2660021156446 B2660021156446 B

CIRRUS HD-OCT
Instructions for Use – 400,4000
Instrument and Review Software 8.1
ii

This abbreviated translation of the CIRRUS User Manual contains the instructions for use
for the CIRRUS HD-OCT instrument, including safety information. The full version of the
CIRRUS User Manual, which is translated into multiple languages, may not be available in
this language.

Copyright
© 2015 Carl Zeiss Meditec, Inc. All rights reserved.

Trademarks
CIRRUS, FastTrac, FORUM, GPA, Live OCT Fundus, and Stratus OCT are either registered
trademarks or trademarks of Carl Zeiss Meditec, Inc. in the United States and/or other
countries.
Windows, Windows Media, Windows Server, and Microsoft are either registered
trademarks or trademarks of Microsoft Corporation in the United States and/or other
countries.
Mac OS, iMac, iPad, and QuickTime are either registered trademarks or trademarks of
Apple Inc. in the United States and/or other countries.
All other trademarks used in this document are the property of their respective owners.

Patents
www.meditec.zeiss.com/patents

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Contents

(1) Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1

Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1
Indications for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1
Purpose of This User Manual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3
CIRRUS HD-OCT Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-5
CIRRUS HD-OCT System Hardware . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-5
User Changes to Software or Hardware . . . . . . . . . . . . . . . . . . . . . . . . . . 1-7
Instrument Installation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-7
Precautions and Tips to Avoid Damage . . . . . . . . . . . . . . . . . . . . . . . . . . 1-8
Embedded Windows License . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-8
Product Compliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-9
Protection of Patient Health Information . . . . . . . . . . . . . . . . . . . . . . . . . 1-9
Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-9
Electromagnetic Compatibility (EMC) . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-15
Symbols and Labels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-19
Rear Connectors 400/4000 Illustrated . . . . . . . . . . . . . . . . . . . . . . . . . . 1-21
Instrument Disposition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-22
Disposal of the Product within the European Union. . . . . . . . . . . . . . . . 1-22
(2) Operational Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-1
Chapter Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1
System Start and Login. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1
Initial System Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3
Operational Modes and Screens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-11
Common Screen Elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-12
Performance Verification Check for Models 400/4000 . . . . . . . . . . . . . . 2-18
Anterior Segment Module Calibration for Anterior Chamber and Cornea
External Lenses (licensed option) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-24
Power Down the System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-25
(3) Acquire Scans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-1
Chapter Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1
Prepare the Patient. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1
Identify a Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2
Select Scan Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-8
Anterior Segment Scans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-10
Preparing the Patient for the Exam Experience . . . . . . . . . . . . . . . . . . . 3-10
Select the Fixation Method. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-11
Acquire Scan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-12
Guidelines for Obtaining Good Quality Scans. . . . . . . . . . . . . . . . . . . . . 3-22

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Acquire Screen for Posterior Segment Raster Scans . . . . . . . . . . . . . . . . 3-28

HD 5 Line Single and Multi-Line Views. . . . . . . . . . . . . . . . . . . . . . . . . . 3-28
Review Screen for Posterior Segment Scans . . . . . . . . . . . . . . . . . . . . . . 3-30
(4) Anterior Segment Scan Acquisition . . . . . . . . . . . . . . . . . . . . . . .4-1
Anterior Segment Scans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1
Anterior Segment Scan Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2
Anterior Segment Scan Instrument Imaging Process . . . . . . . . . . . . . . . . 4-2
Anterior Segment Scan Acquisition Controls . . . . . . . . . . . . . . . . . . . . . . 4-2
Attaching an External Lens to the Instrument Lens Mount. . . . . . . . . . . . 4-5
Anterior Chamber Angle Scans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-5
Anterior Scan Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6
Anterior Segment Scan Review Features . . . . . . . . . . . . . . . . . . . . . . . . 4-15
(5) Routine Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-1
Chapter Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1
Fuse Replacement (Models 400/4000) . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1
Handling Error Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4
Hard Disk Defragmentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5
Routine Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6
User Replacement Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-8
(6) Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-1
HD-OCT Imaging for Posterior Segment Scans . . . . . . . . . . . . . . . . . . . . . 6-1
HD-OCT Imaging for Anterior Segment Scans. . . . . . . . . . . . . . . . . . . . . . 6-1
Fundus Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2
Iris Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2
Electrical, Physical and Environmental . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3
(7) Legal Notices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-1
Software Copyright. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1
Software License Agreement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1

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(1) Introduction

Intended Use
The CIRRUS™ HD-OCT with Retinal Nerve Fiber Layer (RNFL), Macular, Optic Nerve Head,
Ganglion Cell, and Asian Normative Databases is indicated for in-vivo viewing, axial
cross-sectional, and three-dimensional imaging and measurement of anterior and posterior
ocular structures.

Indications for Use

The CIRRUS HD-OCT is a non-contact, high resolution tomographic and biomicroscopic
imaging device. It is indicated for in-vivo viewing, axial cross-sectional, and
three-dimensional imaging and measurement of anterior and posterior ocular structures,
including cornea, retina, retinal nerve fiber layer, ganglion cell plus inner plexiform layer,
macula, and optic nerve head. The CIRRUS normative databases are quantitative tools for
the comparison of retinal nerve fiber layer thickness, macular thickness, ganglion cell plus
inner plexiform layer thickness, and optic nerve head measurements to a database of
normal subjects. The CIRRUS Asian Normative Database is a quantitative tool for the
comparison of these measurements to a database of normal subjects of Asian descent. The
CIRRUS HD-OCT is intended for use as a diagnostic device to aid in the detection and
management of ocular diseases including, but not limited to, macular holes, cystoid
macular edema, diabetic retinopathy, age-related macular degeneration, and glaucoma.
Note: The CIRRUS HD-OCT is not intended to be used as the sole diagnostic method for
disease.

Essential Performance
The Essential Performance of the instrument is to provide accurate measurements of
anterior and posterior ocular structure.

Patient Population
The CIRRUS HD-OCT may be used on all adults in need of diagnostic evaluation of the eye.
This includes (but is not limited to) patients with the following disabilities or challenges:
• Wheelchair user
• Very low or not measurable visual acuity
• Fixation problems
• Postural problems
• Deafness
• Large body, but not those above 99th percentile based on anthropomorphic data
There is a general requirement that the patient be able to sit upright and be able to place
their face in the chin and forehead rest of the instrument (with or without supplemental
human or mechanical support).

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Part of the Body

CIRRUS HD-OCT is designed for in-vivo viewing, axial cross-sectional, and
three-dimensional imaging and measurement of anterior and posterior ocular structures. In
addition, the system physically interacts with the patient's forehead and chin.

Application
The CIRRUS instrument is designed for continuous use, although it is expected that most
sites operate the instrument for 10 hours or less per day, indoors, within a medical office or
hospital setting. This setting shall have clean air free of soot, vapors from adhesives,
grease, or volatile organic chemicals. Other Operating Environment specifications are given
in Chapter 6. Application related warnings are given in this chapter and elsewhere.
CIRRUS HD-OCT is not a portable device. It is intended for placement in one location.
However, there is no permanently installed infrastructure associated with the instrument,
and it can be moved between locations following the applicable guidelines and warnings
in this chapter.

Operator Profile
We assume that users are clinicians or technicians with professional training or experience
in the use of ophthalmic imaging equipment, and in diagnostic interpretation of the
images generated. Specific assumptions regarding the profiles of individuals performing
instrument operation or data interpretation are given below. This manual contains
information that will aid in the proper instrument operation and interpretation of the
resultant data.

Instrument Operation
Demographic
An adult with one of the following qualifications:
• Ophthalmologist or other Medical Doctor
• Optometrist or equivalent
• Nurse
• Certified Medical Technician
• Ophthalmic Photographer
• Non-certified Assistant

Occupational Skills
Must possess all of the following skills:
• Computer literate
• Basic knowledge of the eye
• Ability to work with elderly patients and those with disabilities

Job requirements
Must be able to perform all of the following operations:

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• Power on the unit and log on

• Enter, find and modify patient identifying data
• Clean surfaces that contact patient
• Position patient with the device, including moving the patient, the device, the table
height and the patient's chair
• Select and acquire scan
• Review and save scan or try again
• Generate analysis report using available analysis protocols
• Review the analysis report for completeness
• Output analysis report
• Archive data
• Turn off the unit

Data Interpretation
Demographic
• Ophthalmologist or other Medical Doctor
• Optometrist or equivalent

Occupational Skills
• Computer literate
• Ability to work with elderly patients and those with disabilities

Job requirements
Training and certification as required by governing bodies to interpret the analysis in the
treatment of ophthalmic diseases or other eye-related medical issues.

