GA VISUPAC 4.5 JP

VISUPAC
Digital Image Archiving System
Software description
医薬品医療機器等法による法定表示
販売名画像ファイリング装置 VISUPAC
認証番号 227AHBZX00020000
一般的名称眼底カメラ用プログラム
クラス分類管理医療機器
東京都新宿区本塩町22
製造販売業者カールツァイスメディテック株式会社
03-3355-0331
© 2016, Carl Zeiss Meditec AG, Jena
All rights reserved in the event of granting of patents or registration as a utility

patent.
All names of companies and products cited in this software description may be
trademarks or registered trademarks. References to products of other manufacturers
are for information purposes only. Such references are intended neither as an
approval nor a recommendation of these products. Carl Zeiss Meditec AG accepts
no liability for the performance or use of such products.
Windows® is a registered trademark of Microsoft Corporation, Inc.

VISUPAC® is a registered trademark of Carl Zeiss Meditec AG.
Other brand names, software and hardware names used in this software description
are generally subject to trademark or patent protection. The quoting of products is
for informational purposes only and does not represent a trademark misuse.
The weblinks are dynamic hyperlinks. Before incorporating any links,

Carl Zeiss Meditec AG checks their content to ensure that it is not likely to result in
civil or criminal liability. It does not, however, continuously check for any changes
which could form the basis for liability. If Carl Zeiss Meditec AG determines that a
link which it has incorporated could result in civil or criminal liability, or is alerted to
the fact by a third party, the link will be removed.
This software description is protected by copyright. Unless expressly authorized in

writing, dissemination, duplication or other commercial exploitation of this
document or communication of its contents or parts of it is not permitted. In case of
infringement, the violator may be liable to pay compensation for damages.
Specifications due to technical developments are subject to change. This software

description is not subject to the revision service. Please contact the manufacturer or
authorized dealer to request the latest edition of the software description.
000000-1463-266-SWGA-JP-200116
Contents 1
Contents
Contents .....................................................................................1
Notes on the software description .............................................6

Purpose and availability of documentation .................................................... 6
Questions and comments................................................................................ 6
Explanation of symbols used .......................................................................... 7
Operation ...................................................................................8
Log in as a user under Windows® ................................................................... 8
Launching the VISUPAC software ................................................................... 8
Log in as a user under VISUPAC ..................................................................... 8
Logging off or changing users ........................................................................ 9
Switching off ................................................................................................. 10
User interface layout ................................................................11

User interface of the main menu .................................................................. 11
Open online help and Retina Atlas ...........................................13

Opening help................................................................................................. 13
Retina Atlas ................................................................................................... 14
User management ....................................................................15

The function of user management................................................................ 15
Starting user management ........................................................................... 16
Creating a new user and assigning user rights ............................................. 17
Assigning or changing rights of existing users ............................................. 19
Deleting existing users .................................................................................. 19
Assigning patients not yet assigned to user groups ..................................... 19
Managing authorization groups ................................................................... 20
Managing user groups .................................................................................. 21
Creating new user groups ........................................................................................ 21
Editing user groups ................................................................................................... 22
Deleting a user group ............................................................................................... 22
Transaction log ............................................................................................. 23
Information for the administrator ............................................................................. 23
Opening a transaction log ........................................................................................ 24
Exporting the transaction log as HTML ..................................................................... 25
Deleting the transaction log ..................................................................................... 26
000000-1463-266-SWGA-JP-200116
2 Contents
Patient data management ....................................................... 27

Select patient and data ................................................................................ 28
Displaying STRATUS OCT data into VISUPAC .............................................. 30
Search for data ............................................................................................. 32
Patient information ...................................................................................... 35
Creating a new patient .............................................................................................35
Editing patient data ..................................................................................................36
Deleting a patient .....................................................................................................37
Diagnosis ...................................................................................................... 37
Accept or delete standard diagnoses ........................................................................38
Code scheme ............................................................................................................39
Expanding or reducing the list of diagnoses .............................................................39
Saving the standard diagnoses as an HTML file ........................................................41
Patient's visits .............................................................................................. 42
Entering a visit date ..................................................................................................42
Moving patient visits .................................................................................................42
Deleting patient visits................................................................................................44
Patient data .................................................................................................. 44
Moving images to another patient ...........................................................................44
Delete images ...........................................................................................................46
Restoring deleted data ..............................................................................................47
Examination mode ................................................................... 48

General advice on capturing images ............................................................ 48
Supported image capture sensors ................................................................ 49
Capturing images with the AVT ZK-5 digital camera ................................................50
Capturing images with the Pike F145B and Pike F421B digital cameras ...................52
Image capturing with the Canon EOS 5D Mark III digital camera .............................54
Examination mode tool bar .......................................................................... 56
Keyboard commands .................................................................................... 57
Additional control panel............................................................................... 58
Image capture with the FF 450plus fundus camera ........................................ 59
Color image capture mode .......................................................................................61
Red, green or blue image capture mode ..................................................................61
Autofluorescence AF image capturing mode ............................................................61
Fluo image capture mode .........................................................................................61
ICG image capture mode ..........................................................................................61
Capturing Fluo and ICG series of images ..................................................................62
Import data .............................................................................. 66

Importing DICOM images ............................................................................. 66
Importing images with VISUPAC Acquire .................................................... 68
Image evaluation ..................................................................... 69

Image display ............................................................................................... 69
Activating image display and selecting images .........................................................69
000000-1463-266-SWGA-JP-200116
Contents 3
Marking an image as a favorite ................................................................................ 70

Image display field .................................................................................................... 71
Stereo presentation using standard split views ......................................................... 73
Video viewer ............................................................................................................. 74
Image editing ................................................................................................ 75
Overview of the VISUPAC image editing functions ................................................... 75
Image editing tool selection ..................................................................................... 75
Save image ............................................................................................................... 75
Save modified image ................................................................................................ 76
Select cursor function ............................................................................................... 77
Move image cursor function ..................................................................................... 77
Region of interest cursor function ............................................................................ 78
Undo ......................................................................................................................... 78
Full screen ................................................................................................................. 78
Zoom region ............................................................................................................. 78
Basic functions .............................................................................................. 80
Sharpen image .......................................................................................................... 81
Brightness ................................................................................................................. 81
Contrast .................................................................................................................... 81
Rotate image by 180° ............................................................................................... 81
Invert image.............................................................................................................. 81
Tonal value correction .............................................................................................. 82
Global greyscale correction (automatic).................................................................... 83
Adaptive zooming..................................................................................................... 84
Displaying/hiding graphic elements .......................................................................... 85
Displaying/hiding reference points ............................................................................ 85
Displaying/hiding reference objects .......................................................................... 85
Drawing function .......................................................................................... 86
Moving graphic elements ......................................................................................... 87
Deleting graphic elements ........................................................................................ 87
Using the drawing functions..................................................................................... 88
Mapping function ......................................................................................... 91
Mapping tools selection ........................................................................................... 91
Performing mapping ................................................................................................. 92
Overlay function ............................................................................................ 94
Overlay tools selection .............................................................................................. 94
Performing overlay ................................................................................................... 96
Dynamic comparison ..................................................................................... 97
Executing the dynamic comparison .......................................................................... 98
Selecting an image section while dynamic comparison is running ........................... 98
Saving the dynamic comparison as a video sequence .............................................. 98
Measurement of the eye fundus ..............................................99

Important advice on determining the size of objects on the fundus of
the eye .......................................................................................................... 99
Measured value correction ......................................................................... 100
Absolute measurement ............................................................................... 101
References are available .........................................................................................101
No references are available .....................................................................................102
Defining a reference circle ......................................................................................102
Defining a reference line .........................................................................................104
000000-1463-266-SWGA-JP-200116
4 Contents
Generation of a predefined reference circle........................................................... 105

Generation of a predefined reference angle .......................................................... 106
PDT measurement ...................................................................................... 107
Determining the laser spot diameter required for PDT (photo-dynamic therapy) .. 107
Carrying out the PDT measurement ....................................................................... 107
Performing the PDT measurement including percentage CNV .............................. 108
Body Surface Area - Information ........................................................................... 108
Papillary diagnostics................................................................................... 109
Specifying distances in papillary diameters ............................................... 110
Classification of structures at the fundus ................................................... 111
Maculopathy grading measurement circle ............................................................. 111
AREDS measurement circles................................................................................... 112
Creating panorama images ........................................................................ 113
Automatic creation of a panorama image ............................................................. 113
Zeiss AutoMap - Error messages ............................................................................ 114
Manual creation of a panorama image .................................................................. 115
Approximate positioning of images ....................................................................... 116
Accurate positioning of the images ....................................................................... 116
External modules ........................................................................................ 117
Exporting, archiving and printing .......................................... 118

Exporting data............................................................................................ 118
Exporting image data............................................................................................. 119
Exporting visits ....................................................................................................... 120
Exporting DICOM patient data .............................................................................. 121
Archiving .................................................................................................... 124
Archiving on data storage media ........................................................................... 124
Archiving on an NAS system .................................................................................. 124
Copy function as an additional backup .................................................................. 125
Printing data .............................................................................................. 126
Standard printing ................................................................................................... 126
Print layout ............................................................................................................ 127
Creating a new print layout ................................................................................... 129
Editing defined print layouts .................................................................................. 130
Deleting pre-defined print layouts ......................................................................... 130
Specifying a print layout as the standard layout .................................................... 130
Medical report ............................................................................................ 131
Communication with PACS and EMR systems ....................... 135

DICOM Modality Worklist Query ................................................................ 136
Query by patient .................................................................................................... 137
Query by visit ......................................................................................................... 138
DICOM export............................................................................................. 139
Exporting complete visits ....................................................................................... 139
Exporting DICOM objects to the standard archive ................................................. 140
Exporting DICOM objects to several archives (multiple storages) .......................... 141
000000-1463-266-SWGA-JP-200116
Contents 5
DICOM Query/Retrieve ................................................................................ 142

Archiving on PACS ..................................................................................................142
Query/Retrieve ........................................................................................................143
Information on the SMP interface .............................................................. 145
SMP-Basic ...............................................................................................................145
Annex .....................................................................................146
Installing a license key ................................................................................ 146
Abbreviations/Glossary...........................................................148
Figures....................................................................................149
Index ......................................................................................152
000000-1463-266-SWGA-JP-200116
6 Notes on the software description
Notes on the software description

Purpose and availability of documentation
This software description explains the functions of the VISUPAC® software.
Correct operation of the system is imperative for its safe and successful
function. You should therefore ensure that you are thoroughly familiar with
the user manual and this software description before setting up and using
the VISUPAC system for the first time.
The user manuals and other documentation enclosed with the VISUPAC
system should be kept accessible to users at all times to ensure that the
information required for use of the VISUPAC system is readily available.
Questions and comments

If you have any questions or comments concerning this software description
or the VISUPAC system, please contact ZEISS service or your local dealer.
(Contact details see reverse.)
000000-1463-266-SWGA-JP-200116
Notes on the software description 7
Explanation of symbols used

The symbols used in this software description refer to important safety
information which warn against possible health risks or fatal injuries and
contain useful notes. Whenever you see these symbols, read the
accompanying information carefully and observe all safety notes and
information in the user manual, the software description and on device
labels.
WARNING
Indicates a hazardous situation which may result in death or serious bodily
injury if the appropriate safety precautions are not heeded.
CAUTION
Indicates a hazardous situation which may result in minor or moderate
injury if the appropriate safety precautions are not heeded.
CAUTION - PROPERTY DAMAGE

Indicates possible device damage if the appropriate safety precautions are
not heeded.
 Information, hints and advice to aid understanding of the

instructions to be observed in the operation of the device.
000000-1463-266-SWGA-JP-200116
8 Operation
Operation
Log in as a user under Windows®
After launching Windows you will be requested to log in.
• Select your user name (default: Operator) or enter the user name using
the keyboard.
• Enter the password (by default: java).
 You can only log in as administrator after consulting with ZEISS

service. When entering the password, a distinction must be made
between upper and lower case letters.
Launching the VISUPAC software

If an FF 450plus fundus camera is connected, the VISUPAC software is
launched by double-clicking on the VISUPAC program icon.
If no FF 450plus fundus camera is connected or if data which was captured

using other fundus camers (e.g. VISUCAM) shall only be displayed or edited,
VISUPAC software is launched by double-clicking on the VISUPAC Viewer
program icon.
Log in as a user under VISUPAC
 If the additional user management module is activated, the user

will be required to log when launching VISUPAC.
If user management is activated, the Log in dialog box is opened when

launching the VISUPAC software.
Fig. 1 Log in dialog box
• Log in by entering your user name and password.
000000-1463-266-SWGA-JP-200116
Operation 9
 The user name and password are entered by the administrator (see
section User management, page 15 and following).
Logging off or changing users

Close the VISUPAC software by clicking on the Close button (cross in the
upper right corner).
If the user management is active, the User dialog box is displayed. The
current user name is displayed in the top line of the dialog box. Different
functions can be selected from this dialog box.
Fig. 2 User dialog box
Lock
The user interface is locked and the user will be logged off.
The Lock button changes into Unlock.
Unlock
The Log in dialog box will be opened (Fig. 1). Unlock the user interface by
entering user name and password.
Change user
The Log in dialog box will be opened (Fig. 1). When a new user logs in, the
activities of the previous user will be automatically closed.
000000-1463-266-SWGA-JP-200116
10 Operation
Change password
The Account management dialog box will be opened.
Users can change their password. The user name can only be changed by
the administrator.
Fig. 3 Account management dialog box
Close
The VISUPAC software will be closed.
Cancel
Return to the VISUPAC software. The previous user remains logged in.
Switching off
• Exit the VISUPAC software by clicking the Close button in the upper right
corner of the screen.
 If user management is activated, the User dialog box appears first.

Click the Close button in this dialog box as well.
• Shut down the VISUPAC computer using the Windows® Start menu.
After shutting down the VISUPAC computer all hardware components can
be switched off in any order.
000000-1463-266-SWGA-JP-200116
User interface layout 11
User interface layout

User interface of the main menu
After launching the program, the user interface of the VISUPAC software will
appear.
All necessary functions of the software (e.g. data base, image capture,
image export/import, image editing functions) can be activated from here.
1 Title bar
2 Image display function keys
3 Image display field
4 Tool bar
Fig. 4 User interface of the main menu
 Active buttons will be highlighted in blue, inactive buttons are

greyed out.
The function keys of image display allow to select individual images in the
Overview and display the images in various presentation modes on the
screen or delete them (see section Activating image display and selecting
images, page 69).
In the image display field the images are displayed during capturing, editing
and evaluation. The images are displayed in full resolution.
The function buttons of the tool bar allow to import, export or edit images.
000000-1463-266-SWGA-JP-200116
12 User interface layout
1 Print images/Print layout

2 Help/Retina atlas
3 Open database
4 New patient
5 Export data, Import data
6 Tools selection for image editing
7 Menus for image editing
8 Display selection for graphic elements
Fig. 5 Tool bar of the main menu
 Buttons with a triangle on the right side (e.g. Print images/Print

layout) contain a second level for selecting alternative functions.
Left-clicking on the triangle opens a context menu for the selection
of alternative functions.
000000-1463-266-SWGA-JP-200116
Open online help and Retina Atlas 13
Open online help and Retina Atlas

Opening help
1 Help
2 Retina atlas
Fig. 6 Sections of the user interface
 Depending upon which Help has been used most recently, the
Help or Retina atlas button will appear on the upper left of the
screen (see Fig. 6).
If the symbol of the desired help function is displayed, you can select it by
left-clicking on it.
1 Help
2 Retina atlas
Fig. 7 Help selection context menus
If the desired symbol is not displayed, the context menu can be opened by
left-clicking on the triangle and then selecting the desired help function by
left-clicking.
000000-1463-266-SWGA-JP-200116
14
Retina Atlas
The Retina Atlas is a sample data base with example images for various eye
diseases and explanatory information and descriptions.
All images originated in the Department of Angiography and Laser Therapy
at the Ophthalmic Clinic of the Klinikum Hannover-Nordstadt under the
supervision of Prof. Dr. med. K. Hoffmann. The images were prepared by the
medical staff comprising Dr. T. Behling, M. Eickhorst, Dr. A. Luhr, Dr. C.
Hervatin and N. Salzmann. M. Eickhorst and N. Salzmann were responsible
for the selection of images and wording of comments.
The Retina Atlas, including all its individual elements, is protected by
copyright. Any duplication and use requires the written consent of
Carl Zeiss Meditec AG. All images have been provided with a digital
watermark that enables the identification of electronic or photomechanical
copies.
Fig. 8 Retina Atlas
000000-1463-266-SWGA-JP-200116
User management 15
User management
The function of user management
User management is normally employed when different users are working
with VISUPAC software (e.g. in a hospital).
Only the administrator has access to user management. The user names are
entered and the rights of individual users to insert, modify and delete data in
the VISUPAC application are assigned in the user management.
All important actions carried out by users are saved internally in the
transaction log.
000000-1463-266-SWGA-JP-200116
16 User management
Starting user management
 Only users with administrator rights can access user management.
User management is opened via the start menu:
Start\All Programs\VISUPAC\VISUPAC User Management

• Log in by entering your user name and password in the Log on dialog
box (Fig. 1). The User management dialog box will be opened.
1 Buttons
Edit User groups
New OK
Delete Cancel
Authorization groups
2 Input field
3 Check box to activate display of unassigned patients
4 List of available users
Fig. 9 User management dialog box
By entering text in the Input field users can be filtered faster from an
extensive list.
In the Available users list, all users are listed in a table sorted by user name
and assigned group.
000000-1463-266-SWGA-JP-200116
User management 17
Creating a new user and assigning user rights

• Click the New button. The Create user dialog box will be opened.
Fig. 10 Create user dialog box
• Create a new user by filling in the text fields or select data of existing
users by clicking on the Staff list. The selected data will be imported.
• Click on User account.
The Account management dialog box (Fig. 11) will be opened.
000000-1463-266-SWGA-JP-200116
18 User management
1 User identification
2 Assignment of rights
3 User group
Fig. 11 Account management dialog box
• Enter the user name and password.
In the Rights management field you can define rights for the new user
by activating the appropriate check boxes. Alternatively, you can assign
the user to an authorization group by using the drop-down list Group.
 In order to accelerate the assignment of rights, users should be

divided into authorization groups with different rights.
• Confirm your entry by clicking on OK.

