do not grow into the vitreous. The tangle of ne blood
vessels at the opc disc may be early New Vessels on the disc.
15

Condion 6 This view is of the central fundus with the opc disc
The main clinical features are:
• Focal areas of pigmentaon consistent with
focal laser photocoagulaon
• Mulple hard exudates are seen within the
macular area
• Some in a circinate paern with central
Microaneurysms
This diagnosis is consistent with:
DIABETIC MACULOPATHY: ONGOING WITH PREVIOUS FOCAL LASER PHOTOCOAGULATION
Comment:
Visual acuity will almost certainly be ≤ 6/12. Microaneurysms leak plasma which precipitates
in a lipid-rich protein deposit which is hard exudate. The circinate nature of some hard
exudates with central Microaneurysms clearly suggests this. The central Microaneurysms
within a clump or circinate of exudates are laser photocoagulated to obliterate and seal the
Microaneurysms to reduce plasma leakage.
Condion 5 This view is of the opc disc
The main clinical features are:
• New Vessels formaon on the disc (NVD)
• Myopic Crescent over the temporal edge of
the opc disc
• Peripheral renal pigment layer prominence
This diagnosis is consistent with:
PROLIFERATIVE RETINOPATHY WITH NEW VESSELS ON THE DISC (NVD)
Comment:
New Vessels on the disc are oen dicult to see and the rst sign of Proliferave Diabec
Renopathy. Myopic Crescent over the temporal edge of the opc disc is subtle with
peripheral renal pigment layer prominence (oen seen in Myopia). This should not be
confused with Renis pigmentosa. The New Vessels will grow further into the vitreous and
are fragile and can lead to haemorrhage.
16
Condions and Diseases of the Rena (Connued)

Condion 7 This view is of the opc disc and temporal rena
The main clinical features are:
• Mulple laser scars with areas of hyperpig-
mentaon
• Probable regressed New Vessels at the disc
with residual gliosis
This diagnosis is consistent with:
PAN RETINAL LASER PHOTOCOAGULATION
Comment:
The overall appearance suggests an excellent response to laser photocoagulaon and
medical management. Apart from possible Microaneurysms there is no acve Diabec
Renopathy. The paent will have reduced peripheral vision and a degree of night-blindness
(compare with Renis pigmentosa)
Condion 8 This view is of the opc disc
The main clinical features are:
• Disc area is obscured
• Poorly dened vasculature
This diagnosis is consistent with:
UNGRADABLE RETINOPATHY WITH POSSIBLE NVD
Comment:
The suspicion of bro vascular proliferaon at the disc and along the vascular arcade with
traconal detachment is very strong. This would be a feature of advanced diabec eye
disease.
17

Condion 9 This view is of the opc disc and temporal rena
The main clinical features are:
• Opc disc with uniform central cup with cup
disc rao <0.5 and normal
neurorenal rim
• Renal vessels and macula look normal
• This degree of darker redness in the central
macular area (fovea centralis) is normal
• The slight darkening of the peripheral renal
vessels is also normal
This diagnosis is consistent with:
NORMAL FUNDUS (OPTIC DISC AND RETINA)
Comment:
Sequence for looking at the rena:
• Light reex for cataract, corneal arcus, xanthelesma, conjuncva
• Start at the opc disc
• Superior temporal arcade and inferior temporal arcade
• Macular area
• Superior nasal arcade and inferior nasal arcade
• Peripheral, clockwise sweep to look for peripheral lesions
Condion 10 This view is of the posterior pole centred on the opc disc
The main clinical features are:
• Large cup disc rao (>0.5) indicang cupping
of the opc disc
• Superior polar notching
• Nasal displacement of central blood vessels
This diagnosis is consistent with:
GLAUCOMA
Comment:
Large cup disc rao (>0.5). This means that the cup (central circle) to disc diameter is
> 0.5). The normal rao is 0.3. Tonometry will reveal increased vitreal pressure (usually
greater than 16 mmHg at diagnosis). Glaucomatous damage and its extent is conrmed by
visual elds and tomographic imaging techniques. Central scotoma and a painful eye in most
cases. Consider as cause of severe headache. The diagnosis is an emergency as ongoing
ischaemia due to pressure can precipitate visual loss.
18
Important and Common Renal Condions: Condions 9 - 22
Condions and Diseases of the Rena

Condion 11 This view is of the opc disc and temporal rena
The main clinical features are:
• Disc margins are obscured and swollen and
hyperaemic
• Renal vessels show tortuosity
This diagnosis is consistent with:
PAPILLOEDEMA
Comment:
Spontaneous venous pulsaon may be absent, if present than Papilloedema is unlikely.
Visual symptoms are absent in early stages. A space occupying lesion must be excluded.
Condion 12 This view is of the opc disc and temporal rena
The main clinical features are:
• Opc disc pallor with cupping
• Large area of macular scarring
This diagnosis is consistent with:
OPTIC ATROPHY WITH MACULAR SCARRING (AND GLAUCOMA)
Comment:
Age-related macular degeneraon would be the commonest cause of macular scarring.
Gluacoma is likely with the opc disc to cup rao of considerably < 0.5.
19

Condion 13 This view is of the opc disc and temporal rena
The main clinical features are:
• Focal areas of atrophy of renal pigment in
the central macular area
(fovea centralis)
• Drusen in the macular area
This diagnosis is consistent with:
DRY AGE-RELATED MACULAR DEGENERATION
Comment:
Presence of haemorrhages and oedema in the macular area would suggest wet changes (not
seen here).
Condion 14 This view is of the opc disc and temporal rena
The main clinical features are:
• Focal narrowing of arterioles
• Changes at arterio-venous crossings along
inferotemporal arcade (A-V nipping
This diagnosis is consistent with:
HYPERTENSIVE RETINOPATHY: GRADE 2
Comment:
Absence of haemorrhages (ame shaped) and disc swelling suggest early changes or chronic
hypertension. The grading system can be summarised as follows:
Microaneurysms (MA) are rare in hypertensive renopathy without diabetes mellitus
Grade 1: Arteriolar narrowing
Grade 2: Arterio-venous nipping
Grade 3: Exudates, Haemorrhages, Coon wools spots (CWS)
Grade 4: Papilloedema
20
Condions and Diseases of the Rena (Connued)