STRATUS OCT Model 3000 User Manual Rev A Sw Ver 4.0

Copyright Copyright © 2004 Carl Zeiss Meditec Inc. All rights reserved.

Trademarks Stratus OCT™ is a trademark of Carl Zeiss Meditec Inc. All other trademarks used in this document are the property of their respective owners.

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Contents

Contents Possibilities... 9 (1) Introduction ... 11 •Purpose Of This User Manual ... 11 •Stratus OCT System Described ... 11 • Stratus OCT System Hardware ... 13 •Instrument Installation ... 14 •Tips to Avoid Damage... 14 •Warning: User Changes to Software or Hardware ... 15 •Password Protection... 15 •Safety Precautions ... 19 •EMI Statement... 20 •Symbols Defined... 20 •Instrument Disposition ... 20 (2) Prepare To Scan ...21 •Chapter Overview ... 21 •Power Up The System ... 21 •Navigate To The Stratus OCT Main Window ... 22 •Prepare The Patient ... 23 •Enter Patient Data ... 25 (3) Acquire Scans... 29 •Chapter Overview ... 29 •Adjust The Height ... 29 •Initiate A Scan ... 31 •Position The Patient Module... 33 •Optimize Scan Image... 34 •Adjust Scan Placement ... 36 •Acquire Scans ... 38 •Other Scan Adjustments ... 40 (4) Scan Acquisition Protocols ... 47 •Chapter Overview ... 47 •The Scan Tab... 47 •The Protocol Groups ... 47 •General Tips... 49 •Scan Protocol Descriptions, Options And Tips ... 51

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(5) Analyze Scans ... 57 •Chapter Overview ... 57 •Initiate An Analysis... 57 •Selection Window... 60 •Print Analysis Output... 62 (6) Analysis Protocols... 65 •Chapter Overview ... 65 •The Analyze Tab... 65 •Protocol Lists ... 65 •General Tips... 66 •Normative Data and Its Applicability... 69 •Quantitative Analysis Protocols ... 71 •Image Processing Protocols... 92 (7) The Stratus OCT Browser: Data Management ...97 •Chapter Overview ... 97 •The Stratus OCT Browser ... 98 •What Does That Button Do? ... 101 •Find and Select Records... 102 •Print Patient List ... 105 •Print Patient Data ... 105 •Print Clinical Notes ... 105 •Analyze Exams... 105 •Add a New Patient ... 107 •Edit Patient Records ... 109 •Merge Patient Records ... 109 •Create and Edit Visit Records... 110 •Edit Exam Record Notes ... 111 •Edit Clinical Notes ... 112 •Categorize Patient Records... 112 •Create and Assign Patient Diagnoses ... 115 •Register, Edit and Assign Medical Staff ... 118 •Register, Edit and Assign Insurance Companies ... 119 •Delete Patient, Visit and Exam Records ...121 •Site ID and Logo ... 123 •Defragment Database...124 (8) Archive, Retrieve & Backup ...125 •Chapter Overview ... 125 •The Patient Database... 125 •Data Maintenance Requirements ... 126

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•Recommendations For Automated Data Maintenance ...127 •Archive Registration and Management ... 129 •Manual Archive ... 133 •Care of DVD Archives... 136 •Duplicating an Archive Disk... 136 •Format DVD-RAM Disks...137 •Retrieve Scan Data ... 139 •Manual Backup... 142 •Clear Archived Exams ... 144 (9) Export and Import Scan Data...147 •Chapter Overview ... 147 •Privacy and Data Integrity Features... 147 •Export Data ... 148 •Import Data ...151 (10) Routine Maintenance...155 •Chapter Overview ... 155 •Handling Error Messages... 155 •Hard Disk Defragmentation ... 155 •Routine Cleaning ... 156 •Report Signs Of Wear ... 156 (11) Specifications ...157 •Tomographic Imaging...157 •Fundus Imaging...157 •Electrical Requirements ... 158 •Start-up ... 158 •Measurement Units ... 158 •Calibration... 158 •Display Monitor ... 158 •System Input Devices... 158 •Disk Storage ... 158 •Environmental Conditions... 158 •Physical Dimensions ... 159 •System Weight... 159 •Table Loading Capacity... 159 •Standards and Approval ... 159 •Embedded Windows License ... 159 •Intended Use ... 159

