AR-330A Operators Manual Dec 2005

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Use this device properly and safely.

BEFORE USE, READ THIS MANUAL. This operator’s manual contains information necessary for the operation of the NIDEK AUTO REFRACTOMETER Model AR-330A. This manual includes the operating procedures, safety precautions, and specifications. This manual is necessary for proper use. Especially, the safety precautions and operating procedures must be thoroughly understood prior to operation of the device. Keep this manual handy to verify use whenever necessary. The device complies with ISO 10342 (Ophthalmic instruments-Eye Refractometers). The dioptric powers are indicated with reference wavelength λd = 587.56 nm. There are no user-serviceable parts inside the device except printer paper. If you encounter any problems or have questions about the device, please contact NIDEK or your authorized distributor.

Safety precautions In this manual, a signal word is used to designate the degree or level of safety alerting. The definition is as follows.

CAUTION • Indicates a potentially hazardous situation which, if not avoided, may result in minor or moderate injury or property damage accident.

Even situations that are labeled “ CAUTION” may result in serious injury under certain conditions. Safety must be followed strictly at all times.

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Usage precautions

Before use CAUTION • Do not use the device for other than the intended purpose.

NIDEK is not responsible for accidents or malfunctions caused by careless use.

• Be sure to read the manual prior to operation of the device to understand the safety precautions and operating procedures thoroughly. Using the device for purposes other than specified in this manual may cause unexpected malfunctions and/or adverse events. • Never disassemble nor touch the inside of the device. This may result in electric shock or malfunction. • Install the device in an environment that meets the following conditions. The following conditions must be maintained during use. Use conditions Temperature: +10 to +35°C Humidity: 30 to 75% (Non-condensing) Pressure: 800 to 1060 hPa A dust-free location A place with little external light A level and stable surface free from vibration and shock If the device is not installed and used under the above conditions, the reliability of measured results is impaired, and malfunction may result. In addition, there is a possibility of injury if the device receives shock and falls down. • Avoid storing the device where it is exposed to rain or water, or poisonous gas or liquid is present. Corrosion or malfunction of the device may occur. • Avoid installing the device where it is exposed to direct air-conditioning flow. Changes in temperature may result in condensation inside the device or adversely affect measurements. • Be sure to use a wall outlet which meets the power specification requirements. If the line voltage is too high or too low, the device may not perform properly. Malfunction or fire may occur. • Connect the power plug to a ground outlet. Or connect a grounding wire to a ground terminal. Electric shock or fire may occur in the event of device malfunction or power leakage. • Completely insert the power plug into the outlet as far as the prongs will go. Fire may occur if the device is used with a loose connection.

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CAUTION • Never use a table tap or extension cable to supply the device with power. The electrical safety may be lowered.

• Do not use a power cord other than the one supplied. Also do not connect the supplied power cord to any other device. Failure or fire may result. • Do not place heavy objects on the power cord. The damaged power cord may cause fire or electric shock. • Before connecting the cable, turn off the power switch and disconnect the power cord from the outlet. Malfunction of the device may result. • When the device is carried, two persons should hold (A) and (B) (both right and left sides). Avoid lifting by the forehead rest and main body; hold the bottom of the base. If only one person carries the device, or areas other than the base are used for lifting and the device falls, there is a possibility of injury or malfunction.

(A)

(B)

• To transport the device, use the special packing materials to protect the device from impact of dropping. Excessive vibration or impact to the device may cause malfunction. • In installation and operation of the device, observe the following instructions about EMC (electromagnetic compatibility): - Do not use the device simultaneously with other electronic equipment to avoid electromagnetic interference with the operation of the device. - Do not use the device near, on, or under other electronic equipment to avoid electromagnetic interference with the operation of the device. - Do not use the device in the same room with other equipment such as life-support equipment, other equipment that has major affects on the life of the patient and results of treatment, or other measurement or treatment equipment that involves small electric current. - Do not use the device simultaneously with portable and mobile radio frequency communication systems because it may have an adverse effect on operation of the device. - Do not use cables and accessories that are not specified for the device because that may increase the emission of electromagnetic waves from the device or the system and decrease the immunity of the device to electromagnetic disturbance. • The Electromagnetic Compatibility Directive sets the essential requirements for electrical and electronic equipment that may disturb, or be disturbed by, other equipment. The AR-330A complies with these requirements as tabled on pages 85 to 88. Follow the guidance in the tables for use of the device in an electromagnetic environment.

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During use CAUTION • Before use, perform visual and operation checks. If abnormal conditions are encountered, stop using the device.

