IOLMaster A Practical Operators Guide Sw Ver 5.01 Rev A June 2007

IOLMaster®: A Practical Operation Guide Revision Control

Part Number and Revision

MCAF Number

Based on Software Version

64365 Rev. A

IOL.1411

5.01

Description

Release Date

IOLMaster: A Practical Operation Guide

2007.06

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ii

Copyright

© 2007 Carl Zeiss Meditec, Inc. All rights reserved. Trademarks

IOLMaster is either a registered trademark or trademark of Carl Zeiss Meditec, Inc. in the United and/or other countries. All other trademarks used in this document are the property of their respective owners.

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Contents iii

(1) The Eye and the IOLMaster ...1-1 •Eyes and Optics 101... 1-1 •How the Lenses of the Eye Work...1-2 (2) Entering Surgeon Names and Lenses ... 2-1 •Adding Surgeon Names ...2-1 •Choosing A Lens Modification Option ... 2-3 •Adding A Lens ... 2-5 •Downloading and Importing Lenses ... 2-7

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Contents

(3) Preparing Your Patient for Testing ... 3-1 •External Controls ...3-1 •Patient Preparation Tips ... 3-2 •New Patient Screen: Entering New Patient Information ... 3-3 (4) Taking Measurements... 4-1 •Part 1: Axial Length Measurement...4-1 •Part 2: Corneal Curvature Mode ...4-14 •Part 3: Anterior Chamber Measurement ... 4-20 •Part 4: White-to-White Measurement ... 4-22 •New with 5.01 software: IOLMaster Advanced Technology Plausibility Checks ... 4-24 •Part 5: Calibration Check ... 4-24 •So … What Now? ... 4-25 (5) Lens Calculations... 5-1 •Lens Calculation Mode ...5-1 •Choosing a Formula... 5-4 (6) Optimizing Lenses... 6-1 •Preparing for Optimization ... 6-2 •Lets Get Started! ... 6-5 •Optimizing the Haigis Formula ...6-10 •Now What? ...6-10 (7) Data Management...7-1 •Proper Shutdown...7-1 •Export or Transfer Data... 7-2 •Holladay II Consultant ... 7-4 •Backing Up Surgeon and Lens Data... 7-4 •Restore ... 7-5 •Import... 7-5 •Finding All of This a Little Confusing?... 7-5 (8) Frequently Asked Questions... 8-1

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Introduction Introduction

We are visual creatures. Our society, our technology, our entire way of life is centered around our ability to see. And if that ability is taken away from us, we will do everything we can to restore our sight.

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“The eye is the light of the body; therefore if the eye is good, then the whole body will be full of light, but if the eye is bad, then the whole body will be full of darkness.”

One of the most common causes of vision loss is the cataract – a clouding of the natural lens that sits behind the pupil. Exposure to certain chemicals and medications can cause cataracts to develop. Ultraviolet light may speed up the process as well. Even poor health is thought to play a part. But ultimately anyone who lives long enough will develop a cataract, simply from the passing of time. The first known technique to restore vision lost from a cataract has been traced back to India, where, in the 5th Century B.C., the surgeon Susruta performed an operation which later came to be called “couching.” This technique involved literally pushing the cataract out of the way with a needle inserted into the eye. Though dangerous, couching would continue to be used as the primary form of treatment for cataracts for the next two thousand years. In the 1740’s, a French surgeon named Jacques Daviel performed the first known removal of the cataract from the eye – rather than simply pushing it aside like his predecessors – by physically “popping” the clouded lens out through the pupil in one solid piece. While this new technique of cataract extraction was somewhat safer and more effective than couching, both operations left the patient severely far-sighted; distant objects appeared blurry, and nearby objects looked even worse! The use of thick glasses was required to provide the patient with usable vision after the operation. Then in the 1940’s, Harold Ridley successfully experimented with replacing the natural lens with a synthetic one, in order to provide the patient with functional vision even without glasses after the cataract surgery. In the 1960's, Charles Kelman introduced the technique of phacoemulsification, in which an ultrasonic probe is inserted into the eye, essentially liquefying the lens and suctioning it out through a tube. Ever since those early days, the surgical techniques and lens implant designs have continued to improve. Modern cataract surgery is typically performed as an outpatient procedure, often with no stitches and only anesthetic drops to numb the eye. Lens implants are now inserted in a rolled-up state and then unfold into their proper shape inside the eye itself. While the patient may be at the surgical site for a few hours, the actual removal of the cataract and insertion of the lens implant often takes less than ten minutes.

