TOPCON TOPCON SLIT LAMP Model SL-3DCongratulations on your choice of the TOPCON Slit Lamp, Model SL-3D, which is based on the Model SL-3 but incorporates a few modifications designed to con- tribute to greater operational ease during bio-microscopy. We are sure that it will also give you years of unfailing service, as well as being an attractive instrument for your office This instruction manual covers the assembly, operation, care and maintenance of the TOPCON Slit Lamp, Model SL-3D, for use on the TOPCON Adjustable Instru- ment Tables, Models AIT-2 and AIT-3, and/or TOPCON Ophthalmic Stands. May we suggest that you read this instruction manual carefully, in the order that it is written, before you even touch the instrument Thoroughly familiarize yourself with the instrument and you will be able to get the full benefit of a superior instrument, IMPORTANT READ BEFORE TOUCHING THE INSTRUMENT. 1. Please check the primary voltage and see that it matches that of your line cur- rent. If the primary voltage is different, it can be adjusted if you follow in- structions on “Checking Voltage” 2. Please check the plug on the power cord, too. If it is not suitable for the re- ceptacle, it can be exchanged or attached (if not connected) by following in- structions on “Checking the Electric Plug” 3. Do not touch the surfaces of lenses and mirrors with your fingers or any hard object. Do not switch the light on unnecessarily. 5. Always turn the rotary switch @) to OFF when connecting the power cord to the line current or when exchanging lamps. 6. When disconnecting the power cord, or any other cord, grip the connector or plug firmly and do not pull the cord. 7. Do not leave the instrument in a location which is too dusty, has excessive moisture or where the sun will hit it directly. 8. Always keep the instrument covered with the vinyl dust cover, except when in actual use. 9. Please note that there may be minor differences in the actual instrument deliv- ered to you which are not covered in this instruction manual or by supplementary instructions because such improvements do not differ greatly from the instructions and/or illustrations.fees CONTENTS FEATURES OF THE TOPCON SLIT LAMP, MODEL SL-3D SPECIFICATIONS ..... NOMENCLATURE ...... ASSEMBLY .. 1) Unpacking the Instrument... 2) Checking the Voltage and Plug of the Power Cord . (1) Checking Voltage - . (2) Checking the Electric Plug 3) Assembling the Instrument ... (1) Installation of the Instrument. ) Attachment of the Chin-rest and Head Rest Section ) Holding Down the Electrical Wires ) Setting up the Base } Attachment of the Slit Lamp Arm i ) Attachment of the Microscope .. Attachment of the Shield Fixing the Chin-Rest Pads ......... (9) Connecting the Electrical Wires... (10) Storage of Accessories OPERATIONS .... 1) Preparations 2) Examinations 3) Fundus Examination 4) Exchanging the Mirrors ..... CARE AND MAINTENANCE 1) Exchange of the Slit Illumination Lamp.. 2) Exchange of the Fixation Target Lamp... 3) Exchange of the Fuse... 4) Adjustment of the Slit Width Adjusting Wheels. 5) Adjustment in the Inclination of the Illumination System. 6) Cleaning the Instrument. (4) Cleaning the Lenses and Mirrors ..... (2) Cleaning the Condenser Lens of the Slit Illumination (3) Cleaning the Gliding Plate and Rails (4) Cleaning the Plastic Parts .. . 7) General Care.. OPTIONAL ACCESSORIES . 1) Gonioscope Contact Lens .. 2) Adjustable Instrument Table... 3) Ophthalmic Stand .. BIPARONFEATURES OF THE TOPCON SLIT LAMP, MODEL SL-3D 1) The instrument is very compactly designed, with the height from the table sur- face to the optical axis only 390mm and the working distance from the pa- tient’s eye to the eyepieces only 250mm (with the 16x eyepiece lenses). Thus, operations can be carried out on the patient’s eye, while looking through the instrument, without any straining of the operator's body and with the user's body completely supported by the elbow of the hand placed along the pa- tient’s eye. 2) The anterior camera ocular and vitreous body are observed distinctly in stereo- scopic details, for highly accurate biomicroscopy, due to the combination of a sharp, bright slit image and a superior corneal microscope of high resolving power and contrast. 3) Gonioscopy and fundus examination of horizontal optical sections are also pos- sible because the slit illumination can be inclined up to 20° of the vertical, with the slit image rotated to the horizontal 4) The line of sight of the patient's eye is very easily fixated because the fixation target can be adjusted for the patient's refractive power and located at the far point, 2. SPECIFICATIONS Microscope Type Direct viewing binocular stereoscopic microscope with erect image. Magnification changing system Revolver type objective changing system for making two magnification changes Objectives 1x and 1.6 Eyepieces 10x and 16x Magnifications/fields of view Objectives x Eyepieces = Magnifications Fields of View 1x 10x 10x 18mm diameter 1.6% 10x 16x 14.5mm diameter 1x 16x 16x 11.25mm diameter 1.6% 16x 25.6 9mm diameter Dioptric adjustments 10x eyepieces More than +8 diopters for both eyes 16x eyepieces More than +10 diopters for both eyes Angle of microscope axes 13° Pupillary adjustments 10x eyepieces 55mm to 82mm 16x eyepieces 51mm to 78mm 1Slit IMumination Slit projection Illuminated field Slit width Slit length Aperture diameters Slit angle Filters Lamp Base Longitudinal movement Lateral movement Fine cross-slide adjustments Vertical movement Chin-rest vertical range Power Primary Secondary Fuse Standard Accessories Hruby lens Hruby lens guide plate 2/3 magnification Continuously variable from 0 to 9mm (field of view is round at 9mm) Continuously variable from 8mm to 1mm 9mm, 8mm, 5mm, 3mm, 2mm, 1mm and 0.2mm Continuously variable through 90° from vertical to horizontal; horizontal scanning possible; slit projec- tion can be inclined to 5°, 10°, 15° and 20° Four filters built-in or blue filter, red-free filter, 13% neutral density filter and heat absorbing filter. 6V 27W precentered tungsten filament lamp 80mm 100mm 10mm in both longitudinal and lateral directions. 30mm 80mm AC 100V, 115V, 200V, 220V and 240V; adjust- able with built-in voltage selector; 50/60 Hz AC 4.5V, 6V and 7.5V; adjustable with rotary switch. 