If the device is used under abnormal conditions, intended results may not occur. Also unexpected malfunctions or health hazards may occur due to improper measurement. • Be sure to connect a communication cable, checking the symbols of input (IN: and output (OUT:

)

).

Data transmission may not be performed properly. • Every time before treating a different patient, clean the patient’s contact area (chin rest and forehead rest) using disinfectant alcohol. If chinrest paper is used, remove one piece for each patient. • Keep the measuring window free of fingerprints and dust. The measurement accuracy may decrease substantially. • In the event of smoke or strange odors, immediately turn off the device and disconnect the power plug from the outlet. After you are sure that the smoke has stopped, then contact NIDEK or your authorized distributor. Usage of the device under such abnormal conditions may cause fire or electric shock. In case of fire, use a dry chemical (ABC) extinguisher to extinguish the fire.

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CAUTION • Immediately replace the power cord if the internal wires are exposed, the device turns

on or off when the power cord is moved, or the cord and/or plug are too hot to be held with hands. This may result in electric shock or fire. In the event of malfunction, disconnect the power cord from the wall outlet. Never touch the inside of the device and contact NIDEK or your authorized distributor.

• Never press the LCD display with a hard object such as a ball-point pen. Keep magnetic objects away from the LCD display. The device may be damaged. • Do not operate the LCD display with wet hands. Water seeping into the device may result in failure of the device. • There may be a few constantly-lit, missing, or dead pixels in your LCD which are a characteristic of the LCD. This does not represent failure of the LCD; continuously use the display. • This device has been tested and found to comply with the limits for medical devices to the IEC 60601-1-2: 2001, and Medical Device Directive 93/42/EEC. These limits are designed to provide reasonable protection against harmful interference in a standard medical installation. This device generates, uses and can radiate radio frequency energy and, if not installed and used in accordance with the instructions, may cause harmful interference to other devices in the vicinity. However, there is no guarantee that interference will not occur in a particular installation. If this device does cause harmful interference to other devices, which can be determined by turning the device off and on, the user is encouraged to try to correct the interference by one or more of the following measures: If this device does cause harmful interference to other devices, which can be determined by turning the device off and on, the user is encouraged to try to correct the interference by one or more of the following measures: Reorient or relocate the receiving device. Increase the separation between the devices. Connect the device to an outlet on a circuit different from that to which the other device(s) are connected. Consult the manufacturer or field service technician for help. • The device is Class A (CISPR11 classification). It is allowed in domestic establishments when used under jurisdiction of a health care professional. • Never use the device with cables or accessories other than the designated ones. Malfunction caused by improper electromagnetic compatibility (EMC) characteristics may result. • Never use portable or mobile radio frequency (RF) devices in the vicinity of this device. These devices may adversely affect medical electrical equipment and malfunction may result.

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CAUTION • Information on the avoidance of overexposure to potentially hazardous optical radiation (ISO 15004: 1997)

Spectrally weighted photochemical radiances LB and LA give a measure of the potential that exists for a beam of light to cause photochemical hazard to the retina. LB gives the measure for eyes in which the crystalline lens is in place. LA gives this measure either for eyes in which the crystalline lens has been removed (aphakes) and has not been replaced by a UV-blocking lens or for the eyes of very young children. The value stated for this ophthalmic device gives a measure of hazard potential when the device is operated at maximum intensity and maximum aperture. The values of LA or LB for the AR-330A are sufficiently low as shown on the following page. The retinal exposure dose for a photochemical hazard is a product of the radiance and the exposure time. For instance, at a radiance level of 0.5 mW/(cm2zsr), 480 min irradiation of the dilated (8 mm diameter) pupil would cause the retinal exposure dose level to attain the recommended exposure limit. If the value of radiance were reduced to 0.1 mW/(cm2zsr), five times that time (i.e. 2400 min) would be needed to reach the recommended limit. The recommended exposure dose is based on calculations arising from the American Conference of Governmental Industrial Hygienists (ACGIH) - Threshold Limit Values for Chemical Substances and Physical Agents (1995 - 1996 edition). The following page shows the graph of spectrum output for the AR-330A. Patients will be at low risk of acute optical radiation with the AR-330A. However, it is recommended that the intensity of light directed into the patient’s eye be limited to the minimum level which is necessary for diagnosis. The total of the retinal exposure dose must be carefully watched for infants, aphakes and persons with diseased eyes who are at greater risk when other ophthalmic devices with a high level of radiance are used in conjunction. • Spectrum output of all light source during AR measurement (maximum light intensity)

㪈 㪇㪅㪐

Irradiance (μW/cm2)

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㪋㪇㪇

㪌㪇㪇

㪍㪇㪇

㪎㪇㪇

㪏㪇㪇

Wavelength (nm)

• Spectrum irradiance

LA (mW/cm2/sr) 380 - 700 nm

0.397

LB (mW/cm2/sr) 305 - 700 nm

0.053

LA: Spectrally weighted photochemical aphakic source radiance LB: Spectrally weighted photochemical phakic source radiance

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After use CAUTION • When the device is not in use, turn off the power switch and put the dust cover over the device.