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And yet, even with all of the advances in materials and techniques, there is always a question of which implanted lens strength to use in order to give the patient the best possible vision after surgery. For many years, we simply guessed at the implant power needed, based on the patient’s glasses prescription. More recently, we utilized a combination of ultrasound A-scan devices and manual keratometry tools and a simple algebraic equation to estimate the implant power needed. While such methods were innovative for their time – and certainly a vast improvement over simply guessing – there is now available a much better way to acquire the measurements needed and to correctly choose the best lens power: The IOLMaster. This innovative technology is easy to use, provides an unprecedented degree of accuracy, and has a number of automatic fail-safes to help prevent mistakes and oversights. In the hands of a skilled operator, the IOLMaster can measure and calculate with such precision as to provide the absolute best lens power for each patient. The ability to see is one of the greatest gifts we have been given. And with the help of this technology, you will be instrumental in restoring that gift to your cataract patients. So it is our hope that this guide will assist you in your initial and ongoing use of your new IOLMaster system.

☞ Note: This guide is based on Version 5.01 of IOLMaster system software. Special Thanks

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Introduction v

We give special thanks to Mely Medel and Kathy Lewis for making this project possible, to John Gutierrez for his support in editing and layout, and as always, to our fellow Clinical Application Specialists for their support. We also thank those who reviewed the content of this guide and helped with editing, including Denny Dugal and Claus Dreher for their technical expertise, and Katy Murphy for her clinical expertise. In addition, Joel offers particular thanks to Tom McMillan, who first introduced him to the IOLMaster many years ago. -Joel H. Emerson & Kelly Tompkins Clinical Application Specialists, Carl Zeiss Meditec

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The Eye and the IOLMaster

1-1

Welcome to the first chapter of your IOLMaster’s practical operation guide. Soon enough, you will be reading about your new testing system and how to use it to measure your patients’ eyes. But before we discuss how to go about using the IOLMaster, it’s first important to understand what this system is testing-the human eye. So, in this chapter, we’ll discuss the various structures of the eye, how they assist in focusing light, and how cataracts and cataract surgery affect this ability to focus light. Do you need to read this chapter in order to operate the IOLMaster? Well … technically, no, you don’t. You can follow the steps for testing the eye described in Chapter (4), but I strongly advise against skipping ahead. The human eye is a marvelous and complex organ, and understanding how it interacts with light- both before and after cataract surgery-will give you a better perspective and a more intuitive grasp of the IOLMaster. Of course, if you are a doctor or a technician well-experienced in the anterior segment, what follows will undoubtedly be “old news” to you. But for those new to the ophthalmic field in general, or the anterior segment (that is, the front half of the eye) in particular, I believe you will find this chapter very useful.

Eyes and Optics 101

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(1) The Eye and the IOLMaster

Cornea Lens

Retina

For the purposes of explaining how the eye works, we’re going to simplify the anatomy and mechanisms of the eye and say that the eye is comprised of three main parts-the cornea, the crystalline lens, and the retina.

The crystalline lens is a clear structure about the size and shape of an M&M®, which sits just behind the dark pupil of the eye. Despite it’s name, this lens is not made of crystal, but is transparent living tissue. It is made up of the nucleus which is the core of the lens, several cortical layers that surround the nucleus like the layers of an onion, and finally an outer capsule or “bag” that holds everything in place. The crystalline lens helps to focus images of light onto the retina, and can even change its shape in order to adjust this focus-or “accommodate”-when the various objects being viewed are at different distances from the eye.

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The retina is the tissue at the back of the eye. The cornea and crystalline lens together focus images of light onto the retina, which then converts those images into nerve impulses for the brain to interpret.

How the Lenses of the Eye Work Light reflects off an object and comes to the eyes as parallel rays of light. The outward-curving (or “convex”) clear dome of the cornea bends these rays of light inward into the eye. These converging rays of light then pass through the crystalline lens of the eye, which bends them inward even more sharply.

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The cornea is the clear dome on the front of the eye. Like the crystalline lens, the cornea helps to focus images of light onto the retina. Though it does not change shape like the crystalline lens, the cornea is the more powerful of the two, providing about two-thirds of the light-bending power of the eye.