The Account management dialog box will be closed. The new user will
be displayed in the list of existing Users of the User management dialog
box.
000000-1463-266-SWGA-JP-200116
User management 19
Assigning or changing rights of existing users

• Select the desired user from the list in the User management dialog box
and click on the Edit button.
The Account management dialog box will be opened.
Now you can modify the corresponding user data (user name and
password, access rights or authorization group).
Upon clicking on OK the settings will be accepted and the dialog box
closed.
Deleting existing users

• Select the user to be deleted from the list in the User management
dialog box.
• Click the Delete button. Upon confirming the query, the selected user
will be deleted.
Assigning patients not yet assigned to user groups

If patients have been created but not yet assigned to a user group, this
patient's data will not be displayed under any user.
To access this patient data, the administrator should assign the respective
rights or click the check box to display patients not yet assigned (3, Fig. 9).
These patients will now be visible to all users.
 Unassigned patients are assigned as usual in the patient card

(referring physician, attending physician, operating
surgeon/operator).
 If a user belongs to a user group, all patients assigned to him/her

will be displayed to the other members of this user group.
000000-1463-266-SWGA-JP-200116
20 User management
Managing authorization groups

• Click the Authorization groups button in the User management. The
Authorization groups dialog box will be opened.
Fig. 12 Authorization groups dialog box
groupID = ... (internal number of the authorization group)

permission = ... (internal authorization value)
description = ... (name of the authorization group)
There are four pre-defined authorization groups:
ADMIN and PRINCIPAL:

User possesses all rights, both for VISUPAC and the user management tool.
ADVANCED:
User possesses the rights to edit images, image information (comments),
visits and diagnostics and to manage data exchange (printout, import,
export).
SIMPLE:
User possesses the right to only edit the images.
Authorization groups can be created and deleted in this dialog box.
000000-1463-266-SWGA-JP-200116
User management 21
Managing user groups

• Click the User groups button in User management.
The User groups dialog box will be opened where new user groups can be
created or existing user groups can be edited or deleted.
Fig. 13 User groups dialog box
Creating new user groups

• Click the New button to open the Group dialog box.
Fig. 14 Group dialog box
• Enter the name of the new group in the input field.

• Select a user for this user group in the Select user(s) field (hold down
the <Ctrl> key when clicking to select multiple users).
• Confirm the query by clicking on OK.
000000-1463-266-SWGA-JP-200116
22 User management
Editing user groups

• Select the desired user group in the User groups dialog box and click on
Edit. The Edit dialog box will be opened.
Fig. 15 Edit dialog box
The selected user group will be displayed in the Group line. Users who have
already been assigned to this group will be displayed in the Group column.
Other users are shown in the All column.
• Select the users who should be deleted or assigned to another group.

• Shift the selected users to the desired column using the arrow keys (hold
down the <Ctrl> key when clicking to select multiple users).
• Confirm the query by clicking on OK.
Deleting a user group

• Select the user group to be deleted in the User groups dialog box.
• Delete the selected user group by clicking on Delete. A confirmation
query will appear.
Fig. 16 Delete group dialog box
• Confirm the query with Yes.
000000-1463-266-SWGA-JP-200116
User management 23
Transaction log
If the VISUPAC transaction log module has been activated (during
installation by your ZEISS service), a transaction log is created each time a
user logs in.
A transaction log should only be used in combination with the user

management (see section User management, page 15 and following). If the
user management is not used, the activities of the standard user Operator
will always be logged in the transaction log.
The following activities of a logged-in VISUPAC user will be entered into the
transaction log:
– Creating new patients

– Editing of a patient or visit, with the exception of changes to the Seen
status of a visit
– Deleting patients, visits or images
– Moving visits from one patient to another
– Moving images from one patient to another
– Creating a new diagnosis
– Deleting a diagnosis
– Printing images
– Exporting files of images, videos and documents
– Creating medical reports
The transaction log will be saved in the VISUPAC database and can be
viewed at a later date if required.
Information for the administrator

The transaction log should be saved in regular intervals (see section
Exporting the transaction log as HTML, page 25).
The ZEISS service can set an interval for a reminder to save the transaction
log.
After successfully saving, the old data can be deleted (see section Deleting
the transaction log, page 26).
000000-1463-266-SWGA-JP-200116
24 User management
Opening a transaction log
Fig. 17 Opening the transaction log
The transaction log is opened via the task bar Start\All Programs\VISUPAC.
Click on VISUPAC Transaction Logging. The following dialog box appears:
Fig. 18 Entries in database transactions
LOGID column
The LOGID number is generated automatically by the system.
USERNAME column
Listing of the user names and workstations (computer number, etc.).
 If the VISUPAC SMP communication module is active, the

transaction log will enter the external user name and IP address of
the communication partner into the USERNAME column. To more
easily differentiate between the internal and external users, the
user names of the SMP transactions are automatically marked with
the code SMP_.
000000-1463-266-SWGA-JP-200116
User management 25
USERACTION column
Listing of the actions carried out.
LOGDATE column
Listing of date and time the action was carried out.
Exporting the transaction log as HTML

• Open the transaction log.
• Click the Export data button.
The Select HTML file dialog box will be opened.
1 File name input field

2 Save button
Fig. 19 Select HTML file dialog box
• Enter the file name in the File name input field.

• Confirm the entry with Save. The data will be exported.
000000-1463-266-SWGA-JP-200116
26 User management
Deleting the transaction log

• Open the Entries in database transactions dialog box.
• Select the desired transaction log and click on Delete. The Delete query
will appear.
1 Drop-down list for period selection
Fig. 20 Delete query
• Select the desired period in the drop-down list (1 to 12 months) and

confirm by clicking on OK. A confirmation query will appear.
Fig. 21 Delete confirmation query
• Confirm data deletion by clicking on OK or cancel the dialog box by

clicking on Cancel without deleting any data.
000000-1463-266-SWGA-JP-200116
Patient data management 27
Patient data management

Before any functions can be performed in the VISUPAC software, a patient
must be selected from the VISUPAC database or a new patient data record
must be created. All the following actions will be assigned to the patient
selected.
In the VISUPAC database the system manages all relevant patient data. This
is generally carried out using patient master data such as patient name,
patient first name, date of birth and/or patient number.
New patient data records can be created (see section Creating a new
patient, page 35) or existing data records can be opened.
All saved data can be edited at a later date (see section Editing patient data,
page 36).
It is possible to assign images to another patient later (section Moving

images to another patient, page 44) or to delete patients, visits and images.
Data deleted by mistake can be recovered (see Restoring deleted data,

page 47).
All diagnostic data are linked with the master data of the patient and can be
available in different forms:
– Images (fundus camera, slit lamp, ultrasonic device, surgery
microscope, etc.)
– Videos (slit lamp, ultrasonic device, surgery microscope, etc.)
– Documents (findings, medical reports etc.)
Diagnostic data such as images can be highlighted as favorites, thereby
minimizing the amount of time and handling (see section Marking an image
as a favorite, page 70).
These data can be exported to external institutions or users in DICOM format

using of the export functions (see section Exporting DICOM patient data,
page 121).
Additionally, external DICOM data of a patient can be received/imported and

allocated (see Importing DICOM images, page 66).
000000-1463-266-SWGA-JP-200116
28 Patient data management
Select patient and data

Click the Database button to open the Database dialog box.
1 Tool bar
Open patient Export
New patient Export visit
DICOM import Database tools
DICOM export Search
2 Quick search filter

3 Visits display field
4 Formats display field
5 Available patients selection field
Fig. 22 Database dialog box
Various search filters can be used to select a patient from the database.
• Click on a letter in the Search filter (e.g. "A").
All patients whose name starts with an "A" are listed in the Available
patients selection field.
000000-1463-266-SWGA-JP-200116
• Enter a search word in the input fields of the Search filter (last name or
patient ID) and confirm by pressing <Enter>.
With each letter entered the list in the Available patients selection field
becomes shorter. The patient with the best match appears highlighted in
blue.
Now the patient can be selected in the Available patients selection field. In
the Visits column the visit data of the selected patient is shown.
Selected visits appear highlighted in blue. In the Formats display field the
data types available for this visit are displayed.
All data types can be retrieved directly from the Formats display field. Select
the data type and double click on the visit to display all data of the selected
data type in thumbnail view (see section Image display, page 69 and
following).
 Hold down the <Ctrl> key when clicking to select and open
multiple documents using the <Enter> key.
The Reviewed column lists the images of a visit which have been marked as
"reviewed" (right-click on the symbol in the Reviewed column to highlight
the image).
The Favorites column indicates by the color of the check boxes whether the
files have been highlighted as favorites (see section Marking an image as a
favorite, page 70).
Grey: no favorites highlighted
White: favorites highlighted. Activating the white check box will display only
the images marked as favorites when the images are being loaded.
000000-1463-266-SWGA-JP-200116
Displaying STRATUS OCT data into VISUPAC

• Open the VISUPAC database, see section Patient data management,
page 27.
Selection of the desired patient in the Available patients selection field.

2 Formats display field
3 Available patients selection field
Fig. 23 Selection of STRATUS OCT data
• Click the Images button in the Formats display field.

If STRATUS OCT data is available, it will now be displayed.
• Select the desired data in the Database dialog box and double click on
the visit or press <Enter> on the keyboard to display all the images in
thumbnail view.
000000-1463-266-SWGA-JP-200116
Fig. 24 STRATUS OCT image overview in VISUPAC
000000-1463-266-SWGA-JP-200116
Search for data

The search function allows to search the VISUPAC database according to
specified search criteria.
One or more search criteria can be defined. If several criteria have been
defined, only those patients who fulfil all the criteria will be filtered out.
• Open the VISUPAC database and click the Search button. The Search
dialog box will be opened.
1 Visits filter
2 Format filter
3 Image data filter
4 Patient filter
Fig. 25 Search dialog box
000000-1463-266-SWGA-JP-200116
• Enter your search criteria.
Fig. 26 Patient filter
 The wildcards * (asterisk) and ? (question mark) can be used to

assist the search in the text input fields.
The wildcard ? (question mark) replaces any letter (e.g. M?ller filters
out all patients whose names are Müller, Möller, Miller ...).
The asterisk * represents a group of letters (limit selection) (e.g.
*mann filters all patients whose names end with "mann":
Lehmann, Heinemann...).
Fig. 27 Visits filter
000000-1463-266-SWGA-JP-200116
The search function allows targeted search for visits within a specified
period.
Fig. 28 Format filter
 If the DICOM import not reviewed check box is activated, a

search may be performed for DICOM patient data that has been
imported but not yet viewed.
Fig. 29 Image data filter
• Confirm your entry by clicking on Start search. The search result is

displayed in alphabetical order in the Patient list.
 Following a successful search, the search result will remain active

until the Search button is clicked again (deactivated). As long as
the search result is active, all the following database operations will
be applied only to the search result. The activated search result is
indicated by a "depressed" Search button.
 Clicking the Export result button will create an HTML file with the
most recent search result; this can be viewed and printed with a
suitable HTML browser (e.g. Internet Explorer).
000000-1463-266-SWGA-JP-200116
Patient information
Creating a new patient
• Open the Patient card dialog box by clicking the New patient button in
the VISUPAC database.
All relevant patient data can be entered in the Patient card dialog box.
Mandatory input fields are Name, First name and Date of birth.
 Ametropia, height and weight of the patient are required for

measured value correction.
 For possible entries in the Diagnosis and This patient's visits

input fields, see section Diagnosis, page 37 and Patient's visits on
page 42.
1 Patient data input fields

2 Diagnosis input field
3 Selection button to open the Diagnosis dialog box
4 This patient's visits input fields
Fig. 30 Section of the Patient card dialog box
• Confirm your entry by clicking on OK. The dialog box will be closed. The
patient card is now created and can be selected from the database.
If the patient is already available or name, first name and date of birth
coincide with those of another patient in the VISUPAC database, an
error message will appear.
000000-1463-266-SWGA-JP-200116
Fig. 31 An identical patient already exists dialog box
Click on Cancel to return to the Patient card dialog box and enter another
patient name.
Click on Select patient to expand the Patient exists dialog box. A
selection list of patient names will be displayed. If you select a patient by
double-clicking and confirm this selection by clicking on OK, the
corresponding patient data will be loaded in the Database dialog box. The
data input previously will be deleted.
Fig. 32 Expanded Patient exists dialog box
Editing patient data

• Select a patient from the VISUPAC database and open the Patient
card dialog box by clicking on the Patient button.
Alternatively, you can right-click on the context menu of the patient to
open it and then click on Edit data.
1.
Fig. 33 Context menu of the patient
The Patient card dialog box (Fig. 30) will be opened where you can edit the
patient data.
000000-1463-266-SWGA-JP-200116
Deleting a patient
• Select a patient from the VISUPAC database.
• Left-click on the triangle to open the context menu of the Database
tools and click on the Delete patient button.
Alternatively press the <Del> key on the keyboard.
• The first confirmation query will appear: "Do you want to delete the
patient?" Confirm the entry with Yes.
A second confirmation query: "Do you really want to delete the patient?"
will appear. Again, confirm the entry with Yes.
The data record will be deleted.
 Information on restoring deleted data can be found in section

Restoring deleted data, page 47.
Diagnosis
The diagnosis made for the patient in long or short form is entered in the
Diagnosis input field of the Patient card dialog box.
1 Diagnosis input field

2 Selection button to open the Diagnosis dialog box
000000-1463-266-SWGA-JP-200116
1 HTML export button

2 Drop-down list for code scheme selection
3 OK button
4 Cancel button
5 List of diagnoses for a patient
6 Button to expand or reduce diagnosis selection
7 List of standard diagnoses
8 Check box for Direct search
9 Edit button
Fig. 35 Diagnosis dialog box
Accept or delete standard diagnoses

• Open the Diagnosis dialog box by clicking on the Selection button
(2, Fig. 34) in the Patient card dialog box.
• Select a diagnosis code in long or short form from the Standard
diagnoses or Patient lists. The selection will be highlighted in blue.
– The input fields from the Standard diagnoses list serve as a filter.
– Direct search activated (checked): By entering the short or long form in
the input fields, the diagnosis with the best match appears highlighted
in blue.
– Direct search deactivated: By entering the short or long form in the
input fields, the selection must be confirmed by pressing <Enter>.
– The diagnosis selection can be sorted alphabetically by clicking the
column headers Short form or Long form.
000000-1463-266-SWGA-JP-200116
By double-clicking the diagnosis, the selection will be loaded in the Patient

selection box. By clicking on the blue arrow it will be removed.
• Confirm your selection by clicking on OK.

The dialog box will be closed. Changes in the Diagnosis input field will
be transferred to the Patient card.
 Several diagnoses can be selected subsequently and transferred or

deleted (hold down the <Shift> key while selecting).
Code scheme
ICD codes (ICD 9 or ICD 10) are pre-defined. No additional diagnoses can be
added or removed.
 User-specific codes can be created (e.g. CODE-UNI-XX). Please

contact ZEISS service for more information.
Expanding or reducing the list of diagnoses
 This function is password-protected and available to any user who

has the appropriate rights (see section User management,
page 15).
Only diagnoses from a freely selectable scheme may be expanded
or reduced. These schemes begin with 99_ and may have 16
characters (standard "99_HIKO_DIAGNOSIS" has been defined in
the example).
• Click the Edit button in the Diagnosis dialog box.

A window will appear to enter the password. Enter your password and
confirm by clicking OK. The Edit diagnosis dialog box will be opened.
000000-1463-266-SWGA-JP-200116
1 Information line
2 Diagnosis list
Fig. 36 Edit diagnosis dialog box
• Click on the New entry button to expand the diagnosis selection box.
An empty line will be opened in the diagnosis list and you may enter a
new standard diagnosis.
• If you want to add a further entry, click the New entry button again.
• To delete existing diagnoses click the corresponding line in the diagnosis
list to highlight it and then click the Delete entry button.
If the selected entry is being used, a confirmation query will appear:
Fig. 37 Delete confirmation query
• Confirm with OK. This entry will also be deleted from the data of existing
patients.
000000-1463-266-SWGA-JP-200116
Saving the standard diagnoses as an HTML file

• Click the HTML export button in the Diagnosis dialog box. The Select
HTML file dialog box will be opened:
Fig. 38 Select HTML file dialog box
• Select the desired storage path.