1 ampere glass-shielded fuse For examinations of the vitreous body and fundus. For use with Hruby lens and Goldmann Applana- tion Tonometer. Designs and/or specifications are subject to changes, without advance notice,3. @ ® NOMENCLATURE Table Accessory drawer Power unit Pilot lamp Rotary switch Gliding plate Rail Rail cover Base fixing screw Control lever Elevating wheel Microscope arm fixing knob Slit lamp arm fixing knob Click-stop roller Exclusive table for use on the TOPCON Ad- justable Instrument Table, Model AIT-2 or Model AIT-3. Has gliding plate and twin toothed rails, for providing the cross-slide base section with free moving capability for locat- ing the instrument. (Replaced with smaller exclusive table for use on TOPCON Ophthal- mic Stand but with same gliding plate and toothed rails.) Provided on the above table only for storage of standard accessories, such as eyepiece lenses, mirrors, test rods, etc. (Not available on table for use with Ophthalmic Stand.) Available on both types of tables with built- in step-down transformer for use with AC 100, 115, 200, 220 and 240 volts, as set with voltage selector @ Lights up when rotary switch is switched ON. Has four settings or OFF—4.5--6-—7.5. Used for controlling secondary voltage to the slit lamp and, consequently, brightness of the slit image, as well as for switching OFF the electricity. Provides the cross-slide base with free move- ment in all directions and, therefore, must be kept clean and smooth Toothed rails are provided for accepting the twin rollers of the base, and provide longitu- dinal movement. Snap-in covers are provided for both toothed rails G Used to fix the base from moving. Loosened by counter-clockwise revolution and tightened by clockwise revolution. Used upright for locating the base (after loos- ening the base fixing screw). The tip of the control lever is tilted slightly, in the required direction, for making fine adjustments in the position. Used to elevate or lower the instrument. Locks microscope arm from rotating; when loosened, permits rotation of the microscope arm Couples slit lamp arm and microscope arm when tightened; slit lamp arm rotates alone, when loosened, The click-stop roller indicates when the slit lamp arm is at 0°, or central position, or 10° to the right or left of the central position 3 tt.Protractor scale Hruby lens guide plate Microscope arm. Scale is used for reading the angle between the microscope arm @ and the slit lamp arm. Used for coupling Hruby lens, when placed in the socket of the rotational axis of the micro- scope and slit lamp arms. Also for use as tonometer mount in coupling Goldmann Ap- planation Tonometer. Can be rotated freely or in coupled move- ment with the slit lamp arm.® Chin-rest adjusting wheel ® Chin-rest @ Shield ® Microscope mounting screw ® Magnification changer lever ® 10x eyepiece lenses ® Eyepiece adjustment rings ® Mirror ® Slit width adjusting wheels @® Slit inclination latch @ Slit inclination stopper ® Centering knob @ Hruby lens attachment mount ® Annular fixation target Used for adjusting the height of the chin-rest ®. Clockwise rotation by the user raises the chin-rest while counter-clockwise rotation low- ers it Supports the patient’s chin and can be ad- justed up or down, to locate the patient's eyes at the correct height. Chin-rest pads @® are fixed on the chin-rest to provide a clean supporting surface for each patient Fixed on the patient's side of the microscope arm @ to shield the patient from the user's breath and vice versa Diagonally located screw for fixing the micro- scope on top of the microscope arm. Used for changing magnification of the micro- scope, by changing the objective from 1x to 1.6x or vice versa. Sleeve insert type eyepiece lenses which can be exchanged for standard accessory 16x eyepiece lenses @, to change magnification of the microscope. Used for individually adjusting eyepieces to the user’s eyesight. Has double scales for 10x and 16x eyepieces. Reflection mirror for the slit illumination sys- tem. Long mirror can be exchanged for the short (square) mirror @, in cases where the long mirror obstructs the microscope’s lines of sight. Either wheel can be used for adjusting the width of the slit illumination from 0 to 9mm, by rotating in either direction. Recycles con- stantly. Releasing the latch will permit inclination of the slit illumination system up to 20° of the vertical, for introducing the slit illumination from 20° below the horizontal Stopper plate for 5° intervals in the inclina- tion of the slit illumination system up to 20°. The knob is loosened, by counter-clockwise rev- olution, which will permit movement of the slit image away from the center of the field of view. When tightened, by clockwise revolution, the slit image will be returned to the center. A sliding mount used for attachment of the Hruby lens. Can be located over the guide plate for use in front of either eye. An illuminated fixation target with an open- ing through which an annular or a bull’s-eye 5@ Level marker @ Fixation target adjustment lever @ Slit diaphragm plate handle ® Filter lever @ Slit diameterjiength scale @ Lamphouse cover ® Lamphouse cover fixing screws @ Head rest type target can be seen The target can be focused by the patient when suitably adjusted with the adjustment lever @, for placing the target at the far point Used to indicate the proper height for the patient’s eyes, as adjusted by raising or low- ering the chin-rst Lever is used for focusing the bull’s-eye target of the fixation target, to the far point of the patient's eye, according to its refractive power, Rotation around the axis of the handle pro- duces seven aperture changes of 9mm, 8mm, 5mm, 3mm, 2mm, 1mm and 0.2mm, which is then followed by infinitely variable changes in the slit length from 1mm to 8 mm, as indicated on the slit diameter/length scale @. There are also click-stops at the 1mm and 8 mm settings, in the latter case. ‘Swinging the same handle in the horizontal plane (around the optical axis of the slit lamp) will also rotate the slit image consecutively from the vertical to the horizontal in both directions. Used for insertion of four filters or heat ab- sorbing filter, 13% neutral density filter, red- free filter and blue filter, as well as an open aperture at the beginning, The filters and open aperture are indicated by symbols or an open circle, a grey-colored index, a circular index, a green-colored round index and a blue- colored round index Shows the seven click-stop apertures and the infinitely variable slit lengths produced with the slit diaphragm plate handle. Encloses the slit illumination lamp and can be detached when the two lamphouse cover fix- ing screws @ are loosened These fixing screws are loosened for the detachment of the lamphouse cover , when it is necessary to exchange the slit lamp or clean the condenser lens. The forehead of the patient must be placed against the head rest for proper orientation.