Interacoustics VisualEyes 515 Installation manual

Additional Information
Micromedical
VisualEyes™ 515
VisualEyes™ 525
by Interacoustics
D-0115294-C – 2018/02

Copyright © February 1, 2018 by Interacoustics. All rights reserved. Information in this document is
subject to change without notice. Companies, names, and data used in example herein are fictitious
unless otherwise noted. No part of this document may be reproduced or transmitted in any form or by
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Interacoustics A/S, Micromedical Technologies or its licensees.
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Windows® is a registered trademark of the Microsoft Corporation, registered in the United States and
other countries.

Table of Contents
1TESTING BASICS.........................................................................................................................1
1.1 Default protocol................................................................................................................... 1
1.2 Moving through VisualEyes™............................................................................................. 2
1.3 Eye image adjustment ........................................................................................................ 3
1.4 Focus adjustment................................................................................................................ 6
1.5 Eye image contrast adjustment........................................................................................... 6
1.6 Enlarging eye images ......................................................................................................... 7
1.7 Monocular vs binocular eye recordings .............................................................................. 8
1.8 Common test functions ....................................................................................................... 8
1.9 Add Note............................................................................................................................. 9
1.10 Add tests............................................................................................................................. 9
1.11 Delete tests....................................................................................................................... 10
2CALIBRATION............................................................................................................................12
2.1 Performing calibration....................................................................................................... 12
2.2 Default calibration ............................................................................................................. 14
2.3 Review calibrations........................................................................................................... 15
3TESTING .....................................................................................................................................16
3.1 Overview........................................................................................................................... 16
3.2 Nystagmus Marking and Peak Response......................................................................... 18
3.3 Nystagmus Testing ........................................................................................................... 19
3.3.1 Spontaneous nystagmus test ................................................................................. 19
3.3.2 Dix-Hallpike test...................................................................................................... 20
3.3.3 Positional test ......................................................................................................... 21
3.4 Ocularmotor Testing ......................................................................................................... 22
3.4.1Gaze test ................................................................................................................ 22
3.4.2 Smooth Pursuit test ................................................................................................ 22
3.4.3 Saccade test........................................................................................................... 24
3.4.4 Optokinetic test....................................................................................................... 25
3.5 Caloric testing ................................................................................................................... 28
3.6 Rotational Chair Testing ................................................................................................... 34
3.6.1 Safety checks prior to beginning rotary chair tests................................................. 34
3.6.2 Sinusoidal harmonic acceleration (SHA) test......................................................... 34
3.6.3 Step rotation test..................................................................................................... 41
3.6.4 VOR suppression test............................................................................................. 49
3.6.5 Visual VOR test ...................................................................................................... 53
4PATIENT SESSION ....................................................................................................................57
4.1 Selecting a session........................................................................................................... 57
4.2 Session Review................................................................................................................. 58
5VIDEO RECORDINGS................................................................................................................59
5.1 Recording patient videos .................................................................................................. 59
5.2 Video playback.................................................................................................................. 59
5.3 Delete selected patient videos.......................................................................................... 62
5.4 Exporting patient videos.................................................................................................... 63
6GENERAL AND EDITING TOOLS.............................................................................................65
6.1 Quick access test properties............................................................................................. 65
6.2 Selecting eyes................................................................................................................... 65
6.3 Pupil diameters ................................................................................................................. 66
6.4 Editing nystagmus............................................................................................................. 66
6.4.1 Add Beats ............................................................................................................... 66
6.4.2 Remove Beats ........................................................................................................ 67
6.4.3 Zoom Trace ............................................................................................................ 67
6.4.4 Reset Beats ............................................................................................................ 68

