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Interacoustics VisualEyes 515 Additional Information

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Additional Information
Micromedical
VisualEyes™ 515
VisualEyes™ 525
by Interacoustics
D-0115294-C – 2018/02

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Summary of Contents for Interacoustics VisualEyes 515

  • Page 1 Additional Information Micromedical VisualEyes™ 515 VisualEyes™ 525 by Interacoustics D-0115294-C – 2018/02...
  • Page 2 Copyright © February 1, 2018 by Interacoustics. All rights reserved. Information in this document is subject to change without notice. Companies, names, and data used in example herein are fictitious unless otherwise noted. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, for any purpose, without express written permission of Interacoustics A/S, Micromedical Technologies or its licensees.

  • Page 3: Table Of Contents

    Table of Contents TESTING BASICS ......................... 1 Default protocol ........................1 Moving through VisualEyes™ ..................... 2 Eye image adjustment ......................3 Focus adjustment ........................ 6 Eye image contrast adjustment ................... 6 Enlarging eye images ......................7 Monocular vs binocular eye recordings ................8 Common test functions .......................
  • Page 4 6.4.5 Edit Slopes ......................68 6.4.6 Done Editing ......................70 Editing saccade test results ....................70 Editing smooth pursuit test results ..................72 Editing rotary chair test results ..................73 6.7.1 Editing SHA Tests ....................73 6.7.2 Editing Step rotation tests ..................74 Other functions available in side menu ................
  • Page 5 11.3 De-identify printout ......................120 11.4 Printing calibration ......................120 11.5 Printing a single test or clinical report ................120 11.6 Printing a session ......................120 11.7 Printing traces ......................... 120 11.8 Condensed printing ......................120 11.9 Create PDF ........................120 SYSTEM DEFAULT SETTINGS ....................121 12.1 System Default Settings ....................

  • Page 6: Testing Basics

    Calibration • Spontaneous Nystagmus • Positional • Dix-Hallpike • Calorics VisualEyes 525 Protocol (includes the VisualEyes 515 protocol): • Gaze • Smooth Pursuit • Saccade • Optokinetic If rotational chair hardware is available and licensed these additional tests will appear with the VisualEyes 515 or VisualEyes 525 protocol: •...

  • Page 7: Moving Through Visualeyes

    VIsualEyes 515/525 - Additional Information Page 2 Figure 1.1.2 First test displayed 1.2 Moving through VisualEyes™ VisualEyes™ VNG software suite is compatible with both touch capable screens and standard (non-touch) computer systems. Maneuvering through the software can be done by touch, mouse, keyboard, foot pedal and remote control.

  • Page 8: Eye Image Adjustment

    VIsualEyes 515/525 - Additional Information Page 3 Restarting the test: Tests can be restarted using the Esc key on the keyboard or the RF Remote. While the test is running, the Esc key or ESC key on the RF Remote will abort the data collection and clear the data already collected. In caloric tests, the software will require confirmation of this request.
  • Page 9 VIsualEyes 515/525 - Additional Information Page 4 Figure 1.3.2 Eyes displayed The inner canthus of the right eye should be seen on the right side of the red outlined eye image. The inner canthus of the left eye should be seen on the left side of the blue outlined eye image. The eye images have L and R captions in the corners, which refer both to the eye selected and the direction the eye is looking.
  • Page 10 VIsualEyes 515/525 - Additional Information Page 5 The mirrors can also be rotated inward by holding the mirror edges and rotating inward to adjust for smaller faces and narrow inner-canthal spaces (e.g. with children). When the mirrors are rotated, the image will need to be re-centered and may need focus adjustment.

  • Page 11: Focus Adjustment

    VIsualEyes 515/525 - Additional Information Page 6 1.4 Focus adjustment VisualEyes™ system requires a focused eye image for the pupil tracker to locate the pupil center to optimally record the eye movements. The pupil center is marked with a crosshair (Figure 1.4.1). Figure 1.4.1 Pupil tracker (crosshair) The camera image can be focused by adjusting the focus knob on each camera (Figure 1.4.2).

  • Page 12: Enlarging Eye Images

    VIsualEyes 515/525 - Additional Information Page 7 Figure 1.5.2 Threshold adjustment scrollbars To reset it back to automatic threshold click the icon below each slider. 1.6 Enlarging eye images Enlarging the eye images can help the clinician clearly visualize the eye image during eye image adjustments and within different tests.

  • Page 13: Monocular Vs Binocular Eye Recordings

    VIsualEyes 515/525 - Additional Information Page 8 1.7 Monocular vs binocular eye recordings VisualEyes™ system can record in either monocular (one camera) or binocular (two cameras) mode. Monocular mode may be beneficial for those occasions needing to run a single eye test because one eye may be unable to be tested.

  • Page 14: Add Note

    VIsualEyes 515/525 - Additional Information Page 9 Timer During testing (all tests) the timer will display how much time has elapsed or remains in the current test based on Count Style (Figure 1.8.1). Based on the default system settings, the timer will provide audible beeps and voice prompts at indicated intervals to prompt the examiner and provide audible feedback for the elapsed or remaining time in the test.

  • Page 15: Delete Tests

    VIsualEyes 515/525 - Additional Information Page 10 The left side menu panel will display the currently test session. At the end of the list is the Add Test button. Figure 1.10.2 Test menu Select the Add Test button (Figure 1.10.3). Figure 1.10.3 Add Test button This will present a list of tests to choose to be added to the session.
  • Page 16 VIsualEyes 515/525 - Additional Information Page 11 The left side menu panel will display the currently test session. At the end of the list is the Enable delete option. Activate the Enable delete option. (Figure 1.11.2) Figure 1.11.2 Enable delete option This will present the list of performed tests with a symbol.

  • Page 17: Calibration

    VIsualEyes 515/525 - Additional Information Page 12 2 Calibration Calibrations are particularly important in tests where eye movements are compared with a given stimulus of a known position and/or velocity (e.g. Saccade test). Calibration can be performed on both eyes (binocular) or individually (monocular) by turning off the non-essential eye or using a monocular goggle.
  • Page 18 VIsualEyes 515/525 - Additional Information Page 13 Click the Start Calibration button to begin the calibration routine. (Figure 2.1.4) Figure 2.1.4 Start calibration button Ask the patient to look at the first calibration point. After a few seconds of fixation a target confirmed mark (Figure 2.1.5) will appear to confirm calibration of the center point.