@ Voltage selector @ Fuse holder @ Power cord @ Head rest attachment mount @ Wire holding plate Can be adjusted for primary voltages of AC 100, 115, 200, 220 or 240 volts, after un- screwing the fuse holder 4 cover. Holds 1 ampere glass-shielded fuse & which is exposed when the cover is unscrewed. @ 16x eyepiece lenses @ Hruby lens @ Slit illumination lamps @ Test rod @ Chin-rest pads @ Fixation target lamp @ Luminous fixation target ® Short mirror @ Fuse 6 Adjustable instrument table Fig. 2 Sleeve insert type lenses which can be ex- changed with the 10x eyepiece lenses. Store in accessory drawer when not in use. Used on the Hruby lens attachment mount @, coupled to the guide plate @, for examina- tions of the vitreous body and the fundus. Exposed when lamphouse cover @ is detached. For use in adjusting the eyepiece lenses to the user's eyesight. Used on the chin-rest for providing a clean, hygienic surface for each patient. Used in place of the annular fixation target for strong myopes over 15 diopters. Used in place of the long mirror when the lines of sight of the microscope is obstructed. 1 ampere glass-shielded fuse. Two types of TOPCON adjustable instrument tables are available and must be purchased separately by the user. 7Exclusive table for use on the TOPCON Oph- ® Table thalmic Stand’s lower instrument arm, but otherwise same as the table @ for use on the TOPCON adjustable instrument tables. 48 F 46 a5 a Fig. 34. ASSEMBLY Unpacking the Instrument The Slit Lamp, Model SL-3D, is disassembled and packed carefully for export shipments. Normally, the instrument is packed in three layers of styrol-foam sheets, with cut-outs for inserting individual parts. Therefore, be extra careful when unpacking the case Locate the case with the top side up and open up the top of the case. Take out the contents of the first layer or sheet and then take out the styrol-foam sheet. Continue on to the second layer, in the same manner, and then to the last and third layer, which contains the table © Do not drop the parts, especially optical parts, as they can be damaged beyond repair Once everything has been unpacked, check the contents against the following list:— (1) Table, with power unit and accessory drawer @ 1 each (2) Base section, with twin rollers @) 1 each (3) Slit lamp arm, with long mirror and lamp © Teach (4) Microscope, with 10x eyepiece lenses @ Teach (5) Chin-rest and head rest section © Teach (6) Rail covers @ 1 pair (7) Hruby lens guide plate 0 Teach (8) Shield 2 1 each (9) Long mirror (spare) % Teach (10) Power cord @ Teach (11) 16x eyepiece lenses 1 pair (12) Hruby lens @ Teach (13) Slit illumination lamps (spares) @ 2 each (14) Test rod @ 1 each (15) Chin-rest pads 4 1 pack (16) Fixation target lamp (spare) 6d 1 each (17) Illuminous fixation target si) 1 each (18) Short mirror &2 Teach @ Fig. 5a Fig. 5b(19) Fuse (spare) 1 each (20) Screwdrivers ®, or Plus screwdriver, medium size 1 each Minus screwdriver, large size 1 each Minus screwdriver, small size 1 each (21) Spanner @ 1 each (22) Vinyl dust cover @ 1 each (23) Cleaning brush @ 1 each (24) Silicon cloth @ 1 each (25) Instruction manual 1 each If the Slit Lamp which you have purchased is for use on the TOPCON Ophthal- mic Stand, the first item will be a smaller table, with power unit only, as the contents shown above is that for use on the TOPCON Adjustable Instrument Table Fig. 5c 2) Checking the Voltage and Plug of the Power Cord Before actually assembling the instrument, first, check the primary voltage of the instrument and the electric plug connected to the power cord @. (1) Checking Voltage Turn the table @ over and check the voltage set with the voltage selector @. The required voltage should be seen in the opening on the rim of the voltage selector. If not, however, unscrew the fuse holder @ in the center of the voltage selector, and then pull out the latter. Re-set the voltage selector so that the required voltage (AC 100, 115, 200, 220 or 240 volts) is exposed in the opening of the rim. 10Normally, the instrument is set for the required voltage, at the time of final inspection and, therefore, this adjustment should not be required. (2) Checking the Electric Plug Check whether the electric plug connected to the power cord matches that of the room receptacle. If not, exchange it for a suitable one. On the other hand, the electric plug may not be connected at all, because of specialized requirements in your region, in which case, connect a suitable plug There are three electric wires in the power cord, which are color-coded blue, brown and a bias-striped green/yellow. The blue and brown wires should be connected to the A.C. terminals of the plug while the green/yellow wire should be connected to the grounding terminal, when there is one. Otherwise, ground it as required by your local electrical regulations. If grounding is not required, however, cut off the green/yellow wire at its very end so that it cannot contact the other live wires. 