• Enter the file name in the File name input field.
• Confirm your entry by clicking on Save.
The list will be saved as an HTML file.
The exported list can later be viewed and printed with a suitable browser
(e.g. Internet Explorer).
000000-1463-266-SWGA-JP-200116
Patient's visits
The Visits of the patient input field is part of the Patient card dialog box
(Fig. 30). All entries in this area relate to the selected patient visits.
Entering a visit date

Normally the visit date is set as a default value by the system. However, any
desired visit date may be entered.
• Right-click the context menu of the patient (Fig. 33).
• Click on New visit. The Enter visit date dialog box will be opened.
Fig. 39 Enter visit date dialog box
• Enter the desired date in the input fields and confirm by clicking on OK.
The visit date is entered in the Visits display field. Information such as the
examination results of other physicians or clinics can be entered under
this date.
Moving patient visits

• Highlight the patient in the VISUPAC database and then the visit to be
moved in the Visits selection box.
• Open the context menu of the Database tools button and click the
Move visits button.
• Enter your password in the confirmation query and confirm by clicking
OK. The following warning will appear:
Fig. 40 Changes take effect only in VISUPAC warning
• Confirm this warning by clicking on OK. The Move visits dialog box will
open.
000000-1463-266-SWGA-JP-200116
1 Name input field

2 Patient No. input field
3 Patient selection
Fig. 41 Move visits dialog box
• Highlight the target patient to whom the selected visit is to be assigned.

– Selection in the Name input field (use the <Enter> key to complete
the input).
– Selection in the Patient No. input field (use the <Enter> key to
complete the input).
– Double-click the appropriate name in the Patient selection list.
• Confirm your selection by clicking on OK.

The visit will be moved and the dialog box closed.
000000-1463-266-SWGA-JP-200116
Deleting patient visits

• Highlight the patient in the VISUPAC database and then the visit to be
deleted in the Visits selection box.
Delete visits button. Alternatively, press the <Del> key on the keyboard.
The first confirmation query will appear "Do you want to delete the
visit?". Confirm the entry with Yes.
A second confirmation query will appear "Do you really want to delete
the visit?". Again, confirm the entry with Yes.
 Information on restoring deleted data can be found in section

Restoring deleted data, page 47.
Patient data
Moving images to another patient
• Highlight the patient from in the VISUPAC database whom the images
are to be moved to another patient.
• Select the visit and change to overview mode.
• Highlight the images to be moved in the image display field.
• Left-click the triangle to open the context menu of the Export data
button and click on the lower Move images button.
Fig. 42 Export data context menu
• Enter your password in the confirmation query and confirm by clicking

Yes. Click on OK to confirm the following warning.
The Move images dialog box will open.
000000-1463-266-SWGA-JP-200116
1 Name input field

2 Patient No. input field
3 Patient selection
Fig. 43 Move images dialog box
• Highlight the target patient to whom the selected images are to be

assigned.
– Selection in the Name input field (use the <Enter> key to complete
the input).
– Selection in the Patient No. input field (use the <Enter> key to
complete the input).
– Double-click the appropriate name in the Patient selection list.
• Confirm your selection by clicking on OK. The images will be moved and
the dialog box closed.
000000-1463-266-SWGA-JP-200116
Delete images
• Highlight the patient and the visit from whom images are to be deleted.
• Change to overview mode (header color changes to red).
• Highlight the images to be deleted in the image display field.
• Select the desired split display mode in the navigation bar (1, 2, 4, 9 or 16
images).
• Highlight the images to be deleted again.
• Click the Delete image button.
If the images contain references to other data records, the Referenced

Exams found dialog box will open.
Fig. 44 Referenced Exams found dialog box
The first confirmation query will appear "Do you want to delete the
visits?" Confirm the entry with Yes.
A second confirmation query will appear "Do you really want to delete
the visits?" Again, confirm the entry with Yes.
• Click Yes to delete the image.

Confirm the following confirmation query "Do you really want to delete
the image?" with Yes or All.
The image(s) will be deleted from the hard disk.
If you click No, no data will be deleted.
000000-1463-266-SWGA-JP-200116
Restoring deleted data
 This function is available only for data stored as DICOM files after
capturing.
Restore button.
The Restore dialog box will be opened.
1 Data records selection field

2 Select
3 Cancel search
Fig. 45 Restore dialog box
• Select the deleted data records.

(Data records can be selected by Week, Month or All.)
 Selecting Week, for instance, will display all data records deleted
in the past seven days. In this context, Week is not identical to the
calendar week!
• Select the data records you want to restore.

• Restore by clicking the Recover selected button.
Delete the selected data records irretrievably by clicking the Remove

selected button.
000000-1463-266-SWGA-JP-200116
48 Examination mode
Examination mode
General advice on capturing images
 The storage capacity of the hard disk will automatically be checked

when the examination mode is activated. If insufficient storage
space is available, the examination mode will not start.
The Clear dialog box will appear and the VISUPAC software will
automatically begin to delete the image files from the hard disk.
No data will be lost, as only archived files can be deleted.
The deletion procedure is stopped automatically when sufficient
storage capacity is freed. The deletion procedure can also be
stopped manually by clicking the Stop button.
If sufficient storage capacity cannot be created by clearing the hard
disk, the procedure will be automatically aborted.
The Archive dialog box will be opened. For archiving procedures,
refer to section Archiving on data storage media on page 124.
 A maximum of 40 images can be captured without buffering.

The images selected in the image overview will also reduce the
possible number of images taken.
000000-1463-266-SWGA-JP-200116
Examination mode 49
Supported image capture sensors

Depending on system configuration, various image capturing modes can be
used.
The following images may be captured:
• Color images
• Images with red, blue or green filters
• Autofluorescence images
• Images with previous dye injection: fluorescence or ICG angiographies
This image capturing modes will be available only if the required image
capture sensors are available in your system configuration and connected
correctly.
These prerequisites are described in the table below.
System requirements for image capturing modes

Image capture sensors
Capturing mode Pike F145B/ Canon 5D
Pike F421B AVT ZK-5 Canon 5D Mark III
Color - X X
Red, green, blue (R, G, B) X X X
Autofluorescence (AF) X - -
Fluorescence angiography (Fluo) X X X1
ICG angiography (ICG) X2 - -
X1 Only of limited suitability for fluorescence angiography.

Canon 5D captures an image only about every 2 s, Canon 5D Mark III only
about every 3.6 s.
X2 ICG angiographies are only possible with an FF 450plus IR
X Suitable
- Unsuitable
000000-1463-266-SWGA-JP-200116
50 Examination mode
Capturing images with the AVT ZK-5 digital camera

• Select the AVT ZK-5 image sensor in the Image capture sensor drop-
down list for color, red, green and blue images or for fluorescence
angiographies.
Images of AVT ZK-5 are available in full resolution (5 MP) within one second.
Sensor settings
The AVT ZK-5 Settings dialog box will be opened by clicking on the
Settings button.
 The Settings button will be visible only if the currently logged in

user has the appropriate rights.
Fig. 46 AVT ZK-5 settings dialog box
000000-1463-266-SWGA-JP-200116
Examination mode 51
Value: Displays the set value.

Auto: Grey box: No settings possible.
White box, blank: Automatic function of the camera is
deactivated. Default values are being used.
White box, selected: Camera control selects the value itself.
On: Grey box: No settings possible.
White box, blank: Default values are being used.
White box, selected: Values may be changed using the slider.
Save: Saves changes. Settings are accepted as default values.
Default: Restore to AVT ZK-5 factory settings.
Close: Return to the capture mode without accepting the changes.
The following settings can be modified:
Brightness: Used to set the brightness.

Autoexposure: Used to set the exposure time.
Sharpness: Used to set the sharpness.
White balance White balance: for adjusting the color settings.
Two sliders are available for setting. The upper adjusts red and
the lower blue. Both colors are changed in relation to green. In
this procedure, green has a fixed value.
White balance with upper slider:
Select higher values if the image appears too green, and lower
values if the image appears too red.
White balance with lower slider:
Select higher values if the image appears too green, and lower
values if the image appears too blue.
Hue: Hue: Corresponds to the colors red, green and blue.
Saturation: Used to set the color saturation.
Gamma: Contrast correction: Higher values show darker images with
more contrast. It might be necessary to increase the flash level.
Lower gamma values show lighter images with less contrast.
Shutter: Used to set the shutter time.
Gain: Enhancing the optical signal: The higher the gain value, the
higher the enhancement.
000000-1463-266-SWGA-JP-200116
52 Examination mode
Capturing images with the Pike F145B and Pike F421B digital
cameras
• Select the AVT Pike F145B or AVT Pike F421B image sensor in the
Image capture sensor drop-down list for red, green and blue images,
for autofluorescence images or for fluorescence and ICG angiographies.
The Pike F145B and Pike F421B cameras produce only black & white images.
The Color capture mode is not available.
 The Pike F145B and Pike F421B digital cameras differ from one
another only in resolution and sensitivity. The Pike F145B camera
has a higher sensitivity, but a lower resolution than the Pike F421B.
Images of Pike sensors are available in full resolution (5 MP) within one
second.
The resolution of the Pike F145B is 1392 x 1040 Pixel (1.5 MP) and that of
Pike F421B is 2056x 2062 Pixel (4.2 MP).
Sensor settings
Click on the Settings button to open the Settings dialog box for Pike F145B
or Pike F421B.

Fig. 47 AVT Pike 421B Settings dialog box
000000-1463-266-SWGA-JP-200116
Examination mode 53
Value: Displays the set value.

Auto: Grey box: No settings possible.
White box, blank: Automatic function of the camera is
deactivated. Default values are being used.
White box, selected: Camera control selects the value itself.
On: Grey box: No settings possible.
White box, blank: Default values are being used.
White box, selected: Values may be changed using the slider.
Default: Return to the factory settings of the Pike 145B or Pike F421B.
Close: The dialog box will be closed.
Brightness: Used to set the brightness.

Autoexposure: Used to set the exposure time.
Gamma: Contrast correction: Higher values show darker images with
more contrast. It might be necessary to increase the flash level.
Lower gamma values show lighter images with less contrast.
Shutter: Used to set the shutter time.
Gain: Enhancing the optical signal: The higher the gain value, the
higher the enhancement.
Binning: The binning mode can be switched on or off with the Off
button. In binning mode sensitivity is increased and noise
reduced by combining pixels. Image resolution is reduced to
about half. An image captured with activated binning mode
appears lighter.
000000-1463-266-SWGA-JP-200116
54 Examination mode
Image capturing with the Canon EOS 5D Mark III digital camera
• Select the Canon EOS 5D Mark III image sensor in the Image capture
sensor drop-down list for color, red, green and blue images or for
fluorescence angiographies.
 The Canon EOS 5D Mark III is only of limited suitability for

fluorescein angiography. It can only capture an image every 3.6 s.
Sensor settings
Click on the Settings button to open the Settings dialog box for
Canon EOS 5D MARK III.

Fig. 48 Canon EOS 5D MARK III Settings dialog box

Default: Return to factory settings of Canon EOS 5D MARK III.
Close: The dialog box will be closed.
000000-1463-266-SWGA-JP-200116
Examination mode 55
Capture mode: Defines the capture mode.
 Only the settings relevant in each case, depending on which

capture mode is selected, are active and changeable.
Image resolution. You can select one of three resolutions:

Small: 2200 x 1920 (4.2 MP)
Medium: 2920 x 2560 (7.5 MP)
Large: 4360 x 3840 (16.7 MP)
 We recommend to use the "Small" resolution to reduce the

amount of space needed for storage of an image, especially
when creating ZEISS AutoMap panoramic images.
ISO speed: Sets the light sensitivity of the image capture. The higher the
ISO value, the higher the light sensitivity setting.
Image interferences can be reduced by reducing the ISO.
Images will have more definition.
Color Used for color balance, changes general color settings.

temperature:
WB shift AB: Used for white balance (WB), changes the green portion of
the image while the blue portion remains constant.
Select higher values if the image appears too blue, and
lower values if the image appears too green.
WB shift GM: Used for white balance (WB), changes the green portion of
the image while the magenta portion remains constant.
Select higher values if the image appears too red, and lower
values if the image appears too green.
 The function of the white balance sliders of Canon 5D Mark III

is reversed compared to the white balance of ZK-5.
000000-1463-266-SWGA-JP-200116
56 Examination mode
Examination mode tool bar
1 Print
2 Help/Retina atlas
3 Setting the capturing standard
4 Color capture mode for color images
5 AF Autofluorescence capture mode
6 Capture mode for red (R), green (G),
blue (B) images
7 Fluo (fluorescein) and ICG
(indocyanine green) angiography
capture modes
8 Swivel Exciter (exciter filter) and
Barrier (barrier filter) in and out
9 Toggle between ocular observation
and display on observation monitor
10 Timer start or reset
11 Timer for angiography images
12 Display of flash level
13 Reduce flash level
14 Increase flash level
15 Switch Boost mode on/off
16 Live mode
17 Activate Stereo mode
18 Image capture counter
19 Set image angle
20 Right/left eye display
21 Image capture sensor selection box
22 Image capture sensor settings
23 Automatic flash level adjustment
24 Automatic tone value correction
25 Brightness slider for ambient
illumination
26 Save images
27 Next patient
28 Save images and exit examination
mode
Fig. 49 Tool bar
000000-1463-266-SWGA-JP-200116
Examination mode 57
Keyboard commands
Some functions of the examination mode can also be activated from the
computer keyboard.
The keyboard commands work only in examination mode.
Function Key Description

Color C Activating the color capturing mode
R R Red images
swivels in the ICG excitation filter
G G Green images
swivels in the green filter
B B Blue images
swivels in the Fluo excitation filter
Fluo F Activating the Fluo capturing mode
ICG I Activating the ICG capturing mode
1 Activate camera sensor on PORT 1
View V Toggle between ocular observation and display on
observation monitor
Timer 0 Start/reset the timer
Exciter 8 Swivel in/out excitation filter for observation
Barrier 9 Swivel in/out barrier filter for observation
+ p Increase flash level by one step
- m Reduce flash level by one step
Stereo S Set stereo tags for the next two images
mode
F12 Toggle between full resolution image and image fit
to window size in single image display
000000-1463-266-SWGA-JP-200116
58 Examination mode
Additional control panel
Fig. 50 Keypad of the additional control panel
Using the additional control panel assists in fast and simple setting of the
fundus camera in examination mode. The following functions can be used:
- Selecting the capturing sensor via port number (PORT1, PORT2, PORT3)
or toggling between ocular observation and live image display on
external observation monitor (VIEW)
- Selecting the examination mode:
– COLOR Color image
– FLUO Fluorescence angiography
– ICG Indocyanine green angiography
– GREEN Green (red-free) image
– BLUE Blue image
– RED Red image
- Swiveling in and out the exciter (EXCIT) and barrier filter (BARR) for
FLUO and ICG modes
- Starting and resetting the timer (TIMER) for FLUO and ICG modes
- Activating the stereo mode (stereo tag) for stereo image capturing
- Increasing (+) and reducing (-) flash level
The additional control panel is an alternative to operation using the mouse

or keyboard commands in examination mode.
 The keyboard commands and function keys of the additional

control console are simultaneously active and are not mutually
exclusive.
000000-1463-266-SWGA-JP-200116
Examination mode 59
Image capture with the FF 450plus fundus camera

Prior to starting image capture, a patient must be selected from the
database, the capturing mode selected and the fundus camera adjusted to
the patient.
The following steps are required:
• Open the VISUPAC database.

the visit to display all the images in thumbnail view.
If the patient has not yet been entered in the VISUPAC database, a new
patient card must be created (see section Patient data management,
page 27).
The image display field in Overview mode will be opened and the
patient name shown in the title bar at the top edge of the display.
• Click the Fundus camera button to start the VISUPAC examination

mode.
The display is switched to Single image display mode since this will
show the image in the highest quality. In principle, however, other
display modes may also be selected.
However, if images were selected prior to starting the examination mode,
these will be displayed.
• Select the desired image capture mode from the tool bar on the left side
of the monitor (e.g. Color, R, G, B, AF, Fluo, ICG).
 Default settings are automatically made for the selected image

capture mode. These include image capture sensor, flash level,
filter settings, ambient lighting intensity).
The pre-defined sensor can be changed using the Image capture sensor
selection box.
The flash level can be increased or reduced by clicking the + and - buttons.
The Exciter and Barrier filters can be swiveled in and out individually.
000000-1463-266-SWGA-JP-200116
60 Examination mode
The ambient lighting intensity can be adjusted either in the fundus camera or
using the VISUPAC tool bar.
 The current capture settings such as flash level, filter settings,

active image sensor and ambient lighting, will be saved by clicking
the Set capturing standard button. These settings are
automatically specified as the individual capturing standard next
time the examination mode is activated.
There are two automatic image enhancement functions:
– Auto-flash:
This function optimizes the flash. If the captured image is too bright or
too dark, the flash level will be adjusted automatically prior to the next
image capture.
 This function is only of limited suitability for angiographies.
– Image stretching:
This function automatically improves the image (tonal value
correction).
The FF 450plus fundus camera must be adjusted for examination of a patient
prior to image capture as described in the separate user manual (see FF 450 plus
user manual).
The image capture is triggered by the joystick of the FF 450plus fundus
camera.
 The image last captured can be deleted directly after image capture
by pressing the <Space bar> on the computer keyboard.
All captured images will initially be saved on the hard disk. This ensures that
no images are inadvertently lost.
After terminating image capture, images which do not need to be saved
permanently can be highlighted by clicking on them in the Overview image
display mode. The selected images will be superimposed with a red cross.
The deletion marking can be undone by clicking on the image again.
Images with a red cross will be deleted only if:
– they are buffered (Save).

