SIRIUS - Users SW Manual Phoenix (CSO) - V1.0

PHOENIX
User’s Manual
Phoenix Manual
Phoenix Manual– v.0.2
Contents
CONTENTS ............................................................................................................................. III
1 PHOENIX PROGRAM START-UP .................................................................................... 7
1.1 File Menu ..................................................................................................................................... 8
2 PATIENTS DATABASE .................................................................................................... 9
2.1 Patients List ............................................................................................................................... 10
2.2 Patient Data ............................................................................................................................... 10
2.3 Editing Patient Data.................................................................................................................. 11
2.4 Selecting a Patient ..................................................................................................................... 11
2.5 Advanced Search ....................................................................................................................... 12
2.6 Delete Patient ............................................................................................................................. 13
3 EXAMINATIONS DATABASE ........................................................................................ 14
3.1 New Exam .................................................................................................................................. 14
3.2 Selecting an Examination ......................................................................................................... 14
3.3 Editing Examination Data ........................................................................................................ 14
3.4 Deleting an Examination .......................................................................................................... 15
3.5 Refraction .................................................................................................................................. 15
3.6 Capture ...................................................................................................................................... 16
3.7 Image Gallery ............................................................................................................................ 16
4 CAPTURE OF SCHEIMPFLUG IMAGES ....................................................................... 18
4.1 Focusing ..................................................................................................................................... 18
4.2 Centering.................................................................................................................................... 21
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4.3 Capture ...................................................................................................................................... 21
5 SUMMARY ...................................................................................................................... 22
5.1 Menus ......................................................................................................................................... 22
5.2 Scale ............................................................................................................................................ 33
5.3 Local Values............................................................................................................................... 34
5.4 Using the Right Mouse Key ...................................................................................................... 35
5.5 Patient Data ............................................................................................................................... 35
5.6 Indices Panel .............................................................................................................................. 35

5.6.1 Summary Indices..................................................................................................................... 35
5.6.2 Keratometries (Anterior) ......................................................................................................... 36
5.6.3 Keratometries (Posterior) ........................................................................................................ 39
5.6.4 Corneal asphericity ................................................................................................................. 39
5.6.5 Keratorefractive Indices .......................................................................................................... 41
5.6.6 Keratoconus Screening ........................................................................................................... 42
6 IMAGES .......................................................................................................................... 45
7 SINGLE MAP .................................................................................................................. 48
7.1 Map Selection ............................................................................................................................ 48

7.1.1 Corneal Thickness ................................................................................................................... 49
7.1.2 Anterior Tangential Map ......................................................................................................... 51
7.1.3 Posterior Tangential Map ........................................................................................................ 52
7.1.4 Anterior Sagittal Map.............................................................................................................. 52
7.1.5 Posterior Sagittal Map ............................................................................................................. 53
7.1.6 Anterior Elevation Map .......................................................................................................... 53
7.1.7 Posterior Elevation Map.......................................................................................................... 54
7.1.8 Frontal Anterior Refraction Map ............................................................................................ 54
7.1.9 Frontal Posterior Refraction Map ........................................................................................... 55
7.1.10 Equivalent Refraction Map ................................................................................................. 55
7.2 3D Map ....................................................................................................................................... 55
8 MULTI-MAP .................................................................................................................... 58
9 OPTICAL ANALYSIS OF THE CORNEA ....................................................................... 59
10 MORPHOLOGICAL SUMMARY ................................................................................. 61
11 DIFFERENTIAL MAPS ................................................................................................ 63

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11.1 Differential Keratometric Indices............................................................................................ 65
12 MAPS COMPARISON ................................................................................................. 66
13 ADVANCED ALTIMETRY ........................................................................................... 69
13.1 Aspherotoric Fitting (Anterior and Posterior) ....................................................................... 70

13.1.1 Scale .................................................................................................................................... 70
13.1.2 Reference surface ................................................................................................................ 71
13.1.3 Position of the surface ......................................................................................................... 72
13.2 Zernike Altimetry Analysis (Anterior and Posterior) ........................................................... 73

13.2.1 Scale .................................................................................................................................... 73
13.2.2 Fitting Parameters ............................................................................................................... 74
13.2.3 Indices ................................................................................................................................. 76
14 CORNEAL ABERROMETRY ...................................................................................... 77
14.1 Zernike Summary ..................................................................................................................... 77

14.1.1 Menus .................................................................................................................................. 78
14.1.2 RMS and Pupil Diameter .................................................................................................... 82
14.1.3 Scale .................................................................................................................................... 82
14.1.4 Zernike Polynomials ........................................................................................................... 83
14.1.5 Icons .................................................................................................................................... 83
14.2 Visual Quality Summary .......................................................................................................... 83

14.2.1 Menus .................................................................................................................................. 84
14.2.2 OPD ..................................................................................................................................... 88
14.2.3 Thibos Pyramid ................................................................................................................... 88
14.2.4 PSF ...................................................................................................................................... 90
14.2.5 Spot Diagram ...................................................................................................................... 91
14.2.6 Visual Acuity ...................................................................................................................... 92
14.2.7 MTF .................................................................................................................................... 95
15 WAVEFRONT COMPARISONS .................................................................................. 99
16 CONTACT LENSES AUTOFIT .................................................................................. 101
16.1 Menus ....................................................................................................................................... 101
16.2 Lenses Management Icons...................................................................................................... 101
16.3 Scale .......................................................................................................................................... 107
16.4 Using the Mouse Pointer and the Reference Cross on the Lens ......................................... 108
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16.5 Refraction ................................................................................................................................ 108
16.6 Select Lens ............................................................................................................................... 109
16.7 Top 10 ....................................................................................................................................... 110
16.8 Customize Lens ....................................................................................................................... 110
17 PUPILLOGRAPHY .................................................................................................... 112
18 SETTINGS ................................................................................................................. 113
18.1 Language .................................................................................................................................. 113
18.2 Groups ...................................................................................................................................... 113
18.3 Miscellaneous (Other) ............................................................................................................. 114
18.4 Instruments .............................................................................................................................. 116
18.5 Calibrations ............................................................................................................................. 117

18.5.1 Sirius Calibration .............................................................................................................. 117
18.6 DICOM (Digital Imaging and COmmunications in Medicine) .......................................... 122
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1 Phoenix Program Start-up

Click the Phoenix icon on the desktop. The screen shown below will appear, asking the user to send an
e-mail containing the code for unlocking the software.
Figure 1-1: Registration Screen

The main screen will open.
Figure 1-2: Main Screen of the Phoenix Program
This first screen allows the user to manage the database of patients and the examinations associated
with each. It is made up of various sections and menus.
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When the program is launched, all the windows are empty.
1.1 File Menu
Settings
Allows the user to select the software language, manage groups and instruments, and make
other settings (see Chapter 18). This menu may be accessed only if the patient list is not
displayed. If patients are displayed in the list, click [Clear Patient List] to enable the
Settings function.
Esc
Exits and closes the program.
Figure 1-3: Confirm Exit from Program
Selecting the suitable box on the Settings/Other menu (see Chapter 18), displays a request for
confirmation of exit from program. Click Yes to exit or No to continue using the program.
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2 Patients Database
Figure 2-1: Search Panel
Each patient is identified by Last Name, First Name, and an Identification Code that is automatically
generated by the program.
To locate a patient in the Database, type the Last Name and First Name in the Patient Box or type the
Identification Code.
To select a search criterion, click the button alongside Last Name, First Name or alongside the
Identification Code.
To view a patient, type his/her Last Name, First Name (or Identification Code) in the Patient Box. As
the letters or numbers are typed, the pull-down list will display patients meeting the criteria. If the
typed characters do not yield any results, a warning icon will appear . The warning icon is also
displayed in the case an excessive number of results is returned.
Once a patient is selected, his/her Last Name, First Name (with Identification Code and date of birth)
will be displayed in large type in the top portion of the screen.
Fill Patient List

Displays all the patients entered in the database.
Empty Patient List

Empties the contents of the window in which the patient list is displayed but does not delete the
patients from the database.
Search
Permits searching patients in the database by gender, date of birth, check-in number,
examination date, patient age, referring physician, instrument, or group (see Paragraph 2.5).
To enter a new patient in the database, click the icon on the main screen to open a new window
Enter the patient data in the window: last name, first name, date of birth, and gender. Typing a Last
Name, First Name pair in the Patient Box automatically opens the window for entering the data for the
new patient.
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Figure 2-2: New Patient Data Window
Date of birth must be entered in the form: two digits for the day, two digits for the month, and four
digits for the year. Entering an invalid datum will cause a warning icon to be displayed.
Entering a patient whose data are identical to those of a patient already contained in the database will
likewise open a window containing a warning message.
The identification code is automatically entered by the system unless a different option is selected from
the DICOM Settings menu. See Chapter 18.3.
To confirm new patient entry, press the Enter key or click the [OK] button. To cancel, click [Cancel].
Whenever a new patient is created, an examination associated with that patient is also created. A
window for selecting the examination type then opens (See New Exam below).
2.1 Patients List

Any new patient entered is displayed in the patients list window on the left-hand side of the screen. To
view the list of all the patients entered, click the button. To empty the contents of the patients list
from the main screen, click the button.
2.2 Patient Data

When a patient is selected, the entered data will be displayed on the main screen (red rectangle).
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Figure 2-3: Patient Data
2.3 Editing Patient Data

To edit the patient data, move the mouse pointer to the patient name and right-click. Select
, which reopens the patient data window for editing the last name, first name,
date of birth, and/or gender. Click OK after having made all required changes.
2.4 Selecting a Patient

A patient already listed in the database can be selected in a number of different ways:
Type a last name and first name in the Patient Box. In order to insert the last name and name
correctly you must type: Last Name comma First Name, without spaces. If the typed name does not
correspond to any patient already present in the database, press Enter to open the window for
entering a new patient.
Click the button and use the ↑ ↓ keyboard keys to scroll the patients list or select a patient
directly from the list. With the Patient Box empty, press Enter or double-click the highlighted
patient name. A patient archive may be opened by clicking the button to the left of the name.
Type in a portion of the Last Name, First Name string to display a list of patient names meeting the
criteria. To select a particular patient, proceed as described in the previous point. For instance, you
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may display all the patients whose names begin with a given letter, or who have the same last name,
or who have the same last name and the same first-name initial, etc.
When a patient is selected, the list of associated examinations opens automatically (see Chapter 3:
Examinations Database).
2.5 Advanced Search
Click the button to access the advanced search function.
Figure 2-4: Advanced Search
For each of these categories, clicking the button so as to check (select) it visualizes the
boxes for entering search criteria:
by gender: male or female
by date of birth: start and end dates of the interval to be searched
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by check-in number: a box for entering the number; this field features the automatic
completion function
by examination date: start and end dates of the interval to be searched
by patient age: minimum and maximum age
by referring physician: a box in which to type the physician‟s name
by instrument: a list of possible examination capture instruments (for example, Fundus
camera, keratoscope, pupillograph, Scheimpflug camera, slit lamp biomicroscope)
by group: a list of the groups created via the Settings function (see Chapter 19).
Select the boxes that permit establishing the search criteria. Click [Search] to display the search results.
2.6 Delete Patient
To delete a patient name, right-click the patient, select and then confirm the
deletion request warning message.
Warning: deleting a patient also deletes all the examinations associated with that patient and the
relative images.
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3 Examinations Database
An unlimited number of examinations may be associated with each patient; the examinations are
defined on the basis of the instrument used and the date of creation.
3.1 New Exam
After a new patient is created, an examination will also be created.
To create a new examination for an existing patient, click the button.