3) Assembling the Instrument (1) Installation of the Instrument The Slit Lamp can be used on top of the TOPCON Adjustable Instrument Table or on the lower instrument arm of the TOPCON Ophthalmic Stand, as well as being used on other similiar equipment. As noted, however, Model SL-3D is available with two types of table or an exclusive table @ for use on the adjustable instrument table, which is larger and has a power unit and an accessory drawer, and an exclusive table ® for use on the ophthalmic stand, which is smaller, has a power unit only and also a protrusion or short pole for fitting the socket on the lower instrument arm. a) Attachment on the TOPCON Adjustable Instrument Table If the adjustable instrument table has also been purchased newly for use with the Slit Lamp, then the table top should not be assembled on top of the elevating mechanism, Unscrew the four attachment bolts which will be found on the bottom side of the table ©, temporarily screwed into their screwholes, Use these four bolts for fixing the table @ on top of the elevating mechanism of the adjustable instrument table 6?, as shown in Fig. 6 Once the table @ has been fixed securely, pull up the bellows covering the elevating mechanism and fix it securely to the bottom surface of the table ® with five fixing plates. Fig 6 1The positions of the fixing plates can be determined by the screwholes which have been started for easier attachment It will not be possible to fix the bellows on the side of the accessory drawer, due to the lack of space. (See Fig. 7) Should you be using an adjustable instrument table which has been pur- chased previously, it will, no doubt, be completely assembled already. In this case, detach the bellows from the bottom surface of the table and then detach the table plate. Attach the table @ of the Slit Lamp as noted in the above instance. b) Attachment on the Ophthalmic Stand Simply insert the pole or column protruding from the bottom surface of the table 6 into the socket on the lower instrument arm of the ophthal- mic stand and tighten the fixing screw. The power unit is attached on the bottom surface of the table @ for use in a set-up in which the lower instru- ment arm comes from the ophthalmic stand placed on the right-side of re- fracting chair (when facing the pa- tient). Thus, if the ophthalmic stand is located on the left-side of the re- fracting chair, it will be found that the power unit will prevent complete rotation of the lower instrument arm, unless it is re-located on the right bot- tom surface of the table 6. Simply Fig. 8 unscrew six fixing screws of the power unit and re-attach the power unit, as required. There are six open- ings showing where screwholes have been started for this purpose. (2) Attachment of the Chin-rest and Head Rest Section Unscrew three attachment screws on the head rest attachment mount @ and fix the chin-rest and head rest section to the table @ with three attachment screws. (See Fig. 9) (Assembly is same for table 6 in all cases.) (3)Holding Down the Electrical Wires Next, detach the wire holding plate @ from the head rest attachment mount @, by unscrewing its fixing screw. 12Then, place the wires from the slit illu- mination lamp and the fixation target lamp, which extend downwards from the chin-rest and head rest section, be- tween the wire holding plate and the table and screw in the fixing screw, so that the wires are held neatly and out of the way. (See Fig. 10) (4) Setting up the Base Simply place the base section on top of the table @, with the outrigger roll- ers aligned on top of the toothed rails Next, insert the rail covers @) in place, over the rails. Insert the flange, on the base of the cover, between the slight opening which exists between the rail and the surface of the table. (See Fig. 11) Tighten the base fixing screw facilitate further work. (5) Attachment of the Slit Lamp Arm Fig. 11 Loosen the microscope arm fixing knob @ and rotate the microscope arm 60° or 90° to the right or left, from its central position, which will be more convenient for attaching the slit lamp arm. Next, loosen the setscrew protruding on the outside of the slit lamp arm’s attachment socket so that it no longer protrudes inside the socket. Finally, lower the slit lamp arm carefully into position, as in Fig. 12, while, at the same time, lining up two red dots. When properly aligned, screw in the setscrew tightly, as in Fig. 13, so that the slit lamp arm cannot be detached. Setscreve | Fig. 12 13 Note: Line up two,Before lowering the slit lamp arm into position, however, be sure to clean both the socket and the hub carefully, as dust or small foreign matters on these surfaces could lead to abrasion. (6) Attachment of the Microscope Grasp the microscope firmly from above, so that the screwhole on the central barrel section is on the bottom, Next, align the notched section on the eyepiece end with the stopper on the microscope arm @®. Next, while holding the microscope firmly with one hand, screw in the microscope attachment screw @) from below, with the other hand, until the microscope is attached securely to the microscope arm. (See Fig. 14) (7) Attachment of the Shield Unscrew the shield attachment screw completely, Next, use the screw and attach the shield @, by passing it through the open- ing at the top end of the shield. (See Fig. 15) (8) Fixing the Chin-Rest Pads Pull out the pad fixing pins, on both sides of the chin-rest, by, first, pushing them up from below. Next, take a suitable quantity of the pads and place them on top of the chin-rest. Finally, fix them in place, by passing the two pad fixing pins through the openings of the pads. (See Fig 16) Tear off one tissue pad each, after ex- amining a patient, which will place a new one in place for the next patient. 14 Stopper Screw. Fig. 15 Fig. 16(9) Connecting the Electrical Wires Set the rotary switch @ to OFF. Next, connect the electrical wires and cords to their terminals or sockets, by coinciding their colors or number of pins. (See Fig. 17) The yellow terminal is for the ground- ing wire, the black for the fixation target lamp, the 2-pin connector for the slit illumination lamp and the 3-pin connec- tor for the power cord. Fig. 17 (10) Storage of Accessories Store the standard accessories supplied with the instrument in the accessory drawer @, as shown in Fig. 18, in the case of table @. When the Slit Lamp is used on the lower instrument arm of the ophthalmic stand, there is no accessory drawer and the standard accessories should be stored in the box supplied for this purpose. (See Fig. 19) Fig. 19 REDQ TRUJILLO NOX 155. OPERATIONS 1) Preparations (1) Use the instrument in a dark room. (2) Insert the plug of the power cord @ into the nearest convenient room re- ceptacle. | (3) Take the test rod 4 from the acces- | sory drawer @ and insert it in place of the Hruby lens guide plate 1% or, in other words, into the opening on top of the post around which the micro- scope arm and slit lamp arm rotate. (See Fig. 20) (4) Turn the rotary switch ® to 4.5, from OFF, and check whether the pilot lamp ® and the slit illumination lamp are illuminated or not (5) Project a suitable slit image on the test rod @ Revolve the slit width adjusting wheel 2 to adjust