  • Page 19: Default Calibration

    VIsualEyes 515/525 - Additional Information Page 14 Figure 2.1.9 Calibration failure with values and failure reason If the patient could not fixate on one or target positions, a red cross mark (Figure 2.1.10) shall appear to indicate failure. The software will provide a Redo Horizontal, Redo Vertical, or Redo All button to clear the failure points and allow the calibration of the direction(s) again.

  • Page 20: Review Calibrations

    VIsualEyes 515/525 - Additional Information Page 15 2.3 Review calibrations The patient’s calibration traces (Figure 2.3.1) and videos are saved for later review. These results can be used to determine if the patient’s eyes were properly calibrated before the VNG test was performed. During review it can be determined which subtests are related to which calibrations, if calibration was performed more than once.

  • Page 21: Testing

    VIsualEyes 515/525 - Additional Information Page 16 3 Testing 3.1 Overview To start testing click on Begin Testing from the main menu. The first test in the chosen protocol is displayed. To begin testing with a different test in the protocol, select the desired test using the test menu button. Figure 3.1.1 Test menu button Figure 3.1.2 Session tree displayed The left side panel displays a session tree, which shows all tests included in the current protocol (Figure...
  • Page 22 VIsualEyes 515/525 - Additional Information Page 17 VisualEyes™ VNG offers an easy way to visualize video eye and trace recordings during data collection and review. The general display shows the eye images in the top portion of the screen and directly below it the raw tracings for horizontal and vertical channels (Figure 3.1.4).

  • Page 23: Nystagmus Marking And Peak Response

    VIsualEyes 515/525 - Additional Information Page 18 3.2 Nystagmus Marking and Peak Response Nystagmus beats are marked by small triangles in the eye trace graphs. During data collection, the nystagmus beats are marked by triangles showing the inflection point between the slow and fast phases of the nystagmus beat.Triangles that point upwards (below the tracing) indicate right-beating nystagmus.Triangles that point downwards (above the tracing) indicate left-beating nystagmus.

  • Page 24: Nystagmus Testing

    In tests where the patient’s nystagmus direction changes, the average slow phase velocity (a.SPV) will be measured separately in each direction and the results will be displayed in the a.SPV graph. Nystagmus tests are available in VisualEyes 515 and VisualEyes 525 configurations. 3.3.1 Spontaneous nystagmus test The spontaneous nystagmus test is used to record non-evoked eye movements.

  • Page 25: Dix-Hallpike Test

    VIsualEyes 515/525 - Additional Information Page 20 Figure 3.3.1 Spontaneous Nystagmus Waveform and a.SPV graph 3.3.2 Dix-Hallpike test The Dix-Hallpike test is a specific test to diagnose BPPV (benign paroxysmal positional vertigo). The Dix-Hallpike test is contraindicated in patients who exhibit the following: current or past injuries of the neck or spine, brainstem malformations, such as Arnold-Chiari, pre-existing neurological symptoms including but not to limited to: blurred vision, numbness, weakness of the arms or legs and confusion.

  • Page 26: Positional Test

    VIsualEyes 515/525 - Additional Information Page 21 3.3.3 Positional test The Positional tests allow the examiner to compare several measurements collected with the patient in a variety of head and body positions. Each subtest is set to record for 30 seconds. By default, the Positional test will record Supine, Head Right, Head Left, Body Right, and Body Left.

  • Page 27: Ocularmotor Testing

    VIsualEyes 515/525 - Additional Information Page 22 3.4 Ocularmotor Testing Ocularmotor tests require the patient to follow a target stimulus or pattern. These tests require an external stimulus, such as a TV or projector, and are found in the VisualEyes 525 software configuration. 3.4.1 Gaze test During a gaze test eye movements are measured while the patient is fixating on a stationary target.
  • Page 28 VIsualEyes 515/525 - Additional Information Page 23 Figure 3.4.2 Smooth Pursuit subtest The Gain value is given as a percentage value representing the ability of the patient to track the sinusoidal target without saccadic intrusions (short jumps in the eye position to catch up to the target). Each eye’s gain is measured for each cycle and displayed on the gain graph as a small dot in either blue (for left eye) or red (for right eye).

  • Page 29: Saccade Test

    VIsualEyes 515/525 - Additional Information Page 24 3.4.3 Saccade test During the saccade test the patient’s eyes have to follow randomly moving target jumping from side to side. The default Saccade test will have the target jump horizontally, but the test has optional vertical and combined (a mix of horizontal and vertical positions) subtests available.

  • Page 30: Optokinetic Test

    VIsualEyes 515/525 - Additional Information Page 25 Figure 3.4.7 Saccade results combined subtest The three essential parameters (latency, velocity and accuracy) are analyzed and displayed for both eyes for horizontal and vertical saccades. If the Combined subtest is performed, the software will analyze the horizontal saccades separately from the vertical saccades (Figure 3.4.7).
  • Page 31 VIsualEyes 515/525 - Additional Information Page 26 Figure 3.4.8 Optokinetic summary The optokinetic subtest will display the stimulus pattern on the TV or projection screen. The test will last 15 seconds (though more time can be added with the Add Time button) and display the stimulus moving in the selected direction.
  • Page 32 VIsualEyes 515/525 - Additional Information Page 27 Figure 1.64 Optokinetic test display (during data collection)