Purpose of This User Manual

ZEISS designed this User Manual to serve as a training, usage, and reference guide for
proper scanning and operation. While we offer training in the use of the CIRRUS HD-OCT,
we do not offer instruction in diagnostic interpretation of the data and analyses. And, this
manual does not attempt to do so.
This manual is intended for operation of the instrument and review software. CIRRUS
Review Software running on a separate computer is functionally identical to the software
running on the CIRRUS HD-OCT instrument except for the ability to acquire images.
Note: For CIRRUS photo, refer to CIRRUS photo User Documentation.
Below are explanations of three symbols used throughout the manual that require special
attention:

WARNING: Failure to follow instructions may result in a hazard that can

lead to serious injury. Instructions may also describe potential serious
adverse reactions and safety hazards.

CAUTION: Failure to follow instructions may result in a hazard that may lead to
moderate injury or damage to the equipment or other property.

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Note: Important information which should be given special attention.

Manual Organization
This introductory chapter provides a system description, installation and safety information.
Chapter 2 provides an overview of how to operate the CIRRUS HD-OCT. Chapter 3 explains
in detail how to acquire CIRRUS HD-OCT scans. Chapter 4 explains how to acquire anterior
segment scans. Chapters 5, 6, and 7 cover Routine Maintenance, instrument
Specifications and Legal Notices, respectively.
Note: Your instrument may exhibit minor differences in appearance on individual screens,
depending upon model, video resolution, and operating system.
Note: If you are using CIRRUS Review Software, you can ignore Chapter 3, Acquire Scans.

Navigating within a PDF Version of the User Manual

In the PDF version of the user manual, when the mouse cursor is over a blue
cross-reference link, the mouse cursor changes to a finger pointer ( ). Clicking a
cross-reference link takes you to the referenced section in the manual.
+ • To return to the page where you clicked the cross-reference link, press Alt+left arrow
on the keyboard, as shown on the left.
+ • Press Alt+right arrow to return to the cross-referenced page, as shown on the left.

Text Conventions
• “Click” means “left-click” except where “right-click” is specified.
• Chains of menu items are indicated with the use of the “>” symbol between items. For
example, “File > Exit” directs you to select Exit in the File menu.

Access Menu Options

To access the options offered through each menu, click the menu headings. Then click an
option to select it. Click outside all menu options to make the options disappear.
• Some menus are fields tagged with a down-arrow (drop-down lists). To access these
menu options, click the down-arrow.
• Grayed-out menu options or buttons are not available.

Electronic User Manual Access

The electronic CIRRUS User Manual is provided with the instrument in two ways:
1. On-Line Manual: Select On-Line Manual from the Help (click Help > On-Line Manual)
menu to access the user manual information through the CIRRUS software.
2. On the CIRRUS HD-OCT User Documentation CD or USB flash drive: Included in the
instrument accessory kit. You can view the user manual PDF either using the CIRRUS
system computer, or any other computer.

+ Once opened, you can switch between the user manual and the CIRRUS application by
pressing Alt+Tab, as shown on the left.

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CIRRUS HD-OCT Technology

The CIRRUS HD-OCT is a computerized instrument that acquires and analyzes
cross-sectional and three-dimensional tomograms of the eye using spectral domain optical
coherence tomography (SD-OCT). SD-OCT is a form of non-invasive, low-coherence
interferometry that produces high-resolution tomograms without contacting the eye.
HD-OCT stands for “high-definition optical coherence tomography”.
In low-coherence interferometry, light is sent along two optical paths, one being the
sample path (into the eye) and the other the reference path of the interferometer. The light
source is an 840 nm superluminescent light emitting diode (SLD). Light returning from the
sample and reference paths is combined and introduced to the detector, which is a
spectrometer in SD-OCT. The spectrometer resolves the interference signals throughout the
depth of each A-scan immediately by means of a Fourier transformation. This is possible
because the spectrometer resolves the relative amplitudes and phases of the spectral
components scattered back from all depths of each A-scan tissue sample, without varying
the length of the reference path.
Models of CIRRUS HD-OCT employ different technologies to provide an image of the retinal
area addressed by the scan. Model 4000 instruments include a line scanning
ophthalmoscope (LSO). Model 400 instruments use the OCT beam to create the retinal
image. All models include a CCD video camera to monitor the exterior eye and assist with
scan alignment.

CIRRUS HD-OCT System Hardware

With the exception of the keyboard, mouse and printer, the CIRRUS HD-OCT integrates all
hardware components in a unit, which includes the scan acquisition optics, the
interferometer and spectrometer, the system computer, and video monitor. ZEISS offers an
optional wheelchair accessible motorized power table (shown below), which
accommodates elevation adjustment to each patient's height. The illustration below labels
hardware elements for the Model 4000.

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1 Motorized Patient Alignment Unit 6 Integrated Video Monitor 11 Keyboard

2 Dual Chinrest with Automatic Right/Left Sensors 7 Connectors (USB, network, etc.) and labels under rear cover 12 System Power Switch
3 Imaging Aperture 8 CD/DVD Drive and One USB port 13 Power Table (Optional)
4 Head Rest 9 Table Height Control
5 Port for External Fixation Arm 10 Mouse
Figure 1-1: CIRRUS HD-OCT System Hardware (Model 5000)

Software
ZEISS pre-installs all software necessary to operate the CIRRUS HD-OCT. Software updates
with installation instructions may be provided on a DVD or USB flash disk, or on our
website.

Data Storage
The system computer stores data locally. Archival storage of CIRRUS HD-OCT exam data is
designed to occur in a network environment. We recommend archiving data to a network
file server or a network attached storage device (also known as a network hard drive),
and/or DICOM archive device, which operates as a network file server. For more
information, see the CIRRUS HD-OCT User Manual, Chapter 9, Archive and Retrieve,
Appendix A, Networking Guidelines, and Appendix B, Using a Network Storage Device.

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User Changes to Software or Hardware

The CIRRUS HD-OCT is a medical device. The software and hardware have been designed
in accordance with U.S., European and other international medical device standards
designed to protect clinicians, users and patients from potential harm caused by
mechanical, diagnostic or therapeutic failures.

WARNING: Do not modify or add to the software found on the CIRRUS

HD-OCT except as authorized by ZEISS. Unauthorized modification of
CIRRUS HD-OCT software or hardware (including peripherals) can
jeopardize the safety of operators and patients, the performance of the
instrument, and the integrity of patient data. Unauthorized modification
also voids the instrument warranty.

Approved Software
Please refer to the CIRRUS HD-OCT Third Party Software and Hardware section of our
website (www.meditec.zeiss.com/cirrus) for the current list of approved software.
Note: ZEISS does not provide technical support for the use of third party software.

Instrument Installation
Only an authorized ZEISS service representative should install the CIRRUS HD-OCT. We do
not provide assembly and installation instructions.
Note: Only trained CZM personnel may perform calibration. The Performance
Verification Check for Models 400/4000 (see page 2-18) is not calibration.

Care in Handling
Use extreme care when handling and transporting the CIRRUS HD-OCT shipping boxes.
The instrument contains fragile optics that require highly precise alignment.

Installation Requirements
• The instrument with the optional power table requires an area at least 6' x 8' (1.80 m
by 2.4 m) for installation and patient comfort during use.
• You must install it in a ventilated room and must not block the ventilated instrument
covers that allow heat to dissipate from the device. For more information on
acceptable operating conditions, see Specifications page 6-1.

CAUTION: Failure to provide proper ventilation could potentially lead to heat

build-up, which could cause component failure and/or fire.

CAUTION: Do not bundle the cables at the back of the device inside the rear cover,
as this could lead to heat build-up causing instrument shutdown.

• The CIRRUS HD-OCT should operate on a dedicated power outlet.

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• When using the optional power table, the instrument must be powered through the
table, as described in the Power Table User Instructions.

Precautions and Tips to Avoid Damage

CAUTION: Users are not authorized to dismantle (except to remove the rear cover) or
modify the CIRRUS HD-OCT hardware. To transport the instrument outside the
office, you must consult with a ZEISS service technician. Failure to do so voids all
warranties offered with the CIRRUS HD-OCT.