the width of the slit and revolve the milled knob of the slit diaphragm plate handle , around the axis of the handle, to change the length of the slit (6) Adjust the microscope eyepieces. The dioptric powers of the eyepieces are adjusted with the eyepiece adjust- ment rings 2) on both eyepiece tubes. Draw out the eyepieces completely, by counter-clockwise rotation, which will blur the slit image on the test rod @, when viewed through the eyepieces Next, rotate the eyepiece adjustment ring slowly in the clockwise direction, while checking the slit image in the field of view. Stop revolution when the slit image is sharply focused, which will be the proper correction. Should the ring be revolved past the point of sharpest focus, draw out the eyepiece completely once more and start from the beginning. (See Fig. 21) | The eyepiece lenses are adjusted individually, to assure a satisfactory binoc- ular and stereoscopic examination of the slit image on the fundus. Fur- thermore, the 10x and 16x eyepieces must also be adjusted separately The amount of adjustments made on the eyepieces can be found on the double scales of the eyepiece adjustment rings. The nearer scale, reading from —8 through 0 to +8, is for the 10x eyepieces, while the farther scale, | reading from —10 through 0 to +10 diopters, is for the 16x eyepieces, | 16 |(7) Adjust the pupillary distance. The pupillary distance between the bi- u nocular eyepieces is adjusted by simply rotating the prism housings outwards to increase the distance and inwards ‘ to decrease the distance. The adjustment range is from 55mm to 82mm, with the 10x eyepieces, and 51mm to 78mm, with the 16x eyepieces, (See Fig. 22) F . When the pupillary distance is adjusted properly for the user's eyes, the left Fig, 22 and right fields of view will coincide completely. A really satisfactory stereoscopic examination is only possible when the in- dividual eyepieces are focused carefully for both eyes of the user and the pupillary distance is also carefully adjusted. Therefore, it is very important that these adjustments be made carefully before conducting any examina- tion with the instrument. (8) Check the slit image on the test rod. The slit image focused on the test rod @ must be checked under the fol- lowing two conditions:~ a) Tighten the slit lamp arm fixing knob i and rotate the slit lamp arm and microscope arm together around the upright post (see Fig. 23), and b) Loosen the slit lamp arm fixing knob 3, tighten the microscope arm fixing knob 2 and rotate the slit lamp arm only around the upright post (see Fig. 24) Fig. 23 Fig. 24 In both instances, the slit image should not appear to move, should stay in the center of the field of view of the microscope and should also not be- come blurred and indistinct The test rod is used to check whether the slit lamp and microscope are 7rotating around the same axis and whether the slit lamp and microscope are focused on the identical plane. The accuracy of the instrument should be checked, from time to time, in the above manner. 2) Examinations (1) Seat the patient. Have the patient sit down before the instrument, with the chin placed on the chin-rest @® and the forehead against the head rest ® Rotate the chin-rest adjusting wheel i so that the patient's eyes are ap- proximately level with the level marker B (2) Adjust brightness of the slit illumina- tion. The slit lamp is illuminated when the rotary switch ® is set to 4.5, 6 or 7.8, with the brightness of the illumi- nation increasing in three steps, as the voltage is increased (as indicated by these figures). When set to 6, the 6 volt lamp is used at its rating. There- fore, when the lamp is set to 7.5, the lamp is overloaded considerably, with a consequent increase in brightness and a shortening of the service-life. Using the lamp at 4.5 means that the service-life of the lamp can be extend- ed but that there will be a consider- able drop in the brightness. The ro- tary switch should be set to the lowest permissible setting. (See Fig. 26) On the other hand, when the rotary switch is turned to OFF, all electricity is switched off to the slit illumination lamp. (3) Fixing the patient's line of sight The patient’s line of sight is fixed, by having the patient fixate the fixation target @ with the eye that is not being examined. The direction of the line of sight is changed by simply ad- justing the position of the fixation tar- get, as found suitable. (See Fig. 27) Two types of fixation targets are avail- able with the instrument. One is the annular fixation target, with dioptric Fig. 27 18for the patient's refractive power with the fixation target adjustment lever , in order that the target is located at the far point of the patient's eye, thus eliminating accomodation while fixating the target, as well as convergence. q The range of adjustment is from —15 } through 0 to +15 diopters. The light beam from the fixation target should be directed into the patient's pupil, in order that the patient can see the bull’s-eye type target inside the small opening of the fixation target. adjustments (see Fig. 28), while the | other is the luminous fixation target for use with strong myopes (see Fig. 29) The latter is attached to the fixation target, in place of the front half of the annular fixation target which is detached The annular fixation target is adjusted Fig. 28 For patients with myopia in excess of —15 diopters, the luminous fixation target is recommended, because it is not possible to locate the annular Fig. 29 target at the far point, in this case. Simply detach the end with the an- nular target and attach the luminous fixation target i balance of the fixation target, with the lamp, in place its place, leaving the } (4) Focus the slit image on the iris. The slit image should be roughly focused on the iris of the patient's eye, at this time, with the naked eye, i.e., not through the microscope. First, loosen the base fixing screw @ , which will permit free movement of ! the base in the horizontal plane. Hold the control lever @ upright and posi- tion the base section, At the same time, use the elevating wheel @ and adjust the height of the microscope. Finally, re-tighten the base fixing screw. The slit image should be finely focused, ; after adjusting the width and length of the slit image, etc. Hold the tip of the control lever @ lightly and tilt it