6.4.5 Edit Slopes.............................................................................................................. 68
6.4.6 Done Editing ........................................................................................................... 70
6.5 Editing saccade test results.............................................................................................. 70
6.6 Editing smooth pursuit test results.................................................................................... 72
6.7 Editing rotary chair test results.......................................................................................... 73
6.7.1 Editing SHA Tests................................................................................................... 73
6.7.2 Editing Step rotation tests....................................................................................... 74
6.8 Other functions available in side menu............................................................................. 74
6.9 Fixation suppression......................................................................................................... 76
6.10 Override test results.......................................................................................................... 77
7PROTOCOL MANAGEMENT.....................................................................................................78
7.1 Protocols ........................................................................................................................... 78
7.2 Creating a new protocol.................................................................................................... 79
7.3 Setting default protocol ..................................................................................................... 79
7.4 Remove protocol............................................................................................................... 80
7.5 Exporting protocols ........................................................................................................... 80
7.6 Importing protocols ........................................................................................................... 80
7.7 Restore factory template................................................................................................... 81
7.8 Selection of protocol ......................................................................................................... 81
8TEST PROPERTIES ...................................................................................................................82
8.1 Configuring the tests......................................................................................................... 82
8.2 Configuring oculomotor tests............................................................................................ 83
8.2.1 Configuring the gaze test........................................................................................ 83
8.2.2 Configuration of saccade Test................................................................................ 85
8.2.3 Configuration of smooth pursuit tests..................................................................... 87
8.2.4 Configuring the OPK tests...................................................................................... 89
8.3 Configuring the nystagmus tests....................................................................................... 91
8.3.1 Configuring the spontaneous nystagmus test........................................................ 91
8.3.2 Configuring the Dix-Hallpike tests .......................................................................... 92
8.3.3 Configuring the positional tests .............................................................................. 93
8.3.4 Configuring the caloric test..................................................................................... 94
8.4 Configuring rotary chair tests............................................................................................ 97
8.4.1 Configuring sinusoidal harmonic acceleration test................................................. 97
8.4.2 Configuring step rotation test................................................................................ 100
8.4.3 Configuring VOR suppression test....................................................................... 103
8.4.4 Configuring visual VOR test ................................................................................. 105
9SUGGESTED THRESHOLD VALUES.....................................................................................108
9.1 Updating test thresholds ................................................................................................. 108
9.2 Nystagmus tests.............................................................................................................. 109
9.3 Caloric tests .................................................................................................................... 109
9.4 Optokinetic tests.............................................................................................................. 110
9.5 Smooth pursuit tests ....................................................................................................... 110
9.6 Saccade tests.................................................................................................................. 110
9.7 Sinusoidal harmonic acceleration tests .......................................................................... 111
9.8 Step rotation tests........................................................................................................... 112
9.9 VOR suppression sests .................................................................................................. 113
10 PATIENT REPORT ...................................................................................................................114
10.1 Write report editor ........................................................................................................... 114
10.2 Text styles....................................................................................................................... 114
10.3 Templates ....................................................................................................................... 115
10.4 Findings........................................................................................................................... 117
10.5 Save report...................................................................................................................... 118
11 PRINTING..................................................................................................................................119
11.1 Printing results ................................................................................................................ 119
11.2 Printing patient demographics ........................................................................................ 119

11.3 De-identify printout.......................................................................................................... 120
11.4 Printing calibration .......................................................................................................... 120
11.5 Printing a single test or clinical report............................................................................. 120
11.6 Printing a session............................................................................................................ 120
11.7 Printing traces................................................................................................................. 120
11.8 Condensed printing......................................................................................................... 120
11.9 Create PDF..................................................................................................................... 120
12 SYSTEM DEFAULT SETTINGS...............................................................................................121
12.1 System Default Settings.................................................................................................. 121
12.2 Hardware......................................................................................................................... 121
12.3 Calibration....................................................................................................................... 122
12.4 Timer settings.................................................................................................................. 123
12.5 General ........................................................................................................................... 123
12.6 License............................................................................................................................ 124
12.7 Threshold levels.............................................................................................................. 125
12.8 Reclining chair................................................................................................................. 125
12.8.1 Selecting the reclining rotational chair.................................................................. 125
12.8.2 Maintenance routines with System 2000 Reclining and Orion Reclining
chair ...................................................................................................................... 126
12.8.3 Rotational safety settings...................................................................................... 129
12.9 Print PDF......................................................................................................................... 130
12.10 About this software ......................................................................................................... 130
13 OTHER FUNCTIONS................................................................................................................131
13.1 Help button...................................................................................................................... 131
13.2 Exit button....................................................................................................................... 131