If working with a single instrument, the image capture mode will be automatically accessed. Otherwise,
if at least two instruments are used, the window shown below will open. Select the instrument to be
associated with the current examination. After selection, the capture mode is accessed.
Figure 3-1: Instrument Selection
Each examination is filed by date of creation and instrument type. It is also possible to attribute a
pathology group [Group ]. Classifying the examinations by codified groups is useful for conducting
searches. The groups list may be edited from the Settings menu (see Paragraph 18.2).
3.2 Selecting an Examination

Once a patient has been selected, click the button or press Enter or double-click with the mouse to
access the Examinations Database.
Clicking the + symbol to the left of the patient name opens the list of examinations associated with that
patient. The + symbol becomes a – . Click the – symbol to close the list.
Alternatively, open the list by pressing the  arrow key on the keyboard and close it by pressing the
 arrow key.
To select a previously-stored examination, use the mouse or scroll with the ↓↑ keyboard arrows to
highlight one examination after another and, for each, view the relative images in the window on the
right-hand side of the screen.
3.3 Editing Examination Data

To edit the data for an examination, select the exam, right-click, and select the
command [Edit Exam Data].
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Figure 3-1: Editing Exam Data
This action opens a window in which the user may edit the date and time of the exam and enter the
name of a referring physician. Click OK to confirm the changes; otherwise, click Cancel.
3.4 Deleting an Examination

To eliminate a patient examination from the database, select the examination to be deleted by right-
clicking, then clicking and confirming the deletion request warning message.
Warning: deleting an examination also deletes all the images associated with it.
3.5 Refraction
When an exam is selected, the (Refraction) icon goes active. Selecting the Refraction icon opens a
window from which to enter the patient refraction data.
Figure 3-2: Entering Refraction Data

Two labels permit opening the right eye (OD) or left eye (OS) chart. If the refraction value entered is
the value measured on eyeglasses and the corneal apex-to-lens distance is entered in the box for that
purpose, the system calculates the refraction at the corneal vertex. Enter the values of the sphere in
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diopters (Sph), the cylinder in diopters (Cyl), the cylinder axis in degrees (Ax), and the distance to test
eyeglass in mm (@) in the relative fields. If the data is incomplete, the warning icon will appear.
If the data are correctly entered, the icon will be displayed.

The patient‟s natural visual acuity is entered in the UCVA (Uncorrected Visual Acuity) box; the
maximum visual acuity attainable with correction is entered in the BCVA (Best Corrected Visual
Acuity) box.
The [Cancel] button closes the window without saving the changes. To save the entered data, click the
[OK] button or press [Enter].
3.6 Capture
The Capture icon goes active when a new exam is created or when an empty exam is selected. It
permits selecting the instrument with which to capture the exam and accessing the capture
environment.
3.7 Image Gallery

When an exam previously stored as described above is called up, the Gallery window on the right-hand
side of the main screen will show the images relative to each exam as it is selected.
The images are subdivided by OD (right eye) and OS (left eye).
Figure 3-3: Image Gallery
A type group may be defined for each eye in order to facilitate future searches.
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Figure 3-4: Groups
Click the button to open the pull-down menu of the groups entered in the Settings/Groups menu (see
Chapter 19). To enter the eye being examined in a yet-to-be-defined group, select <new group> to
open a box in which to enter the name of the new group.
Select a group. The buttons permit associating the right eye group with the left, and vice-versa.
Clicking an image displays a preview of the summary of the selected examination in the lower portion
of the screen.
Double-clicking an image opens the processed image summary (Chapter 5).
Right-click a gallery image and select to add a brief description.
To eliminate an image, click .
To open an image, double-click with the left mouse key or press Enter:
If the selected image is a previously-processed map, the topographic maps viewing environment
will open.
If the selected image is a still-to-be-processed Scheimpflug capture, the image is first processed
and the summary environment is then opened (See Chapter 5)
If the selected image is pupillographic, the pupillography examination will open.
If the selected image is an image acquired with the slit lamp, the image viewing environment
will open.
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4 Capture of Scheimpflug Images
The Capture icon on the main screen goes active when a new examination is created or when an
empty exam is selected. Clicking the icon opens the window for selecting the instrument with which to
capture the examination.
Figure 4-1: Instrument Selection
To capture a Scheimpflug image, select the icon.

The instrument automatically sets to the capture position (Home position) and a live capture window
opens.
4.1 Focusing
The window displaying the real-time progress of the capture shows an image of the cornea in profile,
which permits setting the instrument to the correct distance, and a frontal view of the eye, which
permits correctly centering the instrument.
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Figure 4-1: Focusing
Select the icon on the top left to view a joystick diagram that suggests the correct joystick
movements for attaining adequate instrument positioning.
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Figure 4-2 Focusing
In order to conduct the examination at the correct distance from the corneal apex, move the joystick
forward and back until the corneal apex is within the two green lines. As long as the corneal apex is not
at the correct distance, the horizontal lines will be red; when the apex is between the two lines, they
will turn green. When the joystick is moved forward, the profile of the cornea displayed on the monitor
moves upward; when the joystick is moved back, the profile of the cornea moves downward.
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4.2 Centering
Figure 4-3: Centered

The instrument is centered when the reference cross shown on the monitor is inside the square.
To move the cross to the left and right, move the joystick to the left and right.
To move the cross up and down, rotate the joystick clockwise and counterclockwise.
The square turns green when the instrument is centered.
4.3 Capture
When the instrument is centered and focused, press the button on the joystick to capture the image.
This action starts the capture procedure, at the end of which the image is saved.
Once all the images needed have been captured, the capture environment may be closed; the program
returns to the main screen.
Select one of the captured images (see Paragraph 3.7, Image Gallery) to process it and access the
Summary (see Chapter 5).
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5 Summary
This screen displays a clinical summary of the maps and data derived from processing of each single
capture.
The summary is made up of four maps: corneal thickness, anterior tangential, anterior elevation, and
posterior elevation.
Figure 5-1: Summary
5.1 Menus
A series of menus is displayed in the top portion of the screen. From left to right:
File
Figure 5-2: File Menu
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Save current screen as image

Opens a window from which the current screen view may be saved in various image
formats.
Print screen
Opens a window for setting page printing parameters and printing the current screen
view.
Figure 5-3: Print Settings
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This window permits modifying the print settings and inserting a heading by clicking
[Edit]. Select Heading/Edit to enter operator data, which will be printed at the top left of
the page as the printout heading.
Figure 5-4: Enter Heading Screen
Export
CTV
Opens a window that permits exporting a file in .ctv format for the CTView
software.
XYZ file
Exports a text file containing the xyz capture coordinates.
CSV file
Exports a CSV file containing the xyz capture coordinates.
Close
Closes the summary viewing environment and returns to the main screen.
Esc
Exits the application after confirmation of the warning message.
Edit
Reprocess
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Opens the keratoscopy or Scheimpflug capture editing environment to reprocess the

image from the top.
Analysis
The single windows listed below are discussed in detail in the following chapters.
Images
Displays the Scheimpflug images
Keratoscopy
Displays the keratoscopic image
Summary
Not enabled in this case.
Single Map
Displays a single map to permit detailed analysis (see Chapter 6).
Multi-map
Displays four maps chosen by the user (see Chapter 8).
Optical Analysis of the Cornea
Displays three refraction maps and the OPD map (see Chapter 9).
Morphological Summary
Displays four maps to permit detailed analysis of the form of the cornea (see Chapter
10).
Advanced Altimetry
Permits displaying the Zernike elevations (see Chapter 13).
Corneal Aberrometry
Accesses the Zernike Summary and the Visual Quality Summary (see Chapter 14.2).
Contact Lenses
Accesses the contact lens simulation environment (see Chapter 16).
Comparison
Permits comparing different maps (see Chapter 12 ).
Differentials
Permits calculating the differences between 2 or 3 maps (see Chapter 11).
Wavefront Comparison
Permits comparing the wavefronts of two different maps (see Chapter 15).
The Analysis menu icons are repeated on the toolbar underneath the menus bar.
View
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Figure 5-5: View Menu
Show/Hide Pupil
Shows or hides the contour of the pupil.
Show/Hide Limbus
Shows or hides the contour of the limbus.
Show/Hide Eye
Shows or hides the image of the eye on which the map is superimposed.
Show/Hide Map
Shows or hides the map view.
Show/Hide Ruler
Shows or hides the two perpendicular millimeter rulers (the shorter division corresponds
to 0.5 mm; the longer division corresponds to 1 mm).
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Figure 5-6: Corneal Thickness – Ruler
Show/Hide Meridians
Shows or hides a “sunburst” of meridians (one every 30°)
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Figure 5-7: Corneal Thickness – Meridians
Show/Hide Goniometer
Shows or hides the goniometer with 30° divisions.
Figure 5-8: Corneal Thickness – Goniometer
Show/Hide Zones
Shows or hides a series of concentric rings, the first with a 1.5 mm radius (3 mm
diameter); the others distanced from one another by 1 mm (5, 7, 9 mm diameters).
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Figure 5-9: Corneal Thickness – Zones
Show/Hide Extrapolation
Shows or hides the display of the map data extrapolated on an area greater than the
measured area.
Show on Map
Shows or hides indication of certain numeric values over the map.
None
No values are displayed.
Map-dependent:
On the thickness map: the central thickness and the thickness on two rings of 5
and 8 mm diameter.
On the tangential map: the curvature values along the main meridians at 1, 2, and
3 mm from the center.
On the anterior elevation map: the elevations of the anterior surface of the
cornea, with respect to the reference surface, along the main meridians,
expressed in microns.
On the posterior elevation map: the elevations of the posterior surface of the
cornea, with respect to the reference surface, expressed in microns.
Numeric Values
The numeric values are expressed on each map on a point grid.
Colors
Opens a window in which the user may change:
the color of the pen used to draw the ruler and the zones
the color of goniometer text
the color of the pointer
the color of the pupil.
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The View menu may also be opened by right-clicking when the mouse pointer is in the area of
the screen occupied by a map.
Options
Coordinates System
Cartesian coordinates: the pointer position is expressed in x (horizontal distance from
center) and y (vertical distance from center).
Polar coordinates: the pointer position is expressed using the coordinates ρ (distance
from center) and @ (position in degrees).
Curvature Measurement Units
Millimeters: the curvature values are expressed in millimeters.
Diopters: the curvature values are expressed in diopters, using the stroma refraction
index (1.376) for conversion.
Use keratometric index: the values of the curvature of the anterior face of the cornea are
expressed in diopters, using the keratometric refraction index (1.3375) for conversion.
This function permits comparing the curvature values with the values given by a
keratometer or ophthalmometer. The refraction index used is displayed on the anterior
tangential or anterior sagittal map.
Note that expressing the curvature of the cornea in diopters is merely a convention and
that whatever refraction index is used for converting from millimeters to diopters, the
real curvature of the cornea does not change. The true radius of curvature is the radius
expressed in millimeters.
Asphericity
For selecting the units of asphericity measurement: e, p, SF(e2), or Q.
Viewing diameter
For selecting the diameter of the map representations (9 or 12 mm).
Tools
Pointer
When this item is selected, the coordinates and the numeric values (of the thickness,
curvature, or elevation) of the map points touched by the mouse pointer as it is moved
over a map are displayed.
When the pointer is within the area of the screen occupied by a map, it takes the form of
a reference cross . Left-clicking any point on the map drops the cross at that point,
making it independent of the mouse pointer. A second click realigns the reference cross
with the mouse pointer.
Double left-clicking when the mouse pointer is in the area of the screen occupied by a
map accesses the Single Map screen view to analyze the map in more detail.
Distance
Select this item to trace a segment on the map for measuring the distance between two
points.
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Figure 5-10: Tools – Measurements
To trace the segment, left-click any point on the map, then move the mouse to the
desired end-point and left-click again. The length of the segment thus defined will be
displayed on the map, in millimeters.
Graph
With this item selected, moving the mouse pointer over a map displays the graphs
representing the map development along a given meridian. Move the pointer over the
map to select the meridian to be viewed. The graph rotates during selection of the
meridian. Click on the desired orientation to view the graph of that particular meridian.
The graph is always displayed horizontally together with indication of the meridian to
which it refers.
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Figure 5-11: Tools – Graph
To hide the graphs, select Pointer from the Tools menu.
Gradient
With this item selected, the user may trace a segment on the map to measure the gradient
of curvature between two points. The gradient of curvature represents the increase or
decrease of the curvature of the cornea per millimeter along a given segment arbitrarily
selected by the user.
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Figure 5-12: Tools – Gradient
As in the case of the Distance command, to trace the segment first left-click a point on
the map, then move the mouse to the desired end-point and left-click again. The length
of the segment (Dist), the difference between the values of the two points (Val1-Val2),
and the gradient ( ) will now be displayed on the map. Also reported are the data
relative to the two extremities of the segment, P1 and P2, in Cartesian (x,y) or polar
( , ) coordinates depending on Options menu settings, and the map value at that point.
The gradient values and the curvature values may be expressed in diopters (D) or in
millimeters (mm), depending on the unit of measurement selected from the
Options/Curvature Measurements Units menu.
The Tools menu may also be opened by right-clicking when the mouse pointer is in the area of
the screen occupied by a map.
5.2 Scale
The color scale, which permits associating a color with a given interval of values, is shown to the left
of each map. Generally speaking:
In the corneal thickness map: the warmer colors (red, orange, yellow) are associated with the
thinner zones of the cornea, while the cooler colors (green, blue) are associated with thicker
zones.
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In the curvature and powers maps: the warm colors (red, orange, yellow) are associated with
more steeply curved surfaces or greater power while the cool colors (green, blue) are associated
with flatter surfaces or lesser power.
In the elevation maps: the warm colors are associated with areas projecting above the reference
surface, while the cool colors are associated with areas lying below the reference surface.
Three types of scales are available:
Absolute
Always uses the same correspondence between colors and values so as to ensure uniformity in
map comparisons. The absolute scales for each of the maps are described in detail in Chapter 6.
Normalized
Automatically calculated on the basis of the minimum and maximum values for the cornea
being examined. This type of scale can provide the most adequate resolution for each cornea;
however, since the scale is dependent on the difference between the minimum and maximum
values, it is not constant and does not permit directly comparing two different maps.
Adjustable
On this scale, the user may introduce an arbitrary median value and set the interval between one
value and the next.
To set the values, type them directly into the boxes or use the arrow keys . Click the [Apply]
button to view the map with the scale as set. This scale may be used for comparing different
maps without resorting to the absolute scale, which in certain cases may not provide the most
suitable resolution. Maps for which the same median value and the same interval are set are in
fact perfectly compatible for comparison.
5.3 Local Values