slightly in the required direction, which } will shift the base slightly in the same direction. If necessary, use the elevat- ing wheel @ once more, to make ad- justments in the height. | 19 Fig. 30(5) Adjust the slit width. Rotate one of the two slit width ad- justing wheels @% which will produce continuously variable changes in the width of the slit image, from 0 to 9mm. At 9mm, however, the slit will simply become a circular patch of light. (See Fig. 31) These wheels can be rotated in either direction, as the cycles are continously repeated. In other words, the width in- creases to 9mm and then decreases to Omm and then increases to 9mm and so on. The scales on these wheels do not show the actual width but can be used as reference for repeating a previous slit (8) Adjust the slit length Rotate the knurled knob of the slit diaphragm plate handle @ around the axis of the handle which will produce seven changes in the slit length of 9mm, 8mm, 5mm, 3mm, 2mm, Imm and 0.2mm, followed by infinitely vari- able changes from 1mm to 8mm, with click-stops at the Imm and 8mm set- ting, in the latter case. If the slit should be opened to its maximum width, at this time, the former changes will produce circular beams of 9mm, 8mm, 5mm, 3mm, 2mm, 1mm and 0.2mm diameters re- spectively. The changes in lengths (diameters) produced by the seven apertures, as well as the infinitely variable slit lengths produced by a wedge-shaped diaphragm, are indicated on the slit diameter/ length scale @ over the slit diaphragm plate handle. The scale for the infi- nitely variable changes has a minimum division of 0.1mm (7) Rotating the slit. Rotating the slit diaphragm plate handle @ around the vertical axis of illumina- tion, in the horizontal plane, will, on the other hand, rotate the slit image con- tinuously through 90°, from the vertical to the horizontal, with olick-stops at the 20 Fig. 31 Fig. 33(8) (9) vertical, oblique and horizontal positions. The oblique and horizontal positions are convenient for gonioscopy and fundus examination in which oblique and hori- zontal optical sections are required. (See Fig. 33) Inclining the slit illumination system. Release the slit inclination latch 2 and pull the lamphouse end towards the operator, which will incline the slit il- lumination system up to 20° of the vertical The slit image will be introduced at an angle of 20° below the horizontal and, with the horizontally-located slit, will have the same effect as swinging the vertical slit image. Inclining the hori- zontal optical section is particularly val- uable for gonioscopy and fundus ex- aminations. The slit inclination stopper @® engages the slit inclination latch @ at 5° in- tervals, for producing four angles of inclination, or 5°, 10°, 15° and 20° (See Fig. 34) Choice of reflection mirror. Two types of reflection mirrors are available for use in deflecting the slit illumination towards the patient's eye, or a long mirror @, with a tapered handle end, and a short mirror &, which is a simple square. (See Fig. 35) The long mirror is normally used with the vertical slit illumination for standard types of examinations. However, it may obstruct the line of sight of either objective, either partially or completely, when the slit lamp arm and microscope are used at angles of setting between about 3° to 10°, because of the longer tapered mirror section. Thus, if com- pletely unhindered binocular observa- tion is required at these angle settings, with either the vertical or inclined slit, the long mirror should be exchanged for the short mirror as the shorter mir- ror will not obstruct the line of sight of the objective When using the short mirror, the slit 21 be Fig. ® Fig. v Fig. 35 36 52illumination system can be inclined by 10° for reflecting the complete illumi- nation spot. (See Fig. 36) (10) Swinging the slit image The slit image can be swung across the eye, by loosening the centering knob @® and rotating the slit illumination around its vertical axis. Displacing the slit image away from the center of the field of view, in this manner, will pro- duce indirect illumination, retro-illumi- nation, scleral scatter, etc The slit illumination will be returned to the center of the field of view, when the centering knob is re-tightened. The centering knob should be tightened securely for normal examinations. (See Fig. 37) (11) Insertion of filters. Four filters are inserted into the light path with the filter lever @® which is simply rotated horizontally, to the right or left, as the case may be, and set to the required symbol or setting The symbls are a grey-colored round index (®) for the heat absorbing filter, a circular index () for the 13% neu- tral density filter, a green-colored round index (@) for the red-free filter, a blue- colored round index (@) for the blue filter and a plain circle which indicates the open aperture. The blue filter is used for applanation tonometry and examinations with flu- orescein, the rec-free filter is used for obtaining a green-colored field of great- er contrast, the 13% neutral density filter is used for general observation over a wide field with the slit opened to the maximum aperture and the heat absorbing filter is used with the over- loaded lamp (when used at 7.5 volts) with the opened slit. 22 Fig. 37 Fig. 39(12)Magnification changes, The magnifications of the objectives can be changed by simply moving the magnification changer lever @ from 1 x to 1.6x. (See Fig. 40) The magnifications of the eyepiece lenses can also be changed, by simply taking out the 10x eyepiece lenses and replacing them with the standard oe. accessory 16% eyepiece lenses. 