These rays cross over each other at a single spot called the “focal point”, and then begin to spread out or diverge once again. When these diverging rays reach the retina, an image of light is projected there, as if on a movie screen at the theater. Because the image appears beyond the focal point, it is flipped around backwards and upside down. But the brain expects this, and automatically corrects the image’s orientation when it is processing the nerve impulses it receives from the retina. Cataracts

There are a number of patients who will come to your office under the impression that a cataract is a film or growth that forms over the cornea. It is a myth perpetuated by novels and movies in which blind characters have cloudy white corneas. While the cornea can certainly become cloudy over time, that is not a cataract. A cataract is just another name for the crystalline lens; it is what the lens is called after one or more of its layers have become clouded to the point that is affecting the patient’s vision, or to the point that the doctor can clearly see it. A

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The Eye and the IOLMaster

Cataract Surgery

When cataract surgery is performed, the cataract is not merely peeled off of the lens; remember, the cataract and the lens actually are the same thing. Instead the lens-which has become the cataract-is removed from the eye. The good news is that more light can get into the eye now, since the cataract has been removed. The bad news is that without the crystalline lens, the eye is left with only the cornea to focus images of light. Though the cornea is powerful, about twice as powerful as the crystalline lens, typically it is still not powerful enough by itself to focus images properly onto the retina. Thus, if the cataract is removed and nothing more is done, the patient is left aphakic- literally “without a lens.” In most cases, aphakic eyes are farsighted; distant images are blurred, and nearby images are even worse. This is because the eye is shorter than the distance the cornea needs to focus the image by itself.

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cataractous lens does not focus images of light as well as a clear crystalline lens would; by the time the images pass through the cataract, they may have become blurred or faded out. Conversely, some cataracts may also cause light to become scattered as it passes through the lens, causing sources of light to seem overly bright, with distracting streaks and glare.

Placing a lens in front of the eye-either a thick lens in a pair of glasses, or a hard contact lens on the corneal surface-can help an aphakic eye to focus the image onto the retina.

lens implant

remaining lens capsule

Since the 1940's, though, there has been the option to implant a small synthetic lens inside the eye itself, which provides the patient clear vision with minimal need for glasses or contact lenses. Over the past six decades, techniques and technologies have improved continuously, yielding safer surgeries and better implants. Today, in most cases, the front of the crystalline lens capsule is removed, along with the clouded contents

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The Eye and the IOLMaster 1-4 of the lens, leaving the rest of the clear capsule intact to hold the implanted lens in place. Thus, the intraocular lens (or “IOL”) sits more or less in the same position the natural lens once occupied.

Now that we can implant a lens into the eye to replace the natural crystalline lens removed during cataract surgery, the question arises as to how strong the implanted lens should be. If it is too strong, the eye will be left nearsighted (only objects near the eye come into focus), but if it is not strong enough, the eye will be left farsighted (with distant objects blurred, and nearby objects even more blurred). In the past, surgeons simply had to guess at the implant strength, based on the patient’s prescription for glasses or contacts. Then along came the notion of measuring the length of the eye and the curvature of the cornea. How are those two measurements useful for choosing a lens implant strength? Good question… By measuring the curvature of the cornea (these measurements are often called “K’s,” short for “keratometry”-literally, “corneal measurement”), we can determine the focal distance of the cornea-that is, the distance from the cornea to the image it’s projecting on the other side. The steeper the cornea is, the shorter the distance is between the cornea and the image it is projecting. The flatter the cornea is, the longer the distance is between the cornea and the image it is projecting. 4/23/07

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How Strong Should the Implant Be?

By measuring the length of the eye from the cornea to the retina (called the “axial length”), we know what the focal distance should be to get the image projected properly on the retina. Typically once the crystalline lens is removed, the focal distance of the cornea is longer than the axial length of the eye. But by inserting a synthetic lens of the proper light-bending power, the overly-long focal distance can be shortened to match the actual length of the eye.

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The Eye and the IOLMaster

axial length

focal distance shortened

So, all the surgeon needs to do is insert a lens with enough light-bending power to shorten the focal distance to match the patient’s axial length. Easy, right? Well… as it turns out, it’s not as easy as that. Because the lens implant and the cornea have space between them, and because each one sits at different distances from the retina, the equation becomes a bit more complex. That is why it is essential to obtain accurate measurements of both the axial length and the corneal curvature.

