AT 900 D Instructions For Use Edition 16 Dec 2016

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INSTRUCTIONS FOR USE Applanation tonometer

AT 900® D 16. Edition / 2016 – 12

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Introduction

Thank you for choosing a HAAG-STREIT device. Provided you comply carefully with the regulations in this instructions for use, we can guarantee the reliable and unproblematic use of our product.

Purpose of use

The Goldman digital tonometer is an appliance that serves to measure intraocular pressure, according to the Goldman method. The measuring of the pressure re‑ quires to maintain a uniform applanation of the surface of the cornea. It is specially indicated in Glaucoma disease.

Contraindication

There is no absolute contraindication for execution of the tonometry. Appropriate professional assessment and caution are necessary. WARNING! Applanation tonometry may only be conducted by appropriately trained and qualified medical personnel. WARNING! Read the instruction manual carefully before commissioning this product. It contains important information regarding the safety of the user and patient. NOTE! Federal law restricts this device to sale by or on the order of a physician or licensed practitioner.

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Contents 1.

1.1 1.2 1.3 1.4 1.5 1.6 1.6.1 1.6.2 1.6.3 1.6.4 1.6.5 1.7 1.8

2.

2.1 2.2 2.3

3.

3.1 3.2 3.3 3.4 3.5 3.6 3.7

4.

4.1 4.2 4.3 4.4 4.5 4.6 4.7

5.

5.1 5.2 5.3 5.4

Safety ... 4

Areas of application of the device...4 Ambient conditions...4 Shipment and unpacking...4 Installation warnings ...4 Operation, environment...4 Disinfection...5 Cleaning and disinfection of the measuring prism...5 Visual inspection of the measuring prisms for damages...5 Service life of reusable measuring prisms...6 Tonosafe...6 Monthly device checks...6 Warranty and product liability...6 Symbols...6

Introduction... 7

Overview ...7 System components ...7 Bluetooth adapter (optional)...7

Equipment assembly / installation... 7

AT 900 D model R...7 AT 900 D model T...7 AT 900 D model BQ...7 Magnet unit for automatic L/R detection...8 Which slit lamp with which tonometer...8 Installation position of the tonometer...8 Description models...9

Commissioning... 9

Switching the device on and off...9 Programming the settings...9 LED indicator...9 Setting the display brightness...9 Adjusting the volume...10 BluetoothTM function...10 Battery status...10

Operation ... 10

Measuring tips...10 Astigmatism...10 How pressure is measured...11 Preparing the patient...11

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5.4.1 5.5 5.5.1 5.5.2 5.6 5.7 5.7.1 5.7.2 5.7.3 5.7.4

Patient instructions...11 Preparing the tonometer...11 AT 900 D model R and AT 900 D model BQ...11 AT 900 D model T...12 Measuring correctly...12 Sources of error...12 Incorrect distance to the patient ...13 Position too far to the right/left...13 Position too high/low...13 Incorrect pressure...14

6.

Software / Help menu / Error messages... 14

7.

Technical data... 14

6.1

8.

Error messages on the tonometer display...14

Maintenance... 15

8.1 8.2 8.3 8.4

Repairs...15 Cleaning...15 Checking the tonometer AT 900 D...16 Changing the battery...17

A.

Appendix... 18

B.

Legal regulations... 18

C.

Classification... 18

D.

Disposal ... 18

E.

Standards... 18

F.

Information and manufacturer's declaration regarding electromagnetic compatibility (EMC) ... 19

A.1 A.2

F.1 F.2 F.3 F.4 F.5

Accessory original HAAG‑STREIT measuring prism...18 Accessory tonosafe...18

General...19 Emitted interference (standard table 1)...19 Immunity (standard table 2)...20 Immunity for non-life support devices (standard table 4)...21 Safe distances for non-life-supporting devices (standard table 6)...22

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DANGER! Failure to comply with these instructions may result in material damage or pose a danger to patients or users. WARNING! These warnings must absolutely be complied with to guarantee safe operation of the device and to avoid any danger to users and to patients.

when moving. NOTE! Check the calibration of the instrument before first use according to the instructions in section 8.3.

1.4

NOTE! Important information: please read carefully.

1.1

Areas of application of the device

1.2

Ambient conditions

The device is intended for use in doctor's practices, hospitals, and optometrists' and opticians' premises.

Storage: Use:

Temperature Air pressure Relative humidity Temperature Air pressure Relative humidity Temperature Air pressure Relative humidity

from −40°C to +70°C from 500 hPa to 1060 hPa from 10% to 95% from −10°C to +55°C from 700 hPa to 1060 hPa from 10% to 95% from +10°C to +35°C from 800 hPa to 1060 hPa from 30% to 90%

1.3 Shipment and unpacking • Before you unpack the appliance, check whether the packaging shows traces of

• •

incorrect handling or damage. If this is the case, notify the transport company that has delivered the goods to you. Unpack the equipment together with a represen‑ tative of the transport company. Make a report of any damaged parts. This report must be signed by you and by the representative of the transport company. Leave the device in the packaging for a few hours before unpacking it (conden‑ sation). Check the appliance for damage after it is unpacked. Return defective applianc‑ es in the appropriate packaging.