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(12) Legal Notices...161 •Limited Warranty ...161 •Service Contract... 162 •Software Copyright... 162 •Software License Agreement ... 163 Appendix A: Version 4.0 Networking Guidelines ...165 •Notice ... 165 •Network Capabilities ... 165 •Warning: Risks of Internet Connectivity... 166 •Prohibited Activities ... 167 •Network Activities Not Supported ... 167 •Not Recommended ... 168 •Network File Server Minimum Requirements... 168 •Network File Server Recommendations ... 168 •Using The Network File Server... 169 •Configuration for Direct Export to a Personal Computer ...171 Appendix B: Macula Normative Database ... 173 •Introduction...173 •Selection Criteria ...173 •Data Collection ...174 •Data Analysis and Normalization ...174 •Age Coefficient ...175 •Conclusion ...177 Index ...179

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Possibilities “Biopsies without surgery. Non-contact, non-invasive, near-cellular, micron resolution diagnosis in vivo. Research at the Massachusetts Institute of Technology and top ophthalmic thought leaders around the world offers the hope that Optical Coherence Tomography will one day take the place of traditional biopsies.” -Industry Week, V246, N16, P60 (1)

Figure 1 The Stratus OCT START WINDOW

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Introduction

(1) Introduction Congratulations on the purchase of your Zeiss Stratus OCT Model 3000 (Stratus OCT). The Stratus OCT enables examination of the posterior pole of the eye at an extremely fine spatial scale, without surgical biopsy or even any contact with the eye. The name Stratus OCT (derived from “stratum,” Latin for “layer”) refers to its unique ability of direct cross-sectional imaging of the layers of the retina. The Stratus OCT minimizes patient discomfort as it permits detailed examination of the retina and optic nerve head at the office or clinic. The Stratus OCT facilitates diagnosis and management of retinal diseases and glaucoma.

Purpose Of This User Manual Zeiss designed this User Manual to serve as a training, usage and reference guide. We assume that users are clinicians or technicians with professional training or experience in the use of retinal imaging equipment, and in diagnostic interpretation of the images generated. While we offer training in the use of the Stratus OCT, we do not offer instruction in diagnostic interpretation of the images generated. This manual does not attempt to do so.

Organization of The Manual This introductory chapter provides a system description, installation and safety information. Chapters (2) through (6) are organized according to the normal sequence of operation of the Stratus OCT, followed by data management and data transfer functions in Chapters (7) through (9), as follows:

• Prepare To Scan, explained in Chapter (2). • Acquire Scans, explained in Chapter (3). • Scan Acquisition Protocols, described in Chapter (4). • Analyze Scans, explained in Chapter (5). • Analysis Protocols, described in Chapter (6). • The Stratus OCT Browser: Data Management, explained in Chapter (7). • Archive, Retrieve & Backup, explained in Chapter (8). • Export and Import Scan Data, explained in Chapter (9). Chapters (10), (11) and (12) cover Routine Maintenance, instrument Specifications and Legal Notices, respectively. Users who wish to use the Stratus OCT in a networked environment should see Appendix A: Version 4.0 Networking Guidelines.

Stratus OCT System Described The Stratus OCT is a computer-assisted precision optical instrument that generates cross sectional images (tomograms) of the retina with ≤ 10 microns axial resolution. It works by using an optical measurement technique known as low-coherence interferometry.

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How The Stratus OCT Works The principle of operation of interferometry is analogous to ultrasound, except that it uses light rather than sound. The difference permits measurement of structures and distances on the ≤ 10 micron scale, versus the 100-micron scale for ultrasound. Another important difference is that optical interferometry does not require contact with the tissue examined, unlike ultrasound. The Stratus OCT contains an interferometer that resolves retinal structures by measuring the echo delay time of light that is reflected and backscattered from different microstructural features in the retina. The Stratus OCT projects a broad bandwidth near-infrared light beam (820 nm) onto the retina from a super luminescent diode. It then compares the echo time delays of light reflected from the retina with the echo time delays of the same light beam reflected from a reference mirror at known distances. When the Stratus OCT interferometer combines the reflected light pulses from the retina and reference mirror, a phenomenon known as interference occurs. A photodetector detects and measures interference. Although the light reflected from the retina consists of multiple echoes, the distance traveled by various echoes is determined by varying the distance to the reference mirror. This produces a range of time delays of the reference light for comparison. The Stratus OCT interferometer electronically detects, collects, processes and stores the echo delay patterns from the retina. With each scan pass, the Stratus OCT captures from 128 to 768 longitudinal (axial) range samples, i.e., A-scans. Each A-scan consists of 1024 data points over 2 mm of depth. Thus the Stratus OCT integrates from 131,072 to 786,432 data points to construct a cross sectional image (tomogram) of retinal anatomy. It displays the tomograms in real time using a false color scale that represents the degree of light backscattering from tissues at different depths in the retina. The system stores the scans you select for later analysis.