The reference cross is associated with a series of data referred to each single map point and displayed
on the top left of each map.
On the tangential and sagittal maps:

Pointer distance from the corneal vertex in Cartesian or polar coordinates
Corneal curvature radius in millimeters/diopters
On the elevation maps:

Rbf: value of the curvature radius of a sphere most closely approximating the surface being
viewed.
Δz: point-by-point difference along the z axis, in μm, with respect to the values given by the
sphere with curvature radius equal to the Rbf.
On the refraction power map:

Power in diopters.
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5.4 Using the Right Mouse Key

Right-clicking when the mouse pointer is in the area of the screen occupied by a map opens a window
containing the Tools menu and the View menu (see above).
5.5 Patient Data

A window opens on the right-hand side of the screen, displaying the patient and examination: Last
Name, First Name, date of birth, identification code, and date and time of the examination.
5.6 Indices Panel

A series of pull-down windows open below this window:
Summary Indices
Keratometries (Anterior)
Keratometries (Posterior)
Form Indices
Keratorefractive Indices
Keratoconus Screening
Click the  arrow to open the pull-down menu.

Click the  arrow to close the pull-down menu.
Right-clicking with the pointer positioned on the window title displays the Help icon. Left-
clicking the icon opens a help window.
Click × to remove the title from the screen view. To restore title display, click the icon.
Configure the indices panel. Click the  arrow to open the list of sections that have been closed, and
select the section to be restored.
5.6.1 Summary Indices

HIVD (Horizontal Iris Visible Diameter)
Horizontal diameter of the cornea, in millimeters.
Pupil (Topographic)
The center of the pupil is marked on the maps with the + cross when the Show Pupil function is
selected from the View menu. This window reports the coordinates of the pupil center.
Thinnest Point
The thinnest point of the cornea is marked on the corneal thickness map with the symbol.
This window reports the position of the thinnest point and the thickness at that point (Thk).
Apex
The corneal apex is marked by the × cross on the anterior tangential map. This window reports
the position of the apex and the thickness at that point.
Anterior Chamber
Indicates the depth of the anterior chamber.
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5.6.2 Keratometries (Anterior)
Various keratometric values for the anterior surface of the cornea may be selected for viewing from the
pull-down menu for that purpose. The refraction index used is either the keratometric index (1.3375) or
the stroma refraction index (1.376), depending on the selection made on the Options/Curvature
Measurement Units.
Sim-K
The Sim K index simulates the readings that would be obtained with a keratometer. The
amplitude of the zone taken into consideration will therefore vary in relation to the measured
curvature of the cornea.
Figure 5-13: Indices – Sim-K
K1: the flattest meridian (in blue) with its curvature (expressed in mm or D, depending on
which option is selected from the Options/Curvatures menu), direction, and asphericity
(expressed in p, e, Q, or SF, depending on which option is selected from the
Options/Asphericity menu).
K2: the steepest meridian (in red) with its curvature (expressed in mm or D, depending on
Options/Asphericity menu.
Avg: the mean curvature between K1 and K2.
Cyl: corneal toricity; that is, the difference between K1 and K2, in diopters, and the orientation
of the negative cylinder.
Meridians
Shows the curvature values for the meridians with the greatest and least curvature in the 3-mm,
5-mm, and 7-mm zones of the cornea, forcing the axes into perpendicularity the one with the
other.
36
Figure 5-14: Indices – Meridians
The following are displayed for each zone:

K1: the flattest meridian (in blue) with its curvature (expressed in mm or D, depending on
K2: the steepest meridian (in red) with its curvature (expressed in mm or D, depending on
Avg: the mean curvature between K1 and K2.
Cyl: corneal toricity; that is, the difference between K1 and K2, in diopters, and the
orientation of the negative cylinder.
Semimeridians
Shows the curvature values for the single semimeridians with the greatest and least curvature in
the 3-mm, 5-mm, and 7-mm zones of the cornea. It is not necessary for the semimeridians to be
perpendicular the ones to the others. The curvature and orientation values of each semimeridian
are indicated for each zone.
37
Figure 5-15: Indices – Semimeridians
Peripheral Degrees
Opens a table reporting the curvature and sphericity values at various map positions. Right-click
when the pointer is over the table to open the area for calculating the sagittal angle (10°, 20°,
30°, 40°, 50°) or peripheral ring in mm (6 mm, 7 mm, 8 mm, 9 mm, 10 mm) on the nasal,
temporal, inferior, and superior semimeridians and the relative mean values (AVG).
The reference angles for the nasal, temporal, inferior, and superior zones are reported in the
bottom portion.
38
Figure 5-16: Indices – Peripheral Degrees
5.6.3 Keratometries (Posterior)

The procedure for displaying the curvature values for the meridians and semimeridians and the
peripheral degrees of the posterior surface of the cornea are analogous to those for displaying the
anterior surface values (see above). The refraction indices of the stroma (1.376) and the aqueous humor
(1.336) are used for calculation of the curvature in diopters.
5.6.4 Corneal asphericity

Various form indices for the anterior and posterior faces of the cornea may be displayed for two
different corneal diameters selected by the user from the pull-down menu for that purpose.
39
Figure 5-17: Indices – Form
Rf: Flat Radius

Represents the radius of the curve that best approximates the curvature of the flattest
meridian for the given diameter. Each radius value is associated with an asphericity
value (p, e, SF, or Q, depending on which index is selected from the Options menu).
Rs: Steep Radius
Represents the radius of the curve that best approximates the curvature of the steepest
meridian for the given diameter. Each radius value is associated with an asphericity
value (p, e, SF, or Q, depending on which index is selected from the Options menu).
RMS (Root Mean Square)
Mean square error representing the deviation of the surface being examined from the
aspherotoric surface of best fit described by Rf, Rs and relative asphericity. If the RMS
is low, the surface of the cornea in the area delimited by the given diameter is very
regular. The higher the RMS, the more irregular the corneal surface.
RMS/A
Root Mean Square per unit surface Area.
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5.6.5 Keratorefractive Indices
Figure 5-18: Keratorefractive Indices
Astigmatism
3 mm: corneal astigmatism, expressed in diopters, in an area of the cornea 3 mm in
diameter and centered on the corneal vertex.
5 mm: corneal toricity, expressed in diopters, in an area of the cornea 5 mm in diameter
and centered on the corneal vertex.
These two values represent the cylinder and the axis of the regular astigmatism
component for the two diameters. A difference in axis or power between the two
diameters indicates an irregular astigmatism that cannot be efficaciously corrected with
an ophthalmic lens.
The following indices are referred to a portion of the cornea with a diameter of 4.5 mm, centered in the
geometric pupil center
Mean Pupil Power
Represents the mean axial curvature, expressed in diopters, of an entire portion of the
cornea 3 mm in diameter and centered on the entrance pupil and takes into consideration
the Stiles-Crawford effect; that is, greater weight is assigned to the central points. This
parameter represents the sphere equivalent to the cornea in a 3 mm pupillary zone and is
useful for defining the central mean curvature for irregular corneas such as those seen in
cases of keratoconus, perforating keratoplasty, trauma, etc., or in highly aspherical
corneas such as may be seen following refractive surgery.
Longitudinal Spherical Aberration
Longitudinal Spherical Aberration (LSA), expressed in diopters, in an area of the cornea
4.5 mm in diameter centered on the center of the pupil. This parameter represents the
difference between the marginal power and the paraxial power. It is calculated by a
41
procedure involving ray tracing of the best-fit conical section on a 4.5 mm zone of the
pupil.
Mean asphericity of an area of the cornea 4.5 mm in diameter centered on the center of
the pupil. This coefficient expresses the measure by which the optical zone of the cornea
is prolate or oblate. It may be expressed as p, Q, e, or SF (in our example, in p).
Irregularity of Curvature
Standard deviation (or root mean square, RMS) of the instantaneous curvature with
respect to a best-fit aspherical surface, calculated for a 4.5 mm-diameter area of the
cornea centered on the center of the pupil. This index is expressed in diopters. An
irregularity index of 0 indicates a perfectly smooth surface approximating an
aspherotoric reference surface.
Surface Asymmetry
The SAI (Surface Asymmetry Index) is the index of surface asymmetry of a 4.5 mm area
of the cornea centered on the center of the pupil, calculated as the mean of the
differences between the axial curvature along the two opposite semimeridians of each
meridian. In a cornea with a perfectly symmetrical optical zone, the SAI value is equal
to zero. In the case of asymmetry, the mean instantaneous curvature of the flattest
corneal hemisphere of the 4.5-mm diameter area of the cornea centered on the center of
the pupil is shown in blue, while the mean curvature of the most steeply curved corneal
hemisphere is shown in red.
Anomalous values for Longitudinal Spherical Aberration, Asphericity, Irregularity of Curvature, and
SAI are flagged with a warning icon .
5.6.6 Keratoconus Screening

Indicates whether or not the topographic picture of the eye being examined is compatible with
keratoconus.
Figure 5-19: Keratoconus data
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Figure 5-20: Keratoconus Data