• Only ZEISS authorized technicians should disassemble or service this

instrument. In the case of malfunction, error messages or operational
problems, call ZEISS customer service: In the U.S., call 800-341-6968. Outside
the U.S., contact your local CZM distributor.
• This instrument has no special measures to protect against harmful ingress of
water or other liquids (classified IPXO—ordinary equipment). Do not place
containers of liquid on or near the instrument, and do not use aerosols on or
near it.
• The optional power table has an IP21 classification, which provides the
specified degree of protection against harmful ingress of water. Still, do not
place containers of liquid on or near the table where spillage onto the
instrument or table could occur, resulting in a safety hazard and/or damage to
the instrument or the table.
• In case of a non-medical emergency related to the instrument, unplug the
power cord from the wall outlet and call for service immediately.
• To prevent heat buildup that could damage the instrument, you must install it in
a ventilated room and must not block the ventilated instrument covers that
allow heat to dissipate from the device. For more information on acceptable
operating conditions, see Specifications page 6-1.
• With the exception of the main power fuses and the top fan filter, there are no
user-replaceable parts in the instrument. For the replacement of any
component, accessory, or peripheral, except fuses, call ZEISS customer service:
In the U.S., call 800-341-6968. Outside the U.S., contact your local CZM
distributor.
• Although this instrument is designed for continuous operation, it should be
turned off when not in use for an extended period.
• See Routine Cleaning on page 5-6 for instructions on cleaning the imaging
aperture.

Embedded Windows License

Each CIRRUS HD-OCT instrument is issued with an embedded Windows® license. The
license label, which includes the license number, is located under the rear cover (see
Figure 1-2).

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 Introduction 1-9

Product Compliance
Complies with the European Union 93/42/EEC Medical Device Directive.
The product is RoHS-compliant according to Directive 2011/65/EU.
Complies with US and Canadian medical electrical system safety requirements.

Protection of Patient Health Information

Note: Health care providers have responsibility for the protection of patient health
information (PHI), both hardcopy and electronic. To protect patient confidentiality of your
exported electronic data, the use of encryption is recommended and is the responsibility of
the user.

Safety
Note: If a serious incident has occurred in relation to this medical device, to the user, or to
another person, then the user (or responsible person) must report the serious incident to
the medical device manufacturer or the distributor. In the European Union, the user (or
responsible person) must also report the serious incident to the Competent Authority in the
state where the user is established.
Product Safety
The CIRRUS HD-OCT instrument is classified as follows:
• Class I Equipment – Protection against electrical shock.
• Type B – Degree of protection against electric shock of applied part (chin and
forehead rests).
• Ordinary Equipment (IPX0) – Degree of protection against ingress of liquids (none).
• Continuous Operation – Mode of operation.

WARNING: To prevent electric shock, the instrument must be plugged into

an earth grounded outlet. Do not remove or disable the ground pin. Only
an authorized ZEISS service representative may install the instrument.

WARNING: Do not open the instrument covers. (Exception: You may

remove the rear cover to access the fuses, labels and connectors.) Opening
the instrument covers could expose you to electrical and optical hazards.

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WARNING: To maintain patient safety, if the instrument is externally

connected to non-medical peripheral devices (i.e., printer, storage devices,
etc.), the complete system must comply with the system requirements in
standard IEC 60601-1. This standard requires the usage of an Isolation
Transformer to power the non-medical peripheral device(s) if located
within 1.5 m from the patient. If the peripheral device is located outside
the patient environment (beyond 1.5 m) and is connected to the
instrument, a separation device must be used if there shall be electrical
connection between the non-medical peripheral device and the
instrument.

The person or the responsible organization connecting additional devices

or reconfiguring the system must evaluate the complete system to ensure
compliance to the applicable IEC 60601-1 requirements.

The instrument operator must not attempt to touch the patient and the
peripheral device simultaneously.

WARNING: This instrument may cause ignition of flammable gases or

vapors. Do NOT use in the presence of flammable anesthetics such as
nitrous oxide, or in the presence of pure oxygen.

WARNING: The instrument itself is transportable and may be moved from

one location to another. However, if the instrument is placed on a power
table provided by CZM, do not move the table to another location while
the instrument and any other peripherals are placed on it. Doing so may
cause the system components to tip over and cause harm to the patient,
the operator, or others in the vicinity.

WARNING: Do not scan patients who have been injected with

photo-dynamic therapy (PDT) treatment drugs, such as Visudyne®, in the
previous 48 hours. Failure to observe this warning could result in
unintended exposure and uncontrolled treatment of neovascular vessels.

CAUTION: Avoid tipping. Do not use the instrument on an uneven or sloped surface.
Also, do not roll the table in deep pile carpet or over objects on the floor such as
power cords. Failure to observe these precautions could result in tipping of the
instrument and/or table and resulting injury to operator or patient and damage to
the instrument.

CAUTION: When you complete scan acquisition and before you click the Finish or ID
Patient buttons in the ACQUIRE Screen, always prompt the patient to sit back and
move the head away from the chinrest. Clicking either of these buttons in the
ACQUIRE screen causes the chinrest to reposition itself beyond the point where the
patient’s eye would contact the lens if the head remained in the chinrest. Failure to
observe this warning could result in injury to the patient.

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CAUTION: The operator should check that the patient is not holding on to the
instrument before or during tests. Although movement of the motorized chinrest is
slow, giving plenty of warning for patients to remove their fingers, there is potential
for fingers to be squeezed and possibly injured.

CAUTION: (United States) Federal law restricts this device to sale by or on the order
of a licensed healthcare practitioner.

CAUTION: Do not reconfigure system components on the table, nor add non-system
devices or components to the table, nor replace original system components with
substitutes not approved by ZEISS. Such actions could result in failure of the table
height adjustment mechanism, instability of the table, tipping and damage to the
instrument, and injury to operator and patient.

CAUTION: Do not use the printer, the instrument, or the optional power table with
an extension cord or a power strip (multiple portable socket outlet).

Note: The optional CIRRUS HD-OCT Power Table is safe to use within the patient
environment when the instrument is powered through it, as instructed herein.

Optical Safety
• IEC 60825-1
• EN ISO 15004-2
• Classification: Group 1 Instrument - Per EN ISO 15004-2. Group 1 instruments are
ophthalmic instruments for which no potential light hazard exists.

WARNING: This device contains visual stimuli, including flickering light

and flashing patterns, between 5 and 65 Hz. Medical professionals need to
determine whether this device should be used for patients who may be
photosensitive, including those with epilepsy.

CAUTION: Applicable Phototoxicity Statements (FDA CDRH Ophthalmoscope

Guidance #71): Because prolonged intense light exposure can damage the retina,
the use of the device for ocular examination should not be unnecessarily prolonged.
While no acute optical radiation hazards have been identified for direct or indirect
ophthalmoscopes, it is recommended that the exposure time for the patient’s eye be
limited to the minimum time that is necessary for diagnosis. Infants, aphakes and
persons with diseased eyes will be at greater risk. The risk may also be increased if
the person being examined has had any exposure with the same instrument or any
other ophthalmic instrument using a visible light source during the previous 24
hours. This will apply particularly if the eye has been exposed to retinal
photography. Note: This medical device has no user adjustable intensity settings for
light incident on the retina, nor does it produce UV radiation or short-wavelength
blue light.

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CAUTION: The appliance coupler is the main disconnect device of the instrument.
Position the instrument in such a way to have easy access to disconnect the
appliance coupler in case of an emergency.

CAUTION: In case of an emergency, disconnect the appliance coupler from the back
of the instrument.

When the power cord is connected to the instrument, the green light on the power switch
will start flashing. When the power switch is pressed, the light will change to sold green
and the entire instrument will be powered.

Check and Replace Instrument Fuses (Models 400/4000)

WARNING: When replacing fuses, carefully follow the instructions in
Chapter 5 to safely check and replace fuses. Always power down the
instrument and unplug the power cord before proceeding. At all times, use
the minimum force necessary to accomplish each step so as to prevent
damage or injury.

WARNING: Always replace fuses with the same type and rating. Failure to
do so may create a risk of fire.

WARNING: Do not rotate the drum immediately above the fuses, since this
changes the instrument power voltage setting. Powering the instrument
with the incorrect setting could result in electrical shock to users and
patients and severe damage to the instrument.

Networking
WARNING: When networking the CIRRUS HD-OCT, use only network cables
with an unshielded RJ-45 connector. Use of a shielded network cable in the
CIRRUS HD-OCT could result in electrical shock to the patient and/or
examiner.

Network Attached Storage Device Safety

WARNING: To directly connect the NAS device to the CIRRUS HD-OCT, use a
network patch cord only with an unshielded RJ-45 connector. Use of a
shielded network patch cord will ground the NAS device through the
CIRRUS HD-OCT, which could result in electrical shock to the patient and/or
examiner.