– the next patient is selected (Next Patient).
– the examination mode is exited (Save&Quit)
 The amount of data held for each patient can be minimized by

deleting images before saving.
A new data record is created for the new images with the current date.
000000-1463-266-SWGA-JP-200116
Examination mode 61
Color image capture mode

Color images can be captured using a color sensor. Suitable sensors are e.g.
AVT ZK-5, Canon 5D and Canon 5D Mark III.
• Select the Color image capture mode from the Tool bar.
Red, green or blue image capture mode

Images can be captured in green, red or blue spectral ranges using these
capturing modes. The images can be made with all supported image capture
sensors.
• Select the corresponding image capture mode R, G or B from the Tool
bar.
Autofluorescence AF image capturing mode

To capture autofluorescence images, a monochrome image sensor (e.g. Pike
F145B or Pike F421B) and an optional filter set are required.
The filter set must be inserted prior to each autofluorescence image capture
and must be removed before changing to other capture modes.
• Select the AF image capture mode from the Tool bar.
Fluo image capture mode

The Fluo image capture mode enables the capture of fluorescence
angiographies using the dye sodium fluorescein which is injected
intravenously to the patient.
These images can be made with all supported image capture sensors.
However, it is recommended to use monochrome sensor for angiographies
due to higher image quality compared with color sensors.
ICG image capture mode

Special filters are required for the ICG image capture mode. These filters are
only available for the FF 450plus IR fundus camera.
To capture ICG angiographies, the fluorescing indocyanine green (ICG) dye is
injected intravenously to the patient.
Images are captured exclusively with monochrome sensors such as Pike
F145B or Pike F421B in contrast to fluorescein angiography.
000000-1463-266-SWGA-JP-200116
62 Examination mode
Capturing Fluo and ICG series of images

The Fluo timer can run independently of the ICG timer, so that the contrast
media for both procedures can be injected either simultaneously or with a
time delay.
The settings for the image capture (flash, ambient lighting intensity, filter
setting, camera type), patient data and image capture are managed during
the entire examination by the VISUPAC software.
For the selected patient, the current time (stopwatch) and the time the last
image was captured are displayed in the time display fields.
The Boost function is available in the ICG image capture mode. It is used to
enhance image brightness. The Boost function can only be used with an
image angle of 50°.
Prior to image capture, the Fluo and ICG filters can be set for observation via
the eyepieces (ocular) or via the observation monitor. The Exciter filter is set
as a default for observation. When the capture is triggered, the required
filters are automatically swiveled in, independent of the settings used for
observation.
The angiographies of several patients can be created very effectively in a
parallel manner in the multi-patient mode (see section Adding or removing
patients to/from the multi-patient mode, page 64).
Capturing angiography images:

• Select the patient for capturing new images and start the examination
mode (see section Image capture with the FF 450plus fundus camera,
page 59).
• Select the desired image capture mode (Fluo or ICG) from the tool bar
on.
Prior to starting the injection, the focusing can be checked using a green
image. For this purpose, change to the Green (G) capture mode. Once
the green captures have been completed, return to the ICG or Fluo
image capture mode.
• Inject the dye (e.g. sodium fluorescein for Fluo) and start the timer.
Start the Timer by clicking on it or by releasing the first image capture by
pressing the joystick button.
000000-1463-266-SWGA-JP-200116
Examination mode 63
 It is possible to inject both dyes for ICG and Fluo either

simultaneously or with a time delay.
The following work steps are normally performed:
• Change to the first capture mode
• Injection of first dye
• Start the timer
• Change to the second capture mode
• Injection of second dye
• Only when injecting with time delay: Start the timer
If the dyes are injected simultaneously, the timer needs to be
started only once. When toggling between Fluo and ICG capture
modes, the corresponding images are marked with a time stamp of
the timer.
 The timer can be restarted during an image capture series.

If the Reset timer button is activated before the angiography is
completed or the images are saved, the timer will be stopped and
restarted.
The new timer readings will be applicable only to images captured
from this point onwards. Images that have already been captured
will retain their original times.
• Trigger the image capture with the joystick.

When the capture is triggered by the joystick of the fundus camera, the
respective excitation and barrier filters are automatically moved into the
optical path of the fundus camera FF450 , independent of the filter
plus
settings used for observation.
 Serial image captures can be made at the rate of one image per
second by holding down the trigger button. The serial image
capture stops when the trigger button is released.
• In section Image capture with the FF 450plus, page 59, the selection of
images to be saved is described.
000000-1463-266-SWGA-JP-200116
64 Examination mode
Adding or removing patients to/from the multi-patient mode

Angiographies with several patients can be produced very efficiently in
parallel whereas the individual injection time for each patient is shown in the
overview.
1 Add or remove patients to/from the multi-patient mode

2 Patients to be examined list
Fig. 51 Database in multi-patient mode
• Add:
– Select the patient from the upper list (the line will appear in blue).
– Click the Add button (1, Fig. 51, down arrow key).
– The patient with his/her date of birth will be added to the Patients to
be examined list. Initially, the FLUO and ICG timer is set to 00:00:00.
– Additional patients can be added, if required, up to a maximum of 14
names.
• Remove:
– Select the patient from the lower list (the line will appear in blue).
– Click the Remove button (1, Fig. 51, up arrow key).
– The patient's name will be removed from the list.
000000-1463-266-SWGA-JP-200116
Examination mode 65
Selecting a patient for examination or changing the patient

If several patients have been already transferred to the multi-patient mode,
the patient to be examined must be selected from the list of Patients to be
examined (lower list in VISUPAC database window) to ensure that the
captured images are assigned correctly.
• Select the desired patient and double click on the visit to display all the
images in thumbnail view.
Please check: The patient's name should be displayed on the title bar.
• When the examination of the patient has been completed, remove the
name of the patient from the list of Patients to be examined.
Patients can be changed by using the Next Patient button in

examination mode. The database will be opened without exiting the
examination mode.
000000-1463-266-SWGA-JP-200116
66 Import data
Import data
The Import data function enables the import of data to the VISUPAC
database without a patient data attachment. The import formats supported
are GIF, JPEG, BMP, PNG, TIFF, DOC, PDF, TXT, HTML, MP3, WAV and AVI
(uncompressed), by renaming MPG and MPEG are also available.
Importing DICOM images

The DICOM import function transfers one or more patient images in DICOM
format (*.dcm), always together with the pertinent patient data, to the
VISUPAC database. They can then be processed in the same way as internal
data.
Individual images are imported (without attaching patient data) by the
Import images function.
 The standard path for DICOM import is the G:\dicom_in directory.
• Copy the data to be imported to the standard G:\dicom_in directory.
 Do not use subfolders.

• Click the DICOM import button. The DICOM import function is launched
immediately:
The progress is displayed in an information box.
If the DICOM import function determines that data already exists, the
following error list will appear
Fig. 52 Unable to save record dialog box
• Confirm with OK. The dialog box will be closed.
000000-1463-266-SWGA-JP-200116
Import data 67
Clicking the Export result button will open the Windows save dialog and
the error list can be stored in HTML format.
It can then be viewed and printed out with Internet Explorer.
 DICOM files can be imported automatically with the aid of an

optionally available tool. Ask your distributor.
On completion of import, all imported patient data including corresponding
visits will be available for viewing in the database.
 The contents of the G:\dicom_in directory are automatically deleted

as soon as the data transmission has been completed. Only the
imported DICOM files are displayed in the database dialog. Existing
data will not be displayed. For this purpose, the patient must be re-
selected.
All transferred data is provided with an internal label. This data can
be separately retrieved in the database at a later date by using the
search function DICOM import unseen. After opening the
imported DICOM data (images) for the first time, the label will be
deleted.
If only the Viewer has been installed, the import directory must be
changed. For further information, please contact ZEISS service.
000000-1463-266-SWGA-JP-200116
68 Import data
Importing images with VISUPAC Acquire
 An optional VISUPAC Acquire license is required to use the

functions described in this section.
 Images can be imported only in the JPEG format.
The VISUPAC Acquire module which is available as an option enables to

assign images which have been archived by external systems in a directory
automatically to a patient in VISUPAC.
Select a patient in VISUPAC as usually and start VISUPAC Acquire.
As soon as images have been stored in a pre-configured directory, they are
imported automatically into VISUPAC, assigned to the selected patient and
displayed.
After image import the settings such as OD/OS assignment or details on
capturing image can be entered using the image information dialog.
CAUTION
Make sure to select the correct patient.
Fig. 53 User interface of the VISUPAC Acquire module
000000-1463-266-SWGA-JP-200116
Image evaluation 69
Image evaluation
Image display
Activating image display and selecting images
• Open the VISUPAC database and select a patient.
• Highlight the desired visit in the Visits display field.
One or several visits can be selected by mouse click. The selected visits
will be highlighted in blue.
 To select several visits simultaneously, hold down the <Ctrl> key

while clicking.
the visit. The image display field will be opened in the Overview image
display mode.
1 Image display mode

2 Scroll in overview mode
3 Scroll in split mode
4 Number of selected images
5 Deselect all images
6 Delete images
7 Image display field
Fig. 54 Image display with active image overview
000000-1463-266-SWGA-JP-200116
70 Image evaluation
 If no images are available under the selected patient and patient

visits, empty frames will be displayed in the image overview.
The modes available depend on the monitor resolution.
• Highlight the images by clicking on them in the Overview image display

mode. Using <Shift> key multiple consecutive images can be selected.
The headers of the selected images will appear in red or blue (favorites).
The number of selected images is displayed in the Number of selected
images display field.
If more than 25 (resp. 16) images are selected, the image pages can be
scrolled with the help of the Scroll in overview mode buttons.
• Click the desired images in the image overview. Each selected image is
highlighted with a red or blue (favourites) header. The number of selected
images is displayed in the Number of selected images display field.
 Double-clicking on an image will display the image in the image

display mode 1 split. Double-clicking will return to the overview.
Double-clicking the Deselect all images button will reset the
complete image selection (available only in the Overview image
display mode).
• Select the desired Image display mode. Click 1 if a single image is

preferred.
• Use the Scroll in split mode button to scroll between the selected
images.
Marking an image as a favorite

• Right-click on the header of the favorite image. The Mark as favorite
dialog will appear.
• Click the dialog. From now on the image will have a blue header.
Repeating this action resets the marking.
 Images marked as favorites can now be displayed or searched with

preference.
For displaying the favorite images of a specific patient or visit, see the Visits
display field in Fig. 22.
For a global search for favorite images by search mask, see section Search
for data on page 32.
000000-1463-266-SWGA-JP-200116
Image evaluation 71
Image display field

Each image display field has a header containing information:
1 Image information
2 Capturing date
3 Image number
Fig. 55 Image display field
The image label consists of the following data: Capturing mode (e.g. Fluo,
Blue etc.), Date and if necessary Time since start of the timer (only for
angiographies). This data is set automatically by the program.
If the FF 450plus fundus camera is used for capturing, the information Right
eye (OD) or Left eye (OS) will be added automatically. If the stereo tag
function is used, an S will be added as identification (see section Stereo
presentation on page 73).
The Image number of the image display field is a simple consecutive
number and means in this example: Image no. 1 of 4 selected images.
Click the Image information button to open the Information dialog box
(see Information dialog box on page 72).
000000-1463-266-SWGA-JP-200116
72 Image evaluation
1 Comments
2 Drop-down lists
3 Details button
4 Image information
Fig. 56 Information dialog box
Additional comments may be entered into the Comments input field; these
will subsequently be displayed in the header of the image display field and
Patient card dialog box.
The values for Eye, Angle and Stereo can be modified at a later date. For
this purpose select the desired entries in the drop-down lists.
Click the Details button to display the available additional information.
000000-1463-266-SWGA-JP-200116
Image evaluation 73
Stereo presentation using standard split views

This function enables a stereoscopic display of stereo image pairs on the
computer monitor when using optical stereo viewers.
One or more stereo pairs can be selected for stereo viewing in the 2-image,
4-image, 9-image or 16-image split display. For stereo presentation, always
select image pairs.
• Select the images in the Overview mode by clicking on them and select
the desired image display mode.
The images for stereo presentation can be individually shifted on the monitor
to ensure correct alignment.
– Use mouse wheel to zoom individual images.
– Select the zoom factor so that each image can be moved in any
direction.
– Check that you select the same zoom factor for each image (zoom
factor is displayed in the left part of image header).
– Move the images so that an optimum stereo view is obtained.
 It is important to achieve correct vertical alignment of each image

of a stereo pair.
If stereo view is not correct change the left and right image.
000000-1463-266-SWGA-JP-200116
74 Image evaluation
Video viewer
Video recordings can be played on the installed video viewer with the AVI
format.
To enable this, the corresponding video recordings must first be imported
into the system (see also Import data, page 66).
Then select the video recording and start (see Formats display field in
Fig. 22).
1 Pause
2 Start
3 Stop
4 Repeat loop
Fig. 57 Video sequence
000000-1463-266-SWGA-JP-200116
Image evaluation 75
Image editing
Overview of the VISUPAC image editing functions
The VISUPAC image editing functions enable the enhancement of diagnosis
options from captured or imported images. Depending upon the task, there
are different image editing tools to optimize the view.
Image editing tool selection
1 Select cursor function

2 Move image cursor function
3 Region of interest cursor function
4 Undo
5 Zoom region
6 Full screen
7 Save image
8 Reset
9 Edit images
10 Edit images tools selection
11 Measure
12 Drawing
13 Mapping
14 Overlay
Fig. 58 Image editing tools selection
Save image
A copy is always made of the modified images, which are marked by M in
the header. The original image always remains unchanged.
When closing the modified images or clicking the Save image button, the
query "Save image No...?" will appear.
000000-1463-266-SWGA-JP-200116
76 Image evaluation
No:
Return to overview, the modifications will not be saved.
Yes:
The system will save the modified image and automatically create a new file.
The original image will remain unchanged. Modified images are marked with
a red M in the header.
Save modified image

Click the Save button.
The Save image dialog box will be opened.
Fig. 59 Save image dialog box
You have the following options:

Replace:
The image will be saved under the same name, but with the changes.
New image:
The original image will not be altered. A newly created image will be saved.
No:
The changes will be discarded.
Images with graphic elements and saved with Replace or New image are
displayed with a D in the header.
1 D label
Fig. 60 Image with graphic element
000000-1463-266-SWGA-JP-200116
Image evaluation 77
Select cursor function

The Select cursor function is the standard setting of the mouse cursor. The
cursor appears as an arrow. In this setting the following functions can be
executed or selected by clicking the appropriate buttons with the mouse.
– Selection of images
– Selection of menu functions
– Selection of sequence control
Move image cursor function
 This cursor function is used only if an image has been captured

with a resolution higher than that of the screen and hence cannot
be adequately displayed in the image display window.
The Move image cursor function cannot be applied in a zoomed
image.
In the Move image cursor function the cursor has the shape of a hand in
the image display field. Parts of an image that are not displayed can be
selected.
Procedure:
• Click the Move image button.
• Click the image and hold down the mouse button. Drag the cursor into
the desired direction.
After releasing the mouse button, the selected image section will be
displayed.
000000-1463-266-SWGA-JP-200116
78 Image evaluation
Region of interest cursor function

In the Region of interest cursor function, the cursor has the shape of a
cross in the image display field. In the current image display field, sections
can be marked, then the selected area can be zoomed.
Procedure:
• Click the Region of interest button.
• Set the initial point of the frame in the image display field by holding
down the left mouse button and drag the mouse cursor in the desired
direction. Thus a new frame will be created.
When the left mouse button is released, the frame (yellow rectangle) will
be defined.
To move the frame, left-click inside the frame and drag (holding down
the mouse button).
 The size of the frame cannot subsequently be changed. If

necessary, a new frame must be drawn.
Undo
The last change in the image is undone.
Full screen
Toggling between pixel-exact display (1 image pixel corresponds to 1
monitor pixel) or scaled display (the image is fit to the window size).
 This function is only available in single image display.
Zoom region
With this function a defined section can be enlarged. The function cannot be
repeated. In this case, a new section of the image must be selected.
The zoom functionality can also be performed by scrolling the mouse wheel.
Load the images in one of the split views and set the mouse cursor on the
image to be zoomed. The image can be zoomed in by scrolling the mouse
wheel upwards and zoomed out by scrolling the mouse wheel downwards.
000000-1463-266-SWGA-JP-200116
Image evaluation 79
The Move image cursor will appear on the image as soon as the mouse
wheel is used to perform zoom-in or zoom-out actions on the image.
The zoomed-in image can be panned to the required position using the
Move image cursor.
 Zoom action can be applied to the whole image.
000000-1463-266-SWGA-JP-200116
80 Image evaluation
Basic functions
 The basic functions for image editing can be selected only if:
– the Image editing button is shown active (image to be
edited must be opened in 1 split mode)
– the Select cursor function is selected.
• Right-click on the image. The Basic functions context menu will be

opened.
Fig. 61 Basic functions context menu
• Click the desired basic function such as Brightness or Sharpen image or

Contrast to get the respective mouse cursor displayed on the image.
• To increase the brightness or sharpness or contrast of the image, hold the
left mouse button, drag the cursor upwards on the image and then
release the mouse button.
• To decrease brightness or sharpness or contrast of the image, hold the
left mouse button, drag the cursor downwards on the image and then
 All functions can be applied to the whole image.
 The basic context menu functions such as Brightness, Sharpen

image and Contrast can be applied for group of linked images as
well.
• Load the images in 2 or 4 or 9 or 16 split view, link them by selecting the
desired images using <Ctrl> key. The result should be applied for all the
linked images when Brightness or Sharpen Image or Contrast action is
performed on any one of the linked images.
000000-1463-266-SWGA-JP-200116
Image evaluation 81
Sharpen image
This function changes the sharpness of the image. Sharpen increases the
sharpness of blurred pictures by increasing the contrast of the neighboring
pixels.
Click the Sharpen image button to open the Sharpen image dialog box.
The sharpness can be infinitely adjusted using the controller. After releasing
the mouse button, the modification will be displayed in the image.
Brightness
With this function, simple corrections can be performed to the tonal value of
an image. This correction is evenly performed for each pixel in the image.
Click the Brightness button to open the Brightness dialog box.
The brightness can be adjusted continuously using the slider.
Shift to the right: Brighter

Shift to the left: Darker
After releasing the mouse button, the modification will be displayed in the
image.
Contrast
With this function, simple corrections can be performed to the tonal value of
an image. This correction is evenly performed for each pixel in the image.
Click the Contrast button to open the Contrast dialog box.
The contrast can be infinitely adjusted using the slider. After releasing the
mouse button, the modification will be displayed in the image.
Rotate image by 180°

This function rotates the image by 180°, so that it can easily be compared to
the findings from an indirect ophthalmoscope (e.g. for laser treatment with
contact lenses).
Invert image
This function converts the brightness value of each pixel into the opposite
value on the color scale.
000000-1463-266-SWGA-JP-200116
82 Image evaluation
Tonal value correction

This function increases the image contrast. The color and grey values in an
image or a selected area of that image will be corrected manually to adjust
the highlights and shadows. As a result of the reallocation of the tonal
values, the original distribution is spread over the entire spectrum. This
enables more information to be gained from the image.
Click the Tonal value correction button to open the corresponding dialog
box.
1 Buttons for individual color channel correction

2 Slider
3 Input fields
Fig. 62 Tonal value correction dialog box
Fine tuning of brightness, contrast and mid-tones of the image.