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• Store packaging material carefully, so that it can be used for possible returns or

Safety

Transport:

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Installation warnings

WARNING! ••Do not modify this equipment without authorization of the manufac‑ turer. Installation and repairs may only be performed by trained spe‑ cialists. ••Any third-party device must be connected in compliance with the EN 60601-1 standard. ••The optional magnet unit for automatic L/R detection may only be used with the AT 900 D. Other measuring devices, especially me‑ chanical tonometers, may be affected by the strong magnetic field. ••The device must not be stacked or placed in close proximity to other electronic devices. NOTE! ••When performing assembly on appliances from other manufacturers, the connecting dimensions of the diverse tonometer models are to be taken into account! ••Check: Are the connection parts properly positioned (tonometer on the slit lamp, measuring prisms)?

1.5

Operation, environment

WARNING! ••The examination is to be performed at the medical professional’s dis‑ cretion and consideration in cases of active infections and lesions of the eye. Certain conditions could falsify measured values and the pro‑ cedure may interfere with the patient’s condition. ••Use only original HAAG-STREIT Goldmann tonometer measuring prisms or the sterile disposable measuring prisms TonoSafe from HAAG-STREIT. NOTE! This appliance must only be operated by qualified and trained person‑ nel. The owner is responsible for their training.

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1.6

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Disinfection

NOTE! The device does not need to be disinfected. For more information on cleaning, please refer to the 'Maintenance' chapter.

1.6.1 Cleaning and disinfection of the measuring prism

DANGER! The measuring prisms are made of PMMA. Please take note of the following restrictions: - Do not disinfect with alcohol - Do not clean with acetone - Do not disinfect using UV radiation - Do not sterilise using steam or ethylene oxide - Do not expose to temperatures above 60°C WARNING! Reusable measuring prisms are not shipped disinfected and must be cleaned and disinfected before their first use in accordance with the separate instructions for use on the cleaning and disinfection of tonometer measuring prisms, contact glasses, and DESINSET (HS item no. 7220315). ••Preparation may only be conducted by qualified and trained person‑ nel. Their training is the responsibility of the user. ••Appropriate professional assessment and caution are necessary. ••Only use clean, undamaged, and disinfected measuring prisms! ••Please observe the separate instructions for use on the cleaning and disinfection of tonometer measuring prisms, contact glasses, and DESINSET (HS item no. 7220315)! ••The operator shall be liable in the event of non-observance of the cleaning and disinfecting process! NOTE! ••Only those disinfectants tested by HAAG‑STREIT for material com‑ patibility may be used for disinfection. ••The current list is enclosed with every tonometer and measuring prism, and can also be found on the HAAG‑STREIT AG website (www.HAAG‑STREIT.com).

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••The separate instructions for use on the cleaning and disinfection of

tonometer measuring prisms, contact glasses, and DESINSET is to be consulted regarding the exact functioning, concentration, working times, and idle times. ••Improper preparation can result in the transmission of diseases to the patient and user as well as damage to the measuring prism. ••Residue from cleaning agents and disinfectants may irritate and burn the patient’s eye. ••As a rule, the measuring prisms may be prepared together with each other, but not with any other products. ••In order to achieve a efficient disinfection and storage of tonometer measuring prisms, we recommend the use of our DESINSET. For a selection of cleaning and disinfection agents please refer to the in‑ structions for use “Cleaning and disinfection” and to our “List of Dis‑ infectants”. The efficacy of the disinfectants on tonometer measuring prisms must be guaranteed by the user or the reprocessing responsi‑ ble person with the validation of their own disinfection process. ••The validation report is available from HAAG‑STREIT on request. ••A summary of the validation report can be found on the HAAG‑STREIT website (www.HAAG‑STREIT.com). ••The operator accepts liability for the use of other disinfectants. ••Single-use prisms must be replaced after every examination - see separate instructions for use. ••The instructions for use referred to above, the brief instructions on the disinfection of tonometer measuring prisms and additional information can be found on our website www.HAAG‑STREIT.com at any time.

1.6.2 Visual inspection of the measuring prisms for damages DANGER! Never use damaged measuring prisms. Prior to every use, the contact surface of the measuring prism must be inspected for contaminants or damage (scratches, cracks and sharp edges). This must be performed with a slit lamp microscope at 10x to 16x magnification.

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1.6.3 Service life of reusable measuring prisms

WARNING! How long can measuring prisms be used? Due to the large number of variables to be considered (type and con‑ centration of the disinfectant used, number of patients, handling, etc.) it is practically impossible to provide exact information on how often and/or how long a measuring prism can be used under safe conditions. The measuring prisms are stamped with an expiry date ( YYYY-MM). They must not be used beyond this date. HAAG‑STREIT recommends a maximum service life of two years before the expiry date. This ser‑ vice life applies subject to normal conditions of use, i.e., in compliance with the instructions contained in these instructions for use. The ser‑ vice life starts with the first use. The above-mentioned time periods do not apply to damaged measuring prisms; these must be immediately replaced.

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1.6.5 Monthly device checks

The tonometer must be checked on a monthly basis as described in the 'Mainte‑ nance' chapter. A check will be absolutely necessary if external force is applied (e.g., striking or dropping the appliance). NOTE! If a repair is necessary, please contact your HAAG‑STREIT represent‑ ative.

1.7 Warranty and product liability • Haag-Streit products must be used only for the purposes and in the manner described in the documents distributed with the product.

• The product must be treated as described in the ‘Safety’ chapter. Improper handling can damage the product. This would void all guarantee claims.

• Continued use of a product damaged by incorrect handling may lead to personal injury. In such a case, the manufacturer will not accept any liability.