  • Page 33: Caloric Testing

    Recorded data is analyzed for slow phase velocity and frequency of nystagmus beating and is displayed in various standard diagrams. Caloric testing is available in both VisualEyes 515 and VisualEyes 525 software. Please note that Caloric testing is contraindicated in persons exhibiting the following: •...
  • Page 34 VIsualEyes 515/525 - Additional Information Page 29 Figure 3.5.1 Caloric test results Figure 3.5.2 Caloric summary As each caloric test is performed, the caloric summary will display the results of the caloric subtests together. The caloric summary can be a mix of left eye and right eye results as desired. These results are displayed in the right upper corner of the caloric results display (Figure 3.5.2).
  • Page 35 VIsualEyes 515/525 - Additional Information Page 30 Directional Preponderance (DP) Directional Preponderance is a calculated value that compares the nystagmus strengths in the right beating direction with the nystagmus strengths in the left beating direction. The directional preponderance is given in percent [%]. The default threshold level is 30%. Fixation Suppression Index (FI) The fixation suppression index (FI) quantifies the ability of a patient to deliberately suppress nystagmus by fixating on a given target.
  • Page 36 VIsualEyes 515/525 - Additional Information Page 31 Figure 3.5.4 Caloric summary results for MWST Caloric Results Views The caloric results may be displayed in a number of different standard diagrams. In addition to the Pod View, the caloric results can be displayed in the Bar graph and Freyss line graph. In certain regions the additional options of Scherer, Claussen, and Haid-Stoll graphs are available.
  • Page 37 VIsualEyes 515/525 - Additional Information Page 32 Figure 3.5.6 Pod View The horizontal axis represents time (seconds) and the vertical axis is the SPV (degrees). In the corner of each quadrant is an area that displays temperature of irrigation, a.SPV and FI. In subjects with normal vestibular function this specific arrangement of data plots results in a shape similar to the outlines of a pea pod.
  • Page 38 VIsualEyes 515/525 - Additional Information Page 33 Freyss diagram The Freyss Diagram graphically represents the average slow phase velocities (a.SPV) during the peak response of each irrigation. Figure 3.5.8 Freyss diagram On the left vertical axis, the a.SPV calculated for the irrigations of the right ear are plotted; data points on the right vertical axis show the a.SPV values for left ear irrigations.

  • Page 39: Rotational Chair Testing

    Page 34 3.6 Rotational Chair Testing Rotational chair testing is available in licensed VisualEyes 515 and VisualEyes 525 systems that utilize a reclining chair. The Nydiag 200 and System 2000 Reclining chairs utilize FireWire cameras, and the Orion Reclining chair utilize USB cameras.
  • Page 40 VIsualEyes 515/525 - Additional Information Page 35 The frequencies most often tested during SHA test are the octave frequencies 0.01 Hz, 0.02 Hz, 0.04 Hz, 0.04 Hz, 0.16 Hz and 0.32 Hz. The frequency of 0.64 Hz is also available. The responses are displayed in real-time (in relation to the stimulus).
  • Page 41 VIsualEyes 515/525 - Additional Information Page 36 Example Instruction for the Patient: ”You will feel yourself rotating back and forth slowly in the chair. While you are rotating, I will be asking you several questions to keep you alert. We will test different frequencies and the entire test will take a few minutes.
  • Page 42 VIsualEyes 515/525 - Additional Information Page 37 Analysis of eye movements is performed separately for the right and left eyes and the results are displayed separately. Left eye results are displayed by default. The displayed results can be changed to the right eye by selecting the eye title in the top center of the summary test results screen (Figure 3.6.6).
  • Page 43 VIsualEyes 515/525 - Additional Information Page 38 Phase > 0° Eye movement leads the head movement Gain Gain measurement provides an indication of the responsiveness of the peripheral vestibular system. If the function of the (VOR) is to produce an eye movement that compensates for head movement, then under perfect conditions the slow phase eye velocity of the response to rotation should be a mirror image of head velocity producing a gain of 60 %.
  • Page 44 VIsualEyes 515/525 - Additional Information Page 39 Values displayed in the Symmetry Graph are provided as a percentage (%). Values within the white region of the graph are considered to be within suggested threshold levels and those in the grey shaded regions are considered to be outside of the suggested threshold levels or criteria (Figure 3.6.9).
  • Page 45 VIsualEyes 515/525 - Additional Information Page 40 Figure 3.6.12 Eye position trace Eye velocity display The eye velocity in °/s (blue) relative to stimulus chair velocity (yellow) is displayed beneath the eye position tracing (Figure 3.6.13). Figure 3.6.13 Display showing detailed individual cycles for eye velocity vs. stimulus velocity This graphical display provides a detailed individual cycle view for the examiner to see the patient’s results in relation to the stimulus.

  • Page 46: Step Rotation Test

    VIsualEyes 515/525 - Additional Information Page 41 Figure 3.6.15 Review individual SHA frequency Spectral purity A spectral purity value for each given frequency tested can be viewed in the lower right corner of the eye velocity display (Figure 3.6.16). The spectral purity of the evoked nystagmus may be useful to indicate whether the test values have been influenced by artifact, for instance from failure to adequately alert the patient or from calibration errors affecting the peak eye velocity measurements.
  • Page 47 VIsualEyes 515/525 - Additional Information Page 42 Eye movements are recorded with VisualEyes™ VNG cameras and the responses are displayed in real-time. The patient’s eyes, along with both eye position tracings (°) and eye velocity tracings (°/s) are visible during the testing procedure.
  • Page 48 VIsualEyes 515/525 - Additional Information Page 43 Figure 3.6.18 Expanded test battery view Example Instructions for the Patient: “You will feel yourself rotating in one direction for several seconds. During the rotation, I will be asking you several questions to keep you alert. As you are rotating, you may feel as though you are slowing down. When the chair stops, you will feel as though you are rotating in the opposite direction.
  • Page 49 VIsualEyes 515/525 - Additional Information Page 44 Figure 3.6.19 Step rotation summary If the examiner has selected to move the chair to zero position after testing, then the chair will move to zero position after all four segments for an individual Step Velocity test have been completed. It is optional to perform a spontaneous test as part of the Step Test battery.
  • Page 50 VIsualEyes 515/525 - Additional Information Page 45 Figure 3.6.21 Right eye results for Step Rotation test The summary test results screen displays various analyses. The top portion of the summary results screen displays plots for Gain, Time Constant, and Time Constant Symmetry. These parameters are explained in detail in the following section.
  • Page 51 VIsualEyes 515/525 - Additional Information Page 46 Time constant (Tc) Time constant is the value, in seconds, that represents the amount of time it took for the response to reach 33% of its maximum SPV value. Figure 3.6.23 Time constant graph Time constant values are expressed in seconds (s).
  • Page 52 VIsualEyes 515/525 - Additional Information Page 47 Figure 3.6.25 Numerical value displayed The largest data points represents the velocity (°/sec) page that is currently being displayed. Tapping on a smaller data point will then display the data for that velocity. Alternatively, tap the arrows next to the page numbers to move to results for other velocities (Figure 3.6.26).
  • Page 53 VIsualEyes 515/525 - Additional Information Page 48 The upper portion displays the raw eye position tracing for the specific condition (per/ post-rotary and its relative velocity). Nystagmus beats are marked with triangles to identify left/right beating nystagmus (Figure 3.6.28). Figure 3.6.28 Raw eye movement data trace with identified nystagmus The lower portion displays data points for the corresponding SPV values for the detected beats of nystagmus as they reduce from a peak value to their relative time constant (Tc), or 37% of the maximum generated response.