2 The above changes produce four differ- | L 5 ent total magnifications, or 10x, 16x a (with the 10x eyepieces), 16% and Fig. 40 25.6% (with the 16x eyepieces) 3) Fundus Examination Only the forward one-third portion of the vitreous body can be examined with the preceding examination, since it is not possible to focus the slit image further into the vitreous body due to refraction by the cornea and crystalline lens. The Hruby lens, a preset lens of —58.6 diopters, is, therefore, supplied for the examination of the fundus and the posterior part of the vitreous body. The Hruby lens is used on the Hruby lens attachment mount i coupled to the Hruby lens guide plate @, which should be fixed on the opening in the rota- tional axis of the slit lamp arm and microscope arm. When coupled in this manner, the Hruby lens follows all movements of the microscope while its dis- tance to the patient’s eye remains fixed, thus greatly facilitating examinations of the posterior segment of the eye with the slit lamp immediately after ex- amining the anterior segment. (1) No special preparation is required of the patient, if the pupil will stay open wide enough. If not, a few drops of mydriatic may have to be given to the patient's eye about 20 minutes before the examination, in order to keep the pupil dilated sufficiently (2) Place the Hruby lens guide plate @® in place on top of the rotational axis of the slit lamp and microscope arms. (3) Pull the lever @ of the Hruby lens at- tachment mount @% forward which will free the attachment mount 0 and let it slide laterally below the chin-rest. Locate the attachment mount the Hruby lens guide plate 4 and insert the shank of the Hruby lens 48) into the attachment mount 0, with the lower end of the shank engaging the groove of the guide plate @. If neces- sary, loosen the locking ring to permit the shank to lower sufficiently for cou- pling. (See Fig. 41) 23(4) Center the slit lamp arm and micro- scope arm approximately so that they face the patient's eye. (5) Depending on whether the patient is myopic or hyperopic, move the Hruby lens forward or backward, with the control lever @®), so that a slit image is focused on the fundus. (See Fig. 42) (6) When the Hruby lens is not being used, simply pull the Hruby lens up so that the lower end of the shank no longer engages the coupling groove of the | guide plate @ and tighten ring © to | Prevent the Hruby lens from falling down, Then, move the Hruby lens at- tachment mount @ to the right, as far as it will go, and revolve the lever ® to the right, too. The Hruby lens can be left in this posi- tion until it is next used. (See Fig. 43) Fig. 43, 4) Exchanging the Mirrors As noted, there are two types of mirrors, or long and short, which can be used interchangeably To exchange them, (1) Increase the angle between the microscope and the illumination, (2) Incline the illumination system about 10°, (3) Pull out the mirror. While the long mirror is easily pulled up, by gripping its tapered end (as in Fig 44), the short mirror must be pushed up slightly, with the sharp point of a pencil, etc., (as in Fig. 45) before it can be pulled up. Do not touch the surfaces of the mirrors during exchange and place the de- tached mirror in its slot, in the accessory drawer. ta \ Fig. 44 Fig. 45 246. CARE AND MAINTENANCE 1) Exchange of the Slit Illumination Lamp The slit illumination lamp should be exchanged, in the following manner, by taking off the lamphouse cover i and exposing the vertically suspended pre- centered tungsten filament lamp. (1) First, set the rotary switch @) to OFF and cut off electricity to the slit il- lumination lamp. If the slit lamp has been in use, prior to exchanging the lamp, it will still be quite hot and, therefore, wait several minutes until the lamphouse cover has cooled sufficiently for handling (2) Loosen the two lamphouse cover fixing screws @ and lift up the lamphouse cover %, which will expose the lamp. Simply lift out the old bulb and replace it with a new one. (3) When inserting the new lamp bulb, see that the notch on the flange of the centering base is accurately coincided to the locating plate and/or that the flange is well-seated and not riding high on one side, as otherwise, a slit image will not be projected. (See Fig. 46) Correct Not correct Not correct Fig. 46 (4) When correctly inserted, replace the lamphouse cover and tighten the fix- ing screws @ while pressing down on the cover (See Fig. 47) (5) Rotate the rotary switch to 4.5 and check illumination of the slit illumina- tion lamp, Fig. 47 2) Exchange of the The fixation target lamp ation Target Lamp ) should be exchanged, as follows, by taking off the 254) front target end and exposing the lamp bulb. (1) Loosen the knurled knob of the fixa- tion target @ slightly and detach the target end. (Do not turn the knob too much, as it will become detached.) a (2) Grip the exposed lamp bulb and revolve 4 — in the counterclockwise direction, until Knob. it comes off. (See Fig. 48) (3) Replace with a new bulb, by revolving in the clockwise direction. Replace the . target end and check illumination of the target. Fig. 48 Exchange of the Fuse The fuse should be exchanged, in the following manner, when both pilot lamp @ and slit illumination lamp @ do not light up when the rotary switch @ is turned ON. (1) Turn the rotary switch OFF. (2) Revolve the fuse holder @ cover in the arrow-indicated direction and it will come off, together with the glass- shielded fuse. (See Fig 49) (3) Insert the replacement fuse in the fuse holder and replace the cover. (4) Finally, turn the rotary switch ON and check whether the pilot lamp and slit Fig. 49 illumination lamp actually light up. Use a1 ampere glass-shielded fuse, which normally, available on most markets. Adjustment of the Slit Width Adjusting Wheels If the slit width adjusting wheels @ rotate too freely, even resulting in acci- dental changes of the slit width, or the movement of the wheels is tight, adjust the friction of the adjusting wheels. The friction adjustment screw is located in the center of the right-hand slit width ad- justing wheel. Therefore, adjust the screw with the minus screwdriver, until the ten- sion is just right. (See Fig. 50) Turning the screw in the clockwise direction will pro- duce a tighter movement while counter- clockwise rotation of the screw will slacken the friction of the wheels. 