• Haag-Streit does not grant any warranties, either expressed or implied, including implied warranties of merchantability or fitness for a particular use.

2015 - 10

Year:

• Haag-Streit expressly disclaims liability for incidental or consequential damage resulting from the use of the product.

• This product is covered by a limited warranty granted by your seller. First use

Service life: Maximum two years First use

1.6.4 Tonosafe

For USA only: • This product is covered by a limited warranty, which may be reviewed at www.haag-streit-usa.com.

Replace

Service life: Maximum two years

Replace

NOTE! Tonosafe was developed to avoid the necessary clean‑ ing and disinfection of measuring prisms from applana‑ tion tonometers. Tonosafe is a disposable applanation and optical duplication prism for Goldmann and Perkins applanation tonometers, for single use. Additional details can be found in the separate instruc‑ tions for use.

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1.8

Symbols Read the instructions for use attentively

General warning: Read the ac‑ companying documentation

Disposal instructions. See "Disposal" section.

Test symbol of CSA with ap‑ proval for USA

European certificate of con‑ formity

Manufacturer

Year of production

Serial number

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Product classification Type B

found in the EyeSuite Setup Manual, the usage instructions for the Bluetooth adapter and the description of the error messages are included in the Help section of the soft‑ ware. The help can be opened via the F1 key or in the [?] ‑ [Help] menu.

LOT number

Must not be re‑used

3.

Equipment assembly / installation

3.1

AT 900 D model R

3.2

AT 900 D model T

3.3

AT 900 D model BQ

Introduction

The applanation tonometer functions according to the 'Goldmann method': mea‑ surement of the pressure required to maintain a uniform applanation of the surface of the cornea. The precise measurement of the applanation surface is conducted with the slit lamp at 10x magnification. The pressure measurement is conducted on a slit lamp with the patient sitting down and is a routine test carried out as part of the standard slit lamp microscopy.

2.1

FRANÇAIS

HS reference number

Expiry date (2017‑10 = end of October 2017)

2.

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Overview

1. Measuring prisms (application part) 2. Sensor arm 3. Battery compartment lid 4. Battery compartment locking mechanism 5. Type plate (bottom side) 6. Function key 7. Insert for control weight 8. Digital display 9. Knob 10. Bluetooth adapter (optional)

2.2

System components

2.3

Bluetooth adapter (optional)

1 2

3 4 10

5 6

7 8 9

The Applanation Tonometer AT 900 D system is composed of the following devices: • Applanation Tonometer AT 900 D • Bluetooth adapter (optional) • PC or laptop There is an optional Bluetooth adapter available to transfer the measured data directly to the patient management of the Eyesuite software. The activation of the Bluetooth function is described in Chapter 4.6. The description of the software installation can be © HAAG-STREIT AG, 3098 Koeniz, Switzerland - HS-Doc. No. 1500.7220067.04160 – 16. Edition / 2016 – 12

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WARNING! Installation, repairs and modifications may only be performed by trained specialists.

A pivot is required for use of the Applanation Tonometer AT 900 D model R. It is as‑ sembled as follows: 1. Unscrew the mounting screw found at the top, on the microscope's middle cyl‑ inder housing. 2. Leave the spring in the aperture. 3. Position and screw tightly the pivot for the tonometer. 4. Place the tonometer bearer arm on the pivot's pin and swivel the tonometer to the right until it snaps into position. The tonometer will remain in this position even when not in use. 5. The stop peg must be assembled (11) when using the BM 900 and BM 900 V and must be removed (12) when using the BC 900 or BD 900. The Applanation Tonometer is tucked into one of the holes on the horizontal guide plate over the slit lamp axis using the peg from the tonometer base. 1. Assembly requires the small screwdriver and the 5 mm hexagonal Allen key. 2. Slide the slit lamp to the stop‑piece against the examiner and lock the instru‑ ment base and the microscope arm in the middle position. 3. Swivel the illumination apparatus all the way to the left‑hand side. 4. Disassemble the breath shield from the microscope arm. 5. Remove the cover screw located on the plain, right‑hand surface of the micro‑ scope arm. 6. Bring the swiveling arm of the tonometer and the radial movement bearing to‑ wards one another in an elongated position. 7. Shore up the tonometer on the guide plate and tighten the mounting screw into the boring on the microscope arm. If there is no guide plate present: hold the to‑ nometer in a horizontal position. 7

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8. Loosen up the lock on the microscope arm and the instrument base, then reas‑ semble the breath shield.

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NOTE! The cover screw on the left side of the arm is loosened by turning it in a clockwise direction using the screwdriver (applies only for late tonom‑ eter deliveries). Nur mit von Haag-Streit zugelassenem Digital-Tonometer verwenden Utilisation qu'avec Tonomètre approuvé par Haag-Streit Use only with Digital Tonometer approved by Haag-Streit

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3.4

Magnet unit for automatic L/R detection

The magnet unit for the AT 900 D in combination with the EyeSuite Tonometry soft‑ ware makes it possible to display the intraocular pressure (IOP) and the information on the eye in which the pressure was measured. PROHIBITED The magnet unit may not be used with conventional mechanical Gold‑ mann applanation tonometers, as the magnets can cause erroneous results with these instruments. NOTE! The magnet unit cannot be used with the attachment cart with rail for the Hruby lens. If you have this type of attachment cart affixed on your head rest, please remove it.