  • Page 54: Vor Suppression Test

    VIsualEyes 515/525 - Additional Information Page 49 Figure 3.6.31 Review individual Step Rotation segment 3.6.4 VOR suppression test During VOR Suppression, the patient is rotated in the same sinusoidal alternating pattern as in the SHA test, but this time with a fixation light illuminated within the VisualEyes™ VNG goggles so as to assess the patient’s ability to suppress the Vestibulo-Ocular Reflex (VOR) while rotating.
  • Page 55 VIsualEyes 515/525 - Additional Information Page 50 Figure 3.6.32 VOR Suppression testing The VOR suppression test will be available within the protocol or may be selected directly from the side menu panel by tapping the ‘hamburger’ icon in the upper left corner of the test screen to view the test battery list.
  • Page 56 VIsualEyes 515/525 - Additional Information Page 51 Figure 3.6.33 VOR suppression summary A patient with normal VOR suppression results will produce a tracing that shows significantly reduced nystagmus as the patient is rotated from left to right in the chair. The data points for each frequency tested will appear as triangles in the Gain (%) and Reduction (%) graphs.
  • Page 57 VIsualEyes 515/525 - Additional Information Page 52 Figure 3.6.34 Gain graph with VOR and VOR Suppression tests Gain reduction The percent gain reduction result is obtained by comparing any given frequency of rotation with no visual fixation to the gain result at the same frequency of rotation with visual fixation. Percent gain reduction is a percentage by which the nystagmus has reduced as a result of fixating on a target.

  • Page 58: Visual Vor Test

    VIsualEyes 515/525 - Additional Information Page 53 Eye position display In the middle portion of the VOR Suppression summary results screen, the eye position (°) tracing is displayed. The eye position tracing (Figure 3.6.37) represents eye movement during chair rotation and is displayed as a function of eye position in degrees (y-axis) over time in seconds (x-axis).
  • Page 59 VIsualEyes 515/525 - Additional Information Page 54 To begin the test: 1. Select ‘Start’ from the left menu panel. 2. The timer will begin counting down. The test time is pre-defined by the number of cycles selected for the test frequency. The chair will activate and begin moving in a sinusoidal pattern.
  • Page 60 VIsualEyes 515/525 - Additional Information Page 55 Gain Gain (%) is the ratio of maximum slow phase eye velocity to maximum head (chair) velocity. If the function of the Vestibular Ocular Reflex (VOR) is to produce an eye movement that compensates for head movement, then under perfect conditions the eye velocity of the response to rotation should be a mirror image of head velocity producing a gain of 60 % (Figure 3.6.40).
  • Page 61 VIsualEyes 515/525 - Additional Information Page 56 Eye position and eye velocity displays Below the Gain, Phase, and Symmetry graphs are the eye position and eye velocity displays, just as in SHA and VOR Suppression (Figure 3.6.43). The eye position tracing should resemble a sinusoid. The eye velocity should appear as a mirror image to chair velocity.

  • Page 62: Patient Session

    VIsualEyes 515/525 - Additional Information Page 57 4 Patient session 4.1 Selecting a session VisualEyes™ VNG software easily allows review of current and or previous sessions for the selected patient. To review a previous patient session, select the Patient Sessions button (Figure 4.1.1) from the main screen.

  • Page 63: Session Review

    VIsualEyes 515/525 - Additional Information Page 58 4.2 Session Review From the test screen the results can be reviewed by selecting the test menu button in the top left corner of the test screen. Figure 4.2.1 Test menu button A drop down menu will appear with the ‘Review Session’ button displayed at the bottom (Figure 4.2.2). Figure 4.2.2 Review Session button Review Session will list the tests within the protocol that have been or are yet to be completed (Figure 4.2.3).

  • Page 64: Video Recordings

    VIsualEyes 515/525 - Additional Information Page 59 5 Video recordings 5.1 Recording patient videos Video recording is set to record some tests in the protocol by default. Which tests to record the video is set in the individual test settings in Protocol Manager. •...
  • Page 65 VIsualEyes 515/525 - Additional Information Page 60 The video playback can be controlled by buttons (Figure 5.2.2) displayed in a playback menu bar underneath the timer: Figure 5.2.2 Playback menu Go to previous frame (hold to play backwards in slow motion). Play/pause.
  • Page 66 VIsualEyes 515/525 - Additional Information Page 61 Following a completed session the recorded videos are archived in the Patient Videos menu. The video for each individual test can be reviewed by selecting the Patient Videos menu from the main screen (Figure 5.2.4). Figure 5.2.4 Patient Videos button The tests are categorized by date and test type (Figure 5.2.5).

  • Page 67: Delete Selected Patient Videos

    VIsualEyes 515/525 - Additional Information Page 62 Figure 5.2.6 Video playback within a compatible video player 5.3 Delete selected patient videos Should it be decided that the video recording for a specific test is of low importance (i.e. normal) it can be deleted after the test is complete.

  • Page 68: Exporting Patient Videos

    VIsualEyes 515/525 - Additional Information Page 63 • Select the Delete Selected Videos option • Prior to removal a prompt will appear, confirming removal of selected videos Figure 5.3.3 Prompt confirming removal of selected videos • Touching or clicking OK will delete the videos permanently from the VisualEyes™ system 5.4 Exporting patient videos VisualEyes™...
  • Page 69 VIsualEyes 515/525 - Additional Information Page 64 Figure 5.4.3 Destination selection for export video files When Export is complete a dialogue message will appear confirming successful transfer of video files: ‘Export succeeded’.