How It Works for You The Stratus OCT delineates intraretinal, cross-sectional anatomy with axial resolution of ≤10 microns and transverse resolution of 20 microns. The Stratus OCT software package includes 19 scan acquisition protocols and 18 analysis protocols. Together they enable you to analyze the optic disc, retinal nerve fiber layer and the macula with a single instrument. The Stratus OCT facilitates the evaluation of both glaucoma and vitreoretinal disease. The Stratus OCT video camera enables you to view the patient's fundus as you work, and to store video and scan images together. The data management system enables you to keep Stratus OCT histories, so you can monitor patients over time. You can archive images and data on rewritable DVD-RAM disks. The inkjet printer enables you to generate color hard copy.

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Stratus OCT System Hardware The Stratus OCT system hardware consists of the Patient Module; the Computer Unit; the Flat Screen Video Monitor; the keyboard, mouse and color inkjet printer. The hardware mounts on a wheelchair accessible motorized power table. The table accommodates elevation adjustment to each patient's height. The illustration below labels hardware elements. System specifications are in Chapter (11).

Figure 2 Stratus OCT System Hardware

Software and Storage Media Zeiss pre-installs all software necessary to operate the Stratus OCT. We also provide three unformatted, rewritable digital versatile disk (DVD) cartridges to archive the patient database.

We recommend you use the automated data maintenance features to archive scans  Note: and backup the patient database. This helps ensure the preservation of patient data in case of computer malfunction. See Chapter (8), Archive, Retrieve & Backup.

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Instrument Installation Only an authorized service representative should assemble and install the Stratus OCT. Zeiss does not provide assembly and installation instructions. The buyer should make a free on-site installation appointment to coincide with delivery. System integration and calibration require approximately one business day.

Care in Handling The Stratus OCT hardware is shipped in separate boxes. Use extreme care when handling and transporting the boxes. In particular, the box containing the Patient Module contains fragile optics that require high precision alignment.

Installation Requirements

• The instrument requires an area at least 6' x 8' (1.80 m by 2.4 m) for installation and patient comfort during use.

• The Stratus OCT should operate on a dedicated power outlet. Based on your specification, we configure your Stratus OCT at the factory to use either 100V, 115V, or 230V line voltage.

Tips to Avoid Damage To transport, dismantle or modify the Stratus OCT hardware, you must consult with  Note: a Zeiss service technician before you disconnect any of the components. Failure to do so voids all warranties offered with the Stratus OCT.

• This instrument has no special measures against harmful ingress of water (IPX0 classification). Do not place the instrument in or near a wet or moist environment. Do not allow condensation to form on the instrument. Do not place a container holding liquid on top of the instrument.

• Only Zeiss technicians should disassemble or service this instrument. In the case of malfunction, error messages or operational problems, call Carl Zeiss Meditec for service at 1-877-486-7473 in the U.S.A., or contact your local Carl Zeiss office or distributor.

• In case of emergency related to the instrument, unplug the power cord from the wall outlet and call for service immediately.

• There are no user-replaceable parts in the instrument. For the replacement of any component, accessory, or peripheral, including fuses and lamps, call Carl Zeiss Meditec for service at 1-877-486-7473 in the U.S.A., or contact your local Carl Zeiss office or distributor.

• Although this instrument is designed for continuous operation, it should be turned off when not in use for an extended period.

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Warning: User Changes to Software or Hardware The Stratus OCT is a medical device. The software and hardware have been designed in accordance with U.S., European and other international medical device standards designed to protect clinicians, users and patients from potential harm caused by mechanical, diagnostic or therapeutic failures. Unauthorized modification of Stratus OCT software or hardware (including peripherals) can jeopardize the safety of users and patients, the performance of the instrument, and the integrity of patient data; it also voids the instrument warranty. Approved Software Use of software supplied or approved by Carl Zeiss Meditec for the Stratus OCT is authorized.