3.5

15

Which slit lamp with which tonometer

BD 900 BM 900 BI 900 BP 900 BQ 900 BX 900

3.6

14

Model R

Model T

Model BQ

Installation position of the tonometer

• For metal chin rests (13), screw the magnet unit directly into the rear, closer to‑ gether holes on the chin rest using the knurled screws.

• For plastic chin rests (14), screw the two spacer sleeves into the provided •

threaded sockets on the chin rest first and then affix the magnet unit into the external holes on the spacer sleeves using the knurled screws. Check that you can still see the bottom side label (15) after assembly when you view the chin rest from below.

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AT 900 D model R Can be fitted on the peg on the microscope.

AT 900 D model T AT 900 D model BQ Can be fitted on the guide Mounted on the micro‑ plate on the swiveling peg scope arm. for the microscope and il‑ lumination arm.

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3.7 Description models • The Applanation Tonometer AT 900 D Model R can be left on the slit lamp per‑ •

•

4.

manently. It is fastened to the microscope on a mounting base and swiveled in front of the microscope for the examination. The observation of the applanated surface is conducted monocularly – only through the left eyepiece. The Applanation Tonometer AT 900 D Model T is set on the guide plate over the slit lamp axis, for tonometry purposes. The instrument can be moved between two positions on the guide plate for observation through the right or left eyepiece. The sensor arm with the measuring prism projects from the bottom side into the beam path of the microscope and the illumination. The Applanation Tonometer AT 900 D Model BQ has a working position and two resting positions. To set the correct angle of incidence of the illumination, the to‑ nometer is swiveled and the illumination apparatus is positioned to the left of the tonometer bracket. The patient's left and right eyes can be easily examined in this position (no 60° position). The applanated surface is observed monocularly through the right eyepiece of the stereo microscope.

4.1

Commissioning

WARNING! It is imperative to read the 'Safety' section and observe its precautions before operating the equipment.

Switching the device on and off

Switch the tonometer on by pressing the function key briefly. We recommend checking the display ele‑ ments regularly to ensure they are functioning when switching the tonometer on. [8.8.8] appear shortly and then each individual LED segment lights up, follow‑ ing by the software version: a 3-digit number. At the same time, the red and green displays will flash alter‑ nately. If a display value appears after that, then the device is ready for use. The digital display lights up and displays the set tonometer value. The tonometer switches off automatically after 90 seconds if no ad‑ justments are made. If the BluetoothTM function is dis‑ abled (Section 5), the tonometer can also be switched off by pressing the function key. © HAAG-STREIT AG, 3098 Koeniz, Switzerland - HS-Doc. No. 1500.7220067.04160 – 16. Edition / 2016 – 12

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4.2

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Programming the settings

The display brightness, volume and Bluetooth func‑ tion can be changed. Press the function key and hold it down for two seconds to access the programming mode. The functions can be set in the following order according to the following points: 1. Display brightness 2. Volume 3. Bluetooth function

4.3

LED indicator

4.4

Setting the display brightness

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2 seconds 2 seconds 2 seconds

The LED below the display value is used to check whether the measuring prism is within the permitted measuring range during measurement. It lights up red as long as the tonometer is not in contact with the cornea and changes to green as soon as the measur‑ ing prism makes good contact with the cornea. If the tonometer is too close to the eye, the color changes back to red and a warning tone alerts the user to the fact that he/she has gone outside of the measuring range and the sensor is in the safety distance. The measuring range is between 3 and 75 mmHg. Above the measuring range, the display shows [HI], below it [Lo]. Hold the function key depressed for approx. 2 sec‑ onds. The display shows [- - -] (three dashes) and a signal sounds. Release the function key again. [br] appears on the display, along with the brightness set‑ ting 1 to 3. The brightness is adjusted by pressing the function key briefly. We recommend leaving the device in the basic setting [br1] to ensure long bat‑ tery life.

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Adjusting the volume

Hold the function key depressed for approx. 2 sec‑ onds. The display shows [- - -] (three dashes) and a signal sounds. Release the function key again. [Ld] appears on the display, followed by levels 1 to 6. The volume is adjusted by pressing the function key briefly.

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5.

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Operation

Measuring tips

NOTE! Measurements of shortest-possible duration should be conducted on both eyes.

• This measurement can be repeated multiple times. Excited and anxious patients frequently have a higher inter-ocular pressure during the first measurement.

• In the first minute, however, tension drops as the patient realizes that tonometry 4.6

BluetoothTM function

Keep the function key depressed for approx. 2 sec‑ onds to switch to the BluetoothTM function menu. Pressing the function key briefly switches the Blue‑ toothTM function on [bon] / off [boF]. This function can only be used together with the HAAG‑STREIT Blue‑ toothTM adapter (102623) and the corresponding soft‑ ware. Detailed information can be found in the corre‑ sponding operating instructions. Disable the function [boF] if you do not require it, in order to avoid wast‑ ing the batteries' power. Pressing the function key for more than two seconds returns you to the normal measuring mode. The normal measuring mode can also be reached by waiting until the device switches itself off and then switching it back on again.

4.7

Battery status

If [bAt] appears in the display instead of a numerical value when the device is switched on, then the bat‑ teries should be replaced immediately (4x commer‑ cially available 1.5V LR03 (AAA) batteries). You can continue measuring until the tonometer switches off automatically.