VIsualEyes 515/525 - Additional Information Page 1
1Testing basics
1.1 Default protocol
To begin the testing process, from the main screen select Begin Testing (Figure 1.1.1).
Figure 1.1.1 Begin Testing Button
The VisualEyes™ system has a default protocol defined by the product installed. VisualEyes™ 515 (VNG
without oculomotor tests) and VisualEyes™ 525 (VNG with oculomotor tests) protocols with default settings
are created that allows the user to begin testing immediately. The following tests and their order make up the
default VNG test battery:
VisualEyes 515 Protocol:
•Calibration
•Spontaneous Nystagmus
•Positional
•Dix-Hallpike
•Calorics
VisualEyes 525 Protocol (includes the VisualEyes 515 protocol):
•Gaze
•Smooth Pursuit
•Saccade
•Optokinetic
If rotational chair hardware is available and licensed these additional tests will appear with the VisualEyes
515 or VisualEyes 525 protocol:
•Step Velocity
•Sinusoidal Harmonic Acceleration
•VOR Suppression
•Visual VOR
The process of creating custom protocols can be found in the Protocol configuration section of this manual,
7.1 Protocols.
Using the touch screen or mouse select the Begin Test and the first test in the list will be shown on screen
(Figure 1.1.2).

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Figure 1.1.2 First test displayed
1.2 Moving through VisualEyes™
VisualEyes™ VNG software suite is compatible with both touch capable screens and standard (non-touch)
computer systems. Maneuvering through the software can be done by touch, mouse, keyboard, foot pedal
and remote control.
Tests can be started in multiple ways:
•Click the Start button on the Test Screen. This option is available for all tests.
•Press the Enter button on the RF Remote (if available). Ideal for starting the test when not at the
computer. This option is available for all VNG tests. Rotational chair tests do not respond to the RF
Remote’s Enter button as a patient safety measure.
•Press the Goggles Switch on the side of the goggles. The Top mount camera goggles switch is
ideal for starting the test when at the patient’s side such as in Dix-Hallpike and Positional tests.
•Press the irrigator handle button on the Air Fx or Aqua Stim to start the irrigation and test. This is
only available in caloric tests.
•Press the foot pedal (if available). Ideal for starting the test when not at the computer. This option is
available for all tests. Care should be taken if using the foot pedal with the reclining chair that the
foot pedal is far enough away from the reclining chair for the operator to not be injured from the chair
in rotation.
Moving through the screens
•Home button will return to the main screen
•The up arrow button will exit an individual subtest and go to the test summary screen
•Remote control will navigate the buttons in pop up message windows, allowing the user to respond
to pop up messages with the remote control
Figure 1.2.1 Test Navigation Bar

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Restarting the test:
Tests can be restarted using the Esc key on the keyboard or the RF Remote. While the test is running, the
Esc key or ESC key on the RF Remote will abort the data collection and clear the data already collected. In
caloric tests, the software will require confirmation of this request.
Rotational chair tests can be restarted using the Esc key on the keyboard, though the use of the RF Remote
is ignored during rotational chair tests as a patient safety measure. The software will require confirmation of
this request.
Caution
No other PC programs should be running or minimized while testing the patient with the software. This can
interfere with the running of the VisualEyes™ Software.
1.3 Eye image adjustment
Figure 1.3.1 Test Screen Display (Spontaneous Nystagmus)
To see the eye image, select Begin testing from the main menu display. This will open the first test and the
image of the patients eyes (Figure 1.3.1) will appear in the upper portion of the user display. Prior to
beginning the testing procedure, it is desirable that the eye images are aligned (horizontally/vertically) so that
the pupil is centered in the observed eye image.