If not, dust may affect the measurement accuracy. • Do not yank the power cord to disconnect it from a wall outlet but hold the plug. This can damage the metal core of the cord and may result in fire, short circuit or electric shock. • Occasionally clean the prongs of the main plug with a dry cloth. If dust settles between the prongs, the dust will collect moisture, and short circuit or fire may occur. • If the device will not be used for a long time, disconnect the power cord from the wall outlet. Fire may occur. • Maintain the surrounding temperature and humidity in the following ranges during transport and storage of the device. Environmental conditions Temperature: -20 to +55°C Humidity: 10 to 95% (non-condensing) Atmospheric pressure: 700 to 1060 hPa A dust-free location A place not exposed to direct sunlight • To transport the device, use the special packing materials to protect from shock and impact. Excessive vibration or impact may cause device malfunction.

Maintenance and check CAUTION • Only service technicians properly trained by NIDEK can repair the device.

NIDEK is not responsible for any accidents resulted from improper servicing.

• When performing maintenance work, secure sufficient maintenance space. Maintenance work in an insufficient space may result in injury. • When the device is sent back to NIDEK for repair or maintenance, wipe the surfaces (especially, the area where patients contact) of the device with a clean cloth dampened with ethyl alcohol for disinfection. • Contact NIDEK or your authorized distributor to check whether the device needs measurement accuracy calibration if the AR-measured results are substantially different from subjectively measured results.

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Disposal CAUTION • Follow the local ordinances and recycling regulations regarding disposal or recycling of the components.

It is recommended to commission the disposal to a designated industrial waste disposal contractor. • When disposing of packing materials, sort them by material and follow local ordinances and recycling regulations.

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{ Patient environment The patient environment represents a space where there is a possibility of direct contact between the patient or the operator and third person. When another type of device is used in the patient environment, use a device that complies with IEC 60601-1. If the devices that do not comply with IEC 60601-1 are used, it is necessary to use an isolating transformer as a power supply or to connect the devices to additional protective grounding.

Radius of 1.5 m

2.5 m

1.5 m

1.5 m

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Table of Contents 1. BEFORE USE... 1 1.1 Outline of the Device...1 1.2 Indications for Use...1 1.3 Principles...1 1.4 Configuration...2 1.5 Measurement Screen Description...6 1.6 Labels...10 1.7 Checking Contents...11 1.8 Before First Use...12

2. OPERATING PROCEDURES... 17 2.1 Operation Flow...17 2.2 Preparation for Measurement...18 2.2.1 2.2.2 2.2.3

Checking the measuring window for soiling at device start-up...24 Sleep mode...25 Finishing the measurement...25

2.3 AR (refractive error) Measurements...26 2.4 View Comparison Function...33 2.4.1

Importing LM data...37

2.5 PD (Pupillary Distance) Measurement...38 2.5.1 2.5.2

Auto-PD measurement...38 Manual PD measurement...38

2.6 Printing...40 2.6.1 2.6.2 2.6.3

Printing measured data...40 Eyeprint...43 Printing parameter settings...44

2.7 Parameter Settings...45 2.7.1 2.7.2 2.7.3

Parameter tables...48 Setting date and time...56 Entering comments...58

3. OPERATION WHEN PERIPHERAL DEVICES ARE CONNECTED... 61 3.1 Connecting to the NIDEK Motorized Refractor (RT) or Computer...61 3.1.1 3.1.2 3.1.3

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Outline...61 Connecting procedure...62 Operating procedure...62

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3.2 Connecting to the NIDEK Auto Lensmeter (LM)... 63 3.2.1 3.2.2 3.2.3

Outline... 63 Connecting procedure... 63 Operating procedure... 64

3.3 Reading Patient IDs... 65

4. MAINTENANCE... 67 4.1 Troubleshooting... 67 4.2 Error Messages and Countermeasures... 69 4.3 Replacing Printer Paper... 72 4.4 Fixing Chinrest Paper... 74 4.5 Checking the AR Measurement Accuracy... 75 4.6 Cleaning... 77 4.6.1 4.6.2