In the case of images with more than one color channel, All the color
channels can be corrected at the same time or the channels red (R), green
(G) or blue (B) can be corrected individually. For this purpose, click the
respective button.
The lower or upper tonal values can be hidden using the left and right
sliders. The remaining tonal values can be expanded again to 255 values
(contrast increases).
By correcting the mid-tones (slider in the middle) the brightness in the
middle range of grey can be adjusted without changing the highlights and
shadows.
– Shift to the left: brighten
– Shift to the right: darken
The lower, middle and upper tone values can be adjusted directly by
entering the appropriate numerical values in the Tonal value correction
input fields.
000000-1463-266-SWGA-JP-200116
Image evaluation 83
Global greyscale correction (automatic)

This function increases the image contrast. The color and grey values in an
image or a selected area of that image will be corrected automatically to
adjust the highlights and shadows. The reallocation of color and grey values
will cause the original distribution to be spread over the entire spectrum.
This enables more information to be gained from the image. Details will
stand out more clearly.
000000-1463-266-SWGA-JP-200116
84 Image evaluation
Adaptive zooming
This function is used to compare two image sections taken from different
angles, with different sensors or different image capturing modes.
Right-click in the image to be adapted to the other. The Basic functions
context menu will open.
Click the Zoom line to open the context menu. Click Adapt.
 If you select Full screen the selected image will be displayed. To

go back use double click.
Fig. 63 Zoom context menu
A Before adaptive zooming

B After adaptive zooming
Fig. 64 Examples of images before and after adaptive zooming
000000-1463-266-SWGA-JP-200116
Image evaluation 85
 Adaptive zooming requires a knowledge of the pixel size of the

images stored in the system. In the VISUCAM and FF450plus the
required references are transmitted automatically.
If no references exist, the Adaptive zoom function cannot be
selected.
Displaying/hiding graphic elements

If graphic elements, e.g. rectangles, circles, graphic text, have been applied
to an image (see section Drawing function on page 86), they can be
displayed/hidden by clicking the Graphic elements check box.
Displaying/hiding reference points

If reference points have been applied to an image (see e.g. section Mapping
function on page 91), they can be displayed/hidden by clicking on the
Reference points check box.
Displaying/hiding reference objects

If reference objects have been applied to an image (see e.g. section Defining
a reference circle on page 102), they can be displayed/hidden by clicking on
the Reference objects check box.
000000-1463-266-SWGA-JP-200116
86 Image evaluation
Drawing function
The Drawing function is used to apply graphic elements to the image (e.g.
to mark specific details). The graphic elements are saved independently of
the content of the image and can be deleted.
The Drawing function can be carried out in 1-image, 2-image, or 4-image
split presentation.
• Click the Drawing button to open the Drawing dialog box.
1 Drop-down lists for color and font

2 Graphic elements
3 Selecting element
4 Delete
Fig. 65 Drawing tools selection
• Select the desired color and font size from the two drop-down lists.
• Select a graphic element (e.g. a polygon) and draw the desired element in
the image.
 For help on using the graphic elements, see section Using the
drawing functions on page 88.
000000-1463-266-SWGA-JP-200116
Image evaluation 87
Moving graphic elements

• Click the Selecting element button.
• Click the desired element to be moved (color of the selected graphic
element will change).
• Right-click on the selected graphic element and (holding down mouse
button), drag it to the desired place or click and drag the selected
element using the arrow buttons with the exact number of pixels.
 Circles can be increased or decreased using the mouse. Select the

circle, position the cursor on the outer edge and drag the element
to the desired size.
Deleting graphic elements

• Click the Selecting element button and select the element to be deleted
by clicking it (color of the selected element will change).
• Click the Delete button. The selected element will be deleted.
000000-1463-266-SWGA-JP-200116
88 Image evaluation
Using the drawing functions

Rectangle
• Click on a corner of the rectangle, then hold down the mouse button
while dragging the rectangle, then release the mouse button.
Circle
• Right-click the Circle button. The Circle context menu will be opened.
1 Set the circle center

2 Define the circumference
3 Drag the diameter
Fig. 66 Circle context menu
Three options for creating a circle can be selected by clicking the

corresponding button in the Circle context menu.
• Determine the midpoint for a circle (first mouse click) and the radius
(second mouse click)
• Define the circumference with three points (click the left mouse button
three times). After the third mouse click, the circle will be drawn.
• Position a boundary point per mouse click (hold down the left mouse
button). Drag the circle to the desired size and position, then release the
mouse button. The diameter will be shown in the image of the circle.
000000-1463-266-SWGA-JP-200116
Image evaluation 89
Line
There are two ways to draw a line:
• Specify the starting and end point by clicking with the mouse.
• Click the starting point of the line with the left mouse button, then hold
down the mouse button and drag the mouse until the end point. Then
Open polygon
• Set the starting point by left-clicking.
• Add further lines by left-clicking. Straight lines will be drawn between
points.
• To terminate, click the right mouse button.
Free hand surface

• Right-click the Free hand surface button. The Free hand surface
context menu will be opened.
1 Polygon
2 Free hand surface
Fig. 67 Free hand surface context menu
Polygon:
• Set the starting point by left-clicking.
• Add further lines by left-clicking. Straight lines will be drawn between
points.
• To terminate, click the right mouse button.
Free-hand surface:
• Set the starting point by left-clicking, then hold down the mouse button.
• Trace the desired boundaries of the free hand surface with the mouse.
Here, every movement of the mouse will immediately be displayed as a
boundary line.
• To terminate, release the left mouse button.
000000-1463-266-SWGA-JP-200116
90 Image evaluation
Arrow
There are two ways to draw an arrow.
• Specify the starting and end point by left-clicking with the mouse.
• Left-click the starting point of the arrow. Drag the mouse pointer to the
endpoint while holding down the mouse button, then release the mouse
button.
Free hand contour

• Set the starting point by left-clicking, then hold down the mouse button.
• Drag the free hand contour around the desired section.
• To terminate, release the left mouse button.
Point
• Specify the midpoint of the cross by clicking with the left mouse button.
Text field
• Select the font size and color in the drop-down lists (see Drawing
function, page 86).
• Set the starting point of the text. For this purpose, click on the desired
position in the image.
• Enter the text using the keyboard.
• Terminate the entry by pressing the <Enter> key.
• To move the text field, highlight it (Selecting element button) and drag
it to the desired position while holding down the mouse button.
000000-1463-266-SWGA-JP-200116
Image evaluation 91
Mapping function
The Mapping function permits the marking of identical details on images
(series of images) or on images of the same patient taken with different
capturing modes (ICG, Fluo) or from different angles.
The Mapping function can be performed in 2-image or 4-image split
representation. At least two images must be selected.
Each of the selected images is aligned by two reference points. Now the
desired image details can be selected with the aid of the six available graphic
elements (circle, rectangle, polygon, line, cross or free-hand line).
The same graphic elements are projected identically on each image in the
selected split representation. The drawn elements are saved separately from
image content and can be deleted at any time.
Mapping tools selection
1 Color selection box of graphic elements

2 Tools selection
Fig. 68 Mapping tools selection
Reference points
For using the reference points, see section Performing mapping on page 92
and section Performing overlay on page 96.
Automatching
Helps to precisely align the reference points in all images, independently of
the structure of the selected images. The Automatching function may not
work under some circumstances.
000000-1463-266-SWGA-JP-200116
92 Image evaluation
Procedure:
• Set all reference points (e.g. 1st reference point - square with a cross) on
the same feature in all the selected images.
• Click on the reference point that is placed best (reference point displayed
in yellow).
• Click the Automatching button. All reference points with squares will be
matched in all images.
• Repeat the same procedure for the second reference point (circle with
cross).
 The use of the other graphic elements is described in section Using

the drawing functions on page 88.
Performing mapping
• Select at least two images and click e.g. the 2-image split display mode or
the 4-image split display mode (see section Activating image display and
selecting images on page 69).
• Click the Mapping button to open the Mapping tools selection.
1 1st reference point

2 2nd reference point
3 Mapping tools selection
Fig. 69 Mapping screen display
The Reference points button is already activated in the Mapping tools

selection.
000000-1463-266-SWGA-JP-200116
Image evaluation 93
• In the first image, left-click on the 1st reference point (square with a
cross), hold down the button and drag it to the desired position in the
first image.
• Repeat the same action in all images.
• In the first image, left-click on the 2nd reference point (square with a
cross), hold down the button and drag it to the desired position in the
first image.
• Repeat the same action in all images.
 The more precisely the reference points are placed in each image,
the more precisely the following graphic elements will be
transferred.
Double-clicking on the selected image will enlarge the image to its
original size. With the next double-click, the image will change
back to its previous size.
The Automatching function can also be used for setting reference
points. Refer to section Automatching on page 91.
• Confirm the position of the reference points by clicking the Reference

points button.
• Select the desired graphic element from the Mapping tools selection (for
description of the graphic elements see section Using the drawing
functions on page 88).
The graphic elements created in any image can be instantly projected to

all other chosen images:
Fig. 70 Mapping function carried out
000000-1463-266-SWGA-JP-200116
94 Image evaluation
Overlay function
This function enables two images (from series capturing) to be overlaid, in
order to optimally display specific image areas. The grey or color values of
the images will be added or subtracted pixel by pixel.
Similar to the Mapping function, both images must first be aligned with the
aid of reference points.
The Overlay function can be performed in 2-image or 4-image split
representation.
Overlay tools selection
1 Selection box
2 Overlay tools selection
Fig. 71 Overlay tools selection
Selection box
If monochrome images are edited with the Overlay function, an option list
is opened by clicking the arrow keys. The selected image is colored by
clicking the appropriate line. The available options are Red, Green and
Blue. Click Original to restore the original state.
Reference points
For using the reference points, see section Performing mapping on page 92
and section Performing overlay on page 96.
Automatching
See the description of Automatching in section Mapping function, page 91.
000000-1463-266-SWGA-JP-200116
Image evaluation 95
Image addition
This mix mode adds the tonal values of pixels in the foreground and the
background. This enables more information to be gained from the image.
Image subtraction
This mix mode subtracts the tonal values of the pixels in the foreground and
the background. This enables more information to be gained from the
image.
Transparency
Click the Transparency button to open the Transparency dialog box.
1 1st image
2 Slider of 1st image
3 2nd image
4 Slider of 2nd image
Fig. 72 Transparency dialog box
The mixing ratio of the selected images can be changed as desired using the
sliders.
Crossfading
The selected images will be displayed alternatingly and in rapid order (see
section Dynamic comparison, page 97).
000000-1463-266-SWGA-JP-200116
96 Image evaluation
Performing overlay
Using the Overlay function is similar to the Mapping function. The same
procedure should be followed as described in section Performing mapping
on page 92.
 If monochrome images have been loaded, they can be tinted red,

green or blue before overlaying. Click the desired image and select
the color from the drop-down list (Fig. 71).
• Click the Image addition or Image subtraction button (see section

Image addition, page 95 and section Image subtraction, page 95). The
active image (red header) will be added to the other image. The mixed
image will be shown in the image display field of the image not selected.
The mixed image can then be optimized.
• Click on the mixed image to activate it, then click the Transparency
button (see Transparency dialog box, page 95).
000000-1463-266-SWGA-JP-200116
Image evaluation 97
Dynamic comparison
With the Dynamic comparison function, the images are displayed in a
separate dialog box as an overlay which is rapidly alternated. Both
rapid/dynamic (e.g. in angiographic series) and slow changes (as in progress
monitoring and screening) can be identified clearly.
1 Speed controller
2 Save as video button
Fig. 73 Dynamic comparison screen display
Two to four images may be used for comparison in the 2-image or 4-image
split representation.
The mouse can be used to draw a frame around an area of special interest,
enabling better evaluation of details.
The image change will then occur only within the drawn frame. Refer to
section Selecting an image section while dynamic comparison is running
on page 98.
The activated dynamic comparison can be saved as a video sequence. Refer to
section Saving the dynamic comparison as a video sequence on page 98.
000000-1463-266-SWGA-JP-200116
98 Image evaluation
Executing the dynamic comparison

• Use the Overlay function as described in section Performing overlay,
page 96.
• Select the desired images with the <Ctrl> key held down.
The selected images have a red header and the Crossfade button will be
activated.
• Click the Crossfade button. The selected images will be displayed
alternatingly and in rapid order. The speed can be adjusted and stopped
with the speed controller.
• Terminate the comparison by clicking the Close button.
Selecting an image section while dynamic comparison is

running
 The image section is delimited while the Dynamic comparison

function is being performed.
• Click on a corner of the rectangle, then hold down the mouse button
• while dragging the rectangle, then release the mouse button.
• Left-click and hold down mouse button on the boundary of the desired
section, then drag the mouse in the desired direction. A rectangle with a
red boundary will be displayed.
• Release the left mouse button. The Dynamic comparison function will
be performed only within the boundary.
Creating a new boundary removes the previous one.
A simple mouse click will again activate the image change for the
complete dialog box.
Saving the dynamic comparison as a video sequence

• Click the Save as video button. The Comments dialog box will be
opened.
• Enter the comment in the input field and confirm by clicking OK. The
current dynamic comparison will be saved as a video sequence.
• The saved video sequence can be displayed again later. See the Formats
display field (Fig. 22).
000000-1463-266-SWGA-JP-200116
Measurement of the eye fundus 99
Measurement of the eye fundus

Important advice on determining the size of objects
on the fundus of the eye
 Due to the measuring method and a number of variables such as

device optic and image sensor tolerances, visual defects of the
patient, imprecise drawing of markers, the Measure function of
the VISUPAC software is subject to a degree of inaccuracy which
cannot be excluded.
The readings obtained should thus be regarded as a guide only;
their accuracy should be verified on the basis of medical experience
before embarking on treatment.
In the case of patients with a substantial refractive deviation from
the schematic eye according to Gullstrand, the vision defect and
corneal radius actually determined can be entered into the
calculation of object size according to Littmann by means of the
Measured value correction function (section Measured value
correction on page 100).
The readings must be considered as a guide only; they should be
checked for accuracy using medical experience.
 The Measure function can be executed in 1-image, 2-image or 4-

image split representation.
Use the graphic elements Rectangle, Circle, Free hand surface
and/or Polygon to determine an area.
The graphic elements Free hand contour, Line or Open polygon
are to be used for determining a line.
000000-1463-266-SWGA-JP-200116
100 Measurement of the eye fundus
Measured value correction

The accuracy of measurements can be increased by making an allowance for
the influence of the patient eye.
• Open the Patient card dialog box (see section Patient data
management, page 27).
• In the Visual defects and Corneal radius input fields enter the correct
values for the patient's right and left eye and confirm by clicking OK.
If data for visual defects or corneal radius has been entered in the patient
card, the measured values can be corrected accordingly.
• For this purpose, activate the Correction check box in the Measure tool
bar (1, Fig. 75).
The correction values are incorporated in the next measurement.
 If the Correction check box (1, Fig. 75) is grey, no correction data
for this patient has been entered.
1 Correction check box
Fig. 75 Section of Measure tool bar
000000-1463-266-SWGA-JP-200116
Absolute measurement
References are available
• Click the Measure button. On the left side of the screen, the Measure
tool bar will be displayed (Fig. 76).
• Select a graphic element for measurement and drag it over the area or
line to be measured. On releasing the left mouse button, the reading will
be automatically applied to the image and assigned to the graphic
element.
 Newly-saved images with measurement/reference objects will be

shown with a green M in the header of the image display field.
1 Reference functions
2 Measurement functions
Fig. 76 Measure tools selection
 If a reference object has already been defined in an image, the

results of the measurements will also exist. When a new reference
object is defined, all previous definitions and results will lose their
validity. Delete the previous measurement results in order to avoid
errors.
000000-1463-266-SWGA-JP-200116
No references are available

• Click the Measure button. The Measure dialog box will be displayed on
the screen (see Measure tools on page 101).
• Define a reference object. Four options are available:
– Defining a reference circle.
Refer to section Defining a reference circle on page 102.
– Defining a reference line.
Refer to section Defining a reference line on page 104.
– Defining a reference angle.
Refer to section Generation of a predefined reference angle on
page 106.
– Creating a predefined reference circle.
Refer to section Generation of a predefined reference circle on
page 105.
Defining a reference circle
 Reference objects are only needed if the images were not captured
with ZEISS fundus camera.
• Click the Reference circle button.