  • Page 70: General And Editing Tools

    VIsualEyes 515/525 - Additional Information Page 65 6 General and editing tools 6.1 Quick access test properties There may be times where it is necessary to make a quick change to a specific test in the protocol. VisualEyes™ VNG software suite provides a way to quickly access test properties that allow temporary changes to be made to a test.

  • Page 71: Pupil Diameters

    VIsualEyes 515/525 - Additional Information Page 66 6.3 Pupil diameters This graph shows how the pupil diameter changes over time. It is used for pupillometry assessment. The value is given in pixels and refers to the pupil size shown on the camera. Only relative size is indicated and it is not possible to indicate the absolute size (e.g., millimeter).

  • Page 72: Remove Beats

    VIsualEyes 515/525 - Additional Information Page 67 Figure 6.4.3 Added beats to nystagmus trace 6.4.2 Remove Beats This function will remove multiple nystagmus beats at the operator’s discretion (Figure 6.4.4) • Use the selection box to define the start and end points of the time to remove all nystagmus beats in the selected time frame •...

  • Page 73: Reset Beats

    VIsualEyes 515/525 - Additional Information Page 68 Figure 6.4.6 Gaze test Right 30 degrees 2X magnification (time and amplitude) 6.4.4 Reset Beats This feature resets the waveform back to the original software analysis. (Figure 6.4.7 and Figure 6.4.8). • By selecting this tool all data altered will return to its original software analysis Figure 6.4.7 Nystagmus waveform with removed beats Figure 6.4.8 Nystagmus reset to original software analysis 6.4.5...
  • Page 74 VIsualEyes 515/525 - Additional Information Page 69 Figure 6.4.9 Selected nystagmus slope • The operator can tab through individual beats using the left and right arrow keys on the keyboard or by using touch screen • For each beat the current SPV value will be displayed on the graph •...

  • Page 75: Done Editing

    VIsualEyes 515/525 - Additional Information Page 70 Figure 6.4.11 Nystagmus Parameters • This will give a quick view of the actual slow phase velocity of the nystagmus (Figure 6.4.12) Figure 6.4.12 Slow phase velocities highlighted and eyes split into separate graphs 6.4.6 Done Editing Figure 6.4.13 Done Editing button...
  • Page 76 VIsualEyes 515/525 - Additional Information Page 71 Figure 6.5.2 Saccade editing tools Click or touch the Enable Saccades button. The selection box that the user creates on the waveform will enable any saccades that were disabled the analysis. Click or touch the Disable Saccades button. The selection box that the user creates on the waveform will disable any saccades and remove them from the saccade analysis.

  • Page 77: Editing Smooth Pursuit Test Results

    VIsualEyes 515/525 - Additional Information Page 72 6.6 Editing smooth pursuit test results Editing tools are available for viewing and editing the smooth pursuit tests. These tools are accessed after the data collection is complete by selecting the Edit Tools button. These tools are also available from the Smooth Pursuit summary view.

  • Page 78: Editing Rotary Chair Test Results

    VIsualEyes 515/525 - Additional Information Page 73 6.7 Editing rotary chair test results 6.7.1 Editing SHA Tests This section pertains to all tests in which the rotary chair rotates in a sinusoidal harmonic acceleration pattern (SHA, VOR Suppression, and Visual VOR). The following edit tools can be accessed by tapping the Edit Tools button in the left side menu available within a specific test review screen, or from the summary test results screen.

  • Page 79: Editing Step Rotation Tests

    VIsualEyes 515/525 - Additional Information Page 74 6.7.2 Editing Step rotation tests The edit tools available for Step Rotation tests are the same tools available for all nystagmus tests. Please refer to the section pertaining to edit tools for nystagmus tests. The Step Rotation edit tools can be accessed by tapping the Edit Tools button in the left side menu available within a specific test review screen, or from the summary test results screen.
  • Page 80 VIsualEyes 515/525 - Additional Information Page 75 Figure 6.8.4 Rotational Chair functions When a reclining rotary chair is configured with VisualEyes™ 515/525 there may be additional side menu functions available to the user (Figure 6.8.4). Lock Chair: Orion Reclining Chair This function is designed to place the chair into an immobile state in order to ensure patient safety when seating and/or disembarking the patient from the reclining chair.

  • Page 81: Fixation Suppression

    VIsualEyes 515/525 - Additional Information Page 76 Figure 6.8.6 Foot brake released Figure 6.8.7 Foot brake applied Home Chair: Orion Reclining Chair and Nydiag 200 Chair The chair will have a default position to which it will move prior to testing. This position is called the home position.

  • Page 82: Override Test Results

    VIsualEyes 515/525 - Additional Information Page 77 6.10 Override test results Results will automatically be classified whether inside or outside threshold levels based on the criteria set in the suggested threshold tables in the system settings. The red diamond will indicate results outside of threshold and the green tick will indicate results within threshold.

  • Page 83: Protocol Management

    VIsualEyes 515/525 - Additional Information Page 78 7 Protocol Management 7.1 Protocols Protocols are able to be customized to the desired settings of the end user. They are composed of a list of tests and designated to be performed in a specific order at the preference of clinician or clinic. Protocols can be created for a specific clinician’s testing style, screening versus clinical test lists, or to create a default protocol template for a clinic.

  • Page 84: Creating A New Protocol

    VIsualEyes 515/525 - Additional Information Page 79 7.2 Creating a new protocol The left side panel displays the existing protocols. The New Protocol button is used to create a new blank protocol. Figure 7.2.1 New Protocol button Enter a name for the new protocol. By default this will be called New Protocol 1. Figure 7.2.2 Enter Protocol Name To add tests to the protocol, press the Add Test button and select one of the tests.

  • Page 85: Remove Protocol

    VIsualEyes 515/525 - Additional Information Page 80 Figure 7.3.2 Set Default Protocol button 7.4 Remove protocol To permanently remove a protocol and all tests in the selected protocol, select the Remove Protocol button. The software will ask to confirm the protocol removal. Figure 7.4.1 Remove Protocol button 7.5 Exporting protocols Protocols can be exported for later use.