VIsualEyes 515/525 - Additional Information Page 4
Figure 1.3.2 Eyes displayed
The inner canthus of the right eye should be seen on the right side of the red outlined eye image. The inner
canthus of the left eye should be seen on the left side of the blue outlined eye image. The eye images have
L and R captions in the corners, which refer both to the eye selected and the direction the eye is looking.
(Figure 1.3.2)
Prior to launching VisualEyes™ make sure that the cameras are connected. If the cameras are disconnected
an informational status will be displayed.
Figure 1.3.3 Cameras Disconnected Status
Should this appear for either camera, check the camera cables make a solid connection between the camera
and the computer.
Side mounted cameras
Use the knobs on the camera cabinet to move the camera horizontally and vertically to center the eye image
on the screen. (Figure 1.3.4).
Figure 1.3.4 Side mount cameras adjustment knobs
1. The upper knob moves the camera vertically.
2. The left knob moves the camera horizontally.
3. The center knob adjusts image focus.

VIsualEyes 515/525 - Additional Information Page 5
The mirrors can also be rotated inward by holding the mirror edges and rotating inward to adjust for smaller
faces and narrow inner-canthal spaces (e.g. with children). When the mirrors are rotated, the image will need
to be re-centered and may need focus adjustment. (Figure 1.3.5)
Figure 1.3.5 Mirror adjustment for smaller faces
Top mounted cameras
The top mount camera goggle eye image is centered in the viewing area by clicking on or touching the
center eyes button (Figure 1.3.6), which will appear in the top center of the image viewing area when
touching the eye images or hovering over with the mouse. Once this button is clicked or touched, the eye
will be centered in the viewing area.
Figure 1.3.6 Center eyes button
Front mounted cameras
Position the front mounted camera unit on the viewport with the fixation light at the top center. Use the ball
and socket mechanism on the camera unit to aim the camera and center the eye image approximately in the
software. Next, with one hand on the back of the patient’s head, push in gently on the camera to lock it in
place. Lock the cable in the clip on top of the goggles.
Figure 1.3.7 Placement of Front Mount Camera in Goggles

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1.4 Focus adjustment
VisualEyes™ system requires a focused eye image for the pupil tracker to locate the pupil center to optimally
record the eye movements. The pupil center is marked with a crosshair (Figure 1.4.1).
Figure 1.4.1 Pupil tracker (crosshair)
The camera image can be focused by adjusting the focus knob on each camera (Figure 1.4.2). Each image
must be adjusted separately. Turn the knob clockwise or counterclockwise while watching the image on the
screen. Stop turning the knob when the image is clear and the eye appears to be in focus.
Figure 1.4.2 Adjustment control for focusing eye image on each camera
Should the image not be optimally focused, the pupil tracker may fail to adequately record the eye
movements, leading to poor test results.
NOTE: This crosshair will also be present in the review videos for easier discrimination between
abnormalities and technical difficulties.
1.5 Eye image contrast adjustment
The VNG system automatically adjusts the threshold (contrast), in order to display an optimized eye image.
Nevertheless, in some cases it might be necessary to adjust the threshold. In these cases, the automatic
threshold adjustment can be turned off before or during recording by clicking the threshold adjustment button
(Figure 1.5.1).
Figure 1.5.1 Threshold adjustment button
When the threshold adjustment button is selected, a scrollbar will appear for each eye’s contrast level. By
default the A button will be highlighted indicating the system is automatically adjusting the contrast threshold
level. Slide the scrollbar value with the mouse or finger to the position where the crosshair is viewable. Have
the look left, right, up, and down to verify the threshold level and adjust as necessary so the crosshair will
track the pupil while looking in each direction. (Figure 1.5.2)