265) Adjustment in the Inclination of the Illumination System If the illumination system moves on its own and does not remain in the inclined position at which it is set, between any two stops of the slit inclination stopper @, adjustment must be made in the rotational axis of the illumination system. Adjustment screws are located on both sides of the rotational axis, as in Fig. 51 Both screws must be adjusted with a minus screwdriver until the proper tension is ob- tained, and, it should be noted that, this does not necessarily mean that both screws must be adjusted by the same amount As with the slit width adjusting wheels, clockwise rotation will increase friction while Fig, 61 counter-clockwise rotation will slacken fric- tion. Cleaning the Instrument (1) Cleaning the Lenses and Mirrors As a general rule, the surfaces of the lenses and mirrors should not be touched, as much as possible. When dirty, try to brush away the dust and dirt with the accessory clean- ing brush, which should, furthermore, be stored in accessory drawer when not in actual use. If the lens and/or mirror cannot be cleaned by brushing, however, wipe the surface with a soft, well-washed cotton cloth, linen cloth, etc., which can be lightly dipped into a solution of 4 parts ether and 1 part alcohol. Do not wet the cloth excessively but repeat, if necessary. Furthermore, do not rub the surface but wipe lightly, repeating, if necessary, until the sur- face is clean. Do not use anything which might scratch the delicate sur- faces. (2) Cleaning the Condenser Lens of the Slit Illumination The condenser lens of the slit illumination system may have to be cleaned, if the illumination seems slightly dark. First, detach the lamphouse cover @, vr by unscrewing the fixing screws @. Lamp's centering Next, unscrew the four knurled knobs base chip_ which will be exposed, as in Fig. 52.0 Then, pull up the lamphouse which will "i expose the surface of the condenser | lens. Clean the surface in the same | manner noted above. | The lamphouse can only be replaced so that the locating plate, for the lamp's centering base chip, is located on the Fig. 52 side of the patient. (See Fig. 52) 27(3) Cleaning the Gliding Plate and Rails The gliding plate @ and rails @ on the table @ must be cleaned from time to time, to insure smooth movement of the base over the table. Otherwise, if these parts should become dirty, with dust, dirt and other foreign matters, as well as with medicines and other solutions which might drop, the movement of the base over the table area will become heavy. Clean the gliding plate with the silicon cloth and the rails with a brush, If the former should become too dirty, it can also be cleaned with a cloth soaked in a soapy solution or in detergent, but the gliding plate should then be wiped dry with a clean cloth. (4) Cleaning the Plastic Parts The plastic parts of the instrument, such as chin-rest, head rest, etc., should not be cleaned with any kind of chemical solution. Use the silicon cloth to keep these parts clean. If further cleaning is re- quired, wipe them with a cloth soaked in a light detergent solution or in soapy water. When cleaned in this manner, however, finish with a clean wet cloth to eliminate any residue and then wipe dry with a clean cloth, too. 7) General Care The instrument should not be used in a room which is dusty, is damp or has direct sunlight. The vinyl dust cover should always be placed over the instrument when i not being used, 287. OPTIONAL ACCESSORIES Several optional TOPCON accessories are available for use with the instrument, such as gonioscope contact lens, adjustable instrument table and ophthalmic stand In addition to these TOPCON accessories, however, it is also possible to use the Goldmann Applanation Tonometer, Models R900 and T900, with the instrument, without requiring any special adaptation of the instrument, except for the use of the Hruby lens guide plate 48 with the Model T900. Model R900 Model T900 Fig. 53 1) Gonioscope Contact Lens The gonioscope contact lens is a three- mirror contact lens for the examination of the entire fundus and angle of the anterior chamber, in combination with the instru- ment. The TOPCON gonioscope contact lens weighs 25 grams and has three internal glass mirrors arranged at different angles of 78°, 69° and 62° to the plane front sur- face, with the three mirrors spaced at in- tervals of 120°, thus providing complete Fig. 55 coverage in gonioscopy @ 2) Adjustable Instrument Table There are two types of adjustable instrument tables available. The Model AIT-2 adjustable instrument table is a free-rolling instrument table Which can be moved around freely on four casters and fixed with a stopper. At the same time, table height can also be adjusted from 700mm to 900mm above the floor level, with height adjustments made by simple foot switch op- erations. The model has a lifting capacity of 100 kgs. (220 Ibs.) and an elec- 29trical outlet for connetcions of instruments placed on top of the table, with the sec- ondary voltage corresponding to the primary one. The Model AIT-3 adjustable intrument table also has four casters, with stoppers, for free-wheeling movements, and a spare elec- trical outlet for connection of the instru- ment used on it. However, the equipment is as a rule, not supplied with the table, with the table @ of the Model SL-3D Slit Lamp being attached directly on top of the elevating mechanism of the Model AIT-3 adjustable instrument table. Motoriz~ ed lifting action is activated by a lever switch located on the column with the maximum lifting capacity 50 kgs. (110 Ibs.) Both models can be supplied for use with A.C. 100, 115, (AIT-2), 117 (AIT-3), 200, 220 or 240 volts, as specified at the time of order 3) Ophthalmic Stands There are three ophthalmic stand models available for use with the Model SL- 3D Slit Lamp, or Models IS-10, IS-20 and IS-30, which all have an electrical outlet for utilization by the instrument. The TOPCON optional accessory and equipment noted above are avilable against special orders and at extra cost. They are all recommended for optimum perform- ance of the TOPCON Slit Lamp. At the same time, it should be noted that there may be changes in these accessory andjor equipment in the future. 30TOPCON TOKYO OPTICAL CO., LTD. 75-1 Hasunuma-cho, Itabashi-ku, Tokyo, 174 Japan. ‘Telex: 0272-2384 Phone: 3-967-N101 Fax:3-260-4214 TOPCON INSTRUMENT CORPORATION OF AMERICA ‘CORPORATE OFFICE 65, West Century Road, Paramus, New Jersey 07652, U.S.A ‘Telex : 124538 Phone: 201-261-9450 Fax : 201-387-2710 WESTERN REGIONAL OFFICE 325 North Wiget Lane, Walnut Creek, California 94598, U.S.A Phone 415-347-4800 "Fax : 419-847-3064 TOPCON EUROPE B.V. ‘Groothandelsgebouw, P.O. Box 29038, 001 GA Rotterdam, Netherlands. Telex: 23783 Phone: 10 127279 Fax 10 149545 TOPCON DEUTSCHLAND GmbH Krefelderstrasse 19-21, D-4156 Willich 1, West Germany. Telex 8531981 Phone: 2164 427061 ~6' Fax: 2154-40909 TOPCON SINGAPORE PTE. LTD. "24 Pasit Paniang Road, #05-15 PSA Multi-Storey Complex, Singapore 0511 Telex: RS20022 Phone:2760222 Fax: 2733540