The evaluation of (in)compatibility of the topographic context with the keratoconus is made based upon
several indices:
Rbf: measurement, in mm, of the apical curvature radius of the best-fit ellipsoid with the
eccentricity of an average eye (p = 0.8). This value tends to decrease in eyes presenting with
keratoconus.
BCV: as we know, thinning of the cornea creates an incurvation in the inferotemporal area of
the cornea with consequent loss of symmetry on the topographic map. Through analysis of the
coma and trefoil Zernike decomposition terms (C(3, ±1), C(3, ±3)), the BCV index permits
evaluating the presence and status of an ectasia in the area in which keratoconus is statistically
most likely to develop.
BCV = (α C3±1RMS + β C3±3RMS) f (C3±1αx)
The evaluation is derived from the combination of RMS of coma and trefoil weighed by f (C(3,
±1) αx) that adjusts its value in case the direction is not the one that statistically is expected
Parameters α e β, obtained by a statistical base weigh the preponderant importance of the coma
relatively to the trefoil of the analyzed sample material (502 keratoconus patients).
C(4,0): statistics show that in advanced or central keratoconus there is a directional and
statistically significant alteration of the primary Spherical Aberration coefficient C(4,0).
TL: Least corneal thickness
Each of these indices is shown both with their numerical value and represented graphically in a
background-colored bar. The measured values are referred to those of a normalized population,
determined by statistic methods. The bar ends in a green, yellow or red zone dependent on the fact
whether the value is considered „normal‟, suspect or completely compatible with keratoconus.
 values in the interval of two standard deviations from the mean for the normal population and
considered normal and placed against a green background.
43
 values in the interval between two and three standard deviations from the mean for the normal
population and considered borderline and placed against a yellow background.
 values differing from the mean for the normal population by more than three standard
deviations and considered anomalous and placed against a red background. Values deviating
from standard are also flagged with a warning icon .
Based on a combined evaluation of these indices, the software calculates a probability index whether or
not the eye examined is likely to be afflicted by keratoconus (KPI: Keratoconus Probability Index) or
by Pellucid (PPI: Pellucid Probability Index). Both KPI and PPI are expressed as percentages.
When the topographical context appears compatible with keratoconus or indicates a suspicion of
keratoconus, a series of morphological indicators are presented for evaluation of the entity and for
study of variations over time:
Vertex: indicates the Cartesian coordinate of the most prominent point of the cone.
Height: indicates the height of the cone with respect to the best-fit ellipsoid.
Centroid: indicates the Cartesian coordinates of the centroid of the cone.
Area: indicates the area covered by the cone.
The keratoconus screening indices provide indications based on the calculated

instantaneous curvature map but are not sufficient for assessing either instrument
calibration status or the patient‟s clinical situation. These indices should thus be
considered as diagnostic tools for the user but not as indicators of certain diagnosis of
keratoconus.
We therefore caution the user to take maximum care when evaluating these values
and to correlate the screening indices with other tests and with the patient‟s clinical
history.
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6 Images
To access the image screen:
select this item from the Analysis menu
or click the icon on the bar at the top of the screen
Figura 6-1: Scheimpflug images
This context allows visualization of the single images acquired by the Scheimpflug camera on all 25
meridians.
A series of menus is displayed in the top portion of the screen. From left to right:
For a complete description of the menu refer to Chapter 5.1.

Below the main toolbar a series of tools is available:
Zoom
When selected, it is possible to modify the magnification of the image shown on screen, using
the mouse‟s scroll bar.
Distance
Allows to draw on the image a segment and measure its length, to allow an evaluation of the
distance. To draw the segment, click once to sign the starting point, and secondly to sign the
end point. To delete the measure, press [Delete] key.
Angle
45
Allows for drawing and measuring the size o fan angle. To draw the angle, click once to
indicate the point of the angle, and another two times to indicate both sides of the angle. To
delete the measure, press [Delete] key
Histogram
Show on the image of the corneal profile the graph of reflection highlights: how thicker the
materia, the creare the image will become. To move the origin of the graph, click on the point of
interest.
Figura 6-2: Histogram
Advanced
Brightness
When this item is selected, it is possible to change the brightness of the image, using the
mouse‟s scrollbar
Contrast
When this item is selected, it is possible to change the contrast of the image, using the
mouse‟s scrollbar
Gamma
When this item is selected, it is possible to change the gamma of the image, using the
mouse‟s scrollbar
Restore the original values for the image, undoing any kind of modification of brightness,
contrast and gamma
Invert background color
Allows for inverting the image.
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Figura 6-3: Inverted image
Meridian
Using the pull-down list, this menu allows to select the single image frame directly, out of the
25 images acquired. Both semimeridians are indicated with different colors, orange and green,
to allow a precise recognition of the exact position of the optical section of the anterior segment
shown on screen
Figura 6-4: Choice of meridian
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7 Single Map
To access the Single Map screen:
or click the icon on the bar at the top of the screen
or select from the Summary, double-clicking the map of choice.
Figure 7-1: Map – Anterior Tangential
The menu bar, the patient data window, and the indices panel are equivalent to those appearing on the
Summary screen (see above). The same is true for use of the mouse pointer on the map and for viewing
the various tools.
7.1 Map Selection

To select a map for viewing, select an item from the pull-down menu at the top left next to the Current
Map tag.
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Figure 7-2: Map Selection
7.1.1 Corneal Thickness

The corneal thickness map shows the thickness of the cornea in microns (μm): thicker areas are shown
in cooler colors; thinner areas are shown in warmer colors. The correspondence between color and
thickness is keyed in the scale on the left of the screen.
With the mouse pointer on the color scale, right-click to select among three types of scales:
Absolute Scale: the thicknesses that may be represented on the map range from 170 to 890 μm,
divided into 30 μm steps.
Normalized Scale: the minimum and the maximum correspond to the thinnest and the thickest
point on the map being viewed. The interval is always divided into 25 steps.
Adjustable Scale: the user may set the median value and the step (minimum 1 μm). The interval
is always divided into 25 steps.
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Figure 7-3: Map – Corneal Thickness
Pointer distance from the corneal vertex in Cartesian or polar coordinates.
Thickness of the cornea in microns.
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7.1.2 Anterior Tangential Map

Maps the tangential curvatures of the anterior surface.
Figure 7-4: Map – Anterior Tangential
With the pointer on the color scale, right-click to select among three types of scales:
Absolute Scale: varies according to the setup selected from the Options/Curvature Measurement
Units menu.
o in mm: from 3.30 to 10.80 mm, with 0.30 mm steps.
o in diopters:
 if the curvature values are expressed in diopters obtained using the stroma
refraction index (1.376) for conversion, the scale ranges from 33 D to 70.50 D in
1.5 D steps.
51
 if the keratometric index (1.3375) is used for conversion, the scale ranges from
28 D to 65.50 D with 1.5 D steps.
Normalized Scale: the minimum and the maximum correspond to the flattest and steepest points
on the map being viewed. The interval is always divided into 25 steps.
Adjustable Scale: the user may set the median value and the step (minimum 0.25 D or 0.05
mm). The interval is always divided into 25 steps.
Radius of curvature of the cornea in millimeters/Diopters.
7.1.3 Posterior Tangential Map

Maps the tangential curvatures of the posterior surface.
The curvatures may be represented in mm or in diopters: select the desired unit from the
Options/Curvature Measurement Units menu. When the values are expressed in diopters, conversion is
carried out taking into consideration the refraction indices of the stroma (1.376) and the aqueous humor
(1.336) and the curvatures are indicated with negative numbers.
Units menu.
o in diopters: 16.17 D to -4.04 D, with steps corresponding to 0.30 mm.
7.1.4 Anterior Sagittal Map

Maps the sagittal curvatures (also called axial curvatures) of the anterior surface.
Absolute Scale. varies according to the setup selected from the Options/Curvature Measurement
Units menu.
o in diopters:
 if the curvature values are expressed in diopters obtained using the stroma
refraction index (1.376) for conversion, the scale ranges from 33 D to 70.50 D in
1.5 D steps.
 if the keratometric index (1.3375) is used for conversion, the scale ranges from
28 D to 65.50 D with 1.5 D steps.
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7.1.5 Posterior Sagittal Map

Maps the sagittal curvatures (also called axial curvatures) of the posterior surface.
Options/Curvature Measurement Units menu. When the values are expressed in diopters, conversion is
carried out taking into consideration the refraction indices of the stroma (1.376) and the aqueous humor
(1.336) and the curvatures are indicated with negative numbers.
Units menu.
o in diopters: 16.17 D to -4.04 D, with steps corresponding to 0.30 mm.
7.1.6 Anterior Elevation Map

Maps the elevations of the anterior surface of the cornea with respect to a reference surface. The radius
of the reference surface is shown on the top left (Rbf) and represents the radius of the sphere that best
approximates the cornea being examined (Best Fit Radius). The radius of the best-fit sphere is selected
in such a manner as to minimize the mean square error of the corneal elevations with respect to the
reference surface.
The scale is in microns (μm): the warm colors (red, orange, yellow) are associated with areas projecting
above the reference surface and the cool colors (green, blue) are associated with areas lying below the
reference surface.
Absolute Scale: from -120 μm to 120 μm, with 10 μm steps.
Normalized Scale: the minimum and the maximum correspond to the lowest and the highest
53
viewed;
7.1.7 Posterior Elevation Map

Maps the elevations of the posterior surface of the cornea with respect to a reference surface. The
radius of the reference surface is shown on the top left (Rbf) and represents the radius of the sphere that
best approximates the cornea being examined (Best Fit Radius). The radius of the best-fit sphere is
selected in such a manner as to minimize the mean square error of the corneal elevations with respect to
the reference surface.
The scale is in microns: the warm colors (red, orange, yellow) are associated with areas projecting
above the reference surface and the cool colors (green, blue) are associated with areas lying below the
reference surface.
Absolute Scale: from -120 μm to 120 μm, with 10 μm steps
Normalized Scale: the minimum and the maximum correspond to the lowest and the highest
viewed.
7.1.8 Frontal Anterior Refraction Map

Maps the powers of the anterior face of the cornea. The powers are expressed in diopters and are
calculated using the stroma refraction index (1.376) and applying Snell‟s law point by point.
The scale is in diopters: the warm colors (red, orange, yellow) are associated with areas with higher
powers and the cool colors (green, blue) are associated with less refractive areas.
Absolute Scale: from 28 D to 65.5 D with 0.30 D steps.
Power in diopters.
54
7.1.9 Frontal Posterior Refraction Map

Maps the powers of the posterior face of the cornea. The powers are expressed in diopters and are
calculated using the refraction indices of the stroma (1.376) and the aqueous humor (1.1336) and
applying Snell‟s law point by point.
powers and the cool colors (green, blue) are associated with less refractive areas. The powers of the
posterior face of the cornea are negative.
Absolute Scale: from -3.75 D to 10 D with 0.25 D steps.
Power in diopters.
7.1.10 Equivalent Refraction Map

Maps the powers of the cornea. The powers are expressed in diopters and are calculated using the
stroma refraction index (1.376) and applying Snell‟s law point by point.
powers and the cool colors (green, blue) are associated with less refractive areas.
Absolute Scale: from 28 D to 65.5 D with 0.30 D steps.
Power in diopters.
7.2 3D Map
When working with the single maps, the toolbar displays a button. This button is used to view a
three-dimensional graph of the current corneal map. The user may select a map from the toolbar.
55
Figure 7-5: 3D Map
Hold down the left mouse key and drag the end points of the Cartesian diagram enclosing the
map to view it from different perspectives. To return to the two-dimensional map click the red
cross on the top right.
Right-clicking displays a menu from which to print the screen, save the screen as an image, or
change the view type (wireframe).
Figure 7-6: Print Map
56
Figure 7-7: 3D Map
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8 Multi-map
To access the Multi-map screen:
or click the icon on the bar at the top of the screen.
The operator may select any four maps to view in this screen.
To select the maps, open the pull-down menu on the bottom right of each map and select the desired
item.
Figure 8-1: Multi-map Screen
This screen is managed in a manner analogous to the Summary screen.
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9 Optical Analysis of the Cornea

To access the screen for optical analysis of the cornea:
Figure 9-1: Optical Analysis of the Cornea
This screen displays the following maps: frontal anterior refraction, frontal posterior refraction,
equivalent refraction, and OPD for a 6-mm pupil.
Frontal Anterior Refraction Map