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CAUTION: We strongly recommend you use peripheral devices supplied or approved

by ZEISS, when available, because they will have been tested to work with the
instrument. If you do use a peripheral device that conforms with the requirements in
this section but is not supplied by ZEISS, do not install any unapproved third party
software on the instrument. Installation of any unapproved software, including
drivers, could degrade the performance of the instrument and/or lead to corrupted
diagnostic or therapeutic information and may void the instrument warranty.

CAUTION: Do not use the NAS device or the instrument with an extension cord or a
power strip (multiple portable socket outlet). For additional safety, do not plug the
NAS device and the instrument into the same wall outlet. Failure to observe this
instruction could result in electrical shock to the patient and/or examiner.

Printers
WARNING: Except when powering the printer through an isolation
transformer in the USB configuration, peripheral devices such as printers
must be placed at least 1.5 meters (4.9 feet) away from the patient, such
that the patient cannot touch a peripheral device with any part of his or
her body while being examined. In addition, the instrument operator must
not attempt to touch the patient and a peripheral device at the same time
while examining the patient. Failure to observe this warning could result
in electrical shock to the patient and/or examiner. Use of a printer in a
wireless configuration enables you to observe this warning more easily.

WARNING: When using the printer in the USB configuration, you must
power the printer through an isolation transformer. Failure to observe this
warning could result in electrical shock to the patient and/or examiner. To
do so, you must use a special power cable. In North America, the required
cable has an IEC-320-14 connector on one end and a NEMA S-15R connector
on the other end. This cable is included in the accessory kit shipped with
the instrument.

WARNING: To directly connect a printer to the CIRRUS HD-OCT using a

network patch cord (UTP cable), only use an unshielded RJ-45 connector. Use
of a shielded network patch cord will ground the printer through the CIRRUS
HD-OCT, which could result in electrical shock to the patient and/or examiner.
It could also invalidate the system safety approval. In this configuration, the
printer must be placed at least 1.5 m away from the patient.

CAUTION: If you use a non-approved device or if you connect it incorrectly—for

example, by plugging the printer into the wall while using a USB connection, or by
using a shielded network (UTP) cable—you could invalidate the system safety
approval.

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CAUTION: We strongly recommend you use peripheral devices supplied or approved

by ZEISS, when available, because they will have been tested to work with the
instrument. If you do use a peripheral device that conforms with the requirements in
this section but is not supplied by ZEISS, do not install any unapproved third party
software on the instrument. Installation of any unapproved software, including
drivers, could degrade the performance of the instrument and/or lead to corrupted
diagnostic or therapeutic information and may void the instrument warranty.

CAUTION: Do not use the printer or the instrument with an extension cord or a
power strip (multiple portable socket outlet). For additional safety, do not plug the
printer and the instrument into the same wall outlet. Failure to observe this
instruction could result in electrical shock to the patient and/or examiner.

Patient Record Deletion

CAUTION: Deletion is permanent in Native Archive mode; you cannot recover a
patient record nor retrieve its archived exams, because deleting a patient record
includes deleting that patient’s index data. The deleted index data includes where
the archived exam data can be found.

Patient Records Merge

CAUTION: Be certain that you select the correct patient records to merge. Once you
merge patient records, you must use the Move Scan feature to separate the merged
file.

Data Archive and Retrieve

CAUTION: We strongly recommend that you archive daily to a network archive
location (a network file server or network attached storage device). If you do not
archive at all, paper records are the only way to retain patient information in case of
system hard drive malfunction.

Risks of Internet Connectivity

CAUTION: When connected to the Internet, the CIRRUS HD-OCT may be vulnerable
to serious security risks, including viruses and worms that could disable your system
or adversely affect its performance. Internet connectivity enables third party
software, software drivers and updates to be downloaded to your system, either
automatically or intentionally. Installation of any unapproved software, including
drivers, could degrade the performance of the instrument and/or lead to corrupted
diagnostic or therapeutic information and may void the instrument warranty.

Windows Automatic Update

CAUTION: All non-high-priority updates (driver, hardware or optional updates, etc.)
should not be installed.

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Prohibited Activities
The following activities are prohibited using the CIRRUS HD-OCT instrument.

CAUTION: Attempting to perform these prohibited activities may void your CIRRUS
HD-OCT warranty and may result in damage to your CIRRUS HD-OCT system. ZEISS is
not responsible for software upgrades or repairs necessitated by the attempted
performance of the following prohibited activities.

• Do not relocate the CIRRUS HD-OCT database to a network file server.

• Do not share CIRRUS HD-OCT folders with other computer systems via the network.
• Do not share the CIRRUS HD-OCT system printer on the network if the printer is
connected to the USB port.

Network File Server Backup

CAUTION: Failure to backup the network file server may result in the loss of medical
exam data.

Electromagnetic Compatibility (EMC)

WARNING: The use of accessories, transducers and cables other than those
specified may result in increased emissions or decreased immunity of the
equipment.

WARNING: The CIRRUS HD-OCT should not be used adjacent to or stacked

with other equipment. If adjacent or stacked use is necessary, the
equipment or system should be observed to verify normal operation in the
configuration in which it will be used.

CAUTION: The CIRRUS HD-OCT has special EMC precaution requirements and needs
to be installed and put into service according to the EMC information provided
herein.

CAUTION: Portable and mobile RF communications equipment can affect medical

electrical equipment.

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Guidance and manufacturer’s declaration - electromagnetic emissions

The CIRRUS HD-OCT is intended for use in the electromagnetic environment specified below. The customer or user of the CIRRUS HD-OCT
should assure that it is used in such an environment.
Emissions Test Compliance Electromagnetic environment - guidance
The CIRRUS HD-OCT uses RF energy only for
RF emissions Group 1 its internal function. Therefore, its RF
CISPR 11 emissions are very low and are not likely to
cause any interference in nearby electronic
equipment.
RF emissions Class A The CIRRUS HD-OCT Models 400/4000 are
CISPR 11 suitable for use in all establishments other
than domestic establishments and those
Harmonic emissions Class A
connected to a low voltage power supply
IEC 61000-3-2
network which supplies buildings used for
Voltage fluctuations/flicker emissions Complies domestic purposes.
IEC 61000-3-3

Guidance and manufacturer’s declaration - electromagnetic immunity

The CIRRUS HD-OCT is intended for use in the electromagnetic environment specified below. The customer or user of the CIRRUS HD-OCT
should assure that it is used in such an environment.
Immunity Test IEC 60601 test level Compliance level Electromagnetic environment - guidance
Electrostatic Discharge ± 6 kV contact ± 6 kV contact Floors should be wood, concrete, or ceramic tile. If
(ESD) IEC 61000-4-2 ± 8 kV air ± 8 kV air floors are covered with synthetic material, the
relative humidity should be at least 30%.
Electrical fast ± 2 kV for power supply ± 2 kV for power supply Mains power quality should be that of a typical
transient/burst lines lines commercial or hospital environment.
IEC 61000-4-4 ± 1 kV for input/output ± 1 kV for input/output
lines lines
Surge IEC 61000-4-5 ± 1 kV differential mode ± 1 kV differential mode Mains power quality should be that of a typical
± 2 kV common mode ± 2 kV common mode commercial or hospital environment.
Voltage dips, short <5% UT (>95% dip in UT) <5% UT (>95% dip in UT) Mains power quality should be that of a typical
interruptions, and voltage for 0,5 cycle for 0,5 cycle commercial or hospital environment. If the user of
variations on power supply 40% UT (60% dip in UT) for 40% UT (60% dip in UT) for the CIRRUS HD-OCT requires continued operation
input lines. IEC 61000-4-11 5 cycles 5 cycles during power mains interruptions, it is
70% UT (30% dip in UT) for 70% UT (30% dip in UT) for recommended that the CIRRUS HD-OCT be powered
25 cycles 25 cycles from an uninterruptible source.
<5% UT (95% dip in UT) <5% UT (95% dip in UT)
for 5 sec for 5 sec
Power frequency (50/60 Hz) 3 A/m 3 A/m Power frequency magnetic fields should be at levels
magnetic field characteristic of a typical location in a typical
IEC 61000-4-8 commercial or hospital environment.
Note: UT is the a.c. mains voltage prior to application of the test level.

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Guidance and manufacturer’s declaration - electromagnetic immunity

The CIRRUS HD-OCT is intended for use in the electromagnetic environment specified below. The customer or user of the CIRRUS HD-OCT
should assure that it is used in such an environment.
Immunity Test IEC 60601 test level Compliance level Electromagnetic environment - guidance
Portable and mobile RF communications equipment
should be used no closer to any part of the CIRRUS
HD-OCT, including cables, than the recommended
separation distance calculated from the equation
applicable to the frequency of the transmitter.

