PLUSOPTIX A09 User manual

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Pediatric Autorefractor
plusoptiX A09
INSTRUCTION MANUAL
(Version 5.0.20.0)
Plusoptix GmbH
Neumeyerstr. 48
90411 Nuernberg
Germany
www.plusoptix.eu
Englisch

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Table of contents
1. Safety instructions........................................................................................4
1.1 Warning and Symbols .................................................................................................4
1.2 Handling of the plusoptiX A09 ...................................................................................5
1.3 Exclusive use of the plusoptiX A09 ............................................................................5
1.4 Operation of the plusoptiX A09 ..................................................................................5
1.5 Duties of the operator ..................................................................................................5
2. Delivery.......................................................................................................6
2.1 Storage.........................................................................................................................7
2.2 Unpacking.................................................................................................................... 7
2.3 Setting up.....................................................................................................................7
3. Connecting and switching on the system....................................................8
3.1 Connection...................................................................................................................8
3.2 Switching on the system..............................................................................................9
4. Settings......................................................................................................10
4.1 General (Basic settings)............................................................................................10
4.2 Installing a printer.....................................................................................................11
4.3 Practice network .......................................................................................................12
4.4 My Address (License Z, optional)............................................................................13
4.5 System ......................................................................................................................14
5. Binocular measurement ............................................................................15
5.1 Measurement procedure ...........................................................................................15
5.2 Documentation..........................................................................................................19
5.3 Viewing the video of the last measurement.............................................................. 22
5.4 Storing a video..........................................................................................................23
5.5 Loading a video ........................................................................................................25
6. Monocular measurement............................................................................26
7. Switching off the system............................................................................27
8. Printing the measurement report (License Z, optional).............................28
8.1 Adding an info column.............................................................................................29
8.2 Creating text modules...............................................................................................30
8.3 Printing the measurement report...............................................................................31

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9. Patient database (License D, optional) ......................................................32
9.1 Entering patient data.................................................................................................32
9.2 Measurement data.....................................................................................................33
9.3 Deleting or modifying patient data...........................................................................34
9.4 Backing up measurement results..............................................................................35
10. Warranty.....................................................................................................36
11. Service and maintenance ...........................................................................37
11.1 Service .......................................................................................................................37
11.2 Maintenance...............................................................................................................37
12. Practical tips...............................................................................................38
12.1 Measurement results..................................................................................................38
12.2 Troubleshooting.........................................................................................................41
13. Specifications.............................................................................................42

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0123
1. Safety instructions
Please read all of the instructions in this manual by all means in order to avoid any
danger to life and health, to achieve reliable measurement results and to obtain the
device in good working conditions.
1.1 Warning and Symbols
ATTENTION: This symbol is intended to advise the user of the presence of
important operating or maintenance requirements.
Service or repair to be performed by qualified authorized personnel only.
There are no user serviceable parts inside the instrument. Opening this
device can expose the user to harmful invisible electrical shock.
Note: Disassembly of plusoptiX A09 device will void the warranty. Refer
all servicing to Plusoptix authorized service representatives listed in
the section Service and Maintenance (Chapter 11).
Do not sterilize the plusoptiX A09 device or any of the components.
CAUTION: Use of controls or adjustments or performance of procedures
other than those specified herein may result in wrong
measurements.
Use only with IEC 60601-1 approved printers or keep printer out of patient
vicinity.
Double insulated power supply.
The CE mark on this device indicates that it has been tested and conforms
to the provisions noted within the 2007/47/EG Medical Device Directive.
At the end of life time (electronic waste): Please ship your device back to
the company you have purchased it from. The company will refund the
shipping cost.
ESD sensitive device: Discharge human body by touching a grounded plane
or use ground strips before installation or touching the connectors.
This symbol shows that this product keeps the requirements for an
application part type B of EN 60601-1.