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Figure 1.5.2 Threshold adjustment scrollbars
To reset it back to automatic threshold click the icon below each slider.
1.6 Enlarging eye images
Enlarging the eye images can help the clinician clearly visualize the eye image during eye image
adjustments and within different tests. Alternatively the eyes are displayed on the TV stimulus in VisualEyes
525 when no target is used, providing an even larger image of the eyes for viewing.
Double clicking on one of the displayed eyes will enlarge the eye windows on the screen. (Figure 1.6.1). The
eye position traces are hidden while the eye images are enlarged. To exit this viewing mode, double click on
the eyes again.
Figure 1.6.1 Enlarged eye images

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1.7 Monocular vs binocular eye recordings
VisualEyes™ system can record in either monocular (one camera) or binocular (two cameras) mode.
Monocular mode may be beneficial for those occasions needing to run a single eye test because one eye
may be unable to be tested. (i.e. the eye is artificial or severe ptosis). To select an eye to ignore during
testing, touch the eye images or hovering over with the mouse to display the eye tools menu (Figure 1.7.1).
Click or touch the eye button for the eye to ignore during testing and the software will ignore the selected
camera for the duration of testing. To track the pupil again, display the eye tools menu again and select the
ignored camera.
Figure 1.7.1 Eye tools menu
Figure 1.7.2 Left eye selected and right eye ignored
1.8 Common test functions
The following basic test functions apply to all tests within VisualEyes™ VNG.
Start – Begins the testing procedure (video and eye trace recordings).
Stop – Stops the testing procedure (video and eye trace recordings).
Next – Moves onto next test/subtest in the protocol.
Back – Moves back one test/subtest in the protocol.

VIsualEyes 515/525 - Additional Information Page 9
Timer
During testing (all tests) the timer will display how much time has elapsed or remains in the current test
based on Count Style (Figure 1.8.1). Based on the default system settings, the timer will provide audible
beeps and voice prompts at indicated intervals to prompt the examiner and provide audible feedback for the
elapsed or remaining time in the test. To change these settings, see the section 12.4 Timer settings.
Figure 1.8.1 Timer display
Further time may be added to the test during the procedure by pressing the Add Time button (Figure
1.8.2).This will add a further 30 seconds (default) to the time remaining on the counter.
Figure 1.8.2 Add Time button
1.9 Add Note
One can insert a note at a specific point in the raw trace, during or after testing by selecting Add Note
(Figure 1.9.1). This can also be used as an event marker to identify a unique event within the recording.
Figure 1.9.1 Add Note button
The time at which the note is inserted is shown with the line symbol:
The text for note taking is limited to 33 characters. It will be hidden in the traces, but will be uncovered when
hovering over or clicking on the note symbol. When printing the test in the report, the note added will be
displayed after the graphical printouts.
1.10 Add tests
To insert additional tests into the current testing session, use the Add Test button accessed from the test
menu on the testing screen.
Select the test menu button.
Figure 1.10.1 Test Menu button

VIsualEyes 515/525 - Additional Information Page 10
The left side menu panel will display the currently test session. At the end of the list is the Add Test button.
Figure 1.10.2 Test menu
Select the Add Test button (Figure 1.10.3).
Figure 1.10.3 Add Test button
This will present a list of tests to choose to be added to the session. (Figure 1.10.3)
Figure 1.10.4 Adding a test
Once the test is selected, it is added to the bottom of the patient’s test session.
1.11 Delete tests
Tests with or without data can be removed from the session from the test menu allowing to clear irrelevant
tests or deleting tests to replace with new customized tests.
Select the test menu button.
Figure 1.11.1 Test Menu button

VIsualEyes 515/525 - Additional Information Page 11
The left side menu panel will display the currently test session. At the end of the list is the Enable delete
option. Activate the Enable delete option. (Figure 1.11.2)
Figure 1.11.2 Enable delete option
This will present the list of performed tests with a symbol.
Clicking or touching this symbol will remove the test from the session.The current test cannot be deleted.
Note: Once deleted, the test data cannot be recovered.
Figure 1.11.3 Test menu with delete option enabled