Recommended separation distance

d = 1.17 P 80 MHz to 800 MHz

Conducted RF 3 Vrms 3V d = 2.33 P 800 MHz to 2,5 GHz

IEC 61000-4-6 150 kHz to 80 MHz
where P is the maximum output power rating of the
Radiated RF 3 V/m 3 V/m
transmitter in watts (W) according to the transmitter
IEC 61000-4-3 80 MHz to 2,5 GHz
manufacturer and d is the recommended separation
distance in meters (m).
Field strengths from fixed RF transmitters, as
determined by an electromagnetic site survey,a
should be less than the compliance level in each
frequency range.b Interference may occur in the
vicinity of equipment marked with the following
symbol:

Note 1: At 80 MHz and 800 MHz, the higher frequency applies.

Note 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures,
objects and people.
a Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land mobile radios, amateur radio,

AM and FM broadcast, cannot be predicted theoretically with accuracy. To assess the electromagnetic environment due to fixed RF
transmitters, an electromagnetic site survey should be considered. If the measured field strength in the location in which the CIRRUS HD-OCT is
used exceeds the applicable RF compliance level above, the CIRRUS HD-OCT should be observed to verify normal operation. If abnormal
performance is observed, additional measures may be necessary, such as reorienting or relocating the CIRRUS HD-OCT.
b Over the frequency range 150 kHz to 80 MHz, field strengths should be less than 3 V/m.

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Recommended separation distances between portable and mobile RF communications equipment and the
CIRRUS HD-OCT
The CIRRUS HD-OCT is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or
the user of the CIRRUS HD-OCT can help prevent electromagnetic interference by maintaining a minimum distance between portable and
mobile RF communications equipment (transmitters) and the CIRRUS HD-OCT as recommended below, according to the maximum output
power of the communications equipment.
Rated maximum output power of Separation distance according to frequency of transmitter
transmitter m
150 kHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2,5 GHz
W
d = 1.17 P d = 1.17 P d = 2.33 P
0.01 0.117 0.117 0.233
0.1 0.370 0.370 0.737
1 1.170 1.170 2.330
10 3.700 3.700 7.368
100 11.700 11.700 23.300
For transmitters rated at a maximum output power not listed above, the recommended separation distance d in metres (m) can be estimated
using the equation applicable to the frequency of the transmitter, where P is the maximum output power rating of the transmitter in watts (W)
according to the transmitter manufacturer.

Note 1: At 80 MHz and 800 MHz, the higher frequency applies.

Note 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures,
objects and people.

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Symbols and Labels

Warning

Caution

Note

Must Follow Instructions for Use

Stand-by

Fuse

Direct Current

Type B applied parts

Manufacturer

Authorized European Community Representative

Serial number

Catalog number / part number

Model number

European Conformity

Disposal of the Product within the E.U. Do not dispose via domestic waste disposal system or
communal waste disposal facility.

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Protective Packing Symbols

The protective packing symbols specify the handling requirements and the transport and
storage conditions.
Handling Requirements Transport Conditions

Relative Humidity (10% to 100%, including

Fragile, Handle with Care
condensation)

Keep Dry Temperature (-40 to +70 deg. C)

This End Up Atmospheric Pressure Limits (500 hPa to 1060 hPa)

Note: The instrument is not intended to be transported outside of its original package.

Unpacking Instructions Symbol Sheet

The following symbol sheet serves as instructions to safely unpack the instrument from its
shipping box.

CAUTION: To prevent injury or damage to the instrument, observe especially

instruction 4 at lower right, for two people—not one—to lift the instrument out of
the box, bending the knees and keeping the back straight.

Note: When the CIRRUS HD-OCT is being unpacked, save the original shipping materials
for possible future use. To prevent damage, the instrument must be transported in its
original shipping package.

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Product Labels and Serial Number Location

The product label is located just above the rear cover of the instrument.
To gain access to the label showing the serial number, remove the rear cover. To remove
the rear cover, depress the two snaps at its top edge.

Figure 1-2: Removing Rear Cover (exact appearance depends on the model and year)

A small label indicates the month and year of manufacture in MMYYYY format (for
example, 042013).

Rear Connectors 400/4000 Illustrated

Under the rear cover are connectors with inscriptions stamped in the nearby metal that
illustrate the types of connectors found on the rear of the device, as shown in Figure 1-3
below.

Mouse USB (6)

Keyboard Ethernet

Figure 1-3: Rear Connectors and Explanatory Diagram (Models 400 and 4000)

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Instrument Disposition
When it comes time to upgrade the CIRRUS HD-OCT, please contact ZEISS to inquire about
trade-in or upgrade values we may offer. Should you not wish to trade in the instrument,
please dispose of it in accordance with local and national requirements.

Disposal of the Product within the European Union

Packaging materials should be retained for future relocation or repair. If you wish to
dispose of the packaging material, contact a recognized collection system for recycling.
The device contains electronic components. At the end of its lifetime, the product and its
integrated batteries should be disposed of in accordance with the relevant national
regulations.
In accordance with applicable EU guidelines and national regulations at the time at which
the product was brought onto the market, the product specified on the consignment note
is not to be disposed of via the domestic waste disposal system or communal waste
disposal facilities.
For further information on disposal of this product, please contact your local dealer or the
manufacturer or its legal successor company. Please read the latest Internet information
provided by the manufacturer.
Where the product or its components are resold, the seller must inform the buyer that the
product is to be disposed of in accordance with the currently applicable national
regulations.

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(2) Operational Overview

Chapter Overview
This chapter provides an overview of how to operate the CIRRUS HD-OCT. It explains basic
operations like startup and shutdown, and initial system setup tasks. It introduces common
features like the toolbar and menu system. It also provides an overview of the typical
workflow and introduces the screens you will use in these contexts.

System Start and Login

To activate power, press the system power switch, found below the monitor (see CIRRUS
HD-OCT System Hardware on page 1-5).

Log On to Windows
For Model 400 and 4000 instruments, after the computer boots up you must log in to the
Windows operating system. The Log on to Windows dialog appears, showing the default
user name Zeiss. Use the password November171846, the founding date of the Carl Zeiss
company. After successful logon to Windows, the CIRRUS HD-OCT software loads
automatically and performs a system check before you can log in to the application. It
requires about 60 seconds for the startup process to complete.
Note: The first time you log in to Windows on a new CIRRUS system, before you can use
the CIRRUS application, you must create an institution name and create at least one
CIRRUS user account. See Initial System Setup on page 2-3 for details.
Note: To preserve system access, optimum system configuration, and networking
capabilities, do not change the default Windows user account and password.
Note: Do not edit nor delete the Tech Support account, which is used only by ZEISS
technical support personnel. If you change or delete this account, CZM technical support
may be unable to restore access to your system, in case you lose the password for the
Administrator account. In this case, a service call would be required to replace the system
hard drive.

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System Check During Start

Figure 2-1: System Check at Startup

During system start, CIRRUS HD-OCT checks the following items displayed on screen:
• Database: Checks accessibility and integrity of the database. If this check fails, you
will not be able to log in and use the instrument.
• Instrument Storage Space: Checks for adequate free space on the hard drive to
acquire new scans. If free space is critically low, you may be required to clear archived
exams before you acquire new scans.
• Network Storage Space: Checks accessibility of the network archive location and for
adequate free space to archive new scans. You may continue without passing this
check, but archiving may not be available. Under the default settings, you will be
prompted upon shutdown to archive unarchived exams.
• Installation Files: Checks that critical system software files are present and have not
been altered. If this check fails, you will not be able to log in and use the instrument.
• Instrument: Checks the connectivity of the instrument hardware with the system
computer. If this check fails, you will not be able to log in and use the instrument.
Overall Pass or Fail: Below this list of items, the overall system check reports Pass or Fail.
• If the system passes all checks, it will automatically advance to user login.
• If it reports Pass but fails either storage space check, the system check will remain on
screen and inform you of the results. You may click Details for more information. Click
Continue to advance to login.
• If it reports Fail, the system check will remain on screen and the Continue button will
not be available. If this occurs, call ZEISS customer service: In the U.S., call
800-341-6968. Outside the U.S., contact your local CZM distributor. Be prepared to
communicate the system check details, which are accessible by clicking the Details
button.

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User Login
You must log in to access the CIRRUS HD-OCT functions. The USER LOGIN dialog appears
when the instrument passes the system check upon startup, and each time a user logs out
of the system software.