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1.2 Handling of the plusoptiX A09
The plusoptiX A09 is an optical electronic measuring device. The construction and
functionality of the plusoptiX A09 is very similar of a video camera / camcorder. So,
please handle the device as carefully as you would use your own camcorder. If you
follow this advice, the plusoptiX A09 will last you for many years without any trouble.
1.3 Exclusive use of the plusoptiX A09
The exclusive use the plusoptiX A09 device is to measure refractive data, asymmetry of
the corneal reflexes, pupil size and pupil distance in real time. Both eyes are measured
at the same time (binocular) from one meter (3.3 ft) away from the child.
Note: Detecting anisometropia in miosis is only possible with a binocular
measurement of refractive data in real time, like with the plusoptiX A09. And in
this case it is not important whether the children are accommodating during the
measurement, because the refractive difference between both eyes is always the
same. The measurement is from one meter distance to the patient and so +1.00
dpt accommodation is included into the measurement result.
The measurement results can only be translated into a prescription for
glasses/contact lenses by a licensed eye care professional and are not to be
taken directly for a prescription.
1.4 Operation of the plusoptiX A09
Check all cable connections from the mains as well as the VGA cable
between the plusoptiX A09 device and the monitor and, if present, the
connection between keyboard, mouse and network are in good conditions
every time before switching on the system.
Make sure that any cables or connectors which show any damage are
replaced before switching on the plusoptiX A09 system.
Use only the delivered medical power adapter MES30B-3P1J and the
delivered cables.
The plusoptiX A09 complies with the requirements of the directive of medical devices
2007/47/EG.
1.5 Duties of the operator
The operator must ensure that only personnel who have been trained in handling of the
plusoptiX A09 are permitted to operate the system. All users must read the operating
manual and take note of the safety instructions and provisions.
Note: Training courses on the operation of the plusoptiX A09 subject to safety notes
and provisions for medical products are available on request.
Where the operator connects systems other than those supplied by Plusoptix,
he should ensure that these comply with norms EN 60601-1 and EN 60601-
1-1 in conjunction with the plusoptiX A09.

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2. Delivery
The plusoptiX A09 device is delivered in a paper carton. The following information is
printed on the carton:
Only 5
cartons on
each other
This side
up
Fragile
Keep dry
Carton
manufactorer
CE conform
Recycleable
Inside the paper carton the measuring device is placed in a preformed inset to avoid
damages to the plusoptiX A09 device during transportation.
Paper carton size: 51 cm x 41 cm x 20 cm (20 inches x 16 inches x 8 inches)
Preformed insert: Polyurethane foam (volume weight 28 kg / CBM)
Weight: 3.5 kg (7.7LB) carton including plusoptiX A09 device
In case the paper carton shows any damages which may be caused by external force
during transportation, e.g. careless loading or unloading, please do not accept the
delivery and inform the company you have purchased the device from.
Cradle
Cover
Camera
Medical power
unit
Cables

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2.1 Storage
The plusoptiX A09 device can be stored in the original package when the storage room
fulfils the following requirements:
Temperature: 0°C to +50°C (32°F to 122°F)
Humidity: 10% to 85% (no condensation)
Keep the plusoptiX A09 device away from any heat source.
2.2 Unpacking
Open the carton only in position „This side up“.
After unpacking the plusoptiX A09 please check that all items are delivered which are
listed on the delivery note. Missing items can only be replaced when a claim has been
forwarded to the company you have purchased the device from within one week after
accepting the delivery.
Note:Please keep the original packing material in case later transportation may be
required.
Do not store the packing material in a room with an open fire place.
2.3 Setting up
When you set up the plusoptiX A09 make sure that no cable can be reached by children.
Protect the plusoptiX A09 from direct sunlight.