Cleaning the measuring window... 77 Cleaning the printer... 79

4.7 List of Replacement Parts... 80

5. SPECIFICATIONS AND ACCESSORIES... 81 5.1 Classifications... 81 5.2 Specifications... 82 5.3 Standard Configuration... 84 5.3.1 5.3.2

Standard accessories... 84 Optional accessories... 84

6. EMC (ELECTROMAGNETIC COMPATIBILITY)... 85 7. GLOSSARY... 89 8. INDEX... 91

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1. BEFORE USE 1.1

Outline of the Device

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The NIDEK AR-330A is an auto refractometer which objectively measures refractive errors of sphere, cylinder, and axis. Refraction is mainly performed as a reference for lens prescription to correct the visual acuity using glasses or contact lenses. This device is an integral unit with the main body mounted on a base. The base is provided with a chinrest on the patient side and an Eye Care card reader/writer that saves measured results on the operator side. The measuring unit is provided with an LCD display, operating buttons, joystick and printer for alignment and operation. The device offers the following features in addition to the above features: • For easy measurement, an auto-tracking mechanism is provided; the device automatically controls the up-and-down, right-and-left and back-and-forth movements for alignment and focusing. • An auto-shooting function is provided; measurements take place automatically when the device is best aligned and in focus. • A motorized up-and-down chinrest allows the operator to easily adjust the height of the chinrest. • An IC card (Eye Care card) reader/writer is included as standard equipment to cordlessely exchange data with other devices. • A built-in RS-232C interface allows data export to computers and such.

1.2

Indications for Use The model AR-330A Auto Refractometer is a diagnostic device that is indicated for use in the automated measurement of refractive errors of the eye.

1.3

Principles Fine measurement beams are projected on the fundus of the patient’s eye by a projecting optical system and then computation is performed by capturing its reflected beam as a ring image to measure the refractive errors (SPH, CYL, AXIS) of the patient’s eye.

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BEFORE USE: Configuration

1.4

Configuration

{ Front view

Function buttons

LCD display

Memory indicator

Start button

Locking lever

Joystick

Power switch Eye Care card slot

Cover open button Printer cover

Function buttons Used to set the device and switch the screen. Functions assigned to the function buttons are displayed by icons on the screen. Two buttons on the left of the screen have unique functions when the measurement screen is displayed. •Clear button (

)

Used to clear the measured data. When the clear button is pressed for about a second, all the measured data is erased.

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BEFORE USE: Configuration

•Print button (

)

If this button is pressed when the memory indicator is lit, the measured data is printed out. If this button is pressed when the memory indicator is not lit, the printer paper is fed.

LCD display

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5.7-inch LCD display. Pulling the bottom of the display panel provides an adjustable viewing angle. For measurement in a standing posture, set the panel at a suitable angle. The panel is reset to its original position by magnet.

Memory indicator Indicates that measured data is being stored in memory. ON

Being saved

OFF

Not being saved

Flashing

Sleep mode

Start button When the start button is pressed, measurement takes place regardless of the alignment and focusing condition of the device. Joystick Used for alignment and focusing. Alignment in the right and left directions can be performed by moving the joystick to the right and left. Rotating the joystick is for alignment in the up and down directions. For focusing, move the joystick back and forth.

Eye Care card slot Insert an Eye Care card. S, C, A values of both eyes and PD value can be saved. LM data used for the view comparison function can also be read from the Eye Care card. Insert Eye Care card before measurement.

Saved when data is printed.

Insert Eye Care card after measurement.

Saved when Eye Care card is inserted.

Locking lever Used to fix the main body to the base. To lock the main body, press the locking lever down.

Power switch This part turns on the power to the device. Printer cover Inside is the printer equipped with the auto cutter located. Open the printer cover for replacing printer paper by pressing the cover open button. Cover open button To open the printer cover, press this button.

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BEFORE USE: Configuration

{ Rear view Forehead rest Eye level marker

Measuring window Chinrest up/down buttons

Chinrest

PD window

Forehead rest During measurement, the patient’s forehead should be gently placed over the forehead rest. Clean the chinrest for each patient.

Measuring window Check the window for soiling before measurement. Chinrest Clean the chinrest for each patient. Eye level marker Used as a guide for the patient’s eye level during measurement. The height of the chinrest should be adjusted so that the center level of the patient’s eye almost aligns with this line.