Figure 2-2: User Login Dialog

Select a user name from the drop-down list and enter the corresponding password to
access the system software. Note that passwords are case-sensitive.
• No user names appear in the drop-down list until user accounts are created (see
Initial System Setup on page 2-3 on page 2-3).
Note: We strongly recommend that you create individual user accounts for each staff
member who acquires or analyzes scans, and that staff members routinely logout to secure
the instrument. (To create user accounts, see Initial System Setup on page 2-3 on page
2-3.)
If you enter an invalid user name or password, a message will prompt you to try again.
When you log in successfully, the ID PATIENT screen appears. See Identify a Patient on
page 3-2 on page 3-2 to use the ID PATIENT screen.

Logout Locks the System

To prevent unauthorized access, you can lock the CIRRUS HD-OCT software at any time by
selecting Logout at upper right. When you lock the CIRRUS HD-OCT, it reverts to the USER
LOGIN dialog, enabling login again. Upon successful login, the system always returns to the
ID PATIENT screen.
Note: The Logout button is not available on the ACQUISITION or ANALYSIS screens. To logout
of the application from those screens, you must click Finish or ID Patient to return to the ID
PATIENT screen.

Automatic Logout
You can configure Windows to go into sleep, hibernate, or hybrid mode after a specified
time has elapsed without user input and can also require a password on wakeup. For
instructions on configuring these options, see the Windows documentation at Control
Panel\All Control Panel Items\Power Options.

Initial System Setup

Upon initial system start, before you can use the CIRRUS application, you must create an
institution name and create at least one CIRRUS user account. Several other initial setup

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items are optional but also are worthy of consideration, and are explained in this section,
which addresses the following topics:
• Create an Institution Name on page 2-4, page 2-4
• The admin User Account on page 2-5, page 2-5
• Create User Accounts on page 2-5, page 2-5
• Preferences on page 2-6, page 2-6
This section explains how to perform both the required and optional initial setup tasks.

Create an Institution Name

Before you can use the CIRRUS application, you must create an institution name for your
system. The institution name is required as part of the information by which data is uniquely
associated with the system where it is acquired. The INSTITUTION EDIT dialog appears
automatically each time the CIRRUS application starts until you save an institution name.

Figure 2-3: Institution Edit Dialog

In the Name field, type the name of your institution. The field requires at least one
character and accepts up to 64 characters, including spaces. The name field cannot be
empty.
Enter the value of the Issuer of Patient ID in its field. Note that numbers are the default
value, but letters may be entered, as well. If the Issuer of Patient ID already exists—for
example, the same one used in the previous software version—the value appears in the
Issuer of Patient ID field, where it can be edited, if desired. If it does not exist, a new
Issuer of Patient ID can be added. Any change made only applies to patients going
forward; the change does not appear on patient information already in the database.
Note: The Issuer of Patient ID field denotes assigning authority of patient IDs entered at
a particular site or practice. As a recommendation, it should be set to the same value on
every instrument in the practice and to the same value as in the leading patient
information system, if applicable.
The logo graphic is optional. If you are not going to use a logo graphic, click Save to save
your changes and exit the dialog. To add a logo graphic now, see the CIRRUS HD-OCT User

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Manual, Chapter 8. Once you have supplied the name and logo, they will appear on all
analysis printouts.

The admin User Account

To manage administrative functions, CIRRUS HD-OCT dedicates a special user account with
the user name admin. Only the admin user can create and edit the institution name,
user accounts and staff records. (See the CIRRUS HD-OCT User Manual, Chapter 8, for
details. for details.)
The admin account never appears in the drop-down list of user names on the login screen.
You must type it in. The admin account accepts any password or none. The admin user
cannot acquire or analyze scans.

Create User Accounts

No user names are available to log in with until user accounts are created. This section
explains how to create user accounts.
Note: We strongly recommend that you create individual user accounts for each staff
member who acquires or analyzes scans, and that staff members routinely log out to
secure the instrument. Following these procedures helps prevent unauthorized access to
CIRRUS HD-OCT data and functions, and enables accurate record-keeping. For
record-keeping, CIRRUS HD-OCT records the user name under which each scan is acquired;
it displays the current user next to the Logout link at upper right.

Register (Create) Staff Records

To access the STAFF REGISTRATION dialog, you must be logged in as the admin user.
1. Click Tools > Options > Users.... The STAFF REGISTRATION dialog appears.
2. In the STAFF REGISTRATION dialog, click New. The NEW STAFF dialog opens.

Required fields in bold

Figure 2-4: New Staff Dialog

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3. Edit the staff registration fields as desired. A staff record must have either a last name
or first name or both; other fields are optional. To log in with this user name and
acquire scans, the Operator checkbox must be checked. You may check more than one
of the checkboxes to assign privileges. When finished with your changes, click Save.
• To discard the changes before saving, click Cancel. A dialog prompts you to confirm
your choice.
Note: If the password field is left blank, that user must leave the password field blank to
log in. User names are not case-sensitive, but passwords are.
Note: Once logged in, any user can change his or her own password by selecting Tools >
Change My Password... and completing the PASSWORD CHANGE dialog. The admin user may
take advantage of this feature by creating new user accounts with a temporary password,
providing it to the user, and asking the user to change the password.

Preferences
Archive/Synchronize
CIRRUS HD-OCT gives you a way to modify the default archive behavior for both Native
and DICOM Archive modes. Select Records > Preferences... to access the PREFERENCES
dialog at the Archive/Synchronize tab.

Figure 2-5: Preferences > Archive/Synchronize

Figure 2-5 displays the default settings for Archive/Synchronize. It is possible to

select one, neither or both Start up and Shutdown. When finished selecting your
preferences, click OK to save your changes and exit, or click Cancel to exit without saving.
The options are described below.

Archive Alert
By default, the system alerts you to the presence of unarchived exams upon shutdown and
asks if you want to archive them. Should you choose neither archive checkbox, the system
will not prompt you to archive at all. However, when the hard disk status turns yellow, you
may have to archive exams in order to clear enough archived exams to return the status to
green. At that time, archiving may take several hours. You must archive if the hard disk

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status turns red and you cannot clear enough space to enable scanning and analysis. You
can archive manually at any time by selecting Records > Archive Now.

Normative Data Settings (Option)

If you have the optional Asian Normative Database License, the Normative Data Settings
tab is displayed in the Preferences dialog.

Figure 2-6: Preferences > Normative Data Settings

The normative database selected from the Normative Data menu becomes the default
setting used for image normative data analysis for all patients on the system, unless a
different normative database is specified in a patient’s record (see Add New Patient
Tab on page 3-5 on page 3-5). If you do not have an optional Asian Normative Database
license, the Diversified normative database is used and the Normative Data Settings tab is
not shown.

DICOM Archive
Select Records > Preferences... to access the PREFERENCES dialog, and then select the
DICOM Archive tab.
In DICOM Archive Mode, the available options are shown in Figure 2-7. Checked options
are the defaults—uncheck a checkbox to deselect an option. When finished, click OK to
save those options or Cancel to leave this dialog.

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Figure 2-7: Preferences > DICOM Archive – DICOM Archive Mode

Enable Auto-Query/Retrieve: This option enables automatic query and retrieval from the
FORUM® DICOM archive. Deselect this option when there is limited or no connectivity to
the FORUM DICOM archive. Query and retrieval must be manually performed using
Records > DICOM Retrieve.
Purge Archived Data for Current Patient after Finishing Analysis: With data already saved
to the DICOM Archive, this option automatically deletes current patient data from the local
database when you click Finish on the ANALYSIS screen.
Purge Archived Data for all Patients at Shutdown: With data already saved to the DICOM
Archive, this option deletes all patient data from the local database when you shut down
the CIRRUS application.
Note: Local data is purged after archiving by default. This ensures that the DICOM archive
contains the only copy of the patient exam record. It is strongly recommended to keep both
Purge Archive Data settings enabled as shown in Figure 2-7. If the user chooses to
disable either Purge Archived Data option, then the user must ensure that the local data is
kept consistent with the DICOM Archive.
Send OP and OPT IODs During Archive (Except After Saving): This functionality enables
exporting image files from the instrument or CIRRUS Review Software in a standard DICOM
format for viewing on a remote station. See the CIRRUS HD-OCT User Manual, Chapter 9
and 10, for more information. With this option enabled, you may choose the desired
prompt option:
• Send Without Prompt
• Prompt Before Sending
Enable Auto-Archive: This option enables automatic archiving of newly acquired exams or
a modified analysis. Deselect this option when there is limited or no connectivity to the
DICOM Archive. Exam data or modified analyses must be manually archived using Records
> DICOM Archive, if Auto-Archive is disabled.
When this option is enabled, you may choose the desired archive function:

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• Archive Current Exam After Saving

• Archive Today’s Exams After Finishing Analysis
In Native Archive Mode, you still have access to the Modality Worklist from the Modality
Worklist Provider (Figure 2-8). With this option enabled, you may choose the desired
prompt option:
• Send Without Prompt
• Prompt Before Sending
However, if the Modality Worklist Provider is not accessible, you may want to disable the
Auto-Query feature of the Modality Worklist to improve performance by unchecking the
checkbox next to Enable Auto-Query of Modality Worklist. Click OK.