Maps the powers of the anterior face of the cornea. The powers are expressed in diopters and
are calculated using the stroma refraction index (1.376) and applying Snell‟s law point by point.
The scale is in diopters: the warm colors (red, orange, yellow) are associated with areas with
higher powers and the cool colors (green, blue) are associated with less refractive areas.
Frontal Posterior Refraction Map
59
Maps the powers of the posterior face of the cornea. The powers are expressed in diopters and
are calculated using the refraction indices of the stroma (1.376) and the aqueous humor (1.1336)
and applying Snell‟s law point by point.
higher powers and the cool colors (green, blue) are associated with less refractive areas. The
powers of the posterior face of the cornea are negative.
Equivalent Refraction Map
Maps the powers of the cornea. The powers are expressed in diopters and are calculated using
the stroma refraction index (1.376) and applying Snell‟s law point by point.
higher powers and the cool colors (green, blue) are associated with less refractive areas.
OPD
Maps the aberrations of the eye in an area with a 6-mm diameter centered on the center of the
pupil. The OPD (Optical Path Difference) map expresses the differences in height between the
wavefront generated by the cornea being examined and a spherical wavefront; that is, a wavefront
with no aberrations (see Chapter no. Corneal Aberrometry).
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10 Morphological Summary
To access the morphological summary screen:
Figure 10-1: Morphological Summary
This screen displays the following maps: anterior tangential, posterior tangential, and corneal thickness.
Anterior Tangential Map
Maps the tangential curvatures of the anterior surface.
Absolute Scale: with intervals of 1.5 D from 33,00 to 70,50 D.
Relative Scale
Adjustable Scale
Posterior Tangential Map
Maps the tangential curvatures of the posterior surface.
.
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Options/Curvature Measurement Units menu. When the values are expressed in diopters,
conversion is carried out taking into consideration the refraction indices of the stroma (1.376)
and the aqueous humor (1.336) and the curvatures are indicated with negative numbers.
Absolute Scale
Relative Scale
Adjustable Scale
Corneal Thickness
The corneal thickness map shows the thickness of the cornea in microns (μm): thicker areas are
shown in cooler colors; thinner areas are shown in warmer colors. The correspondence between
color and thickness is keyed in the scale on the left of the screen.
Absolute Scale: thicknesses that may be represented on the map range from 170 to 890 μm,
divided into 30 μm steps.
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11 Differential Maps
Select Differentials from the Analysis menu or click the icon on the toolbar to open a window
from which to select maps to subtract from the current map. One or two maps may be selected for this
comparison; if three maps total are selected (current map plus two), the program will calculate the
differences between the first and the second and the second and the third.
Figure 11-1: Differential Map Selection Window
Click the button to view the entire patient database list. Select a patient and the relative
examination containing the maps to be compared. Click the button to conduct an advanced
search. Selecting an examination opens the gallery of topographies relative to the exam.
To select a topography for comparison, double-click the desired image or drag the selected map into
the space on the right.
The topographic map being worked on is shown on the right; underneath it is an empty space in which
the comparison map (or maps) are displayed after selection. Up to three images may be compared.
To change your map choice, right-click and then click Delete. To view the comparison, click [OK]. To
cancel a selection and close the window, click [Cancel].
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Figure 11-2: Differential Maps
The first three maps in the upper portion of the figure represent the topographic processing results
based on the map type selected from the pull-down menu on the top left.
Figure 11-3: Map Type
The other three maps, in the lower portion of the screen, show the numerical differences between the
processed images (1-2), (1-3), (2-3).
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11.1 Differential Keratometric Indices
Select capture 1, 2 or 3 on the pull-down menu on the top left, shown below.
Figure 11-4: Capture Selection
The indices for the selected capture will be displayed.
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12 Maps Comparison
Select Compare from the Analysis menu or click the button to open a window for selecting a map
to compare with the current map. Up to four maps may be selected for this type of comparison.
Figure 12-1: Map Comparison Selection Window
Click the button to view the entire patient database list. Select a patient and the relative
examination containing the maps to be compared. Click the button to conduct an advanced
search. Selecting an examination opens the gallery of topographies relative to the exam: to select a
topography for comparison, double-click the desired image. The topographic map being worked on is
shown on the right; underneath it is an empty space in which the comparison map (or maps) are
displayed after selection. Up to three images may be compared. To change your map choice, right-click
and then click Delete. To view the comparison, click [OK]. To cancel a selection and close the
window, click [Cancel].
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Figure 12-2: Map Comparison
Moving the mouse pointer over one map moves the reference cross over all the maps and gives all the
local values corresponding to each map.
Besides the menus and Options described in Chapter 5, two other menus are displayed:
Current map, on the left-hand toolbar, which opens a pull-down menu for selecting the type of
map to be displayed.
Figure 12-3: Current Map
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Indices referred to capture, on the top right, with indication of the capture number,
Figure 12-4: Capture Number
which permit selecting the capture for viewing the indices shown in the Summary Indices,
Keratometries, Visual Quality Indices, and Keratoconus Screening menus.
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13 Advanced Altimetry
To access the Advanced Altimetry screen:
Figure 13-1: Zernike Altimetry Analysis
A pull-down menu permits selecting between two types of analysis for the anterior and posterior faces
of the cornea: anterior and posterior aspherotoric fitting; anterior and posterior Zernike altimetry
analysis.
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13.1 Aspherotoric Fitting (Anterior and Posterior)
Figura 13-2: Aspherotoric fitting
The aspherotoric fitting represnets the corneal map as offset by a surface reference, that can be chosen
by the operator using the menu options on the right hand side of the screen.
13.1.1 Scale
The scale is in microns (μm): the warm colors (red, orange, yellow) are associated with the areas
projecting above the reference surface and the cool colors (green, blue) are associated with the areas
lying beneath it.
Right-clicking the scale opens a menu containing three scale options:
Absolute
Fixed for all corneas. The scale runs from -120 m to +120 m, with 10 m intervals.
Normalized
The scale used is automatically calculated on the basis of the minimum and maximum height
values for the cornea being examined. This scale provides the most adequate resolution for each
70
map; nevertheless, since the scale is dependent on the difference between the minimum and
maximum values, it is not constant and does not permit directly comparing two different maps.
Adjustable
value and the next. This scale may be used for comparing different maps: maps for which the
same median value and the same interval are set are in fact perfectly compatible for comparison.
13.1.2 Reference surface
Figura 13-3: Scelta della superficie di riferimento
Using the pull-down list it is possible to select the surface against which we want to offset the eye in
examination:
Spherical
The user can choose the surface radius (rf) in diopters or millimeters, based on the
measure unit selected for the curvature, selected in the Options menu
The asphericity and toricity are null
The user can choose the cornea diameter (Ø mm) based on which parameters for best fit
are calculated.
Aspheric
The user can choose the surface radius (rf) in diopters or millimeters, based on the
measure unit selected for the curvature, selected in the Options menu
The toricity is null.
The user can choose the asphericity value, espresse in p, e, e2 or Q, based on the measure
unit selected for the asphericity, selected in the Options menu.
are calculated.
Aspherotoric
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Figura 13-4: Aspherotoric reference surface
The user can choose flat radius (rf) and steep radius (rs) in diopters or millimeters, based
on the measure unit selected for the curvature, selected in the Options menu.
The toricity is calculated by the software as the difference between rf and rs.
The user can choose the asphericity value, espresse in p, e, e2 or Q, based on the measure
unit selected for the asphericity, selected in the Options menu.
The user can choose the toricity axis, along which the surface of reference is oriented.
are calculated.
Normal eye
The surface‟s asphericity is not modifyable and is equal to that of a normal eye: p =
0,80; e = 0,45; e2 = 0,20; Q = - 0,20.
The user can set all other parameters, just like for the aspherotoric surface.
Best fit
Calculate the spherical, aspherical, aspherotorical surface or for a normal eye, based on
which of these reflects best the eye in examination on the diameter (Ø mm) selected.
Apply
Recalculate the map considering the modifications made on the reference surface.
13.1.3 Position of the surface
Figura 13-5: Posizione della superficie di riferimento
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The reference surface can be translated along the z axis, perpendicular to the cornea
Vertex tangent
The reference surface is placed at the tangent to vertex of the cornea
Best dz
The reference surface is translated in order to minimize differences between cornea and
surface
Click on shift
Clicking on any point of the map, the surface is translated tangent to that point
Adjustable
It is possible to freely modify the translation value
Tilt
Indicates how much the surface reference is inclined respective to the z-axis.
Tilt axis
Indicates the direction in which the surface is inclined
RMS
Mean square error representing the deviation of the reference surface and the cornea.
The value is lower when the two surfaces are more alike
13.2 Zernike Altimetry Analysis (Anterior and Posterior)

The map of Zernike altimetry values expresses the differences in height between the cornea being
examined and an ideal surface, called the Cartesian Oval, which generates an aberration-free
wavefront. The apical radius of the reference surface is selected in such a manner as to minimize the
mean square error MSE of the corneal elevations with respect to the reference surface (best fit surface).
Analysis of surface aberrations is then carried out.
It is also possible to view the maps of the single components of the overall aberration or of specific
combinations of these components.
13.2.1 Scale
The scale is in microns (μm): the warm colors (red, orange, yellow) are associated with the areas
projecting above the reference surface and the cool colors (green, blue) are associated with the areas
lying beneath it.
Absolute
Fixed for all corneas. The scale runs from -60 m to +60 m, with 5 m intervals.
Normalized
The scale used is automatically calculated on the basis of the minimum and maximum height
values for the cornea being examined. This scale provides the most adequate resolution for each
map; nevertheless, since the scale is dependent on the difference between the minimum and
maximum values, it is not constant and does not permit directly comparing two different maps.
Adjustable
value and the next. This scale may be used for comparing different maps: maps for which the
same median value and the same interval are set are in fact perfectly compatible for comparison.
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13.2.2 Fitting Parameters
Figure 13-6: Window for Selecting the Components of Total Aberration and Pupil Diameter
Size
A pull-down menu for selecting the diameter of the area (from 3 to 12 mm) on which to conduct
altimetry analysis.
Figure 13-7: Pupil Diameter Window
Coefficients
For selecting the Zernike coefficients to be displayed on the map. In order to facilitate selection of
the various components, the coefficients are represented in graphic form in a pyramidal
arrangement called the Zernike pyramid, which represents the first 36 Zernike coefficients.
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Figure 13-8: Corresponding Aberrations Window
Total: all the coefficients are selected.