Chinrest up/down buttons (

,

)

Used to move up or down the chinrest. PD window An LED that detects the PD value is located.

• Materials composed of parts that contact the patient during measurement are as follows: Forehead rest: synthetic rubber Chinrest: ABS resin

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BEFORE USE: Configuration

{ Bottom view

1

Inlet

RS-232C connectors

USB-A connector

Inlet Used to connect a detachable power cord. RS-232C connector Used to connect a communication cable to send/receive measured data to/from a diagnostic device or such. Connectable devices RT-1200 series, RT-2100 series, RT-5100 LM-970, LM-990/990A, LM-1000/1000P, LM-1200 (OUT)

To export measured data to the refractor (RT), an external computer or such, connect a communication cable to this side.

(IN)

To import measured data to from a NIDEK lensmeter, connect a communication cable to a lensmeter.

Connecting the lensmeter to the

side and the RT-2100 to the

side allows data transmission to the

connected refractor via the AR-330A.

USB-A connector Used to connect the optional barcode scanner. Do not connect equipment other than the barcode scanner.

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Accessory equipment connected to the analog and digital interfaces must be certified according to the representative appropriate national standards (for example, UL 1950 for Data Processing Equipment, UL 60601-1 for Medical Equipment, and CSA C22.2 No. 601-1, EN 60601-1, and IEC 60601-1.) Furthermore, all configurations shall comply with the system standard IEC 60601-1-1. Anyone who connects additional equipment to the signal input part or signal output part configures a medical system, and is therfore responsible that the system complies with the requirements of the system standard IEC 60601-1-1. If in doubt, cosult the technical service department or your local representative.

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BEFORE USE: Measurement Screen Description

1.5

Measurement Screen Description The screen for AR (refractive error) measurement has page 1 and page 2. The difference between page 1 and page 2 lies only in icons displayed to the right of the screen.

<When page 1 is displayed> Auto-tracking mark Auto-shooting mark Patient’s eye

CYL mode

View comparison button

ᵏ

PD button

Target

Focusing indicator

Auto button

CYL mode button

Min. pupil mark

Measured values

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Eye print button

Mire ring Page button

Patient’s eye Indicates the right or left eye of the patient. View comparison button (

)

Used to switch to the view comparison screen that presents the view corrected by AR measurement and uncorrected eye view (or that corrected by LM data). See “2.4 View Comparison Function” (page 33) for details of the view comparison function.

Target Used as a guide to locate the patient’s eye in the center of the screen. Align the mire ring projected on the patient’s eye with the target. Auto button (

)

Used to select the auto-tracking function and auto-shooting function. Select auto-tracking from 3D, 2D, or OFF. Select auto-shooting from ON or OFF.

Min. pupil mark Indicates the minimum pupil size measurable. Measurement may not be possible when the pupil is smaller than this mark or eyelashes are on this mark.

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BEFORE USE: Measurement Screen Description

Measured values Displays the latest measured results. A numeric value displayed on the right of the R/L indication represents the count of each measurement.

Auto-tracking mark Represents the setting of the auto-tracking function (alignment in the up, down, right and left directions and focusing in the back and forth directions). One of the following settings is displayed: 3D, 2D, or Manual (No indication). Auto-tracking in the back-and-forth, side-to-side and up-and-down directions is turned on. Auto-tracking in the side-to-side and up-and-down directions is turned on. (No indication)

Manually align the device and bring the eye into focus.

Auto-shooting mark Represents the setting of the auto-shooting function. Measurement starts automatically when the eye is aligned in the horizontal and vertical directions and the eye is focused. (No indication)

Press the start button to start measurement.

CYL mode Represents the selected cylinder mode. PD button (

)

Used to switch from AR measurement to manual PD (pupillary distance) measurement. Pressing the PD button to switch to the manual PD measurement screen. To return from PD measurement to AR measurement, press the exit button

.

Focusing indicator Indicates the distance between the main body and the patient’s eye. Operate the joystick until the optimum condition (

CYL mode button (

) is displayed.

)

Used to switch cylinder mode. CYL-

Indicates cylindrical power by - reading.

CYL+

Indicates cylindrical power by + reading.

CYL±

Cylinder data is indicated by + reading when the refractive error is positive for any axis angle. Indicates the cylindrical power by - reading in other cases.

Cylinder mode can be switched even after measurement. Data is printed out with the mode status at the time of printing.

Eye print button (

)

Prints the eyeprint view of measured data. An eyeprint(s) is printed out regardless of its parameter setting. See “2.6.2 Eyeprint” (page 43) for details of eyeprints.

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