Carl Zeiss Meditec does not provide technical support for the use of approved third  Note: party software. Please refer to the Stratus OCT Technical Support section of our website (www.meditec.zeiss.com) for the current list of approved software, including updates and patches to the Windows operating system. As of this writing, the following software has been approved for use with the Stratus OCT. Security Software Please take precautions to shield your Stratus OCT from software viruses and other corruption. We strongly recommend that you do not connect the Stratus OCT to the Internet, but we have validated the following security software to work with the Stratus OCT to enhance security in either a network or standalone setting.

• Norton AntiVirus® 2004 (configured for Automatic LiveUpdate™ if connected to the Internet) and Norton Personal Firewall® 2004, both of which are part of the Norton Internet Security® 2004 software package. Other elements of this package have not been validated to work with the Stratus OCT. Also note that Norton Personal Firewall must be properly configured, usually by an information technology specialist, so that it permits desired communications while blocking undesired communications.

Note Regarding Network Security: Stratus OCT Software Version 4.0 is compatible with  Windows 2000 Service Pack 4, which is primarily a security update to the Windows operating system. Therefore, if you connect the Stratus OCT to an office network, we encourage you to install Service Pack 4. Furthermore, please consider the information in Appendix A: Version 4.0 Networking Guidelines. If you connect the Stratus OCT to the Internet, which is not recommended, see Warning: Risks of Internet Connectivity on page 166.

Password Protection It is the user’s responsibility to implement whatever instrument and data security measures are desired or appropriate. This section instructs you how to use the Windows operating system to

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require users to enter a password before they can access the Stratus OCT computer. The Stratus OCT is shipped with Windows password protection turned off, so that upon system startup, any user has administrator privileges (access to all functions) via the default user account.

If you establish password protection, the Stratus OCT software will not launch  Note: automatically upon system startup. You will be required to log on to the computer by entering a valid user name and password combination. After logging on, you will have to launch the Stratus OCT software by double-clicking on the STRATUS OCT Host desktop icon. User Types and Privileges The following information and instructions are intended for the use of the Stratus  Note: OCT in a standalone setting. If you have installed the Stratus OCT in a network environment, we assume that you will apply your own user account management procedures. We do not offer recommendations or instructions for password protection in a network environment. In general, we recommend that you use good practices in creating, administering and securing passwords. You implement password protection in Windows by turning on password protection and then creating one or more new user accounts that have a user name and password. When you create user accounts, you must select a user type among three choices: Standard user, Restricted user, and Other-Administrator. For purposes of working with the Stratus OCT, the privileges afforded to each kind of user are explained below: Administrators belong to the Administrators Group by default. The default user account is an administrator account.

• Users in the Administrators Group can use all Stratus OCT functions. • Administrators can modify the computer and install programs-and thereby implement Stratus OCT software upgrades.

• Only administrators can create new user accounts, manage network settings and read the files of other users. Standard users belong to the Power Users Group by default.

• Users in the Power Users Group can use all Stratus OCT functions. • Standard users can modify the computer and install programs-and thereby implement Stratus OCT software upgrades.

• Standard users cannot create new user accounts, cannot manage network settings and cannot read the files of other users. Restricted users belong to the Users Group by default.

• Users in the Users Group can use all Stratus OCT functions. • Restricted users cannot modify the computer and install programs-and therefore cannot implement Stratus OCT software upgrades.

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• Restricted users cannot create new user accounts, cannot manage network settings and cannot read the files of other users.

How to Activate Password Protection To activate password protection, follow these steps: 1. Power up the system. Exit the Stratus OCT program (click File > Exit or click the

at upper

right) to enter the Windows environment. 2. Click Windows Start > Settings > Control Panel. In the Control Panel, double-click Users and Passwords. 3. In the Users and Passwords dialog box, select the checkbox near the top that says “Users must enter a user name and password to use this computer.” This activates the Add, Remove and Properties buttons.

Figure 3 Users and Passwords Dialog Activated

Warning: Do not attempt to remove, edit the properties or edit the passwords of the “Administrator” and “Tech Support” accounts. Failure to observe this warning could disable access to the system. 4. Click the Add button. The Add New User dialog box appears. Enter a user name and record it. The user name is not case sensitive. (The other information is optional.) Click Next. 5. You will be prompted to enter and to confirm a new password for this user name. The password is case sensitive. Record the password you have entered. When finished, click Next. 6. The Add New User dialog box now lets you select the level of access of the new user account. A. For the first new user account, we strongly recommend that you select the Other radio button and then select Administrators from the drop down list, as in the example below. You must have access to an administrator account to retain full control of your system,

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particularly the ability to create new user accounts. When you create the first new user account, you lose access to the default administrator account, since you do not know its password. (If the default account password were changed and then lost, access to the system would be disabled.) Therefore, it is advisable that the first new account be an administrator account whose password you will create.