Astigmatism: only the two components (vertical and oblique) of astigmatism are selected.
High Orders: all coefficients except for the astigmatism coefficients are selected.
Coma-like: only the odd-order coefficients are selected.
Spherical-like: only the even-order coefficients are selected.
Custom: this option permits selecting or deselecting single components. Double-click an icon
to select a coefficient for use and then click the button to view the modifications on the
map.
If a value different from “total” is selected from the Coefficients menu, the elements not considered in
calculation are automatically selected with a cross.
Figure 13-9: Modified Coefficients Window
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13.2.3 Indices
The RMS and RMS/A values are displayed in the Indices pull-down menu.
Figure 13-10: Indices Window
RMS (Root Mean Square)

Mean square error of the altimetric differences, which permits numerically quantifying the
deviation of the examined surface from the reference Cartesian Oval.
RMS/A
Root Mean Square of the altimetric differences per unit surface Area.
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14 Corneal Aberrometry
The program permits conducting analysis of the wavefront generated by the anterior surface of the
cornea, starting with the topographic data and applying Zernike analysis.
The aberrometry map expresses the differences in height between the wavefront generated by the
cornea being examined and a spherical wavefront; that is, a wavefront with no aberrations.
The aberrometric analysis working environment is accessed by selecting [Corneal Aberrometry] from
the [Analysis] menu displayed in the Corneal Map viewing environment.
A new menu opens:
Figure 14-1: Corneal Aberrometry Menu
14.1 Zernike Summary
The aberrations are displayed as total aberrations and divided into their various components. A set of
36 Zernike polynomials is used for analysis of the various components of total aberration; the analysis
results are reported in the summary as numerical indices and as graphic representations. The pupil
diameter may be selected on the left side of the screen in a range from 2 mm to 8 mm with 0.5 mm
steps.
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Figure 14-2: Aberrometric Analysis Working Environment
14.1.1 Menus
The top portion of the screen displays a series of menus. From left to right:
File
See Paragraph 5.1.
Edit
See Paragraph 5.1
Analysis
See Paragraph 5.1
View
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The View menu is composed of various submenus. If the maps display rulers, meridians,
and other features, the window shown on the right is displayed; otherwise, the window
shown on the left is displayed. Note that once the View function is enabled the item
Hide . . . will be shown; otherwise, Show . . . will be displayed.
Figure 14-4: Image with View Options Enabled
Show Rulers/Hide Rulers
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Permits viewing or hiding the Cartesian axes centered on the corneal vertex.
Show Meridians/Hide Meridians

Permits viewing or hiding the meridians at 30° intervals centered on the corneal vertex.
Show Goniometer/Hide Goniometer

Permits viewing or hiding the goniometer, with divisions at 30° intervals, drawn around
the map and centered on the corneal vertex.
Show Zones/Hide Zones

Permits viewing or hiding the concentric rings centered on the corneal vertex, with
radiuses from 1.5 mm to 5.5 mm, with 1 mm steps.
Colors
Figure 12-14: Colors Menu
Pen Color
For changing the color of the pen on the map (Ruler or Meridian).
Text Color
For selecting the color of the text on the map (Text on top left of map or other
text).
Pointer Color
For selecting the color of the pointer (for Distance or Gradient).
Options
Figure 14-5: Options Menu
Coordinates System
Figure 14-6: Numerical Coordinates Menu
For selecting the coordinates used on the map: Cartesian or polar.

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Units of Measurement RMS
Figure 14-7: Units of Measurement
For selecting the units of measurement (micrometers or equivalent diopters) used for
expressing the numerical values.
Representation
Figure 14-8: Aberrations Measurement Menu
Permits choosing among 4 different options:
1. OPD: the Optical Path Difference map represents the difference in the optical
path between the examined wavefront and a spherical wavefront; that is, a
wavefront completely free of aberrations. This map shows total aberration, which
corresponds to the sum of all the aberration components to the exception of tilt
and defocus, up to the 36th polynomial (7th Zernike order).
2. WFE: an alternative manner of representing the OPD map, which simply inverts
the sign of the Zernike polynomials.
3. Seidel: the Seidel panel represents the Seidel third-order aberrations, which
correspond to the following primary aberrations:
Regular astigmatism, for which are reported the map, the RMS of the
entity expressed in equivalent diopters or in µm, and the axis.
Coma, with RMS and direction.
Spherical aberration, with map, the RMS of the LSA (longitudinal
spherical aberration) expressed in equivalent diopters or in µm.
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Residual aberrations, given by the difference between the total OPD and
the aberrations just described: reported are the map and the RMS of the
entity expressed in equivalent diopters or in µm.
High-order aberrations, with map and RMS of the quantity expressed in
equivalent diopters or in µm, grouping all the aberration components of
higher-than-primary orders.
4. Radial Orders: this panel represents the aberrations listed below:

Regular astigmatism, for which are reported the map, the RMS of the entity
expressed in equivalent diopters or in µm, and the axis.
Coma-like: the set of even-order aberrations, for which are reported the
map and the RMS of the entity in equivalent diopters or in µm.
Spherical-like: the set of odd-order aberrations, for which are reported the
map and the RMS of the entity in equivalent diopters or in µm.
High-order aberrations, with map and RMS of the quantity expressed in
equivalent diopters or in µm, grouping all the aberration components of
higher-than-primary orders.
Tools
See Paragraph 5.1
14.1.2 RMS and Pupil Diameter
RMS: represents the mean square error of total aberration, which permits numerically quantifying the
deviation of the examined wavefront from the perfect reference surface.
Pupil diameter ( ): the left-hand side of the window shows buttons for selecting the diameter of the
entrance pupil in a range from 2 mm to 8 mm, by 0.5 mm steps. “Entrance pupil” is understood as the
area of the cornea that covers the image of the real pupil. This datum is extremely important because,
for the same cornea, the aberration increases as pupil diameter increases. Different aberrometry maps
may be compared only if they have been calculated for the same pupil diameter.
14.1.3 Scale
The color scale at the center of the window is expressed in microns; it may be modified.
Absolute
Fixed for all corneas.
Normalized
The scale used is automatically calculated on the basis of the minimum and maximum
height values for the cornea being examined. This scale provides the most adequate
resolution for each map; nevertheless, since the scale is dependent on the difference
between the minimum and maximum values, it is not constant and does not permit
directly comparing two different maps.
Adjustable
On this scale, the user may introduce an arbitrary median value and set the interval
between one value and the next. To set the values, type them directly into the boxes or
use the bar slider (box at bottom). Click the [Apply] button to view the map with the
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scale as set. This scale may be used for comparing different maps: maps for which the
same median value and the same interval are set are in fact perfectly compatible for
comparison.
14.1.4 Zernike Polynomials
On the upper right:

The first column carries the table of the first 36 Zernike polynomials. Generally
speaking, each aberration is represented by a pair of polynomials. Axisymmetric
aberrations are represented by single polynomials.
The second column gives a RMS value and the relative meridian for each aberration.
The last column displays the histogram of the coefficients of expansion of the Zernike
polynomials: the bars represent the weighted value for each aberration. These standard
data are derived from a statistical study of 1000 normal eyes.
To correctly read these histograms it is essential to read the Full Scale value, with respect to
which the program calculates the height of each bar of the histogram. If the Full Scale value is
different for two examinations, the heights of the bars are not directly comparable.
14.1.5 Icons
See Paragraph 5.1
14.2 Visual Quality Summary

A summary simulation of the visual quality of the eye, based on aberrometric analysis of the wavefront,
is displayed.
83
Figure 14-9: Visual Quality Analysis Working Environment
A series of mathematical processing operations produces a simulation of the retina image generated by
the surface being examined. In actual practice, the retina is invested by a wavefront generated by the
eye as a whole and not just by the cornea. The cornea contributes to formation of the retinal image in
the measure of 80% ca. In normal eyes in young subjects, internal aberrations tend to compensate the
corneal aberrations and therefore the visual quality of the eye as a whole should be better than that
simulated for the anterior surface of the cornea alone. In the case of highly distorted corneal surfaces,
the corneal aberrations carry greater weight, to the point that the internal aberrations may be ignored
when simulating the visual quality of the eye. Contrariwise, in older patients the internal aberrations
tend to outweigh the corneal aberrations.
14.2.1 Menus
File
See Paragraph 5.1
Edit
84
See Paragraph 5.1
Analysis
See Paragraph 5.1
View
The View menu is composed of various submenus. If the maps display rulers, meridians,
and other features, the window shown on the right is displayed; otherwise, the window
shown on the left is displayed. Note that once the View function is enabled the item
Hide . . . will be shown; otherwise, Show . . . will be displayed.
Figure 14-11: Image with View Options Enabled
Show Rulers/Hide Rulers

85
Permits viewing or hiding the Cartesian axes centered on the corneal vertex.
Show Meridians/Hide Meridians

Permits viewing or hiding the meridians at 30° intervals centered on the corneal vertex.
Show Goniometer/Hide Goniometer

Permits viewing or hiding the goniometer, with divisions at 30° intervals, drawn around
the map and centered on the corneal vertex.
Show Zones/Hide Zones

Permits viewing or hiding the concentric rings centered on the corneal vertex, with
radiuses from 1.5 mm to 5.5 mm in 1-mm steps.
Colors
Figure 14-12: Colors Menu
Pen Color
For changing the color of the pen on the map (Ruler or Meridian).
Text Color
For selecting the color of the text on the map (Text on top left of map or other
text).
Pointer Color
For selecting the color of the pointer (for Distance or Gradient).
Options
Figure 14-13: Options Menu
Coordinates System
Figure 14-14: Numerical Coordinates Menu
86
For selecting the coordinates used on the map: Cartesian or polar.
Units of Measurement RMS
Figure 14-15: Units of Measurement
For selecting the units of measurement (micrometers or equivalent diopters) used for
expressing the numerical values.
Representation
Figure 14-16: Aberrations Measurement Menu
Permits choosing between 2 different options for the Thibos Pyramid:
OPD: the Optical Path Difference map represents the difference in the optical path
between the examined wavefront and a spherical wavefront; that is, a wavefront
completely free of aberrations. This map shows total aberration, which corresponds
to the sum of all the aberration components to the exception of tilt and defocus, up to
the 36th polynomial (7th Zernike order).
WFE: an alternative manner of representing the OPD map, which simply inverts the
sign of the Zernike polynomials.
Tools
See Paragraph 5.1
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14.2.2 OPD
The window at the top left shows the corneal aberration map as OPD (Optical Path Difference) or
WFE (Wave Front Error). In this case, we have a scale of shades of grey similar that used by
interferometers: the greater the aberration, the greater number of alterations between white and
black observed on the map. The pupil diameter and the RMS are reported underneath the map.
Figure 14-17: Aberrometric Map
14.2.3 Thibos Pyramid
The Thibos‟ Pyramid window on the top left of the screen presents the Zernike coefficients on a
greyscale graph.
The coefficients are arranged in pyramidal form and each corresponds to a rectangular area in which
the shade of grey represents the value of the coefficient. To the right of the pyramid, a greyscale
reports the full scale values corresponding to the maximum (white) and minimum (black) grey tonal
values. The scale is expressed in micrometers and can be modified using the + and – buttons.
88
Figure 14-18: Thibos Pyramid

Right-clicking this figure opens a menu.
Select this box to view the Zernike coefficients.
Figure 14-19: Zernike Coefficients
89
14.2.4 PSF
The PSF (Point Spread Function) represents the intensity of the wavefront on the retina, taking
diffraction into account. The PSF shows how a punctiform object (for example, a star) would be
seen through the cornea being examined.
Figure 14-20: PSF (Point Spread Function) of a Cornea
The value of the Strehl ratio is shown at the bottom of the window. The Strehl ratio is the ratio
between the peak luminous intensity of the PSF of the optical system under examination and the
peak generated by a flat wavefront through the same pupil. An aberration-free PSF has a Strehl
ratio of 1; the ratio decreases as aberration increases.
The upper portion of the window contains the scale factor, consisting of a segment representing
the amplitude of 50‟ arc to provide an idea of the real dimensions of the PSF.
Right-click the figure to open the menu shown below.
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Figure 14-21: PSF Menu
Selecting Black-White or White-Black inverts the greyscale values; besides those, you can
choose a representation in Orange-Violet, or false ZMX colors
100‟ and 200‟ change the amplitude of the arc, or the image‟s dimension: it is useful to select
100‟ for less aberrated cornea‟s, 200‟ for highly abberated cornea‟s.
.
14.2.5 Spot Diagram

The spot diagram represents the aberration of rays passing through the pupil without being affected by
diffraction: each point represents the impact of a single beam on the retina.
Figure 14-22: Spot Diagram
Right-click the figure to open the menu shown below.
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Figure 14-23: Spot Diagram Menu
In this case as well, the image viewing colors can be inverted, between black-white and white-black.
14.2.6 Visual Acuity
A simulation of the vision of an octotype through the cornea under examination is shown in the
window at the top right.
The octotype shown in the figure is logarithmic; the dimensions of the line in the various notations can
be drawn from the table below:
LogMAR MAR decimal C/deg tenths Snellen Snellen Snellen