  • Page 86: Restore Factory Template

    VIsualEyes 515/525 - Additional Information Page 81 Figure 7.6.2 Import Protocol dialog 7.7 Restore factory template The VisualEyes software has a default test template for each test type licensed in the system. The settings for the default test template can be overridden using the Set as default button in each page of the test and subtest settings pages (e.g.

  • Page 87: Test Properties

    VIsualEyes 515/525 - Additional Information Page 82 8 Test Properties 8.1 Configuring the tests All tests within the VisualEyes™ VNG software suite can be configured to the user’ preference. The changes need to be performed prior to conducting the test (cannot be changed post-test). The specific test can be adjusted in 2 ways: From the main screen select Protocol Manager section (under configuration).

  • Page 88: Configuring Oculomotor Tests

    VIsualEyes 515/525 - Additional Information Page 83 8.2 Configuring oculomotor tests 8.2.1 Configuring the gaze test Figure 8.2.1 Gaze summary settings Test Name: Name of the test Results Displayed: Selects which eye is shown by default. Mixed Eyes will allow the user to choose the best eye for each subtest.
  • Page 89 VIsualEyes 515/525 - Additional Information Page 84 Figure 8.2.2 Gaze subtest settings Test Name: Name of subtest Duration: Define how long the eye movement is to be recorded and analyzed (in seconds). Fixation light: Determines when the fixation light in the goggles is displayed. Manual (default) will leave the operator to determine when the fixation light should be displayed.

  • Page 90: Configuration Of Saccade Test

    VIsualEyes 515/525 - Additional Information Page 85 8.2.2 Configuration of saccade Test Figure 8.2.3 Saccade summary settings Test Name: Name of the test Results Displayed: Selects which eye is shown by default. Both Eyes will show both eyes overlapping to allow easy viewing of disconjugate eye movements.
  • Page 91 VIsualEyes 515/525 - Additional Information Page 86 Figure 8.2.4 Saccade subtest settings Test Name: Name of subtest Duration: Length of time to perform the test based on the number of saccades Fixation light: Determines when the fixation light in the goggles is displayed. Manual will leave the operator to determine when the fixation light should be displayed.

  • Page 92: Configuration Of Smooth Pursuit Tests

    VIsualEyes 515/525 - Additional Information Page 87 8.2.3 Configuration of smooth pursuit tests Figure 8.2.5 Smooth Pursuit summary settings Test Name: Name of the test Results Displayed: Selects which eye is shown by default. Both Eyes will show both eyes overlapping to allow easy viewing of disconjugate eye movements.
  • Page 93 VIsualEyes 515/525 - Additional Information Page 88 Figure 8.2.6 Smooth Pursuit subtest settings Test Name: Name of subtest Duration: Length of time to perform the test based on the number of pursuit cycles and frequencies tested Fixation light: Determines when the fixation light in the goggles is displayed. Manual will leave the operator to determine when the fixation light should be displayed.

  • Page 94: Configuring The Opk Tests

    VIsualEyes 515/525 - Additional Information Page 89 8.2.4 Configuring the OPK tests Figure 8.2.7 Optokinetic summary settings Test Name: Name of the test Results Displayed: Selects which eye is shown by default. Both Eyes will show both eyes overlapping to allow easy viewing of disconjugate eye movements.
  • Page 95 VIsualEyes 515/525 - Additional Information Page 90 Figure 8.2.8 Optokinetic subtest settings Test Name: Name of subtest Duration: Define how long the eye movement is to be recorded and analyzed (in seconds). Fixation light: Determines when the fixation light in the goggles is displayed. Manual will leave the operator to determine when the fixation light should be displayed.

  • Page 96: Configuring The Nystagmus Tests

    VIsualEyes 515/525 - Additional Information Page 91 8.3 Configuring the nystagmus tests 8.3.1 Configuring the spontaneous nystagmus test Figure 8.3.1 Spontaneous Nystagmus test settings Test Name: Name of test Duration: Define how long the eye movement is to be recorded and analyzed (in seconds). Results Displayed: Selects which eye is shown by default.

  • Page 97: Configuring The Dix-Hallpike Tests

    VIsualEyes 515/525 - Additional Information Page 92 8.3.2 Configuring the Dix-Hallpike tests Figure 8.3.2 Dix Hallpike summary settings Test Name: Name of the test Results Displayed: Selects which eye is shown by default. Mixed Eyes will allow the user to choose the best eye for each subtest.

  • Page 98: Configuring The Positional Tests

    VIsualEyes 515/525 - Additional Information Page 93 Fixation light: Determines when the fixation light in the goggles is displayed. Manual (default) will leave the operator to determine when the fixation light should be displayed. Timed will have the fixation light come on automatically at the designated time.

  • Page 99: Configuring The Caloric Test

    VIsualEyes 515/525 - Additional Information Page 94 Figure 8.3.5 Positional subtest settings Test Name: Name of test Duration: Define how long the eye movement is to be recorded and analyzed (in seconds). Fixation light: Determines when the fixation light in the goggles is displayed. Manual (default) will leave the operator to determine when the fixation light should be displayed.
  • Page 100 VIsualEyes 515/525 - Additional Information Page 95 Test Name: Name of test Results Displayed: Selects which eye is shown by default. Left Eye will set each subtest to display the left eye. Right Eye will set each subtest to display the right eye. Fixation Light Control: Determines when the fixation light in the goggles is displayed.
  • Page 101 Page 96 Figure 8.3.8 Caloric Summary Irrigator settings 1. VisualEyes™ system is compatible with Interacoustics and Micromedical water (Aqua Stim) and air (AirFx) Caloric irrigators. These irrigators interact with the software allowing for automatic temperature adjustment and activation of the test via the irrigator handle push button. Selecting the Manual option allows using any third-party caloric irrigator, however the software will not directly communicate with the irrigator.