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• • •

does not produce any unpleasant sensations. With appropriate anesthesia and well-opened eyes, the patient does not feel anything. This is why a test measurement is first carried out on both eyes. The results are discarded and three further measurements are then conducted on each eye. The values are correct if the pressure has stabilized. If the correct procedure is used, the range of results will be of ± 0.5 mm Hg. A measurement that takes a longer time may result in some drying of the corne‑ al epithelia in both eyes. A fluorescein-containing ring is formed on the eye that is being measured around the spots where the measuring prism makes contact with the cornea. On the other eye, irregular, 'map-like', fluorescein-containing dry patches are formed that prevent usable measurements from being taken. Extensive dryness disappears quickly without treatment. Visual acuity is affected by these slight epi‑ thelial defects. WARNING! Reusable measuring prisms must be cleaned and disinfected after ev‑ ery examination.

5.2 Astigmatism • If the cornea is spherical, measurements can be taken on any meridian, but it is most convenient to measure on the 0° meridian.

• However, the choice of meridian is significant when measuring eyes with corneal •

astigmatism greater than 3 dioptres, since the flattened area is not circular, but elliptical. It has been calculated that, in cases of greater corneal astigmatism, a surface of 7.354 mm2 (ø 3.06 mm) is applanated if the measuring prism is at an angle of 43° (A) to the meridian of the greatest radius.

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Example: If the corneal astigmatism measures 6.5 mm / 30° = 52.0 dpt / 30° and 8.5 mm / 120° = 40.0 dpt / 120° the 120° graduation mark on the prism is set on the mark (A) of the prism holder.

PORTUGUÊS (A) 43°

If, on the contrary, the measurements are 6.5 mm / 120° = 40.0 dpt / 120° and 8.5 mm / 30° = 52.0 dpt / 30° then the 30° graduation mark is set on the mark (A), meaning that simply the axis position of the largest radius is placed on the mark (A).

5.3

How pressure is measured

The applanation tonometer functions according to the 'Goldmann method': mea‑ surement of the pressure required to maintain a uniform applanation of the surface of the cornea.

• The readings obtained are based on the assumption that a cornea with a 'nor‑ •

mal' thickness is being measured; a different corneal thickness leads to changes in the measured IOP. A 'normal' corneal thickness is considered to fall within the range of 530 to 560 micrometers. If it is suspected that measuring results may be inaccurate, please conduct a functional verification in accordance with the 'Maintenance' chapter.

5.4

Preparing the patient

NOTE! A smooth operation can only be guaranteed with the use of original HAAG‑STREIT measuring prisms and Tonosafe. Should the measuring prism come into contact with the cornea without the correct pressure having been previously set, vibrations may occur in the sensor arm that could be unpleasant for the patient.

1. Anesthesia for both eyes. 2. Use fluorescein if necessary. 3. The correct eye height of the patient can be set via the chin rest.

5.4.1 Patient instructions

1. Press the head firmly against the chin and forehead rests and use a headband to fix the head’s position, if necessary. © HAAG-STREIT AG, 3098 Koeniz, Switzerland - HS-Doc. No. 1500.7220067.04160 – 16. Edition / 2016 – 12

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2. The patient must look straight forward. If necessary, the small fixing light can be used to steady the eyes. 3. It is recommended that the patient be repeatedly reminded to keep his eyes open wide during the examination. It might be necessary for the examiner to keep the eye open by splaying the eyelids with thumb and index finger. This must be done without applying any pressure to the eye. In this case, the angle between the microscope and the illumination apparatus is reduced to approxi‑ mately 10° for the models AT 900 D model T, whereby the light beam is guided through the prism body. A non-reflecting image should be attempted.

5.5

Preparing the tonometer

For all HAAG‑STREIT slit lamps and tonometers 1. The eyepiece adjustment is to be checked before the examination. 2. Set the magnification to 10x. 3. Set the power supply/illumination potentiometer to the lowest setting. 4. Position the blue filter in the beam path of the slit lamp's illumination apparatus and open the slit diaphragm fully. 5. Insert the disinfected measuring prism into the (0° position) holder on the sen‑ sor arm. For Tonosafe, see the separate instructions for use. 6. Snap the sensor arm into place so that the axes of the measuring prism and of the microscope align. 7. Switch on the tonometer and set a value between 5 and 10 mm.

5.5.1 AT 900 D model R and AT 900 D model BQ

1. Swing the illumination apparatus to the left. 2. Release the tonometer from the dwell position to the right of the microscope and swing it forward until it locks into the measuring position. 3. From the left, bring the illumination apparatus into contact with the tonometer bearer arm. This is the only illumination position in which both the patient’s left and right eyes can be easily examined (no 60° position). This arrangement fa‑ cilitates the splaying of the patient’s eyelids, should this be necessary for mea‑ surement. The illumination of the applanated surface through the measuring prism is practically reflection-free. Observation:

with AT 900 D model R in the left eyepiece with AT 900 D model BQ in the right eyepiece

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ENGLISH

DEUTSCH

FRANÇAIS

ITALIANO

ESPAÑOL

5.5.2 AT 900 D model T

1. For an examination through the tonometer’s left or right eyepiece, the angle be‑ tween the illumination instrument and the microscope should be approx. 60° so that the image is bright and reflection-free. Another possibility: illumination from behind at about 10°.