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3. Connecting and switching on the system
3.1 Connection
For operation, the plusoptiX A09 must be connected to a monitor and keyboard with a
mouse. The monitor must fulfill the following system requirements:
Resolution: 1024 x 768 pixels
Interface: VGA
Four (4) USB ports of type A are available on the plusoptiX A09 for connecting e.g.
keyboard, mouse, printer or USB-sticks.
Where a monitor is already available at a workstation, a switch (monitor switch TK 207
by “Trendnet”) can be used to connect this monitor to the plusoptiX A09. This allows
you to save space by using the monitor for your practice network and for the plusoptiX
A09.
The plusoptiX A09 can also be attached to your practice network using an RJ-45
connection (network cable) via a GDT interface. Plusoptix supplies the software
required for operation via a GDT interface at no charge, should you wish to connect the
plusoptiX A09 to your network. In this case please consult your practice network
support personnel.
Fig. 1: Connect the VGA cable from the monitor to the plusoptiX A09. The keyboard
and mouse can be connected to the plusoptiX A09 by means of a USB cable or a
wireless USB adapter. Attach the 12V DC connector to the plusoptiX A09 and
the medical power unit to a 110 –220 V AC (50 –60 Hz) power plug. Ensure
that the power plug is switched off after close of business. This is a precaution in
case a short-circuit occurs during night-time which may cause a fire.
Fig. 2: Location of the connectors on the plusoptiX A09
plusoptiX A09
Fig. 1
Fig. 2
12VDC cable
medical power unit
MES 30B - 3P1J
VGA cable for
monitor
USB wireless adapter
for mouse and keyboard
on/off switch
4 x USB
VGA
RJ-45
12VDC

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3.2 Switching on the system
Switch on the monitor before you switch on the plusoptiX A09 (see Fig. 2 on page 8 for
the on/off switch).
After loading the software (approx. 1.5 minutes) the “Plusoptix Start Page”appears.
You can now start measurements.
Note: When using the system for the first time, first click on “Settings”to adjust the
settings as required for operation.
Plusoptix Start Page
This brief description only
appears after the system has
been switched on.
Please make sure that no USB-stick is inserted in the plusoptiX A09 during switching
on, because it can lead to problems during booting. The USB adapters from keyboard
and mouse as well as probably connected printers are excluded from this.
Settings
Optional
License D License Z
Click here to open
Instruction manual

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4. Settings
For the first start-up it is recommended to adapt settings e.g. general (basic settings),
printer, network (GDT), your address and system to the conditions of your practice.
With the exception of the general settings appears at each page a security query, where
you have to type in “YES”, to perform settings if you are authorized to do that. If you
are not authorized click on “Cancel”. Then you just can have a look at the existing
settings and not perform any settings.
4.1 General (Basic settings)
Click on “Settings” and then on
"General" to perform basic settings.
Click here to switch the video image on the monitor from black and white to false colours. You
can see the brightness profile of the pupils in colour (Brückner test).
Click here to test the volume of the warble sound.
Click here and move the slide to the left using the mouse to decrease the volume of the warble
sound, or to the right to increase the volume.
Click here to measure the astigmatism in minus cylinder or plus cylinder.

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4.2 Installing a printer
To be able to print a screenshot, a self-adhesive label for the patient paper record or a
measurement report (optional, License Z), suitable printer must be installed. You can
attach the printer to the plusoptiX A09 directly via the USB or via your practice
network.
Click on “Settings” and then on "Printer".
Click here to select the network printer.
Click here to select the printer to be used to
print the corresponding document.
A pdf-printer (“PDF”) is already installed on the plusoptiX A09.
If you select the pdf-printer, it is necessary to insert a USB stick into one of the free
USB ports on the plusoptiX A09. After a successful measurement and after clicking on
“Measurement report” or “Screenshot” the document will be saved automatically on the
stick. After about 10 seconds you can remove the stick from the device and print the
document at a computer connected to a printer.

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4.3 Practice network
To connect the plusoptiX A09 to an existing practice network, proceed as follows:
Click on “Settings” and then on "GDT".
Output format of the measurement results in the network - Parser: output in field identifiers
- Human readable: formatted text output
Adherence to GDT standard when transmitting measurement values. A selection can be made
between formatted text and field identifiers 8410 to 8421.
Enter the name of the plusoptiX A09 in the network here.
The paths for data input to the plusoptiX A09 and for data export to the network are extracted from
this value.
Identifiers for data exchange in the practice software.
Specifications for the GDT-standard is available at: http://www.plusoptix.eu/gdt

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4.4 My Address (License Z, optional)
Enter the name, address, telephone, fax and email address of your practice here, to
enable the details to appear on the measurement report.
Click on “Settings” and then on "My address".
Click here to enter the name of your practice.
Click here to enter the address, telephone, fax and email
address of your practice.