  • Page 102: Configuring Rotary Chair Tests

    VIsualEyes 515/525 - Additional Information Page 97 8.4 Configuring rotary chair tests 8.4.1 Configuring sinusoidal harmonic acceleration test Figure 8.4.1 Sinusoidal Harmonic Acceleration summary settings Test Name: Name of the test Results Displayed: Selects which eye is shown by default. Left Eye will set each subtest to display the left eye.
  • Page 103 VIsualEyes 515/525 - Additional Information Page 98 Figure 8.4.2 SHA Summary Computer Screen settings Summary View: Detailed, individual cycles: Detailed view will draw each cycle individually and fit a line to each cycle. Concise combined cycles: Concise will show every cycle overlapped and a single fitted line is drawn through the concise view.
  • Page 104 VIsualEyes 515/525 - Additional Information Page 99 Figure 8.4.3 SHA subtest settings Test Name: Name of subtest Duration: Define how long the eye movement is to be recorded and analyzed (in seconds). This value is calculated based on the Frequency, Peak Velocity, and Number of Cycles. Fixation light: Determines when the fixation light in the goggles is displayed.

  • Page 105: Configuring Step Rotation Test

    VIsualEyes 515/525 - Additional Information Page 100 Figure 8.4.4 SHA subtest Nystagmus Parameters Display nystagmus markers: Enabling this feature will display a marker i.e. triangle above the nystagmus fast phase slope to assist identification of a nystagmus beat. The triangle may face upwards (referring to right/up beating nystagmus) and downwards referring to left/ down beat nystagmus.
  • Page 106 VIsualEyes 515/525 - Additional Information Page 101 Test Name: Name of the test Results Displayed: Selects which eye is shown by default. Left Eye will set each subtest to display the left eye. Right Eye will set each subtest to display the right eye. Run Tests Automatically: If enabled, when the subtest completes, the next subtest will be loaded and started automatically.
  • Page 107 VIsualEyes 515/525 - Additional Information Page 102 Stable Time: Length of time the chair will be rotating at the Velocity value past the time required to reach the Velocity value using the Acceleration rate. Deceleration: Defines the rate the chair decelerates (in deg/sec Stop Time: Length of time (in seconds) the test will continue recording after the chair has stopped.

  • Page 108: Configuring Vor Suppression Test

    VIsualEyes 515/525 - Additional Information Page 103 8.4.3 Configuring VOR suppression test Figure 8.4.8 VOR Suppression summary settings Test Name: Name of the test Results Displayed: Selects which eye is shown by default. Left Eye will set each subtest to display the left eye.
  • Page 109 VIsualEyes 515/525 - Additional Information Page 104 Summary View: Detailed, individual cycles: Detailed view will draw each cycle individually and fit a line to each cycle Concise combined cycles: Concise will show every cycle overlapped and a single fitted line is drawn through the concise view.

  • Page 110: Configuring Visual Vor Test

    VIsualEyes 515/525 - Additional Information Page 105 Number of Cycles: The total number of cycles to be performed for this frequency of chair movement. The initial half cycle is rejected automatically. Figure 8.4.11 VOR Suppression subtest Nystagmus Parameters Display nystagmus markers: Enabling this feature will display a marker i.e. triangle above the nystagmus fast phase slope to assist identification of a nystagmus beat.
  • Page 111 VIsualEyes 515/525 - Additional Information Page 106 Test Name: Name of the test Results Displayed: Selects which eye is shown by default. Left Eye will set each subtest to display the left eye. Right Eye will set each subtest to display the right eye. SHA velocity profile: This option defines whether the SHA subtests use a discrete standard velocity of 60 dps or use a variable velocity which is higher at lower frequencies (80 dps at 0.01 Hz and drops 10 dps for each increase in frequency to 20 dps at 0.64 Hz.) The default setting is Variable.
  • Page 112 VIsualEyes 515/525 - Additional Information Page 107 Invert chair signal: Enabling this feature sets the eye trace to overlap the stimulus trace, providing a different view for comparing results. By default the setting is disabled.

  • Page 113: Suggested Threshold Values

    VIsualEyes 515/525 - Additional Information Page 108 9 Suggested threshold values The VisualEyes™ VNG software suite has suggested threshold tables. The values in these tables are suggested threshold values as published from the text book of Gary Jacobson and Neil Shepard, Balance Function Assessment and Management 2cd edition unless otherwise referenced.

  • Page 114: Nystagmus Tests

    VIsualEyes 515/525 - Additional Information Page 109 9.2 Nystagmus tests The average slow phase velocity (a.SPV) bar graph displays the a.SPV of 3 or more beats found within the peak response time period defined in the test properties. The Max Slowphase Velocity value of 6 degrees per second is treated as within threshold limits and will be displayed as a white bar.

  • Page 115: Optokinetic Tests

    VIsualEyes 515/525 - Additional Information Page 110 9.4 Optokinetic tests The Optokinetic test measures nystagmus and displays gain and symmetry. The analysis of the optokinetic test calculates the average velocity of the movement during the peak response window (a.SPV) and compares this velocity with the projection pattern velocity.

  • Page 116: Sinusoidal Harmonic Acceleration Tests

    VIsualEyes 515/525 - Additional Information Page 111 9.7 Sinusoidal harmonic acceleration tests For SHA tests, threhold values for gain, phase, and symmetry are displayed. There are values for both discrete velocity tests (based on 60 deg/sec for all frequencies) and variable velocity (increased velocity with decreased frequency).

  • Page 117: Step Rotation Tests

    VIsualEyes 515/525 - Additional Information Page 112 Figure 9.7.1 SHA threshold values 9.8 Step rotation tests Step Rotation tests display threshold values for gain, time constants, and time constant asymmetry. Reference: Step Velocity threshold values referenced from the Leen Maes et al. Publication: Normative Data and Test- Retest Reliability of the Sinusoidal Harmonic Acceleration test, Pseudorandom Rotation Test and Step Velocity Test.

  • Page 118: Vor Suppression Sests

    VIsualEyes 515/525 - Additional Information Page 113 9.9 VOR suppression sests VOR Suppression Tests display threshold values for minimum gain reduction (%) for both discrete and variable velocity for frequencies 0.04, 0.08, 0.16, and 0.32 Hz. Figure 9.9.1 VOR Suppression threshold values...