• Draw the reference circle at the corresponding position in the image. The
size of the reference circle is determined by three points which are
generated by mouse clicks.
• Observe the following procedure for correcting the position and size of
the reference circle:
– Modifying the position of the reference circle:
Click and hold down the mouse button on the reference circle, then
drag the mouse at the desired position. Release the mouse button.
– Modifying the size of the reference circle:
Click and hold down the mouse button on the circle line, then drag
the circle to the desired size. Release the mouse button.
000000-1463-266-SWGA-JP-200116
• Click the Reference circle button again.

The Measurement dialog box will be opened:
1 Image angle options

2 Input fields
3 Insert reference value in image check box
Fig. 77 Measurement - Reference circle dialog box
• Select the desired Angle.
 Select the image angle for images which have been captured with
other fundus cameras, or select the unknown option, This
generates the absolute reading for the reference circle.
• Fill in the input fields (specify the size of the reference object).
– Fill in the value (e.g. 1.0).
– Select the unit in the Unit drop-down list.
• Click the Insert reference value in image check box. The selected unit
value will be superimposed on the image.
• Confirm with OK.

000000-1463-266-SWGA-JP-200116
Defining a reference line

• Click the Reference line button.
• Draw the reference stretch at the corresponding position in the image
(click and drag with the mouse). When the mouse is released, the size
and the position will be fixed.
• Observe the following procedure for correcting the position and size of
the reference line:
– Modifying the position of the reference line:
Click and hold down the mouse button on the reference line, then
drag the mouse at the desired position. Release the mouse button.
– Modifying the size of the reference line :
Click and hold down the mouse button on the endpoint of the
reference line, then change the size and direction of the reference line.
Release the mouse button.
• Click the Reference line button again.
The Measurement dialog box will be opened:
1 Input fields
2 Insert reference value in image check box
Fig. 78 Measurement - Reference line dialog box
• Fill in the input fields (specify the size of the reference object).
– Fill in the value (e.g. 1.0).
– Select the unit in the Unit drop-down list.
• Click the Insert reference value in image check box. The selected unit
value will be superimposed on the image.

000000-1463-266-SWGA-JP-200116
Generation of a predefined reference circle

Using this function, reference circles with a predefined diameter can be
drawn.
• Right-click the Circle button to open the Circle context menu.
1 Midpoint circle
2 Three point circle
3 Circle diameter
4 Predefined circle
Fig. 79 Circle context menu
• Click the Predefined circle button.

• Left-click on the image. The Circle predefined dialog box will be
opened.
Fig. 80 Circle predefined dialog box
• Enter the value and select the unit.

• Confirm with OK. The reference circle is generated.
Modifying the position of the reference circle:

– Click the Selecting element button.
– Click and hold down the mouse button on the circle to be moved and
drag it to the desired position.

000000-1463-266-SWGA-JP-200116
Generation of a predefined reference angle
 This function is inactive if a FF 450 fundus camera is connected. If

plus
images are captured with this fundus camera, the image angle
used on the fundus camera will be applied automatically.
• Open the Select Angle and Camera dialog box by clicking the Angle
button.
1 Drop-down list for camera type and angle.
Fig. 81 Select angle and camera dialog box
• In the drop-down list, select the type of camera and camera angle used
for capturing the image.
• Confirm your entry by clicking on OK. Measurement can now be
performed.
 All readings are absolute values. See also section Important advice
on determining the size of objects on the fundus of the eye on
page 99.
000000-1463-266-SWGA-JP-200116
PDT measurement
Determining the laser spot diameter required for PDT (photo-
dynamic therapy)
 Please observe the advice in section Important advice on

determining the size of objects on the fundus of the eye, page 99
for work with absolute values.
Notes on displaying BSA information can be found in section Body
Surface Area - Information, page 108.
The results can be entered into the ZEISS laser without
modification. Conversions are not necessary.
Carrying out the PDT measurement

• Click the Measure button.
• Draw in the entire lesion using the closed polygon or free hand surface
(see section Free hand surface, page 89).
• Click the PDT button.

– The greatest linear diameter (GLD) and laser spot diameter (LSS) are
entered together with the measured values.
– In addition, a crosshair is superimposed, indicating the position of the
laser spot. This assists in the correct positioning of the laser.
– The reticule can be superimposed or faded out by clicking the mouse
outside or inside the defined lesion (after activating the Selecting
element button). The cross lines can also be faded out by clicking on
one of the other buttons.
000000-1463-266-SWGA-JP-200116
Performing the PDT measurement including percentage CNV

• Draw in the entire lesion using the closed polygon or free hand surface
(see section Free hand surface, page 89).
• Draw the classic part of CNV (choroidal neovascularization).
• Select both elements using the Selecting element button while holding
down the <Ctrl> key.
• Click the PDT button.
Body Surface Area - Information

For determining BSA (Body Surface Area), the Height and Weight must be
entered in the patient card (country-specific in cm; kg or ft+in, lb).
 Values for Height and Weight must be always entered/verified

before working with the BSA.
• Select the desired patient.

• Click the Open patient button.
The Patient card dialog box will be opened (see section Section of the
Patient card on page 35).
• Update/verify the values for Height and Weight and confirm with OK.
The BSA will now be superimposed on the image.
 Please observe the advice in section Important advice on

determining the size of objects on the fundus of the eye on
page 99 for work with absolute values.
000000-1463-266-SWGA-JP-200116
Papillary diagnostics
The function enables the ratio between the Cup and Disc to be determined
for assisting papillary diagnostics.
• Load the image in single image mode and click the Measure button.
• Draw the Cup and Disc as two separate areas using the Circle, Closed
polygon or Free-hand area (for using these functions, see section
Circle, page 88 and section Free hand surface, page 89).
• Click the Selecting element button while holding the <Ctrl> key and
then click in the smallest area.
1 C/D ratio values

2 Cup and disk data
3 Ray
Fig. 82 Section of the Measure C/D ratio display
• Click the C/D ratio button.

– At the intersection of the middle rays within the graphic element, the
appropriate C/D ratio value is displayed.
– One ray can be modified as required in terms of size and position,
thus the C/D ratio at any angle of interest can be determined. For this
purpose, left-click with the mouse at the end of the ray and, holding
down the left mouse button, drag it to the desired position.
– Additionally, the area measurement for the Cup and Disc is specified
in mm2 as well as the linear C/D ratio for the entire papilla in %. If
changes in the size of the drawn figures are made, the values will be
automatically adjusted accordingly.
000000-1463-266-SWGA-JP-200116
Specifying distances in papillary diameters

This function enables the comparison of object sizes and positions against
multiple papillary diameters.
• Load the desired image in the 1-image split representation.
• Transcribe the papilla e.g. with the graphic element Circle (for using
these functions, see Circle on page 88).
• Click the Selecting element button while holding the <Ctrl> key and
then click in the smallest area.
Fig. 83 Measurement - Papillary diameters display
• Click the Optic disk diameter distance button.

– Middle rays and circles in multiples of the papillary diameter are
displayed (single, double and triple papilla diameters).
– After changing the position, click the Selecting element button and
then click in the element. Click and hold down the mouse button in
the center of the macula and move the element.
000000-1463-266-SWGA-JP-200116
Classification of structures at the fundus

Structures are classified at the fundus on the basis of reports of the
University of Wisconsin Fundus Photo Reading Centers (UW-FPRC;
http://eyephoto.ophth.wisc.edu). They are classified according to
maculopathy grading measurement circle and seven defined measurement
circles (AREDS = Age Related Eye Disease Study; CIO = Central Inner Outer)
(see section AREDS measurement circles, page 112).
 An optional VISUPAC Analysis GRIDS license is required to use the

functions described in this section.
Maculopathy grading measurement circle

• Load an image in single image mode.
• Click the Maculopathy grading button.

• Click on the desired position in the image using the mouse to generate a
maculopathy grading measurement circle.
Fig. 84 Maculopathy grading measuring circle section
 The radius of the inner circle is 360 µm. This circle also has an
orientation point at the 12:00 o'clock position. The radii of the
other three circles are 600 µm, 1800 µm and 3600 µm.
000000-1463-266-SWGA-JP-200116
• Observe the following procedure for correcting the position and

removing the distance of the measuring circle:
– Changing the position:
The maculopathy grading circle can be rotated. Click he inner border
of the outermost circle and holding the mouse button down, rotate
the circle to the desired position.
– Remove:
Select the desired circle. Press the <Del> key to remove the circle.
AREDS measurement circles

AREDS measurement circles (a set of graded measurement circles;
Wisconsin/AREDS: Age Related Eye Disease Study) serve as a basis for
estimating the area of diseased tissue.
Three groups of circles are used to differentiate between the subfields:
C for central,
I for inner and
O for outer
This is valid for each of the subfields: Circle 1 corresponds to 1/64 (1.6 %)
the size of the subfield and circle 2 to 1/16 (6.3 %).
Using an average papilla of 1.8 mm diameter, the measurement circles have
the following diameters:
C0 0.042 DD = 0.0756 mm
C1 0.083 DD = 0.1494 mm
C2 0.167 DD = 0.3006 mm
I1 0.120 DD = 0.2160 mm
I2 0.241 DD = 0.4338 mm
O1 0.219 DD = 0.3942 mm
O2 0.439 DD = 0.7902 mm
• Load an image in single image mode.

000000-1463-266-SWGA-JP-200116
• Click the CIO button. The AREDS dialog box will be opened (see Fig. 85).
Fig. 85 AREDS measurement circles dialog box
• With a mouse-click, select the desired measurement circle to be drawn

into the image.
• Place the mouse pointer in the center of the structure and create the
measurement circle by clicking the left mouse button.
 Visible variations of up to 2 pixels in the illustration may occur if

the image section is magnified while generating the measurement
circle C0 due to rounding-off errors. This does not, however, affect
the actual size of the measurement circle.
Creating panorama images

A large panorama image can be created and saved from several images
using the Panorama function. Panorama calculates the position of the
individual elements and corrects any differences in contrast, enabling a
homogenous appearance. See section Manual creation of a panorama
image, page 115.
When using the Zeiss AutoMap the panorama image is created
automatically.
Automatic creation of a panorama image
 An optional VISUPAC AutoMap license is required to use the

function described in this section.
 The panorama images generated for the Zeiss AutoMap may not
be used for measurements, as transitional areas may not be shown
to scale.
• Select the desired images.

• Click the Zeiss AutoMap button. The panorama image will be generated
automatically.
 In the event that the panorama image cannot be generated, an

error message will appear on the screen (see Zeiss AutoMap -
Error messages, page 114). Once the error message has been
acknowledged, the Zeiss AutoMap button can be clicked once
again.
000000-1463-266-SWGA-JP-200116
Zeiss AutoMap - Error messages
Error Explanation
The selected images have The selected images were created with different
different resolutions. resolutions (or different sensors). The Zeiss
AutoMap function cannot be executed.
The selected images were The selected images were created in different
captured by different modes. capture modes. The Zeiss AutoMap function
cannot be executed.
The selected images were The selected images were created at different
captured at different angles. angles. The Zeiss AutoMap function cannot be
executed.
The selected images are of The selected images did not all originate from the
different eyes (OS/OD). same eye. The Zeiss AutoMap function cannot
be executed.
Too many images selected. A maximum of 10 images may be selected at one
Please select fewer images. time.
If you are using Canon 5D or Canon 5D Mark III
please make sure that the smallest resolution has
been selected for image captures if the 10
images per panorama image option shall be
used.
The Zeiss AutoMap function cannot be
executed.
Unable to generate Zeiss Reduce the number of images selected for the
AutoMap image. There may panorama.
be not enough storage space. This error message mainly appears with images
Reduce the number of images captured with a Canon 5D or Canon 5D Mark III
loaded in the viewer! in mid-range or high resolution.
The following selection of The Zeiss AutoMap function was executed. This
images cannot be used: message is merely intended as advice that certain
images cannot be used (e.g. no overlap).
The Zeiss AutoMap image has The Zeiss AutoMap function was executed. This
been distorted. The pixel message is merely intended as advice that the
width is not reliable. panorama image is seriously compressed or
stretched.
The Zeiss AutoMap image has The Zeiss AutoMap function was executed. This
been distorted by using a message is merely intended as advice that the
vessel type dark or light. The panorama image is seriously compressed or
pixel width is not reliable. stretched.
000000-1463-266-SWGA-JP-200116
Manual creation of a panorama image
 The generation of panorama images is only possible using images

captured in the same capturing mode.
• Select the desired images and display them in the Split image display
mode.
• Reselect the desired images in Split image display mode while holding
down the <Ctrl> key.
• Click the Panorama button. The Create panorama image program
window will be opened:
Fig. 86 Create panorama image program window (1st)
By double-clicking on the partial images in the bottom half of the screen, the
selected images will be transferred to the upper area of the display screen.
The selected image will be displayed with a red frame; images not selected
will have grey frames.
More images can be added at any time from the lower area of display
screen. In addition, after each step, images can also be removed from the
working area with a double-click.
000000-1463-266-SWGA-JP-200116
Fig. 87 Create panorama image program window (2nd)
Approximate positioning of images

Use the mouse to drag the individual images over one another and
approximately position them.
Accurate positioning of the images

Clicking the AutoMatch button will automatically merge the images. The
best results are obtained when large areas of the images overlap. When the
images are correctly overlapped, the borders will no longer be visible. If the
images cannot be positioned automatically, they will retain their borders.
The images can be positioned pixel-over-pixel using the arrow keys.
The Zoom in + and Zoom out - buttons are used to increase or decrease
the size of the panorama image. Repeated magnifying or reducing the image
is not possible.
The frames will disappear when clicking on the Merge images button.
Click the Cancel button to discard the panorama image and close the
Create panorama image module.
000000-1463-266-SWGA-JP-200116
By clicking on OK the generated panorama image will be stored as a new

image and added to the current split representation. The Panorama
function will be closed. While saving, the contrast levels of the sub-images of
the panorama image will be automatically adjusted to one another.
Fig. 88 Examples of panorama images
External modules
If an external module is installed on your system, it can be activated by
clicking the right mouse button on the header of the image to be edited.
• Select the external module in the context menu under Export to.
The module will be activated with the image and the resulting image
added to the VISUPAC database.
Fig. 89 Activating an external module
000000-1463-266-SWGA-JP-200116
118 Exporting, archiving and printing
Exporting, archiving and printing

Exporting data
The Export image data function allows the export of image data to the
hard disk or to a removable storage medium (CD-RW, DVD-RW, USB).
Depending on the selected file format the entire patient data may be
transferred. If patient data has been recorded on the images, it will be
transferred during data export.
The images can be saved in JPEG, TIFF (uncompressed), HTML, XML, BMP,
TXT or PNG format.
Images with attached patient data can be exported in the VISUPAC database
using the DICOM export function (see section Exporting DICOM patient
data, page 121).
Alternatively, patient data can be exported using the Export dialog box. For
this purpose, select the DCM data format.
Use the Export visit function to export the selected visit with all included
images, video and audio recordings, together with patient data in XML
format, to the defined export directory. Data can thus be transferred in its
entirety to another VISUPAC system.
000000-1463-266-SWGA-JP-200116
Exporting, archiving and printing 119
Exporting image data

• Select a patient in the VISUPAC database and load the images of the visits
(see section Activating image display and selecting images, page 69).
Select the images to be exported by clicking on them in the overview
mode (multiple selection by holding the <Ctrl> key).
• Click the Export data button.
The Export dialog box will be opened.
• Select the file format in the File type drop-down list. The appearance of
the Export dialog box will change depending on the file type selected.
1 Check boxes
2 Format display
3 File type drop-down list
Fig. 90 Export dialog box for BMP, HTML, PNG, TIFF, TXT and XML
Possible default settings, depending on the format to be exported.

– Check box With annotations:
Patient data will also be exported.
– Check box With drawings:

Graphics will also be exported.
Sending images in JPEG format:

• Select the JPEG format in the File type drop-down list and activated the
corresponding check box. Now the quality (compression) of the image
data can be set using the Image quality slider.
000000-1463-266-SWGA-JP-200116
1 Source directory drop-down list

2 Check boxes
3 Image quality slider
4 File type drop-down list
Fig. 91 Export dialog box for JPEG
• Select the target directory.
The program will automatically suggest a file name. This will contain the
patient's last/first name and birth date for unique identification, together
with a consecutive number. The file name may be changed in the File
name input field.
• Click the Export button. The data will be copied in the selected target
directory and the dialog box will be closed.
Exporting visits
• Click on the visits to be exported of this patient (multiple selection by
pressing the <Ctrl> key).
• Click the Export visit button.
Only the XML format is available for the Export visit function.
000000-1463-266-SWGA-JP-200116
The program will automatically suggest a file name. This will contain the
patient's last/first name and birth date for unique identification, together
with a consecutive number. The file name may be changed in the File
name input field.
• Click the Export button. The data will be copied in the selected target
directory and the dialog box will be closed.
Exporting DICOM patient data
 The manufacturer supports the export of images in the DICOM

formats Visible Light (VL) and Ophthalmic Photography (OP). The
DICOM Conformance Statement can be obtained from the
manufacturer on request.
DICOM files can be created and exported:
– of an individual image
– of one or more visits
– of one or more patients.
Patient data is always included when DICOM data is exported.
Individual images are exported (without attaching patient data) using the
Export data function (see section Exporting image data on page 119).
Patient data may be anonymized (Anonymous VISUPAC license is required).
The method is described on the following pages.
• Click on the visits to be exported in the Visits display field. To select
several visits simultaneously, hold down the <Shift> or <Ctrl> key while
clicking. The selected visits will be highlighted in blue.
 If the selected visits contain more than 50 images, a warning will

be displayed. Check whether you really want to export all these
images.
• Click the DICOM export button.
000000-1463-266-SWGA-JP-200116
1 Check boxes
2 Image quality slider
3 Make patient name anonymous check box
Fig. 92 DICOM export dialog box
Available default settings:

– Burn the patient data onto the image: Click the With annotations
check box.
– Include graphics: Click the With graphics check box.
 To reduce data volume, image information can also be

exported in the JPEG format during DICOM export.
When using JPEG, the file size can be further reduced by
changing the image quality. The default setting is 100 %
(uncompressed).
This function may not be supported by all DICOM-enabled
programs from other providers. Check this before use.
Sending images in JPEG format:

• Click the JPEG check box. Now the quality (compression) of the image
data can be set using the Image quality control.
000000-1463-266-SWGA-JP-200116
Anonymizing patient data:
 An optional VISUPAC Anonymous license is required to use the

• Click the Make patient name anonymous check box.