Figure 2-8: Preferences > DICOM Archive – Native Archive Mode (Auto-Query Enabled)

Display Options
A third option in the PREFERENCES dialog, for both Native and DICOM Archive modes, is the
Display Options, shown in Figure 2-9. This allows you to change the default setting,
Find Existing Patients, to Today’s Patients. Click the desired option, then click OK.

Figure 2-9: Preferences > Display Options

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IPv4 / IPv6
CIRRUS instruments and CIRRUS Review Software work on networks that support Internet
Protocol version 6, as well as version 4. This option allows you to select the desired Internet
Protocol version, as shown in Figure 2-10.

Figure 2-10: Preferences > IPv4 / IPv6

Preventive Maintenance Service Notifier

To enable or disable an on-screen reminder at startup when preventive maintenance is
due,
1. Select Preferences from the Records menu, and then click the Preventive Maintenance
tab.
2. Select or deselect the Enable checkbox.
3. Enter your Zeiss customer care number in the Phone Number field, and then click OK.
Note: The service notifier displays the next Preventive Maintenance date during
software startup from 14 days before service is due until Field Service completes the
scheduled maintenance and resets the date for the next required service.

Figure 2-11: Preferences > Preventive Maintenance

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Operational Modes and Screens

The CIRRUS HD-OCT operates in four modes, three of which are associated with a primary
screen:
Table 2-1: Operational Modes and Screens
Operational Mode Primary Associated Screen
Data Management Mode None
ID Patient Mode ID Patient Screen
Acquire Mode Acquire Screen
Analyze Mode Analyze Screen

Sequence of Operation
The flow chart below illustrates the sequence of operation and the relationship of the
operational modes.

System Start Data Management, e.g.:

•Record Management
•Archive / Retrieve
User Login •Backup •Export
•User / Password Management
•Disk Space Monitor
ID Patient
Other Functions, e.g.:
•Institution Identity

Acquire Analyze

Figure 2-12: Sequence of Operation

ID Patient mode is the default mode when you log in to CIRRUS HD-OCT. It is the launch
point for the clinical functions of CIRRUS HD-OCT: scan acquisition and analysis. You must
identify a patient before you can either acquire or analyze exam data; and when you finish
scan acquisition or analysis, you return to ID Patient mode. Other screens and dialogs are
regularly used within each mode, as a subset of the primary function (e.g., scan review
before save), or as an adjunct, like printing analysis output.
Data management mode operates independently and has no primary screen; it operates in
various screens, which you access via menu options. Data management functions critical
for data preservation, like backup, operate automatically.
Some functions do not fall strictly within any of the four modes, for example, customization
of exam protocols. These functions you also access via menu options.
This manual will introduce each screen and dialog in relevant sections that explain its use.

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Common Screen Elements

This section describes elements of the CIRRUS screen that are always present, although their
content and status varies depending on the current context. These common elements are:
• Patient Information Area on page 2-12, page 2-12
• Menu Bar and Menus on page 2-13, page 2-13
• Navigation Bar on page 2-16, page 2-16
• Status Area on page 2-17, page 2-17
These elements are illustrated in the sample screen below.
1 2

4 3
1 Patient information area 2 Menu bar 3 Navigation bar 4 Status area

Figure 2-13: Sample Screen Showing Common Elements

Patient Information Area

This area from upper left to upper middle displays basic patient information (name, ID,
gender, date of birth). Towards the middle it shows the current subject eye, when in
Acquire or Analyze mode.
Note: This area remains blank until you select a patient.
Note: The date of birth must be entered in the MM-DD-YYYY format, and always appears
this way in the software and printouts.

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Menu Bar and Menus

The menu bar appears at upper right and contains the Records, Edit, Tools, and Help
menus. Click to select menus and menu items. Note the following general characteristics of
the menus.

Figure 2-14: Menu Bar (upper right)

• Disabled menu items appear in gray. These items are not available in the current
context.
• Items with an ellipsis [“...”] following indicate the menu item launches a dialog giving
you further options before the command is executed.
The table below identifies and describes the items in each menu, and indicates when each
item is enabled. Note the keyboard shortcuts to the right of applicable menu items.
Menu Items and Descriptions Enabled in Mode
• Clear Archived Exams: Prompts you to clear exams when ID Patient mode
disc space is low.
Records Menu – DICOM Archive • Preferences...: Archive/Synchronize: During instrument ID Patient mode
startup or shutdown, alerts the user to archive exams and
purge data after archiving. Normative Database Settings
allows selection of the normative database to be used as
the default. Display Options allows change to default
setting. DICOM Archive allows you to disable Auto-Query
and/or Auto-Archive. IPv4 / IPv6 allows you to select
Internet Protocol version.
• DICOM Archive: Allows archive of patient records through ID Patient mode
the DICOM server.
• DICOM Retrieve: Allows retrieval of patient records ID Patient mode
through the DICOM server.
• Search Worklist Patients...: Opens the MODALITY WORKLIST ID Patient mode
dialog, allowing you to set parameters for patient search
through the DICOM server.
• Import Exams...: Opens the IMPORT OPTIONS dialog to ID Patient mode
import a CIRRUS export database or to select specific
patients to import.
• Export Exams...: Opens the EXPORT OPTIONS dialog, where ID Patient mode
you can select and export patient records.
• Print Patient list...: Prints patient list that is displayed on ID Patient mode
the main screen.
• Print Today’s Patient list...: Prints today’s patient list that is ID Patient mode
displayed on the View Today’s Patients tab.

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Menu Items and Descriptions Enabled in Mode

Records Menu – Native Archive • Retrieve Archived Exams...: Retrieves selected archived ID Patient mode
exams from the Native archive.
• Archive Now...: Archives all unarchived exams to the ID Patient mode
Native archive.
• Clear Archived Exams: Prompts you to clear exams when ID Patient mode
disc space is low.
• Archive Management: In Native Archive mode only, allows ID Patient mode
you to create archive locations and set default parameters.
• Preferences...: Archive/Synchronize: During instrument ID Patient mode
startup or shutdown, alerts the user to archive exams.
Selecting DICOM Archive, user may disable Auto-Query of
Modality Worklist. Display Options allows change to
default setting. IPv4 / IPv6 allows you to select Internet
Protocol version 4 or 6.
• Search Worklist Patients...: Opens the MODALITY WORKLIST ID Patient mode
dialog, allowing you to set parameters for patient search
through the DICOM Worklist server.
• Import Exams...: Opens the IMPORT OPTIONS dialog to ID Patient mode
import a CIRRUS export database or to select specific
patients to import.
• Export Exams...: Opens the EXPORT OPTIONS dialog, where ID Patient mode
you can select and export patient records.
• Print Patient list...: Prints patient list that is displayed on ID Patient mode
the main screen.
• Print Today’s Patient list...: Prints today’s patient list that is ID Patient mode
displayed on the View Today’s Patients tab.

• Patient Record...: Opens the PATIENT EDIT dialog for the ID Patient mode with a
Edit Menu – Native Archive
current patient, to view and/or edit the record. patient selected
• Merge Two Patients...: Opens the PATIENT MERGE dialog, ID Patient mode
where you can select two patient records to merge.
• Delete Patient: Generates a confirmation prompt, asking ID Patient mode with a
user if they wish to delete the selected or opened patient patient selected
record from the database.
• Move Scan...: Opens the MOVE SCAN dialog, where you can Analyze mode
select a patient file to move the selected scan into.
Edit Menu – DICOM Archive • Patient Record...: Enabled in DICOM Archive Mode, if a record is selected, but only to
use the Add/Remove Categories tab. If no record is selected, then all options are
disabled.