VIsualEyes 515/525 - Additional Information Page 12
2Calibration
Calibrations are particularly important in tests where eye movements are compared with a given stimulus of
a known position and/or velocity (e.g. Saccade test). Calibration can be performed on both eyes (binocular)
or individually (monocular) by turning off the non-essential eye or using a monocular goggle. Calibration is
strongly recommended for all tests to accurately measure the velocity of the nystagmus.
2.1 Performing calibration
In the test screen side panel, click the Calibration button (Figure 2.1.1)
Figure 2.1.1 Calibration button
The Calibration dialog box will open (Figure 2.1.2)
Figure 2.1.2 Calibration screen
Before beginning calibration, center the calibration stimulus for the patient using the target center slider.
Vertical tests will still display the target from the center of the screen, but horizontal tests will display the
target centered at the target center position specified by the target center slider. (Figure 2.1.3)
Figure 2.1.3 Target Center slider
The upper area of the dialog box shows the video images of the eyes that are being calibrated. If necessary,
adjust the pupil threshold to achieve optimal eye detection.

VIsualEyes 515/525 - Additional Information Page 13
Click the Start Calibration button to begin the calibration routine. (Figure 2.1.4)
Figure 2.1.4 Start calibration button
Ask the patient to look at the first calibration point. After a few seconds of fixation a target confirmed mark
(Figure 2.1.5) will appear to confirm calibration of the center point. If the patient fails to fixate on the center
point, the software will present a warning message. (Figure 2.1.6)
Figure 2.1.5 Target confirmed mark
Figure 2.1.6 Eye tracking problem warning
Automatic fixation detection may not be achieved successfully in some patients. In such cases, by observing
the video image of the calibrated eye on the screen, if the calibration point has been fixated upon, clicking
the Accept point button will manually accept the value and move to the next target position. (Figure 2.1.7).
Figure 2.1.7 Accept point button
Ask the patient to fixate on the target to the left without moving his / her head. After a few seconds of fixation,
a yellow target confirmed mark will appear to confirm calibration. The target will then move to the right,
center, up, and then down.
Figure 2.1.8 Calibration completed with all positions accepted
Once calibration is complete, the yellow tick marks will change to green, indicating the patient has achieved
appropriate calibration that is within tolerance at each of the calibration points. (Figure 2.1.8)
Below the calibration diagram are the numerical results from the calibration separated by eye and direction.
In cases where the calibration was unsuccessful, the numerical results may have additional information that
explains why the calibration failed.

VIsualEyes 515/525 - Additional Information Page 14
Figure 2.1.9 Calibration failure with values and failure reason
If the patient could not fixate on one or target positions, a red cross mark (Figure 2.1.10) shall appear to
indicate failure. The software will provide a Redo Horizontal, Redo Vertical, or Redo All button to clear the
failure points and allow the calibration of the direction(s) again.
Figure 2.1.10 Unsuccessful target mark
If the calibration is completed successfully, the Accept and Close action becomes available. Selecting this
action will use the patient derived calibration values and close the calibration screen.
Figure 2.1.11 Accept calibration and close calibration screen button
2.2 Default calibration
Should a calibration be unable to be completed, use the default calibration option (Figure 2.2.1). This sets
the VisualEyes™ system to use software default calibration settings which provide only an approximate
calibration value. Be aware that results for oculomotor tests and nystagmus velocities need to be interpreted
with caution.
Figure 2.2.1 Use default calibration button

VIsualEyes 515/525 - Additional Information Page 15
2.3 Review calibrations
The patient’s calibration traces (Figure 2.3.1) and videos are saved for later review. These results can be
used to determine if the patient’s eyes were properly calibrated before the VNG test was performed. During
review it can be determined which subtests are related to which calibrations, if calibration was performed
more than once. The traces and videos can be accessed from the Session Review screen and Patient
Sessions screen.
Figure 2.3.1 Calibration traces
The results can be printed for hardcopy storage (Figure 2.3.2).
Figure 2.3.2 Print Calibration from Session Review screen