Enter an Alias name in the input field or open the drop-down list.
Click the <+> key or press <Enter> to transfer file names from the Alias
name input field to the list of file names or click <-> to delete them.
 When selecting an anonymized name:

– The gender of the patient is set automatically to unknown.
– When DICOM images are imported to another system (e.g.
to a reading center), anonymized patients will be created.
There, the images can be evaluated and provided with image
comments. Later they can be re-exported with DICOM. If the
images are exported back into the system from which they
were imported, they will again be assigned to the original
patient and respective visit.
– If the patient or the visit has meanwhile been deleted from
the database, no assignment will be possible. In this case,
import will take place in the same way as an import from
other systems. A new patient will be created.
– If the patient's name has meanwhile been changed, the
system will recognize this at the time of import and assign
the data to the correct patient.

• Start the export by clicking on the Export button. The data will be
exported.
A DICOM file is created for each patient image. Apart from the image
information, each DICOM file contains the entire patient data, including
name, first name, date of birth, etc. When exporting the visits of several
patients the correct patient will automatically be assigned to the exported
DICOM files.
000000-1463-266-SWGA-JP-200116
Archiving
Archiving on data storage media
With the Archiving function all new images can be archived on external
data storage media (depending on configuration and installed hardware,
e.g. on network attached storage systems (NAS) or PACS, see section
Archiving on PACS, page 142.
Upon quitting the program the Archiving dialog box will be automatically
displayed on the screen.
Archiving is possible at any time while working with VISUPAC software
(except in image capture mode).
For archiving on an NAS system, the latter must either be connected directly
to the VISUPAC system or available through the network.
Archiving on an NAS system

• Open the dialog box by clicking on Archiving.
Fig. 93 Archiving dialog box
• Click the Start button. The archiving process will be started. If no NAS
system is available, the following message will appear.
Fig. 94 Error message
000000-1463-266-SWGA-JP-200116
Once the archiving process has been completed, the Archiving dialog box
will be automatically closed. The VISUPAC software will remain active. If the
archiving function was launched while exiting the system, the program will
now close.
 A daily backup on the NAS system is recommended.
Copy function as an additional backup

The copy function can be used to copy the last archiving medium as a
backup. This is equivalent to an archive backup. The backup medium
remains at the user's workplace and the additional archive can be kept in a
secure location (archive, safe or similar).
 This function is only available if the data backup on media has

been installed (MOD, CD, DVD).
 This function is only available for the last sealed (complete) data
carrier.
• Left-click the triangle beside the Archiving button to open the context
menu.
1 Archiving
2 Copy disk
Fig. 95 Archiving context menu
Follow the instructions displayed on the screen.
000000-1463-266-SWGA-JP-200116
Printing data
Standard printing
The standard printing function permits one or more images to be printed
at a time.
• Select the images by clicking on them in the overview mode. The headers
of the selected images will appear in red or blue.
• Call up the appropriate Split image display mode (1, 2, 4, 9 or 16
images).
• If necessary, change the order of the images. For this purpose, click on
the corresponding images and the on the Scroll button.
• Click the Print button. The Printing dialog box will appear.
1 Input fields
2 Check boxes
Fig. 96 Printing dialog box
• Fill in the input fields as required. This information will also be printed
out.
If the Mark printed images as favorites? check box is activated, all the
selected images will be marked as favorites. Refer also to section Marking
an image as a favorite on page 70.
• Confirm with OK. Printing will now start.
 Further processing can be carried out using VISUPAC immediately

after the print procedure has been triggered, as printing will run in
the background. However, this is dependent on the printer
connected. The system may be seriously slowed down and it will
be necessary to wait until printing has been completed.
000000-1463-266-SWGA-JP-200116
Print layout
An individual compilation of a printout can easily be created using the print
layout.
In the full screen Print dialog, the previously selected images will be
displayed in the lower section as print layout preview images.
The user can select a user-defined layout in which the images are
automatically arranged (corresponding to settings) or individually placed
using the mouse.
Images from various patient visits can also be assembled for printing.
• Left-click the triangle beside the Print button to open the Print context
menu.
1 Print layout button
Fig. 97 Print context menu
• Left-click the Print layout button.

The Print layout dialog box will be opened.
000000-1463-266-SWGA-JP-200116
1 Select Print layout/Report

2 Brief information display field
3 Loaded images image selection
4 Input fields
5 Brightness slider
6 Check box
7 Pre-defined layouts list
8 Function control buttons
Fig. 98 Print layout dialog box
• Use the mouse to select the desired print layout from the Pre-defined
layouts list. The corresponding print layout will be displayed.
• Select the desired images by double-clicking in Image selection. The
images will now be transferred to the print layout. The images can be
moved within the display field at a later date. For this purpose, click an
image and drag it to a new position while holding the mouse button.
• Click the Snap button. The images will be automatically arranged
according to the criteria defined in the print layout. For defined criteria
see section Editing defined print layouts on page 130.
000000-1463-266-SWGA-JP-200116
 There is no fixed order for the images in standard layouts. Each

defined layout has a specified split arrangement and image
allocation, based on defined criteria (color left, color right, etc.)
After arranging the images, start printing by clicking the Print button in the
Print layout dialog box.
Creating a new print layout

• Click the New button in the Print layout/medical report dialog box.
The matrix for defining a new print layout will be opened.
1 Name input field

2 Split drop-down list
3 Page format option buttons
4 Image position option buttons
Fig. 99 Definition of a new print layout matrix
000000-1463-266-SWGA-JP-200116
• Enter a name for the print layout in the Name input field.
• Open the Split selection box. Use the mouse to select the desired split
presentation (1-image, 2, 4, etc.).
• Select the page format with the Page format option buttons.
• Define the image positions for the new print layout with the Image
position option buttons. The images selected later will be arranged in
this print layout based on the criteria defined here.
• Click the OK button. The new print layout will be transferred to the Pre-
defined print layouts list.
Editing defined print layouts

• Use the mouse to select the desired print layout from the Pre-defined
layouts list (see page 128).
• Click the Edit button in the Print layout dialog box. The matrix for the
respective print layout will be opened.
• Make the desired changes and confirm with OK.
Deleting pre-defined print layouts

• Click the appropriate print layout in the Pre-defined print layouts list.
• Delete the print layout by clicking on Delete in the Print layout dialog
box. The print layout will be deleted.
Specifying a print layout as the standard layout

• Click the appropriate print layout in the Pre-defined print layouts list.
• Click the Set as default button. This layout will now be automatically
specified as the default when the Print layout dialog box is opened.
000000-1463-266-SWGA-JP-200116
Medical report
The Report module (medical summary) can be selected in the Print layout
dialog box (see section Printing data on page 126 and following). This
module enables the user to create a medical report or summary. For the
medical report or medical summary, the patient data on the selected visit
stored in the database is automatically transferred to the automated text
boxes of the Report dialog box.
Additional text may be entered in the six Free text input fields on the right
side of the window. Input fields which are not filled in will not appear in the
medical report. Diagnoses from the database can be entered as text modules
using the Insert text blocks buttons to the right of the input fields.
Various templates are available for formatting text in the medical report. On
request, a letterhead of the physician or clinic can be integrated by ZEISS
Service. Creation of a personal template by the user is not possible.
A report can be created with the template
PhysicianLetter_1_to_4_images_en. Enter the report name in the Subject
text input field; it will be shown as a centered headline for the report.
When the print preview of the medical report is closed, a dialog box Save
medical report will appear. A name may be entered under which the
medical summary/report is saved as a PDF file in the database. The PDF file
can be retrieved at a later date, see Formats display field (Fig. 22).
• Select the patient images from the overview. If necessary, edit the images
using image editing functions.
• In the selection Print layout/Report (1, Fig. 98), switch from the Print
layout dialog box to the Report dialog box.
000000-1463-266-SWGA-JP-200116
1 Functional control button

2 Report template drop-down list
3 Check box
4 Free text input fields
5 Insert text blocks buttons
6 Automated text boxes
7 Brief information display field
Fig. 100 Report dialog box
The details entered in the Patient card dialog box (see Section of the
Patient card on page 35) will be displayed in the automated text boxes. This
data can be edited subsequently in the Patient card dialog box.
• Further details can be entered in the Free text input fields. Insert
diagnoses from the database as required using the Enter text blocks
buttons.
• Select the template in the Report template drop-down list. The last used
template will be selected as a default.
If the With images check box has been selected (default setting), the
previously selected images will also be printed out.
000000-1463-266-SWGA-JP-200116
Print preview
• Click the Report preview button. The medical report will be displayed. If
the last medical report is still open, the Save report dialog box will
appear (see Fig. 101). Here a name may be entered in the Enter
comments text box under which the last medical report is to be saved as
a PDF file in the database.
Fig. 101 Save report dialog box
Print out medical report

• Click the Print button.
Close the print preview

When the print preview closes, the Save report dialog box will also open
and a name can be entered in the Enter comment text box under which
the medical report is to be saved as a PDF file in the database.
000000-1463-266-SWGA-JP-200116
Fig. 102 Example of a medical report, based on the PhysicianLetter_1_to_4_images

template
000000-1463-266-SWGA-JP-200116
Communication with PACS and EMR systems 135
Communication with PACS and

EMR systems
 An optional VISUPAC DICOM license is required to use the function

described in this section. Furthermore, VISUPAC must be
configured accordingly.
The VISUPAC DICOM license enables data exchange between the VISUPAC
database and an external DICOM "Picture Archiving and Communication
System" (PACS) such as FORUM by ZEISS.
VISUPAC receives patient data from PACS via the query of a DICOM
Modality Worklist. After image capture for this patient, the images are
transferred to PACS via a DICOM export.
DICOM Modality Worklist:

The DICOM Modality Worklist service enables the automatic import of jobs,
including the pertinent patient data, from a PACS.
DICOM export:
DICOM export enables image data to be saved on a PACS system. Refer to
section DICOM export on page 139.
DICOM Query/Retrieve:
Archiving of data on a PACS and loading data from PACS Refer to section
DICOM Query/Retrieve on page 142.
000000-1463-266-SWGA-JP-200116
136 Communication with PACS and EMR systems
DICOM Modality Worklist Query

• Click the DICOM import button in the patient dialog. The Worklist
dialog box will be opened.
1 Selection list
Fig. 103 Worklist dialog box
By clicking on the corresponding button it is possible to choose between

two types of queries:
– By patient. Refer to section Query by patient on page 137.
– By visit. Refer to section Query by visit on page 138.
000000-1463-266-SWGA-JP-200116
Query by patient
• Enter the patient name in the Patient's Name input field. If no entry is
made, a wildcard will be set and in the next step a maximum of 50
patients will be listed.
1 Patient's Name input field

2 Submit query button
Fig. 104 Worklist - Query by patient dialog box
• Click the Submit query button. The Patient list will appear:
1 Remove all button

2 Remove selected button
3 Patient list
Fig. 105 Patient list display
000000-1463-266-SWGA-JP-200116
Clicking the Remove selected or Remove all button will cause single or all
patients to be deleted from the Patient list.
• Click the desired patient to select him/her. The selected patient will be
transferred to the database. For the database, refer to section Patient
data management on page 27.
Query by visit
• Complete either the Date range or Exact date input field.

2 Date range input field
3 Exact date input field
Fig. 106 Worklist - Query by visit dialog box
• Click the Submit query button. The Patient list will appear (Fig. 105):
Clicking the Remove selected or Remove all button will cause single or all
patients to be deleted from the Patient list.
• Click the desired patient to select him/her. The selected patient will be
transferred to the database. For the database, refer to section Patient
data management on page 27.
After successful transmission of patient data into the VISUPAC database, the
image can now be captured.
000000-1463-266-SWGA-JP-200116
DICOM export
The DICOM export function enables DICOM images to be exported to a
standard archive or to several archives within the network.
 The desired network connections for the standard archive and all
other archives are set when the VISUPAC system is installed.
The function is used to send the images ordered by a DICOM Modality
Worklist to a PACS system and can be carried out from either the database
dialog (complete visits and patients) or a split representation (individual
images), similar to the DICOM export function.
Exporting complete visits

• Select the patient and visits to be exported in the database.
 Hold down the <Ctrl> key when clicking to select multiple visits.
• Press <Enter> to display all images in the overview mode.

• Alternatively, you can double-click on a visit to display images in overview
mode.
• Select all images which are to be exported.
• Left-click the triangle beside the Export data button. The Export data
context menu will appear.
1 Default storage
2 Multiple storages
3 Export data
4 Move images
Fig. 107 Export data context menu
000000-1463-266-SWGA-JP-200116
• Select the desired archive.

– Transferring to an archive:
Click the Default storage button.
Refer to section Exporting DICOM objects to the standard archive on
page 140.
– Transferring to multiple archives:
Click the Multiple storages button.
Refer to section Exporting DICOM objects to several archives
(multiple storages) on page 141.
• Confirm with OK.
Exporting DICOM objects to the standard archive

Data export and data transmission are temporarily staggered.
Hence, the file may be exported, but transmission may fail.
Errors occurring during connection set-up or during transmission are
displayed immediately.
In case of an error, the user may:
– make a second attempt to transmit the data record,
– continue transmission with the next data record,
– terminate the procedure.
In case of a network failure (cable break, router failure, server failure, etc.)
the procedure should be terminated. The procedure will be temporarily
discontinued. Should the user retry the export function to the standard
archive, the procedure will be restarted and transmission of previously
exported data will continue. The procedure will be resumed with the next
start of VISUPAC.
000000-1463-266-SWGA-JP-200116
Exporting DICOM objects to several archives (multiple storages)

• Open the Multiple export dialog box.
1 Accept for storage button

3 DICOM images display
Fig. 108 Multiple export (1st) dialog box
The dialog box is vertically split into two. DICOM images to be exported are
displayed on the left side and available DICOM archives are on the right.
• Highlight the DICOM images to be exported.
• Click the Accept for storage button.
The DICOM images will be copied and the Submit query button is
activated. Click the button to expand the dialog box.
1 Watch jobs button

2 Remove selected button
3 Remove all button
Fig. 109 Multiple export (2nd) dialog box
000000-1463-266-SWGA-JP-200116
• Click the Watch jobs button. The patient data still to be sent is
displayed. If necessary, certain or all DICOM images can be removed from
the export list by clicking on the Remove selected or Remove all
buttons.
• Start the export by clicking the Submit query button.
• Repeat this procedure for all the desired archives.
• Close the dialog by clicking on OK.
DICOM Query/Retrieve
DICOM Query/Retrieve provides the following functions:
– Archiving data in a PACS (for details see the following section).
– Loading the data archived in the PACS.
Refer to section Query/Retrieve on page 143.
Archiving on PACS
If an archive has been configured, each user will be prompted to archive
data before exiting VISUPAC:
If the appropriate configuration has been made, the DICOM images will be
archived directly in PACS.
 AVI, PDF and DOC formats cannot be archived with PACS. This
data must be saved separately. Refer to section Archiving on data
storage media on page 124.
The system automatically detects data that has not been saved.
• Click the Archiving button. The Archiving dialog box will be opened.
1 Start button
Fig. 110 Archiving dialog box
000000-1463-266-SWGA-JP-200116
• Click the Start button. The archiving process will be started.

Once the archiving process has been completed, the Archiving dialog
box will be automatically closed.
The VISUPAC software will remain active.
Query/Retrieve
If VISUPAC has been configured accordingly, DICOM images which have
been archived in a PACS can be displayed in VISUPAC using the
Query/Retrieve function.
The images are loaded as described in section Activating image display and
selecting images on page 69.
The status (note A) of the attached visit data is indicated in the Visits display
field.
A Status display (note A)

Fig. 111 Section - Database - Query/Retrieve dialog box
Meaning of the status display (note A):

– Archived:
The visit data has been archived.
No indication is given as to where the data has been saved.
– Error:
Contact the system administrator.
– OK:
The data is available in VISUPAC and may be loaded immediately.
– Requested:
The requested data is being loaded (= indication that loading is in
progress).
– Check:
The archiving status is being checked.
000000-1463-266-SWGA-JP-200116
The Remote archive order dialog dialog box will be opened during
loading:
1 Active orders display field

2 Orders failed display field
Fig. 112 Remote archive order dialog dialog box
Work with VISUPAC can continue during loading. As a function of the

requested data volume and network load, this procedure may take several
minutes.
000000-1463-266-SWGA-JP-200116
Information on the SMP interface

In ophthalmology, various examination devices are used for diagnoses and
findings. The patient's master data is manually added to the examination
data produced by these devices. The result is available either as printed
record in the patient's file or in the examination device.
The aim is to find a simple, quick and cost-efficient solution that interlinks
the data of diagnosis, practice management and hospital information
systems.
SMP (Short Medical Protocol) contains standardized rules and agreements
for the exchange of data between the VISUPAC system and other
applications or examination devices, to enable the exchange of medico-
diagnostic data and patients' master data, independently of hardware.
SMP-Basic
 An optional VISUPAC SMP-Basic license is required to use the

000000-1463-266-SWGA-JP-200116
146 Annex
Annex
Installing a license key
When the VISUPAC 4.5 Viewer software is installed on your PC, a demo
license is created for a limited time.
To obtain a full license, take the following steps:
When installing VISUPAC on your PC a text file named "forward to
Carl Zeiss Meditec.txt" will be created on your desktop. It contains your PC's
MAC address, which is needed to create the permanent license key.
• Send this file together with the activation ID on your license certificate to
the email address:
license.meditec.de@zeiss.com
Fig. 113 License certificate example
If you have purchased further software modules you wish to activate on your
computer, transfer the activation IDs from the respective certificates to the
email before sending it off.
000000-1463-266-SWGA-JP-200116
Annex 147
In one to two days you will receive an email containing your permanent
license key.
Fig. 114 Permanent license key example
• Open the c:\eis directory in Windows Explorer.