20ft 6m 4m
1 10 0.1 3 1/10 20/200 6/60 4/40
0.9 8 0.125 3.8 1.25/10 20/160 6/48 4/32
0.8 6.3 0.16 4.8 1.6/10 20/125 6/38 4/25
0.7 5 0.2 6 2/10 20/100 6/30 4/20
0.6 4 0.25 7.5 2.5/10 20/80 6/24 4/16
0.5 3.2 0.32 9.4 3.2/10 20/63 6/19 4/12.5
0.4 2.5 0.4 12 4/10 20/50 6/15 4/10
0.3 2 0.5 15 5/10 20/40 6/12 4/8
0.2 1.6 0.63 18.8 6.3/10 20/32 6/9.5 4/6.3
0.1 1.25 0.8 24 8/10 20/25 6/7.5 4/5
0 1 1 30 10/10 20/20 6/6 4/4
-0.1 0.8 1.25 37.5 12.5/10 20/16 6/5 4/3.2
-0.2 0.63 1.6 47.6 16/10 20/13 6/4 4/2.5
-0.3 0.5 2 60 20/10 20/10 6/3 4/2
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Figure 14-24: Octotypes seen through a physiological cornea
Right-click the image being viewed to open the menu shown below:
Figure 14-25: Visual Acuity Menu
ETDRS: displays Figure 14-24, an octotype seen by a cornea with that visual acuity and pupil.
ETDRS, low-contrast: displays an octotype as in the previous case but with low-contrast letters.
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Figure 14-26: Low-Contrast Octotype
Siemens star: displays a figure that permits identifying astigmatism, if present.
Figure 14-27: Siemens Star
All is Vanity – Charles Allen Gilbert: displays an image of the painting All is Vanity by Charles
Allen Gilbert. The sharp image represents a woman that looks at herself in the mirror,the
blurred one represents a skull
94
Figure 14-28: Charles Allen Gilbert Image
14.2.7 MTF
The window on the bottom right shows the graph of the Modulation Transfer Function (MTF), which
represents the ratio between image contrast and that of the object as a function of spatial frequency.
MTF assessment is a widely-used method for estimating optical system quality. The modulation, which
represents the contrast ratio, is plotted on the y axis; the location frequency (cycles per degree) is
plotted on the x axis. The MTF graph can represent the performance of an optical system at different
contrast levels and for different spatial frequencies. The curve describes the manner in which the
system‟s capacity to perceive detail decreases as contrast decreases. At contrast equal to 1, the capacity
to discriminate detail is maximum; at contrast zero, the capacity to discriminate detail is also zero. On
the other hand, high spatial frequencies are perceptible only at high contrast levels, while low spatial
frequencies remain perceptible at low contrast levels. The MTF curves for the best quality optical
systems lie higher on the graph than the curves for systems with many aberrations.
Right-click to view the menu for selecting among the different representations of the MTF.
Figure 14-29 MTF Menu
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Figure 14-30 Modulation Transfer Function (MTF) for a Normal Cornea (with and without second-order aberrations). The x
and y axis scales are linear. The red line represents the vertical meridian; the blue line represents the horizontal meridian.
Figure 14-31 MTF 3D
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Figure 14-32 MTF + PTF
The MTF + PTF graph represents the variation of the OTF (Optical Transfer Function) as the spatial
frequency varies both in amplitude (Modulation Transfer Function) and in phase (Phase Transfer
Function).
The user may select a linear or logarithmic scale for the MTF graph Right-click:
when the graph is shown with linear-scale axes, to select the commands: logarithmic frequency
axis and logarithmic amplitudes axis.
when the graph is shown with logarithmic-scale axes, to select the commands: linear frequency
axis and linear amplitudes axis.
97
Figure 14-33 Modulation Transfer Function (MTF) of the Same Normal Cornea, with linear scales (left) and logarithmic
scales (right).
98
15 Wavefront Comparisons
Select Wavefront Comparison from the Analysis menu or click the button to open a window from
which to select a map for comparison with the current map.
Figure 15-1: Comparison Map Selection Window
99
Figure 15-2: Wavefront Comparison Figure
This screen compares the Zernike summaries of two different images. For a description of the various
menus, see chapter 14.
100
16 Contact Lenses Autofit

The working environment for simulation of contact lens fit on the cornea is accessed from the
[Analysis/Contact Lenses/Autofit ] menu in the Corneal Map viewing environment or by clicking the
toolbar button.
Figure 16-1: Contact Lens Simulation Working Environment
16.1 Menus
The main bar at the top of the screen carries the main menus as described in Chapter 5.
16.2 Lenses Management Icons
The icons shown in the figure below are used for management of the contact lenses graphics functions.
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Figure 16-2: Contact Lenses Management Icons
Pointer
Select the button to view the local values. Left-clicking on any point on the map drops the
reference cross at that point, making it independent of the mouse pointer. A second click
realigns the reference cross with the mouse pointer. The reference cross is associated with a
series of data referred to each single point on the fluorescein simulation; these data are shown in
the window on the top left of the screen:
Clearance: lifting of the lens with respect to the cornea at that point.
Distance: distance ρ of the center point, if in polar coordinates .
Meridian: meridian on which the point lies, expressed in degrees.
X: abscissa of the point if in Cartesian coordinates, expressed in mm.
Y: ordinate of the point if in Cartesian coordinates, expressed in mm.
Applanation: distance from the cornea, in mm.
Orientation: Cylinder orientation axis.
Graph
Select the button to view a graph of the lens curvature for each meridian. Move the pointer
over the lens and left-click on the point indicating the desired meridian. The graph will be
shown on the lens as highlighted in Figure 16-3.
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Figure 16-3: Lens Graph
Distance
Select the button to measure the distance between two points on the lens. Left-click to
select the first point; select a second point with another click. The distance in mm between the
two selected points will be displayed alongside the second point.
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Figure 16-4: Tools – Distance
Move Lens
Select the button to move the lens. Hold down the left mouse key to drag the lens to
the desired position. When the key is released, the software redraws the lens in the new
position. For the shift in position to be valid, the edge of the lens must not extend
beyond the contour of the limbus. If the shift takes place within this limit, the edge of the
lens will be drawn in white and the software will proceed with the new simulation; if the
contour of the limbus is passed, the edge of the lens will be drawn in red and the
operation will be canceled.
To ignore changes, click the black arrow under the icon and confirm with the
command.
104
Figure 16-5: On the left, a valid lens shift; on the right, an invalid shift.
Tilt Lens
The button is used for tilting the lens. When this item is highlighted a corona that permits
tilting the lens in any direction will be displayed. Click any point on the corona to exert pressure
on the lens in that direction and consequently obtain lifting of the opposite semimeridian. The
effect of tilting can be observed on the simulation and on the graph of the tear layer profile.
Figure 16-6: Tilt Lens
105
Applanate
The applanate button moves the lens away from the cornea by a value established by the
user. Selecting this function displays the window shown below:
Figure 16-7: Applanation Selection
The user may select an applanation value between –200 μm and +200 μm.
Values with a negative sign have the effect of moving the lens closer to the cornea.
To ignore changes, click the black arrow under the icon and confirm with the
command.
Rotate Axis
The button permits rotating the red arrows and orienting the cylinder axis of toric lenses.
Figure 16-8: Rotate Axis
Move the mouse pointer inside the lens and click when the arrows are oriented along the desired
axis. To ignore changes, click the black arrow under the icon and confirm with the
command.
Figure 16-9: Figure with all the options listed below displayed.
Show eye
Icon . Shows or hides the eye in the background to the lens.
Show pupil
Icon . Shows or hides the pupil in the foreground to the lens.
Show limbus
106
Icon . Shows or hides the limbus in the image.
Show rulers
Icon . Shows two scales, in millimeters, along the vertical and horizontal axes.
Show Meridians
Icon . Shows or hides the meridians on the lens.
Show Goniometer
Icon . Shows or hides the goniometer, with divisions at 30° intervals, drawn around the
lens edge.
Show Zones
Icon . Shows or hides the concentric rings, the first with a 1.5 mm radius, drawn on the lens
at 1mm the one from the next.
Refer to Lens Center
Icon . In this case, the numerical coordinates refer to the lens center.
Refer to Corneal Vertex
Icon . The numerical coordinates refer to the center of the cornea.

One of the two preceding options must always be selected.
16.3 Scale
The color scale for the fluorescein simulation is shown alongside the icons on the left side of the lens or
below it: the lightest green represents the thickest accumulation of fluorescein; darker greens represent
increasingly thinner accumulations, shading to black, which represents contact between the cornea and
the lens. Right-clicking the scale opens a menu
107
Figure 16-10: Lens Scales Resolution
for selecting one of three degrees of resolution for the representation:

high resolution: most suitable when the deposits are very thin.
mid-resolution: the most widely used; best simulates the real image of a fluorescein lens fit.
low resolution: for highlighting the contour lines.
16.4 Using the Mouse Pointer and the Reference Cross on the Lens
When the mouse pointer is in the area of the screen occupied by the lens, it takes the form of a
reference cross, which is associated with a series of data referred to each single point on the fluorescein
simulation; these data are shown in the window on the top left of the screen. See Paragraph 16.2.
Left-click any point on the map to drop the reference cross at that point, making it independent of the
mouse pointer. Depending on the command selected from the Tools menu (see above, Paragraph 16.1:
Menus), the mouse pointer may be used to obtain the local values for a given point, to measure a
distance, to obtain the clearance along a given meridian, or to move or tilt the lens.
16.5 Refraction
In the pull-down window on the right-hand side of the screen the user may enter the eye refraction data
or the super-refraction on a test contact lens.
Figure 16-11: Refraction and Over-refraction Data Window
108
When eyeglass refraction data is entered, the program automatically calculates the refraction at the
vertex.
When Super-refraction is selected, the user must enter the radius of the optical zone (BOZR) and the
power of the test contact lens. In the case of toric lenses, enter the two radiuses (BOZRf and BOZRs)
and the two powers of the main lens meridians (PWRf and PWRs: power of a bicylindrical lens).
The refraction or super-refraction data are used by the program to calculate the lens power. The power
is shown in the Select Lens (PWR) window or the Customize Lens window only if the refraction or
super-refraction data have been entered.
The restore button allows the removing of the overrefraction details inserted.
16.6 Select Lens

The pull-down Select Lens window permits selecting the parameters of the lens to be simulated.
Figure 16-12: Select Lens
TLT (Tear Layer Thickness)

Permits setting the value by which the lens is lifted at its center with respect to the cornea.
When the TLT is modified, a new model lens or a new manufacturer must be selected; the
lenses that meet the new application criteria is displayed. The program “remembers” the
variation in TLT setting and uses this criterion the next time the Contact Lenses environment is
accessed.
Manufacturer
Opens the list of contact lens manufacturers from which to select the lens to be simulated. In the
cases of some manufacturers, the lens parameters are not protected and may be viewed and
modified in the Customize Lens section (see below). Many commercial manufacturers‟ data is
instead protected and therefore cannot be either viewed or modified.
When conducting a manufacturer search, the lenses taken into consideration are those belonging
to the model classes included in the Autofit category. In general, lens models featuring reverse
geometry, which are managed in a particular manner (see below), are not included in Autofit
Model
Opens the list of models available from the selected manufacturer.
If the selected model is not a reverse geometry lens, the program will search for the best lens
among that model lenses.
109
If the model selected is a reverse geometry lens, the program opens a window from which to
select the inversion or the preset tear layer depth.
Diameter
Opens the list of diameters available for the selected model.
Base curve
Opens the list of base radiuses available for the selected model.
16.7 Top 10
The Top 10 section contains the data for up to ten different types of lenses that best adapt to the
selected criteria. If a particular manufacturer has been selected (see above), the list will contain only
lenses by that manufacturer.
Select one of the lenses in the list to immediately update the fluorescein simulation. The data for the
selected lens are also entered in the corresponding boxes in the Select Lens window (see above).
16.8 Customize Lens