5.6

PORTUGUÊS

NEDERLANDS

16

SVENSKA 17

Measuring correctly

1. Immediately before taking measurements, the patient should close his eyes briefly so that the cornea becomes sufficiently moistened with fluorescein-im‑ pregnated tear fluid. 2. By moving the slit lamp, the measuring prism comes into contact with the center of the cornea over the pupillary area. During contact, the cornea's limbus takes on a bluish glow. This glow can be best observed with the naked eye from the opposite side of the illumination apparatus. When the limbus glows, stop mov‑ ing the slit lamp immediately. 3. After contact is made, viewing is conducted through the microscope. The uni‑ form pulsation of the two semicircular fluorescein bands, which could be of dif‑ ferent sizes in drum setting 1 depending on the inter-ocular pressure, shows that the tonometer is in the right measuring position. Any necessary corrections are made using the slit lamp control lever, until the flattened surface is observed in the form of two semicircles of similar size in the middle of the visual field (16). Smaller changes in the depth of the slit lamp using the control lever do not af‑ fect the size of the semicircles. 4. The pressure on the eye is increased by turning the tonometer knob until the in‑ ner borders of both fluorescein bands just touch = correct setting (17). When the eye pulsates, both semi circles cross over each other. The width of the fluorescein band around the contact point of the measuring prism should be about 1/10 of the diameter of the applanation surface (0.3 mm). 5. Display value in mmHg. NOTE! If the tonometer is too close to the eye, the color of the LED changes to red and a warning tone alerts the user to the fact that he has left the measuring range and the sensor is in the safety distance. 12

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5.7

Sources of error

Fluorescein band incorrect Wrong distance to patient Position too far to the right/left Position too high/low Incorrect pressure

Ocular images 1–2 3–9 5–9 10 – 14 15 – 18

Fluorescein band too wide (1)

1

The measuring prism was not dried after cleaning or the eye‑ lids came into contact with the measuring prism during mea‑ surement. The slit lamp must be pulled back and the measuring prism dried with a lint-free cloth (e.g., made of cellulose). Fluorescein band too small (2)

2

The tear fluid has dried up during a prolonged measuring pro‑ cess. Allow the patient to close his/her eyes a few times and then repeat the measurement.

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SVENSKA

NEDERLANDS

PORTUGUÊS

5.7.1 Incorrect distance to the patient

3

7

Measuring prism not centered on the eye; eye still too far to the left.

8

Using the control lever, move the slit lamp to the left. 4

Correct setting! (9)

9

Two semicircles appear exactly in the middle of the eyepiece.

5.7.3 Position too high/low

Only part of a semicircle in the upper half (10) 5

Measuring prism not centered on the eye, eye much too far to the right.

10

Measuring prism not centered on the eye; eye far too high. Using the control lever, move the slit lamp upwards.

Using the control lever, move the slit lamp to the right. Whole upper semicircle – part of the lower semicircle (6)

ENGLISH

Measuring prism not centered on the eye; eye much too far to the left.

The image does not change when the measuring drum is turned. Pull the slit lamp back until the uniform pulsations of a correspondingly smaller surface show the correct measuring position and pressure changes immediately cause applanation surface changes. Only part of the upper semicircle (5)

DEUTSCH

Only part of the lower semicircle (8)

Only parts of both oversize semicircles are visible (4)

5.7.2 Position too far to the right/left

FRANÇAIS

Using the control lever, move the slit lamp to the left.

Use a headband if necessary.

If the slit lamp is pushed too far against the patient, or if the patient moves toward the slit lamp, the sensor arm will push against a spring stop. The applanation surface is too large.

ITALIANO

Whole lower semicircle – part of the upper semicircle (7)

No semicircular image, only center line is visible (3) The measuring prism is not coming into contact with the cor‑ nea! If the patient draws his/her head back slightly, irregular pul‑ sations will be caused because the measuring prism is touching the eye only intermittently. If the patient pulls back even further, the fluorescein rings will disappear completely.

ESPAÑOL

Complete circle in the upper half (11) 6

11

Measuring prism not centered on the eye; eye still too high.

Measuring prism not centered on the eye, eye still too far to the right.

Using the control lever, move the slit lamp upwards.

Using the control lever, move the slit lamp to the right.

Nearly entire circle above, incomplete circle below (12)

12

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Using the control lever, move the slit lamp upwards.

13

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ENGLISH

DEUTSCH

FRANÇAIS

ITALIANO

Two incomplete circles, the larger one on top (13)

ESPAÑOL

PORTUGUÊS 13

Measuring prism not centered on the eye; eye still too high. Using the control lever, move the slit lamp upwards. Correct setting! (14)

14

Two semicircles appear exactly in the middle of the eyepiece.

5.7.4 Incorrect pressure

The outside borders of the fluorescein bands are in contact with each other (15) Not enough pressure.

Software / Help menu / Error messages

6.1

Error messages on the tonometer display

The software's help section contains instructions and help for performing an exami‑ nation and descriptions of the error messages. The help can be opened via the F1 key or in the [?] - [Help] menu. WARNING! The software must be installed by trained personnel in accordance with separate installation instructions.

15

16 to

Increase the pressure slightly more by rotating the knob on the tonometer. 17

Pressure is too high. Lower the pressure by rotating the tonometer knob in the opposite direction. Correct setting! (18) The inside borders of the fluorescein bands are contacting each other.

14

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Description

Measures

The measurement is outside the permitted tolerances. The position of the sensor arm is defective.

If one of these errors appears per‑ manently, send the device to the corresponding service branch.

The minimum operating voltage Replace the dead batteries. has not been achieved; the device switches off.