  • Page 119: Patient Report

    VIsualEyes 515/525 - Additional Information Page 114 10 Patient report 10.1 Write report editor A written report can be created within the VisualEyes™ 515/525 software. This is a word processor that saves the created document in the patient review sessions for later viewing or printing. The write report editor can be accessed from the session review screen by selecting ‘Write report’...

  • Page 120: Templates

    VIsualEyes 515/525 - Additional Information Page 115 10.3 Templates The templates section gives the operator an option to customize the patient report using patient information from the OtoAccess database, keywords, and findings templates. Creating a template allows the user to then access the predefined template from the Templates button to use in the report.
  • Page 121 VIsualEyes 515/525 - Additional Information Page 116 By default the name of the template will be New Template 1. This name can be changed at the top of the screen. The report template is then populated with text and can have both keywords and findings added to the template.

  • Page 122: Findings

    VIsualEyes 515/525 - Additional Information Page 117 When the report template is applied, the keywords will be filled with the information from the patient demographics entered into OtoAccess™. Fields that are not filled will be blank in the report. Figure 10.3.9 Report Editor with example template 10.4 Findings Findings are predefined templates that can be added into the written report within report editor.

  • Page 123: Save Report

    VIsualEyes 515/525 - Additional Information Page 118 Figure 10.4.2 Findings Editor screen To create a new finding, tap New finding. A new finding called New Finding 1 will be displayed. Overwrite New Finding 1 in the upper white text box with the desired keyword for the finding. Next enter the text for the finding in the lower white text box.

  • Page 124: Printing

    VIsualEyes 515/525 - Additional Information Page 119 11 Printing 11.1 Printing results The VisualEyes™ system gives the option between printing a single test or a number of tests from a session. A written report and individual tests can be printed out from the session review screen. Figure 11.1.1 Session review and printing options The Print Filter will select the tests for printing in the report.

  • Page 125: De-Identify Printout

    VIsualEyes 515/525 - Additional Information Page 120 11.3 De-identify printout De-identify printout is available from the Session Review screen. Activating this feature will create the results without displaying vital information about the patient. This allows for patient data to be printed without disclosing any identifiers about the particular patient.

  • Page 126: System Default Settings

    VIsualEyes 515/525 - Additional Information Page 121 12 System default settings 12.1 System Default Settings By selecting the Configuration button and choosing System Default Settings, the user will be able to access the various hardware and software settings. Figure 12.1.1 System Default Settings from Configuration menu 12.2 Hardware The Hardware settings screen provides access to the cameras and video settings.

  • Page 127: Calibration

    VIsualEyes 515/525 - Additional Information Page 122 The Goggle Camera selection determines which goggle camera is to be used for testing. • Simulated camera – demonstration option showing only an image of the eyes • Top mount camera– two cameras •...

  • Page 128: Timer Settings

    VIsualEyes 515/525 - Additional Information Page 123 The horizontal and vertical angles to be used for calibration, as well as target size, target color, and background color can all be adjusted within Calibration settings. 12.4 Timer settings The timer settings menu (Figure 12.4.1) presents options to customize the timer function. Figure 12.4.1 Timer settings Beep interval: Assigns the length of time between presentations of the beep and/or speaker.

  • Page 129: License

    VIsualEyes 515/525 - Additional Information Page 124 Figure 12.5.1 General settings 12.6 License The License settings screen allows the user to enter the license keys for the eye cameras. Connect the cameras to the computer, then click or touch the Update button. A dialog will appear with the camera serial numbers that are detected.

  • Page 130: Threshold Levels

    VIsualEyes 515/525 - Additional Information Page 125 Figure 12.6.2 License dialog 12.7 Threshold levels The Threshold Levels settings screen contains age-matched thresholds for various VNG and Rotary Chair tests. The theshold levels are explained in detail in Chapter 9 Suggested threshold values. 12.8 Reclining chair The Reclining Chair settings screen provides access to selecting the reclining rotational chair type connected, calibration of the black reclining rotational chair, and the safety limits for the tests that can be...

  • Page 131: Maintenance Routines With System 2000 Reclining And Orion Reclining Chair

    VIsualEyes 515/525 - Additional Information Page 126 Orion Reclining chair If the Orion reclining chair is selected, then the Controller Board Type will be using USB-231 board. The Board Status will be green if the chair communication is successful, and will be red if there is an error. The Zero Position is used to align the chair with the center of the TV or projection screen for ocularmotor testing.
  • Page 132 VIsualEyes 515/525 - Additional Information Page 127 Figure 12.11 Reclining chair maintenance routines (Orion Reclining chair) Drift calibration Click or touch the Go button for the Drift Calibration to verify the chair does not drift (turn slowly) when enabled. The signal trace (green line) and the tachometer trace (yellow line) will be displayed in the graph. Adjust the Drift Offset value using the triangle buttons to adjust the chair offset to make the traces coincide.
  • Page 133 VIsualEyes 515/525 - Additional Information Page 128 Figure 12.8.5 Velocity Tach calibration (Orion Reclining chair) Sine wave validation Once both calibration tests have been performed, select the Validation option for the maintenance routines to perform the Sine Wave Validation test. Click or touch the Go button to run a sinusoidal test for one cycle at 60 degrees per second at 0.04 Hz.

  • Page 134: Rotational Safety Settings

    VIsualEyes 515/525 - Additional Information Page 129 12.8.3 Rotational safety settings Young patients may be tested in the reclining rotational chair. For the patient’s safety, the reclining rotational chair will not allow faster tests to be performed for young patients. The software is configured to prevent the test from running if the patient’s age falls within the values (Figure 12.8.7).

  • Page 135: Print Pdf

    VIsualEyes 515/525 - Additional Information Page 130 12.9 Print PDF The Print PDF settings screen provides access to automatic PDF document creation settings. Figure 12.9.1 Print PDF settings Print Tests on Separate Pages: Selects whether page breaks should be added before each test is printed in the report.

  • Page 136: Other Functions

    VIsualEyes 515/525 - Additional Information Page 131 13 Other functions 13.1 Help button This manual is accessible by clicking or touching the Help button on the main screen or by pressing the F1 key within the software. Figure 13.1.1 Help button 13.2 Exit button Press the ‘Exit’...

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