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4.5 System
The system settings have been carried out by the company you have bought the device
from. In case you would like to change some system settings, please proceed as follows:
Click here to set the current data and time of day.
Click here to select the date format for entering the date of birth.
Click here to set the keyboard layout.
Click here to activate additional licenses.
Click here to select the language for the operator interface.
Once you have performed all system settings, click on “Binocular” to return to the start
page. You can then begin measurements.

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5. Binocular measurement
5.1 Measurement procedure
Step 1: If the plusoptiX A09 is not connected to a practice network and the
measurement results are to be documented, please enter the patient data. This
data should be entered before the child is seated for measurement.
Enter patient data. The following data are valid:
a) Patient data (Surname, first name, date of birth and gender) or
b) Patient data and ID or
c) ID and date of birth
This brief description only appears after
the system has been switched on.
Optional
License D License Z

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Step 2: Hold the camera approximately 1.20 metres (3.3 feet) away from the child at
eye level and start the camera by pressing once on the trigger in the handle. A
warble sound can be heard to draw the child’s attention to the camera. Avoid
the child observing the monitor. The attention span of young children is
extremely short. Consequently, distractions during measurement such as the
monitor image or other persons in the room should be avoided.
Camera
Note: You can repeat the warble sound as often as required during measurement to
attract the attention of the child to the camera once again.
1 m
(3.3 feet)
Handle
Loudspeaker
Trigger

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Step 3: Align the child’s eyes in the white box on the monitor.
Now move the camera slowly forwards until you can see green circles around both
pupils and you hear another warble sound. You are now 1 m from the child; the
measurement will start automatically. Do not change the distance after this point.
Within one second, a ping tone will signal the end of measurement. The measurement
values will be displayed between the gaze charts, and the measurement result
"measurement completed" appears at the left side of the screen.
Note: If the measurement result "Measurement aborted” appears, the following could be
the cause:
1. A white square around the pupil is a sign that the measurement distance of 1m ± 5cm
was not adhered to. Use a tape measure to check the distance to the child and then
start measurement again.
2. A red edge around the pupil is a sign that the pupil is too small. Reduce the light in
the room to allow the pupils to dilate and repeat the measurement.
3. If the plusoptiX A09 does not find the pupils within 20 seconds, the measurement
procedure is automatically terminated. The most common reasons for this are:
Gaze chart
right eye
Gaze chart
left eye

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a) One or both pupils are not completely displayed on the screen, e.g. eyelashes
or the eyelid is partially occluding the pupil. The mother should lift the child’s
eyelid gently. Repeat the measurement.
b) If the corneal reflexes appear on one gaze chart as red point clouds and on the
other as green point clouds, the asymmetry of the corneal reflexes is ≥ 10
degrees. In this case, it is not possible to perform a binocular measurement.
You can however measure the eyes individually (see 6. Monocular
measurement).
c) One or both pupils show different brightness patterns. This indicates media
blurring, corneal damage, a foreign particle or other reasons.
Step 4: Measurement results
Measurement results:
Refraction: - Sphere [dpt]
- Cylinder [dpt]
- Axis [º]
Corneal reflexes: Symmetry of corneal reflexes [º]
Pupil diameter: Average [mm]
Pupil distance: PD [mm]
Gaze chart: Position of corneal reflexes in relation to pupil centre [º]
Pupil distance
Gaze chart
right eye
Gaze chart
left eye

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5.2 Documentation
The following documents can be printed:
- Measurement report (measurement results with comments)
- Measurement results on self-adhesive label
- Screenshot
To print one of these documents later, videos must be saved to archive the data. To do
so, see chapter 5.4 Storing a video and 5.5 Loading a video.
Click here to print the measurement report with the measurement results
and your comments (optional, License Z).
Click here to print a screenshot.
Click here to print a self-adhesive label for the patient record.
Examples of a measurement report, a screenshot and a self-adhesive label can be found
on the following pages.

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Measurement report (A4 and letter format)