This section allows the user to display the construction parameters for a lens, if the model series to
which it belongs is not protected, or to enter the data relative to a customized lens.
If this section is opened but the simulated lens is protected, the screen will display a warning message:
“Cannot customize an encrypted model. Select a geometry and set parameters manually.”
To simulate a user-created lens, select a geometry and enter the lens parameters in the enabled
numerical-field boxes.
Figure 16-13: Customizing a Lens
Customized lenses are made up of a series of curves, which are conical arcs, characterized by the
following parameters:
r is the radius of apical curvature in mm. In the case of toric lenses, set the flattest and steepest
radiuses of lens curvature.
is the diameter (mm) of the curve.
w is the amplitude of the curve.
e is the asphericity of the curve, expressed as “e.”
110
off is the offset of the curve (mm). It is not available for the base curve, for obvious reasons.
Depending on the lens geometry selected, values must be entered in several numeric fields:
Spherical, bicurve: r and of the base curve; r and w of the peripheral curve.
Spherical, tricurve: r and of the base curve; r and w of the peripheral curves.
Spherical, tetracurve: r and of the base curve; r and w of the peripheral curves.
Spherical, pentacurve: r and of the base curve; r and w of the peripheral curves.
Spherical, exacurve: r and of the base curve; r and w of the peripheral curves.
Spheroaspheric: r and of the base curve; r, w, e, and off of the peripheral curve.
Dual-conic: r, and e of the base curve; r, w, e, and off of the peripheral curve.
Triconic: r, and e of the base curve; r, w, e, and off of the peripheral curves.
Tetraconic: r, , and e of the base curve; r, w, e, and off of the peripheral curves.
Toric, bicurve: r and of the base curve; r and w of the peripheral curve.
Toric, tricurve: r and of the base curve; r and w of the peripheral curves.
Toric, tetracurve: r and of the base curve; r and w of the peripheral curves.
Toric, dual-conic: r, , and e of the base curve; r, w, e, and off of the peripheral curve.
Toric, triconic: r, , and e of the base curve; r, w, e, and off of the peripheral curves.
Toric, tetraconic: r, , and e of the base curve; r, w, e, and off of the peripheral curves.
To draw the fluorescein simulation, click the button
111
17 Pupillography
<Omissis>
112
18 Settings
The Settings menu may be accessed only if the Patients List is not displayed on the main screen. Click
the button to empty the patients list. Then click or open the File menu and select
Settings.
18.1 Language
After selecting Settings, the menu for setting the system language will open.
Figure 18-1: Settings
Select the language to be used by the software and click [OK].
18.2 Groups
For creating, editing, or deleting groups of examinations.
Cataloguing the examinations by homogeneous type groups (for example: keratoconus, PRK myopia,
PPK hypermetrophy, trauma, etc.) is useful as a search aid.
113
Figure 18-2: Groups Menu
Click the button to insert a new group.
The button can be used to edit pre-existing groups. This button goes active when a group is
selected for editing.
The button is instead used to delete a group. It goes active when a group is selected for deletion.
18.3 Miscellaneous (Other)

Clicking [Other] accesses the window shown below:
114
Figure 18-3: Other Information Menu
Database
Clicking the button in this section selects the image management file called root.cso.
Alternatively, use the button to select a file from the database.
Import from Preceding Exam

When the Groups and Refraction option boxes are selected, each new exam will be attributed
the group and the refraction data of the last exam created.
Patient Management
Deselecting Patient ID (external option box) also deselects the other two options (mode and
PMS) and it will be possible to insert the ID code at the moment a patient is created.
If this option box is instead selected, it will not be possible to enter the ID code manually.
Select one of the following two options:
Mode: the ID code is automatically assigned by Phoenix when a patient is created.
PMS: The ID code and relative personal data will be crossloaded to Phoenix from an
external database. The ID of the agency or institution providing the data must be entered
in the field alongside the PMS item.
Note that in the latter case, the patient entry icon is not active.
Confirmation Query
115
The user may select among the following options:
Close application: displays the message requesting confirmation to close the application.
Delete: displays the message requesting confirmation to delete an image from the gallery
Series error: this warning is given when traces of images erroneously moved to other
folders or files remain in the examination in question.
18.4 Instruments
Clicking the Instruments label accesses the section for managing the instruments to be used.
Figure 18-4: Instruments Management
The button permits inserting a new instrument for use.
116
Figure 18-5: Inserting a New Instrument
Enter a name (reported alongside the exam) and an Executable File (select the SCLive executable file),
then select the class from the pull-down window shown in Figure 19-5. When done, click [OK].
The button permits editing an existing instrument.
To eliminate an instrument from the list, select it and click .
Click the button to calibrate the instrument. For calibrating, see Paragraph 18.5.
The .cid file concerning the SNOMED CT medicinal nomenclature may be entered in the box at the top
(in the figure).
18.5 Calibrations
18.5.1 Sirius Calibration

Calibration of the keratoscope is essential for obtaining accurate measurements. To calibrate correctly,
follow the instructions given step-by-step on the screen and carry out all the captures needed, with the
calibration standards requested
The steps in instrument calibration are the following:
117
Figure 18-6: Instruments Management
- Open the Settings menu.

- Select the Instruments box.
- Select the instrument to be calibrated and click the button. When the request
below appears, confirm with [OK]:
Figure 18-7: Calibration Disk Acquisition
- Carry out linear calibration. See below, Paragraph 18.5.1.1.
118
Figure 18-8: 8-mm Spheres Acquisition
- Carry out the curvature calibration as described below. See Paragraph 18.5.1.2.
To calibrate the topograph for convex surfaces, use the 8-mm radius convex sphere for
test capture.
To calibrate the topograph for concave surfaces, use the 8-mm radius concave sphere for
test capture.
The entire procedure must be carried out with great care in order to obtain precise calibration. During
capture, proceed exactly as described, slowly and in a linear manner, always at the same speed, and
avoiding oscillations of the joystick and/or the table.
18.5.1.1 Linear Calibration
119
Figure 18-9: Linear Calibration
Linear calibration is necessary to permit the program to correctly measure the distances on the image.
Linear calibration is carried out by capturing a calibration disk image. This calibration is especially
important; the calibration procedure must thus be followed with particular care.
Figure 18-10: Linear Calibration (cont‟d.)
At this point, move the horizontal and vertical blue arrows to delimit the disk. Position the two red
circumference arcs in such a manner that they coincide with the most external white ring.
When done, click Next to save the changes.
Linear calibration is required for the concave and convex topograph and for the pupillograph.
18.5.1.2 Curvature Calibration

Curvature calibration is necessary to permit the program to correctly measure the curvatures. Position
the instrument as illustrated below:
120
Figure 18-11: Curvature Calibration
This calibration is especially important; the calibration procedure must thus be followed with particular
care.
Figure 18-12: End Calibration
The last step is to capture 3 or 4 images of the 8-mm sphere, creating a patient and a test exam to verify
correct instrument calibration. If the processed measurements are not found to be reliable, repeat the
entire capture procedure.
121
18.6 DICOM (Digital Imaging and COmmunications in Medicine)
DICOM is a medical computer standard adopted by many health agencies and hospitals in all parts of
the world, which permits medical operators to exchange images and other information via computer
systems adopting this standard.
Deselect the “Do not show DICOM messages” box to show any errors that do not interfere with image
capture.
Figure 18-13: DICOM
If DICOM is instead selected, the remaining menus must be used.
Figure 18-14:
Click the PACS or PMS button to open the following windows:
122
Figure 18-15: PACS and PMS Configuration
This window allows the user to identify the PACS system that will receive his information or the PMS
system from which information may be requested.
In the relative fields, enter:
Title: PACS/PMS ID.
Host: PACS/PMS IP address.
Port: PC port to which PACS/PMS is referred.
Timeout(s): maximum waiting time before disconnecting a call.
Limit: for PMS configuration only, identifies the maximum number of exams that may be
received. If the field is left blank, any number of exams may be received.
Clock [OK] to save the settings as entered; otherwise click [Cancel].

Click [Ping] to initiate a call to the PACS/PMS system.
Figure 18-16: Save Parameters
The Save Parameters allow the user to specify several data storage options:
Storage commitment: select to receive a computer receipt for the data sent. Fill in the Port and
Receiving PC fields.
123
Lossless: select this box to select the type of compression used for sending, in a 5% to 100%
ratio in 5% steps, in .jpeg format. Otherwise, the files are sent in the original, uncompressed
format.
Figure 18-17: Java Runtime Environment
This parameter, defining the environment required for using the functions offered by DICOM, is
configured at end of software installation.
124

SIRIUS - Users SW Manual Phoenix (CSO) - V1.0

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PHOENIX

CONTENTS ............................................................................................................................. III

1 PHOENIX PROGRAM START-UP .................................................................................... 7

1.1 File Menu ..................................................................................................................................... 8

2 PATIENTS DATABASE .................................................................................................... 9

2.1 Patients List ............................................................................................................................... 10

2.2 Patient Data ............................................................................................................................... 10

2.3 Editing Patient Data.................................................................................................................. 11

2.4 Selecting a Patient ..................................................................................................................... 11

2.5 Advanced Search ....................................................................................................................... 12

2.6 Delete Patient ............................................................................................................................. 13

3 EXAMINATIONS DATABASE ........................................................................................ 14

3.1 New Exam .................................................................................................................................. 14

3.2 Selecting an Examination ......................................................................................................... 14

3.3 Editing Examination Data ........................................................................................................ 14

3.4 Deleting an Examination .......................................................................................................... 15

3.5 Refraction .................................................................................................................................. 15

3.6 Capture ...................................................................................................................................... 16

3.7 Image Gallery ............................................................................................................................ 16

4 CAPTURE OF SCHEIMPFLUG IMAGES ....................................................................... 18

4.1 Focusing ..................................................................................................................................... 18

5.1 Menus ......................................................................................................................................... 22

5.2 Scale ............................................................................................................................................ 33

5.3 Local Values............................................................................................................................... 34

5.4 Using the Right Mouse Key ...................................................................................................... 35

5.5 Patient Data ............................................................................................................................... 35

5.6 Indices Panel .............................................................................................................................. 35

7 SINGLE MAP .................................................................................................................. 48

7.1 Map Selection ............................................................................................................................ 48

7.2 3D Map ....................................................................................................................................... 55

9 OPTICAL ANALYSIS OF THE CORNEA ....................................................................... 59

10 MORPHOLOGICAL SUMMARY ................................................................................. 61

11 DIFFERENTIAL MAPS ................................................................................................ 63

11.1 Differential Keratometric Indices............................................................................................ 65

12 MAPS COMPARISON ................................................................................................. 66

13 ADVANCED ALTIMETRY ........................................................................................... 69

13.1 Aspherotoric Fitting (Anterior and Posterior) ....................................................................... 70

13.2 Zernike Altimetry Analysis (Anterior and Posterior) ........................................................... 73

14 CORNEAL ABERROMETRY ...................................................................................... 77

14.1 Zernike Summary ..................................................................................................................... 77

14.2 Visual Quality Summary .......................................................................................................... 83

15 WAVEFRONT COMPARISONS .................................................................................. 99

16 CONTACT LENSES AUTOFIT .................................................................................. 101

16.1 Menus ....................................................................................................................................... 101

16.2 Lenses Management Icons...................................................................................................... 101

16.3 Scale .......................................................................................................................................... 107

16.6 Select Lens ............................................................................................................................... 109

16.7 Top 10 ....................................................................................................................................... 110

16.8 Customize Lens ....................................................................................................................... 110

17 PUPILLOGRAPHY .................................................................................................... 112

18 SETTINGS ................................................................................................................. 113

18.1 Language .................................................................................................................................. 113

18.2 Groups ...................................................................................................................................... 113

18.3 Miscellaneous (Other) ............................................................................................................. 114

18.4 Instruments .............................................................................................................................. 116

18.5 Calibrations ............................................................................................................................. 117

18.6 DICOM (Digital Imaging and COmmunications in Medicine) .......................................... 122

1 Phoenix Program Start-up

Figure 1-1: Registration Screen

Figure 1-2: Main Screen of the Phoenix Program

1.1 File Menu

Figure 1-3: Confirm Exit from Program

Figure 2-1: Search Panel