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implant

Before the invention of the IOLMaster, analysis of ultrasonic echoes (i.e., an “A-scan”) was used to measure the axial length; and lining up and focusing images reflected off the cornea (i.e., “manual keratometry”) was used to measure corneal curvature. But with ultrasound, it is difficult to tell whether the scan is directed toward the macula-that is, toward the area of the retina that provides the patient with central vision. What’s more, contact ultrasound requires actually touching the cornea with a probe, which presses the cornea in and artificially shortens the axial length. The alternative to contact ultrasound was immersion ultrasound. While this method certainly is more accurate than contact ultrasound, it requires the patient’s lids to be held open while a plastic tube is placed over the eye and filled with saline. Not only is this uncomfortable for the patient, it still fails to provide certainty that the scan is being directed to the patient’s central vision. As for manual keratometry, this technique was designed for measuring the peripheral cornea for contact lens fittings. Peripheral corneal measurements do not necessarily provide the correct central corneal curvature-the curvature that most directly impacts the patient’s vision. What’s more, the measurement requires

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The Eye and the IOLMaster 1-6

Now we have the IOLMaster. It is quick, easy to use, and highly accurate. It measures the axial length along the eye’s visual axis directly to the macula. It measures more centralized-and thus more relevant-corneal curvature. Its measurements are highly consistent and repeatable. And it has a number of built-in safety checks to help catch any mistakes the tester may make. Now for what you’ve been waiting for…using the IOLMaster. Chapter (2) will deal with setting up your database of doctors and lenses, and Chapters (3) through (5) will deal with testing and calculating results.

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looking through a scope and turning various knobs to carefully align a series of shapes reflected from the patient’s cornea. The accuracy of these measurements depends greatly on the examiner’s skill, patience, and (ironically) his or her own clarity of vision.

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Entering Surgeon Names and Lenses

Okay, so you have an IOLMaster and are probably anxious to get started taking measurements. That time will come soon enough. Before taking any measurements, it is a good idea to set up the user database first. This chapter deals with that very subject.

Adding Surgeon Names 1. From the NEW PATIENT screen, select User Database from the Options menu (click Options > User Database). A dialog titled Please enter password appears. 2. Click the down-arrow by the Name field and select Administrator, as shown.

3. Leave the password blank, and click OK. The User Database dialog appears, showing the tab for the user you selected (Administrator). 4/23/07

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(2) Entering Surgeon Names and Lenses

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Entering Surgeon Names and Lenses 2-2 A list of surgeons (if you have entered any) appears on the left. To add a new surgeon to the list, just type his or her name exactly as you want it to appear on your lens calculation printouts in the Name field at right and click Add. administrator or your physician. Using passwords has pros and cons; ultimately, it is the physician's decision whether or not to use them. If you do assign a password to the administrator, be very careful not to forget it. If you forget the administrator's password, it is not an easy fix and will require a phone call to Carl Zeiss Meditec technical support. As you add new surgeons, their names will be listed alphabetically and each will one will have his or her own tab at the top of the screen. The tabs also appear alphabetically (except that the Administrator tab will always be at the far left). 4.After you have added a surgeon or surgeons (or if they’re already there from before), click on their tab at the top of the screen. You are now in that surgeon’s personal lens file. A list of already entered lenses appears on the left, and a lot of empty fields on the right, unless one of the lenses is highlighted, as shown below.

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☞ Important note: At this stage, you may choose to assign a password to your

These boxes are for the modified lens constants for the various formulas you will be using.

The fields to the right are empty when no lens is selected. In that case, they are for entering new lens data. These fields are highlighted above.

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Entering Surgeon Names and Lenses So, now you are in the surgeon files and are ready to add a lens. At this point, you will have to decide what lens constant information you will be inputting for each new lens.

Each lens comes with a manufacturer’s A-constant, a number which can be used in various lens calculation formulas. But traditionally, this A-constant has been calculated assuming the use of contact ultrasound A-scans and manual corneal curvature measurements. Because the IOLMaster obtains measurements differently than the lens manufacturer’s A-constant is designed for, modifications to this number need to be made. Typically, the IOLMaster measures the axial length measurement longer than contact ultrasound. The reason for this is that with contact ultrasound you are compressing the cornea, thereby shortening the axial length of the eye, but with the IOLMaster there is no contact with the eye and no artificial shortening of the axial length. This difference, if ignored, can result in undesired post-operative refractions.