• Open the license.dat file using an editor, e.g. Notepad.
• Copy the two lines of the permanent licence key from the e-mail to the
end of the license.dat file. If you have purchased more than one software
module and activated them for the same computer, please copy all
licence keys into the file.
 If you have simultaneously activated licenses for a number of PCs,

ensure that you assign the license keys to the correct PC. Compare
the given host ID of the license key as necessary with the contents
of the "forward to Carl Zeiss Meditec.txt" file.
• Save and close the "license.dat" file.
Now you can launch the licensed VISUPAC version.
000000-1463-266-SWGA-JP-200116
148 Abbreviations/Glossary
Abbreviations/Glossary
AREDS Age related eye disease study
BSA Body surface area
C/D Cup/disk
CIO Central inner outer
CNV Choroidal neovascularization
DD Disk diameter
DICOM Digital Imaging and Communications in Medicine
EMR Electronic medical record
Fig. Figure
FLUO Fluorescence
GLD Greatest Linear Dimension
ICG Indocyanine green
KIS Krankenhaus-Informationssystem (Hospital information
system)
LSS Laser spot size
Indicates the value to be set on the laser for the diameter of
the laser spot.
In the LSS a 1 mm safety offset is maintained.
MOD Magneto-optical disk
MWL Modality worklist
NAS Network attached storage
PACS Picture archiving and communication system
PDT Photodynamic therapy
OD Optic disc
SMP Short medical protocol
SPS Scheduled procedure step
TNI Thumbnail
UPS Uninterruptible power supply
WB White balance
000000-1463-266-SWGA-JP-200116
Figures 149
Figures
Fig. 1 Log in dialog box....................................................................... 8
Fig. 2 User dialog box ......................................................................... 9
Fig. 3 Account management dialog box .......................................... 10
Fig. 4 User interface of the main menu............................................... 11
Fig. 5 Tool bar of the main menu ....................................................... 12
Fig. 6 Sections of the user interface .................................................... 13
Fig. 7 Help selection context menus ................................................. 13
Fig. 8 Retina Atlas .............................................................................. 14
Fig. 9 User management dialog box ................................................ 16
Fig. 10 Create user dialog box ............................................................ 17
Fig. 11 Account management dialog box .......................................... 18
Fig. 12 Authorization groups dialog box ........................................... 20
Fig. 13 User groups dialog box........................................................... 21
Fig. 14 Group dialog box..................................................................... 21
Fig. 15 Edit dialog box ........................................................................ 22
Fig. 16 Delete group dialog box ......................................................... 22
Fig. 17 Opening the transaction log ..................................................... 24
Fig. 18 Entries in database transactions ................................................ 24
Fig. 19 Select HTML file dialog box ................................................... 25
Fig. 20 Delete query ............................................................................ 26
Fig. 21 Delete confirmation query ....................................................... 26
Fig. 22 Database dialog box ............................................................... 28
Fig. 23 Selection of STRATUS OCT data ................................................ 30
Fig. 24 STRATUS OCT image overview in VISUPAC ............................... 31
Fig. 25 Search dialog box .................................................................... 32
Fig. 26 Patient filter ............................................................................ 33
Fig. 27 Visits filter ............................................................................... 33
Fig. 28 Format filter ............................................................................ 34
Fig. 29 Image data filter ..................................................................... 34
Fig. 30 Section of the Patient card dialog box .................................... 35
Fig. 31 An identical patient already exists dialog box ...................... 36
Fig. 32 Expanded Patient exists dialog box ........................................ 36
Fig. 33 Context menu of the patient..................................................... 36
Fig. 34 Section of the Patient card dialog box .................................... 37
Fig. 35 Diagnosis dialog box ............................................................... 38
Fig. 36 Edit diagnosis dialog box ....................................................... 40
Fig. 37 Delete confirmation query ....................................................... 40
Fig. 38 Select HTML file dialog box ................................................... 41
Fig. 39 Enter visit date dialog box...................................................... 42
Fig. 40 Changes take effect only in VISUPAC warning .................... 42
Fig. 41 Move visits dialog box ............................................................ 43
Fig. 42 Export data context menu ...................................................... 44
Fig. 43 Move images dialog box ......................................................... 45
Fig. 44 Referenced Exams found dialog box ..................................... 46
Fig. 45 Restore dialog box .................................................................. 47
Fig. 46 AVT ZK-5 settings dialog box................................................. 50
Fig. 47 AVT Pike 421B Settings dialog box ....................................... 52
Fig. 48 Canon EOS 5D MARK III Settings dialog box ........................ 54
Fig. 49 Tool bar.................................................................................... 56
Fig. 50 Keypad of the additional control panel ..................................... 58
000000-1463-266-SWGA-JP-200116
150 Figures
Fig. 51 Database in multi-patient mode ................................................ 64

Fig. 52 Unable to save record dialog box .......................................... 66
Fig. 53 User interface of the VISUPAC Acquire module ......................... 68
Fig. 54 Image display with active image overview ................................. 69
Fig. 55 Image display field ....................................................................71
Fig. 56 Information dialog box ...........................................................72
Fig. 57 Video sequence ........................................................................74
Fig. 58 Image editing tools selection .................................................. 75
Fig. 59 Save image dialog box ..............................................................76
Fig. 60 Image with graphic element......................................................76
Fig. 61 Basic functions context menu ................................................. 80
Fig. 62 Tonal value correction dialog box .......................................... 82
Fig. 63 Zoom context menu.................................................................84
Fig. 64 Examples of images before and after adaptive zooming ............ 84
Fig. 65 Drawing tools selection ...........................................................86
Fig. 66 Circle context menu .................................................................88
Fig. 67 Free hand surface context menu ............................................ 89
Fig. 68 Mapping tools selection...........................................................91
Fig. 69 Mapping screen display ...........................................................92
Fig. 70 Mapping function carried out .................................................. 93
Fig. 71 Overlay tools selection .............................................................94
Fig. 72 Transparency dialog box .........................................................95
Fig. 73 Dynamic comparison screen display ....................................... 97
Fig. 74 Section of the Patient card dialog box................................... 100
Fig. 75 Section of Measure tool bar................................................... 100
Fig. 76 Measure tools selection .........................................................101
Fig. 77 Measurement - Reference circle dialog box ........................... 103
Fig. 78 Measurement - Reference line dialog box ............................. 104
Fig. 79 Circle context menu ...............................................................105
Fig. 80 Circle predefined dialog box ................................................. 105
Fig. 81 Select angle and camera dialog box .................................... 106
Fig. 82 Section of the Measure C/D ratio display .............................. 109
Fig. 83 Measurement - Papillary diameters display ........................ 110
Fig. 84 Maculopathy grading measuring circle section .................. 111
Fig. 85 AREDS measurement circles dialog box .............................. 113
Fig. 86 Create panorama image program window (1st) ................... 115
Fig. 87 Create panorama image program window (2nd) ................. 116
Fig. 88 Examples of panorama images ................................................ 117
Fig. 89 Activating an external module................................................. 117
Fig. 90 Export dialog box for BMP, HTML, PNG, TIFF, TXT and XML .. 119
Fig. 91 Export dialog box for JPEG ..................................................... 120
Fig. 92 DICOM export dialog box ..................................................... 122
Fig. 93 Archiving dialog box .............................................................124
Fig. 94 Error message .........................................................................124
Fig. 95 Archiving context menu ........................................................125
Fig. 96 Printing dialog box ................................................................126
Fig. 97 Print context menu ................................................................127
Fig. 98 Print layout dialog box ..........................................................128
Fig. 99 Definition of a new print layout matrix .................................... 129
Fig. 100 Report dialog box ..................................................................132
Fig. 101 Save report dialog box ..........................................................133
Fig. 102 Example of a medical report, based on the
PhysicianLetter_1_to_4_images template ........................... 134
000000-1463-266-SWGA-JP-200116
Figures 151
Fig. 103 Worklist dialog box ............................................................... 136

Fig. 104 Worklist - Query by patient dialog box ............................... 137
Fig. 105 Patient list display................................................................. 137
Fig. 106 Worklist - Query by visit dialog box .................................... 138
Fig. 107 Export data context menu .................................................... 139
Fig. 108 Multiple export (1st) dialog box ........................................... 141
Fig. 109 Multiple export (2nd) dialog box .......................................... 141
Fig. 110 Archiving dialog box ............................................................. 142
Fig. 111 Section - Database - Query/Retrieve dialog box................... 143
Fig. 112 Remote archive order dialog dialog box ............................. 144
Fig. 113 License certificate example ..................................................... 146
Fig. 114 Permanent license key example .............................................. 147
000000-1463-266-SWGA-JP-200116
152 Index
Index
A
Abbreviations.......................................................................................... 148
Additional control panel............................................................................ 58
Angiography ............................................................................................. 61
AREDS measurement circles .................................................................... 112
Authorization groups ................................................................................ 20
Autofluorescence AF ................................................................................. 61
Automatching ........................................................................................... 91
B
Basic functions .......................................................................................... 80
Blue .......................................................................................................... 61
Brightness ................................................................................................. 81
C
C/D ratio ................................................................................................. 109
Capturing images with the fundus camera ................................................ 59
Color ........................................................................................................ 61
Comments ................................................................................................ 72
Contrast.................................................................................................... 81
Copy function ......................................................................................... 125
Correction of tone value ........................................................................... 82
Creating a user ......................................................................................... 17
Cursor function ......................................................................................... 77
D
Database
Open..................................................................................................... 28
Delete images ........................................................................................... 46
Deleting a patient ..................................................................................... 37
Diagnosis .................................................................................................. 37
DICOM ............................................................................................136, 142
DICOM images.......................................................................................... 66
DICOM patient data ................................................................................ 121
Displaying/hiding graphic elements ........................................................... 85
Displaying/hiding reference objects ........................................................... 85
Displaying/hiding reference points............................................................. 85
Drawing.................................................................................................... 86
Drawing functions .................................................................................... 88
E
Examination mode .................................................................................... 48
Export visit .............................................................................................. 118
Exporting data ........................................................................................ 118
External modules .................................................................................... 117
000000-1463-266-SWGA-JP-200116
Index 153
F
Figures .................................................................................................... 149
Full screen ................................................................................................. 78
G
Glossary .................................................................................................. 148
Graphic elements....................................................................................... 87
Green ........................................................................................................ 61
Greyscale correction .................................................................................. 83
I
ICG............................................................................................................ 61
Image capture ..................................................................................... 50, 52
General.................................................................................................. 48
Image capture sensors ............................................................................... 49
Image display field ..................................................................................... 71
Image editing ............................................................................................ 75
Image editing functions ............................................................................. 75
Installation .............................................................................................. 146
Invert ........................................................................................................ 81
K
Keyboard commands ................................................................................. 57
L
Laser spot diameter ................................................................................. 107
Launching ................................................................................................... 8
license key ............................................................................................... 146
Licenses, optional
Acquire .................................................................................................. 68
Analysis GRIDS ..................................................................................... 111
Anonymous ......................................................................................... 121
AutoMap ............................................................................................. 113
DICOM ................................................................................................ 135
SMP..................................................................................................... 145
Log in .......................................................................................................... 8
M
Main menu ................................................................................................ 11
Mapping ............................................................................................. 91, 92
Marking an image as a favorite .................................................................. 70
Measured value correction....................................................................... 100
Measurement .......................................................................................... 101
Medical report ......................................................................................... 131
Moving patient visits.................................................................................. 42
Multi-patient mode ............................................................................. 64, 65
N
NAS system ............................................................................................. 124
000000-1463-266-SWGA-JP-200116
154 Index
O
Online help ............................................................................................... 13
Operation ................................................................................................... 8
Overlay ................................................................................................94, 96
P
PACS ...................................................................................................... 142
Panorama ........................................................................................113, 115
Papillary diagnostics ................................................................................ 109
Papillary diameter ................................................................................... 110
Patient
Create ................................................................................................... 35
Patient data
Edit ....................................................................................................... 36
Open..................................................................................................... 36
Patient data management ......................................................................... 27
Patients not yet assigned .......................................................................... 19
PDT ........................................................................................................ 107
Print layout ......................................................................................127, 129
Printing ................................................................................................... 126
Q
Query/Retrieve .................................................................................142, 143
R
Red ........................................................................................................... 61
Reference angle ...................................................................................... 106
Reference circle....................................................................................... 105
Reference line ......................................................................................... 104
Reference points ....................................................................................... 91
Restoring data .......................................................................................... 47
Retina Atlas .........................................................................................13, 14
Rotate 180° .............................................................................................. 81
S
Save.......................................................................................................... 76
Save image ............................................................................................... 75
Sharpen .................................................................................................... 81
SMP interface ......................................................................................... 145
Standard diagnoses................................................................................... 41
Standard printing .................................................................................... 126
Switching off ............................................................................................ 10
Symbols ...................................................................................................... 7
000000-1463-266-SWGA-JP-200116
Index 155
T
Tool bar..................................................................................................... 11
Tools selection............................................................................... 75, 91, 94
Transaction log .......................................................................................... 23
Delete .................................................................................................... 26
Export.................................................................................................... 25
Open ..................................................................................................... 24
U
Undo ......................................................................................................... 78
User
Log in ...................................................................................................... 8
User groups
Managing .............................................................................................. 21
User interface ............................................................................................ 11
User management ..................................................................................... 15
User rights ................................................................................................. 17
Users
Changing rights ..................................................................................... 19
Deleting ................................................................................................. 19
V
Visit date ................................................................................................... 42
Visits ......................................................................................................... 42
VISUPAC software
Launching ................................................................................................ 8
Z
Zoom ........................................................................................................ 78
Zooming.................................................................................................... 84
000000-1463-266-SWGA-JP-200116
Carl Zeiss Meditec AG
Goeschwitzer Str. 51-52
07745 Jena
Germany
Phone: +49 3641 220 333
Fax: +49 3641 220 112 000000-1463-266-SWGA-JP-200116
Email: info.meditec@zeiss.com VISUPAC
Internet: www.zeiss.com/med Specifications subject to change

GA VISUPAC 4.5 JP

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

GA VISUPAC 4.5 JP

Uploaded by

Copyright:

Available Formats

VISUPAC

Digital Image Archiving System

All rights reserved in the event of granting of patents or registration as a utility

Windows® is a registered trademark of Microsoft Corporation, Inc.

The weblinks are dynamic hyperlinks. Before incorporating any links,

This software description is protected by copyright. Unless expressly authorized in

Specifications due to technical developments are subject to change. This software

Notes on the software description .............................................6

User interface layout ................................................................11

Open online help and Retina Atlas ...........................................13

User management ....................................................................15

Patient data management ....................................................... 27

Examination mode ................................................................... 48

Import data .............................................................................. 66

Image evaluation ..................................................................... 69

Marking an image as a favorite ................................................................................ 70

Measurement of the eye fundus ..............................................99

Generation of a predefined reference circle........................................................... 105

Exporting, archiving and printing .......................................... 118

Communication with PACS and EMR systems ....................... 135

DICOM Query/Retrieve ................................................................................ 142

Notes on the software description

Questions and comments

Explanation of symbols used

CAUTION - PROPERTY DAMAGE

 Information, hints and advice to aid understanding of the

 You can only log in as administrator after consulting with ZEISS

Launching the VISUPAC software

If no FF 450plus fundus camera is connected or if data which was captured

Log in as a user under VISUPAC

 If the additional user management module is activated, the user

If user management is activated, the Log in dialog box is opened when

Fig. 1 Log in dialog box

• Log in by entering your user name and password.

Logging off or changing users

Fig. 2 User dialog box

Fig. 3 Account management dialog box

 If user management is activated, the User dialog box appears first.

User interface layout

Fig. 4 User interface of the main menu

 Active buttons will be highlighted in blue, inactive buttons are

1 Print images/Print layout

Fig. 5 Tool bar of the main menu

 Buttons with a triangle on the right side (e.g. Print images/Print

Open online help and Retina Atlas

Fig. 6 Sections of the user interface

Fig. 7 Help selection context menus

Fig. 8 Retina Atlas

Starting user management

 Only users with administrator rights can access user management.

User management is opened via the start menu:

Start\All Programs\VISUPAC\VISUPAC User Management

Fig. 9 User management dialog box

Creating a new user and assigning user rights

Fig. 10 Create user dialog box

Fig. 11 Account management dialog box

• Enter the user name and password.

 In order to accelerate the assignment of rights, users should be

• Confirm your entry by clicking on OK.

Assigning or changing rights of existing users

Deleting existing users

Assigning patients not yet assigned to user groups

 Unassigned patients are assigned as usual in the patient card