Figure 4 Select Other, Administrators B. For additional new user accounts, we suggest that you select the Restricted user radio button. In this way, you can prevent unauthorized changes to the Stratus OCT software and the computer. 7. Click Finish. You will return to the Users and Passwords dialog box, and the new account you created will be listed by User Name and Group.

• To add more user accounts, repeat steps 4 through 7. 8. When finished adding accounts, click OK to implement your changes and exit. You can restart the Stratus OCT software by double-clicking on the STRATUS OCT Host desktop icon.

Log On after Restart If the Stratus OCT is connected to a network file server, you may be required to log  Note: on to the server as well as the instrument. Check with your network administrator for the required log on procedures. The first time you restart the system after implementing password protection, you will have to do the following: 1. The Select Netware Logon dialog box will appear. Click Cancel. A Netware Network dialog box will appear. Click Yes. 2. The Windows Logon dialog box will appear with “Administrator” in the User Name field. Delete “Administrator” and type in the user name you wish to use. Then enter the corresponding password in the Password field. The password is case sensitive. Click OK. 3. The Getting Started with Windows 2000 dialog box will appear. Uncheck the box at lower left that says, “Show this screen at startup.” Then click Exit.

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4. We recommend that you set the Windows taskbar properties to auto hide. Right-click on the taskbar and click Properties. In the Properties dialog box, select the checkbox next to Auto hide. Then click OK. 5. We recommend that you create a desktop shortcut to format DVD-RAM disks. To do this, click Windows Start > Programs > DVD-RAM, and right-click on DVDForm and select Create Shortcut. Then drag the new DVDForm shortcut to the desktop. After the first time you log on with a new user name, you will be prompted to enter the user name and password only. The system will open to the Windows desktop. Double-click the STRATUS OCT Host desktop icon to launch the Stratus OCT software.

Safety Precautions Warning: To prevent electric shock, the instrument must be plugged into an earthed ground outlet. Do not remove or disable the ground pin. Only a Zeiss technician may install the instrument. Warning: Do not open the instrument covers. Opening the instrument covers could expose you to electrical and optical hazards. Warning: Do not reconfigure system components on the table, nor add non-system devices or components to the table, nor replace original system components with substitutes not approved by Zeiss. Such actions could result in failure of the table height adjustment mechanism, instability of the table, tipping and damage to the instrument, and injury to operator and patient. Warning: Do not scan the same location on the retina with the same scan pattern for more than 10 minutes per day. Failure to follow this guideline could result in overexposure of the patient’s eye to optical radiation. Warning: This instrument may cause ignition of flammable gases or vapors. Do NOT use in the presence of flammable anesthetics such as nitrous oxide, or in the presence of pure oxygen.

• The Stratus OCT is Type B, Class I protection equipment. • Do not use the instrument on an uneven or sloped surface. Apply the wheel locks except when moving the instrument table. Also, do not roll the table in deep pile carpet or over objects on the floor such as power cords.

• To avoid tipping, the printer supplied with the instrument must be maintained in its place and no others are to be used.

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EMI Statement This instrument meets various international standards for electromagnetic interference (EMI). However, if you experience interference from a radio, TV or other electrical receiving device, attempt the following corrective measures: 1. Move the receiving device and the Stratus OCT away from each other. 2. Reorient the radio or TV antenna. 3. Plug the Stratus OCT into a different electrical outlet so that the instrument and the interfering equipment are on different branch circuits.

Symbols Defined Indicates that there are important operating and maintenance instructions found in the manual.

Indicates risk of electrical shock due to the presence of uninsulated high voltage inside the instrument. Do not remove the instrument cover or parts.

Indicates a fuse is present near this symbol.

Parts of the instrument that touch the patient are of Type B according to the IEC standard.

Instrument Disposition When it comes time to upgrade the Zeiss Stratus OCT, please contact Carl Zeiss Meditec to inquire about trade-in or upgrade values we may offer. Should you not wish to trade in the instrument, please dispose of it in accordance with local and national requirements.