☞ Important note: If you are using immersion ultrasound for your axial length

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Choosing A Lens Modification Option

measurement method and have a lens constant that has already been adjusted for immersion measurements, there is a good chance that this lens constant will also work well with the IOLMaster. You can proceed to the Adding A Lens section on page 2-5 and input these numbers into the IOLMaster lens database. Below are a few of the most common options you have for modifying your lens constants. The surgeon should decide which method to use. 1. Input lens constant information from the ULIB website. The ULIB website contains optimized lens constant information for many lenses, provided by many surgeons all over the world. The ULIB website is maintained by Dr. Wolfgan Haigis, PhD. You can find this website by doing an internet search for “ULIB,” or by following the link in the IOLMaster page on the Carl Zeiss Meditec website, which can be found at www.meditec.zeiss.com/iolmaster. You can then choose either to print out this list of optimized lens constants and manually enter the information into the IOLMaster, or download the information electronically to a CD or USB memory stick and import it directly into the IOLMaster. (For instructions, see the Downloading and Importing Lenses section on page 2-7.) This method has proven very useful for many surgeons and is probably the most commonly used method. However, every surgeon’s technique is different

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You may notice that not every IOL in existence appears on the ULIB list. Only lenses used often enough by the ULIB group to have sufficient data for lens constant optimization make it onto the site. Below is an example of what the list of lenses on the ULIB website looks like.

As you can see there is a lens constant/surgeon factor for each formula that is used on the IOLMaster Please note that the nominal value is the manufacturer’s lens constant. 4/23/07

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– the A-constants that work for one doctor may not necessarily work for another.

You can check Dr. Warren Hill’s website (www.doctor-hill.com) for some additional optimized lens constants. He has some of these posted for you to get started, including some A/C IOL constants.

☞ Important note: Specific A-constants found on the ULIB website and Dr. Hill’s

website are not recommended by Carl Zeiss Meditec. You must examine them and determine if they are right for you. 2.Side by Side comparison study. Measure the axial length on the IOLMaster. Then measure the axial length with contact ultrasound A-scan. You should measure 10 to 20 patients. Subtract the ultrasound’s average axial length from the IOLMaster’s average axial length. This will produce a very small number, probably around 0.10 or 0.15. Whatever this small number is, multiply it by 3. Then add this new number to your manufacturer’s A-constant. Example:

Avg axial length on IOLMaster = 23.70 mm Avg axial length on contact ultrasound = 23.60 mm 23.70 – 23.60 = 0.10 0.10 x 3 = 0.30

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Entering Surgeon Names and Lenses

This method is more customized and takes into account your own practice “compression factor”. 3.Speak to your lens representative, explain that you have an IOLMaster, and ask what numbers you should use. Often lens manufacturers will have a recommended lens constant for use with the IOLMaster. Write this information down, and proceed to the Adding A Lens section on page 2-5. Ultimately, whichever method you use, you are strongly encouraged to: 1. Do a comparison of your old method of measuring and calculating IOL power and the new method using the IOLMaster. Do not rely solely on calculations from the IOLMaster until you feel comfortable with the expected outcomes using the IOLMaster. 2.Perform an optimization of the lens constants, once you have enough post-operative data to do so. Chapter (6) deals with the optimization program on the IOLMaster.

Adding A Lens Now that you have your lens constants, it’s time to enter them into the IOLMaster. You will need to be in one of the surgeon’s files for this. 1. First, type the name of the lens in the lens Name field at upper right. 4/23/07

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This is the number you will add to any manufacturer’s A-constant. Now that you have this number, proceed to the Adding A Lens section on page 2-5.

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3. Next, enter the appropriate lens constant numbers in the fields next to each formula. These numbers are based on the method of lens constant modification you have chosen.

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2. Then type the appropriate number in the Manufacturer A-constant field (called A const.: ____ Manufact, located just below the lens name box). This number is based on the method of lens constant modification you have chosen.

• For option 1, using the ULIB website lens constant information: You can enter the information manually in each field from a printout, or import it directly into the IOLMaster from the media you have downloaded it to. When entering data manually, make sure you enter each number correctly in the field that corresponds to its formula. Remember the nominal number is what you put in the manufacturer’s box; you do not need to enter a manufacturer’s ACD. To import data directly, see the Downloading and Importing Lenses section on page 2-7. • For option 2, side by side comparison: Just add whatever your result was- continuing the example above, you would add 0.3-to whatever A-constant is printed on the lens box. Enter the resulting sum in the Manufact. field. Select ½ D or ¼ D (diopter) steps, and click Add. The instrument will automatically calculate and fill in the rest of the formula fields below. It is a good idea to go back and change the manufacturer’s number to the correct manufacturer’s lens constant and then click Set. This way, you will know at a glance whether the lens constant information was adjusted.