Pressure slightly too low.

Bands are no longer in contact (17)

SVENSKA

6.

Increase the pressure slightly by rotating the knob on the tonometer. Fluorescein bands are superimposed to form a band (16)

NEDERLANDS

18

7.

Battery voltage too high. Incorrect battery type fitted.

Insert the correct batteries.

The tonometer electronics is de‑ fective.

If one of these errors appears per‑ manently, send the device to the corresponding service branch.

Technical data

Generation of measuring force through leverage weight. Measurement range 5 ― 70 mm Hg Measurement de- The measurement deviation in the measuring prism is in the measuring viation range from 4.91 – 58.84 mN and amounts to a maximum of ±1.5% and to a minimum of ±0.49 mN of the nominal value. Backlash width ≤0.49 mN Net weight AT 900 D model R 0.500 kg (without accessories) AT 900 D model T 0.330 kg (without accessories) AT 900 D model BQ 0.550 kg (without accessories) Batteries 4 x LR03 (AAA) 1.5 V Bluetooth Contains TX IC: 1520A-LMX9838 Contains TX FCC ID: EDQLMX9B38 © HAAG-STREIT AG, 3098 Koeniz, Switzerland - HS-Doc. No. 1500.7220067.04160 – 16. Edition / 2016 – 12

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SVENSKA

AT 900 D model R

AT 900 D model T

1. Nominal value 2. Maximum limiting deviation 3. Limiting deviation of 0 to 32.66 mN: Maximum = 0.49 mN 4. Limiting deviation from 32.67 mN: Maximum = 1.5% of nomi‑ nal value

8.

Maintenance

8.1

Repairs

NEDERLANDS

0 mN

PORTUGUÊS

ESPAÑOL

ITALIANO

FRANÇAIS

DEUTSCH

ENGLISH

AT 900 D model BQ 32.66 mN

(2) + 0.49 mN (1) - 0.49 mN

(3)

(4)

(2)

WARNING! Installation, repairs and modifications may only be performed by trained specialists.

To ensure a long service life, the device must be cleaned every week as described and covered with a dust cover when not in use. We recommend having the device checked annually by an authorised service technician.

8.2 Cleaning • Clean the housing with a dry cloth. • Do not use any liquids, corrosive substances or alcohol.

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ENGLISH

8.3

DEUTSCH

FRANÇAIS

ITALIANO

ESPAÑOL

Checking the tonometer AT 900 D

NOTE! This check must be carried out once a month. If the check yields erro‑ neous results, please check the following points:

1. Is the measuring prism properly positioned? 2. Is the control weight correctly set? 3. Repeat the check. Defective equipment must be sent immediately to your HAAG‑STREIT represent‑ ative. NOTE! HAAG‑STREIT offers a repair and service package. For further infor‑ mation, please contact your HAAG‑STREIT representative directly.

PORTUGUÊS

NEDERLANDS

SVENSKA (a)

60 mm Hg 20 mm Hg 0 mm Hg 20 mm Hg 60 mm Hg

NOTE! This is the most important test because measurement of inter-ocular pressure in this area is of critical importance. Test at 20 mm Hg A control weight is used for the check. The weight rod is engraved with five rings. The middle ring corresponds to 0 mmHg, the rings immediately to its left and right correspond to a value of 20 mmHg, and both outside scale rings have a value of 60 mmHg. One of the test position marks (20 or 60 mmHg) is set exactly to the index line on the holder. The weight is fitted on the feeler axis (a) so that the longer part points to the examiner. Check position 19.5 The sensor arm must not move from the free-movement area toward the limit stop in the direction of the examiner before the display shows 19.5 mmHg or after the display shows 20.5 mmHg. Check position 20.5 The sensor arm must not move from the free-movement area toward the limit stop in the direction of the patient before the display shows 20.5 mmHg or after the dis‑ play shows 19.5 mmHg.

16

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SVENSKA

NEDERLANDS

ESPAÑOL

PORTUGUÊS

ITALIANO

FRANÇAIS

DEUTSCH

ENGLISH

Test at 60 mm Hg Set the weight rod to 60 on the scale so that the longer part points to the examiner. Check position 59 The sensor arm must not move from the free‑movement area toward the limit stop in the direction of the examiner before the display shows 59.0 mmHg or after the display shows 61.0 mmHg. Check position 61 The sensor arm must not move from the free‑movement area toward the limit stop in the direction of the patient before the display shows 61.0 mmHg or after the dis‑ play shows 59.0 mmHg.

8.4

Changing the battery

1. Push the HAAG‑STREIT logo (HS) on the side of the digital display carefully downward and remove the battery lid by tilting it backward. 2. Pull the tab at the bottom of the battery compartment carefully. The batteries are released from the holder and can be easily removed. WARNING! • Pay attention to the polarity when inserting the batteries. • Always replace all the batteries with new ones • Only use type LR03 (AAA) batteries. • Never mix old and new batteries. WARNING! Pay attention to the polarity when inserting the batteries. 3. Pay attention to the correct order as written in the compartment when inserting the batteries. 4. Once you have replaced the batteries, close the lid again carefully. Insert the centering tab at the bottom of the battery lid into the corresponding groove in the housing and close the lid by tilting it upward. 5. Gently press the lid upward against the housing and lock the battery compart‑ ment by pushing the HAAG‑STREIT logo back up again. NOTE! Dispose of used batteries properly. © HAAG-STREIT AG, 3098 Koeniz, Switzerland - HS-Doc. No. 1500.7220067.04160 – 16. Edition / 2016 – 12

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1.