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(2) Prepare To Scan Chapter Overview This chapter explains in detail how to prepare for scanning with the Zeiss Stratus OCT. Along the way, it describes the Stratus OCT MAIN WINDOW, from which all functions originate. Scan preparation consists of the following:

• Power Up The System (page 21). • Navigate To The Stratus OCT Main Window (page 22). • Prepare The Patient (page 23). • Enter Patient Data (page 25). Power Up The System The computer power switch activates power to all system components. It is the switch on the upper left corner of the computer (see the Stratus OCT System Hardware drawing on page 13). Press the switch and hold it down for 3-4 seconds to activate power to all components. The Stratus OCT software loads automatically. It requires about 45 seconds for the Stratus OCT START WINDOW to display (pictured on page 9.). During this time, buttons on the keyboard and the Patient Module are disabled.

Power Down the System To power down the system, exit the Stratus OCT software (click File > Exit or click the

at upper

right) to enter the Windows environment. Then select Shut Down from the Windows Start menu at lower left. For later models with soft shutdown, this will power down the whole system. On earlier models, you must flip the computer power switch off to shut down the whole system.

Soft Shutdown To prevent abrupt shutdowns of the system, later models of Stratus OCT power down only through the computer software. On these models, pressing the power switch while the instrument is running will not power down the system.

The Main Menu and Toolbar The main menu and toolbar (below) are on nearly every screen.

Figure 5 The Main Menu and Toolbar From left to right, the buttons are Select Patient, Select Acquisition Protocol, Select Analysis Protocol, Print, Home and Show Old Fundus Image. The three Select buttons all lead to the Stratus OCT MAIN WINDOW (pictured below). The Home button returns you to the Stratus OCT START

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WINDOW. When active, the Print button prints the current screen. Show Old Fundus Image is active when using the Repeat scan protocol. It switches between the current fundus video image and the saved fundus photo of the scan you are repeating. Operation is menu-driven. This means that you do not have to memorize any commands. You can access options easily by clicking on the toolbar buttons and menu headings.

Navigate To The Stratus OCT Main Window Clicking any of the first three Select toolbar buttons leads to the Stratus OCT MAIN WINDOW. It is the primary user interface, from which you can initiate all functions.

Stratus OCT Main Window The MAIN WINDOW has four functional areas:

• The Patient List with Category and Search fields (upper left); • The Scan List (center); • The Scan and Analyze Tabs with Activity radio buttons (right); • The Patient and Scan Group Images Tabs (lower left).

Figure 6 The Stratus OCT MAIN WINDOW

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Each area has its own functionality, which the manual describes in the context of its use. Resize Functional Areas

• You can resize any area by placing the pointer over its interior edge until the two-headed arrow appears. Then click and drag to resize.

Navigation in General To navigate among alternatives on the screen, use the mouse to move the screen pointer. Once you reach your selection, click the mouse. For example, to initiate a scan, move the pointer to the Select Analysis Protocol button and click the mouse. Text Convention

• This manual means “left-click” when it says, “click,” except where “right-click” is specified. Access Menu Options To access the options offered through each menu, click on the menu headings. Then click on an option to select it. Click outside all menu options to make the options disappear.

• Some menus are fields tagged with a down-arrow (drop-down lists). To access these menu options, click on the down-arrow.

• Grayed-out menu options or buttons are not available. Prepare The Patient Patient preparation includes dilating the patient (optional), selecting the fixation method, and preparing the patient for the exam experience.

The forehead and chin rests should be cleaned between each examination with an  Note: alcohol prep swab. Dilate the Patient (Optional) Dilation is an optional procedure to aid in the acquisition of an OCT image. Images of patients with pupils smaller than 3.2 mm may have a decreased image quality due to the blocking of the instrument signal by the iris. Adequate scans may be obtained from small pupils, but require a higher level of user skill to obtain them. If dilation is needed, one drop of tropicamide (0.5% or 1.0%) ophthalmic solution may provide adequate effects. Tropicamide is a commonly used mydriatic for routine eye exams. Side effects of dilating drops are rare, but could include life- or sight-threatening reactions such as acute glaucoma, cardiac irregularities, increased intraocular pressure and sudden high blood pressure.

Select the Fixation Method The Stratus OCT provides for internal or external patient fixation. Internal fixation is more reproducible and is the preferred method. External fixation is indicated when visual acuity in the eye

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