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Entering Surgeon Names and Lenses • For option 3, getting the information from the lens representative: Enter the information you are given in each field, including the fields for each formula. Select ½ D or ¼ D (diopter) steps, and click Add. every surgeon’s file. You must add each surgeon’s desired lenses under his or her own tab. Congratulations! You’ve just added a lens! This lens will now be available to be placed in one of the lens fields in the LENS CALCULATION screen.

Downloading and Importing Lenses Downloading ULIB Lens Constant Data onto a CD-RW or Jump Drive

You will need to use another computer (not the IOLMaster) that is connected to the internet to access the User Group for Laser Interference Biometry (ULIB) website. This computer will need to have a CD burner or a free USB port with a compatible jump drive (also called thumb drives, memory sticks, USB sticks, etc.). 1. Put a blank CD-RW into the CD drive, or plug in your USB memory stick, so that the computer is ready and recognizes the drive. 2. Go the ULIB website: www.augenklinik.uni-wuerzburg.de/eulib/index.htm 4/23/07

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☞ Important note: Adding a new lens to one surgeon’s file will not add it to

Links to it can be found on the IOLMaster page of the Carl Zeiss Meditec website (www.meditec.zeiss.com/iolmaster) and through Dr. Warren Hill’s website (www.doctor-hill.com). 3.Near the bottom of the ULIB webpage, click the link to Download optimized IOL constants for the Zeiss IOLMaster. 4. On the next webpage that appears, explanatory paragraphs at the top conclude with the following sentence: “To proceed with the download, click here for the English version”. Click where indicated-on the highlighted word “here”-and you will be taken to a Zeiss disclaimer page. 5. Read the page. At the bottom, select the checkbox next to “Yes, I’ve read the instructions for using the constants.” When you do, a Start download option will appear. Click Start download. 6. At this point, the instructions may vary depending on your browser. For Internet Explorer, select the Save option. A dialog will prompt you to specify where to save the file. In the Save in: field, use the down-arrow to locate your

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Entering Surgeon Names and Lenses 2-8

If you are using a jump drive, the file will probably be downloaded directly into the jump drive. If you are using a CD burner – depending on the program your computer uses – the download may save the file directly onto the CD, or it may copy it into a temporary file first. If the latter situation obtains, a message will probably pop up on your screen saying something like “You have files waiting to be copied onto CD. Click here to begin.” Complete the copying process onto your CD. Importing Files from the CD or Jump Drive into the IOLMaster

Now you have a CD or a jump drive with a whole list of lenses that can be download into your IOLMaster. Make sure you’ve entered all the surgeons on the Administrator tab before proceeding.

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CD burner (probably the “D:” drive) or the jump drive you have plugged into a free USB port (probably the drive with the highest letter – maybe “E:” or “F:” or “G:”). Click Save.

1. You will want to be back in the Administrator tab for this. If you are already in the Surgeon / Lens files, just click on the Administrator tab (far left) to return to it. If you are back in the NEW PATIENT screen, click Options > User Database, select Administrator in the Name field and click OK to get back to the Administrator tab. 2. Install the CD into its drive (on the left side of the system’s base when facing the screen) or the jump drive into its port (on the right side of the base). Give the computer a few seconds to recognize the CD or jump drive. 3.On the Administrator tab, click Import.

Click Import

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The import dialog that appears has a list of lenses on the left and doctors on the right.

4. Select the desired lenses by clicking on them. To choose more than one lens at a time, hold the Ctrl key while clicking every lens you want to import. 5. Select one or more doctors for whom you will import the selected lenses. Hold the Ctrl key while clicking to select multiple doctors. If each surgeon in your practice uses different lenses you will complete this process separately for each one. 6. Click the >> button to import the highlighted lenses into the lens database for the selected doctor(s). You may notice that not every IOL in existence appears on the list you downloaded. Recall that only lenses used often enough by the ULIB group to have sufficient data for lens constant optimization make it onto the site.

☞ A very important note: If you have already optimized a certain lens, then you do NOT want to import that lens to your lens database on the IOLMaster. If you do, it will erase your optimized lens numbers and replace it with the website’s numbers.

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