2.

3. 5.

4.

17

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ENGLISH

DEUTSCH

A.

Appendix

C.

Accessory original HAAG‑STREIT measuring prism

Operating mode: CE Directive 93/42/EEC FDA

A.1

FRANÇAIS

ITALIANO

NOTE! Order numbers are written in italics An asterisk (*) shows that you should contact your HAAG‑STREIT rep‑ resentative for further information.

The original HAAG‑STREIT measuring prisms are made of PMMA and guarantee the best optical and mechanical quality. Reusable measuring prisms must be cleaned and disinfected after every examination. See Chapter '1.6.1, Cleaning and dis‑ infecting the measuring prism' and the separate instructions for use. HS art. no. 7220316

A.2

ESPAÑOL

2015 - 10

Accessory tonosafe

Tonosafe disposable prisms are a comfortable and effective solution to reduce the risk of cross-infection in patients. Tono‑ safe is available in sterile packages with 5 supports and 100 disposable prisms. HS art. no. 7220345 HS art. no. 7220346 (USA)

B.

PORTUGUÊS

NEDERLANDS

SVENSKA

Classification

Standard EN 60601-1

D.

Disposal

E.

Standards

Applanations tonometer in accordance with protection class I. Continuous operation Class Im (measuring function) Class II

Electrical and electronic devices must be disposed of separately from household waste! This appliance was made available for sale after the 13th August 2005. For correct disposal, please contact your HAAG-STREIT representative. This will guarantee that no hazardous substances enter the environment and that valuable raw materials are recycled. EN 60601-1 EN 60601-1-2

EN ISO 8612 EN ISO 15004-1

Legal regulations

• HAAG‑STREIT maintains a quality management system in accordance with EN • •

ISO 13485. The device was developed and designed in observance of all the standards listed in section 'EMC'. The tonometer AT 900 D is a Class I device with measurement function in accor‑ dance with Appendix IX of Directive 93/42/EEC. By affixing the CE mark we con‑ firm that our device complies with the applicable standards and directives. You can request a copy of the declaration of conformity for the appliance from HAAG‑STREIT at any time.

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SVENSKA

F. F.1

NEDERLANDS

PORTUGUÊS

Information and manufacturer's declaration regarding electromagnetic compatibility (EMC) General

The Tonometer AT 900 D system fulfills the requirements on electromagnetic com‑ patibility according to EN 60601-1-2. The instrument is built so that the generation and emission of electromagnetic interference is limited to the extent that other de‑ vices are not disturbed in their use in accordance with the regulations and so that it itself is suitably immune to electromagnetic interference.

F.2

ESPAÑOL

ITALIANO

FRANÇAIS

DEUTSCH

ENGLISH

WARNING! ••In terms of EMC, electrical medical devices and systems are sub‑ ject to special measures and must be installed in accordance with the EMC information contained in this instructions for use. ••Portable and mobile HF communication systems may interfere with electrical medical devices. WARNING! ••Connecting third-party systems to the same extension cable can com‑ promise the system's safety. ••Any third-party device must be connected in compliance with the EN 60601-1 standard.

Emitted interference (standard table 1)

Guidance and manufacturer's declaration – electromagnetic emissions This product is intended for use in the electromagnetic environment specified below. The customer or the user of this product should assure that it is used in such an environment. Emission test RF emissions CISPR 11

Compliance Group 1

RF emissions CISPR 11

Class B Not applicable

Emission of harmonics according to EN 61000-3-2 Voltage fluctuations / flicker emissions according to EN 61000-3-3

Electromagnetic environment - guidance This product uses RF energy only for its internal function. Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment. This product is suitable for use in all establishments, including domestic establishments and those directly connected to the public low-voltage power supply network that supplies buildings used for domestic purposes.

Not applicable

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ENGLISH

F.3

DEUTSCH

FRANÇAIS

ITALIANO

ESPAÑOL

PORTUGUÊS

NEDERLANDS

SVENSKA

Immunity (standard table 2)

Guidance and manufacturer's declaration – electromagnetic immunity This product is intended for use in the electromagnetic environment specified below. The customer or the user of this product should assure that it is used in such an environment. Immunity test standard Electrostatic discharge (ESD) EN 61000-4-2

EN 60601 test level ± 6 kV contact ± 8 kV air

Compliance level ± 6 kV contact ± 8 kV air

Electrical fast transient / burst EN 61000-4-4 Surge EN 61000-4-5 Voltage dips, short interruptions and voltage variations on power supply lines EN 61000-4-11

Not applicable

Not applicable

Not applicable

Not applicable

Not applicable

Not applicable

Power frequency (50/60Hz) magnetic field EN 61000-4-8

3 A/m

30 A/m

Electromagnetic environment – guidance Floors should be wood, concrete or ceramic tile. If floors are covered withs ynthetic material, the relative humidity should be at least 30%. Mains power quality should be that of a typical commercial or hospital environment. Mains power quality should be that of a typical commercial or hospital environment. Mains power quality should be that of a typical commercial or hospital environment. If the user of this product requires continued function even in the event of interruptions in the energy supply, this product should be powered from an uninterruptible power supply or a battery. Power frequency magnetic fields should be at levels characteristic of a typical location in a typical commercial or hospital environment.

NOTE: UT= the AC mains voltage prior to application of the test level.

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