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Menu Items and Descriptions Enabled in Mode

• Live Fundus Overlay: Toggles the display of the overlay on Acquire mode
Help Menu or off. When off, only the outline of the scan region is
visible (the bounding box) and not the vertical and
horizontal slice locations. The default is checked (overlay
visible).
• Colored OCT: Toggles the display of OCT images from color Acquire and Analyze modes
to grayscale.
• Live OCT Center Lines: Toggles the display of a vertical Acquire mode
“centering” line on OCT images. The default is checked
(center lines visible).
• Auto Repeat: Automatically adjusts the ocular lens and Acquire mode
chinrest to the previous settings for the same patient, eye,
and acquisition function.
• Tracking: Toggles FastTrac™ on or off as a global choice Acquire mode
for all scans (Model 4000 only).
• Print Configuration...: Opens the PRINTOUT CONFIGURATION Always
dialog, where you can select the printout options for
Macular Thickness, ONH, and (HD 5 Line) Raster, as well
as set Macula MultiSlice parameters.
• Change My Password...: Enables you to change the Always, except for admin
password for the current user. user

Tools > Options • Options...: Enables access to the following options. Always
• Categories...: Enables you to create, edit, or delete ID Patient mode
categories, which you can apply to patient records and
search with.
• Institution Edit...: Enables you to customize your CIRRUS When logged in as admin
HD-OCT and reports generated from it by adding or user
editing the institution name, ID Issuer, and optional logo
graphic.
• Equipment Edit...: Open the EQUIPMENT EDIT dialog, When logged in as admin
where you can create a station name for the instrument, user
create DICOM AE Title, and view other equipment
information.
• Users...: Enables you to create, edit, or delete staff as When logged in as admin
users and designate their user privileges. user
• Select Database...: Enables you to switch between Review Software
different instrument databases.

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Menu Items and Descriptions Enabled in Mode

• Keyboard Mouse Shortcuts...: Displays a categorized Always
listing of keyboard shortcut keys and mouse functions.
• On-Line Manual: Opens the CIRRUS User Manual PDF. Always
• License Registration...: Enables you to register a license Always
through the License Registration Utility that appears when
you select a license type.
• View Licenses...: Opens the VIEW LICENSED FEATURES dialog, Always
where you can view the licensing status of optional
features.
• License Mode: Enables you to configure the licensing Review Software
option: Use floating licenses from FORUM or Use (DICOM Mode) Only
Node-Lock Licensing.
• Service Support...: Enables you to select the TeleService Always
web link for remote online servicing of the instrument, and
save a Log file for troubleshooting.
• About....: Displays the ABOUT dialog, which provides Always
software version information.

Keyboard and Mouse Shortcuts

CIRRUS provides keyboard and mouse shortcuts in many contexts. Commonly used or
recommended shortcuts are addressed in relevant sections of this manual. To access
categorized list of all available shortcuts, click Help > Keyboard Mouse Shortcuts... or press
the F1 key.

Navigation Bar
The navigation bar, consisting of a series of buttons by which you access functions or other
operational modes, appears at lower right and across most of the bottom of the screen.

Figure 2-15: Navigation Bar (along bottom)

• ID Patient: Returns you to the ID PATIENT screen.

• Acquire: Initiates scan acquisition. Only active when a patient is selected.
• Analyze: Initiates analysis. Only active when a patient with saved scans is selected.
• Finish: Exits the current activity (scan or analyze) and returns you to the appropriate
screen. Only active when in Acquire or Analyze modes.

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Status Area
The status area at bottom left presents current status information using a single
green-yellow-red indicator.

Figure 2-16: Status Area Showing Yellow Indicator (lower left)

Overall Status by Color

The overall instrument status is communicated by the color. The colors have the following
meanings:
• Green means OK or normal: The instrument is functioning normally.
• Yellow means warning: The instrument is operational but a problem or set of problems
exist.
• Red means critical: One or more serious problems exists that restricts use of the
instrument.

Components of Status
The following components contribute to the overall status.
Note: Mouse over the status indicator and popup text will explain the current status in
terms of the status components below.

Instrument Status
Indicates whether or not the instrument hardware is in communication with the system
computer, and therefore capable of acquiring new scans. It can report status as either
ready to acquire scans (green) or unable to acquire new scans (red).
• Red: If instrument status is red, we suggest you cycle power (power off and then
power on the instrument). If the problem persists, contact CZM customer service.

Hard Disk Status

Indicates available hard disk space status. It can report three statuses:
• Green: Adequate free hard disk space.
• Yellow: Low hard disk space. When free hard disk space is low at startup, you must
click Continue at system start before continuing to the login screen. Also, the system
prompts you to clear archived exam data.
• Red: Critically low hard disk space. When hard disk space is critically low, the Acquire
button is disabled. You must clear a sufficient amount of hard disk space by clearing
archived exams to continue. If there are insufficient archived exams to be cleared, you
must first archive exams and then clear them. You cannot clear unarchived exams.
Once you have created space on your hard drive, the indicator will change to green.
However, the Acquire button remains disabled until you shut down, then restart the
CIRRUS application.

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Network (Archive) Status

Indicates available network (archive) storage space and availability status. It can report
three statuses:
• Green: Network available with adequate network archive disk space.
• Yellow: Low network archive disk space or network unavailable. When archive disk
space is low, you will be prompted to change the archive location, but you can
continue using the same archive location for now. The message Archive volume is not
available indicates that the current archive location is not accessible.
• Red: Critically low network archive disk space. When archive disk space is critically
low, CIRRUS will stop archiving to this location. You must change to a new archive
location to re-start archiving.

DICOM Connectivity Status

• Green: DICOM functions, if DICOM was selected during installation, are normal.
Note: On rare occasions, the DICOM features may not actually be available even though
the Status Indicator is green, indicating that you are connected to DICOM. If this occurs,
check the DICOM Gateway Configuration IP address (see the DICOM Gateway User
Manual ) and ensure that the IP address is set to: 127.0.0.1
• Red: Networking and search errors are reported, along with recommendations for
resolution.

Performance Verification Check for Models 400/4000

With the Performance Verification Check, you can verify that the fundus image of CIRRUS
HD-OCT model 5000 instruments and the OCT scan image overlay are aligned within
specifications as defined by the target inside the Verification Test Tool. Practically, this
means the scan actually is placed where it appears to be placed, based on the fundus
image. You can re-try the check if it does not pass initially. Upon failure of a performance
verification check, data acquired since the last successful check may not be reliable.
Frequency: Weekly, at the beginning of each week you will acquire new scans.
Time Required for Test: Approximately 2 minutes.
Verification Test Tool Required: We provide this tool with each instrument. It contains
fragile parts that must be maintained in their original position for the test measurements to
be accurate. Handle it carefully to avoid dropping. Damage to the Verification Test Tool
can affect test results. If you drop it, we recommend that you do not use it for testing, and
immediately contact ZEISS customer service. In the U.S., call 800-341-6968. Outside the
U.S., contact your local ZEISS distributor.

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Install the Verification Test Tool

Install the Verification Test Tool in the correct orientation, with the part that says “Top”
facing upward. The tool has short pegs at upper left and lower right, and thumbscrews at
upper right and lower left. Each of these corresponds with a hole on the face of the ocular
lens housing.
Using only your fingers, turn the screws (clockwise) on top and bottom to secure the tool in
place. To avoid dropping the tool, make sure that both screws are tight before releasing
the tool.

Figure 2-17: Proper Installation of Verification Test Tool

Run the Check

To run the check, follow these steps:
1. In the ID PATIENT screen, select the patient named Performance Verification and then
click Acquire.
Note: You cannot edit or delete the Performance Verification patient record.
The ACQUIRE screen appears, showing a default Macular Cube 512x128 scan.
2. Select Macular Cube 200x200 in the scan list.

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Select
Macular Cube 200x200

Click Auto Focus

Figure 2-18: Performance Check – Macular Cube 200x200 Selected

3. Click Auto Focus to get a clearer image of the checkered test pattern. (Use the focus
arrows if your system does not have Auto Focus activated.) Besides focus, other
adjustments usually are not necessary, although possible.
4. Click Capture and then select OD or OS in the SELECT EYE dialog that appears. The
REVIEW screen appears automatically.
Note: Pay no attention to the image appearance nor to the signal strength value in the
REVIEW screen. They have no bearing on the co-alignment of the scan and fundus images,
which is what this test evaluates. If necessary, you can adjust the brightness and contrast
later in the ANALYZE screen when evaluating the test.
5. Click Save and then either Finish or ID Patient to exit data acquisition. You will return
to the ID PATIENT screen.
6. Select the Performance Verification patient again and click Analyze.

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7. In the ANALYZE screen, select the scan you just saved. Select Macular Thickness
Analysis in the right-hand column.

Select OCT Fundus overlay

Set Transparency to zero

Figure 2-19: Performance Verification Analyze Screen Initially

8. When the scan loads, select OCT Fundus in the Overlay drop-down menu and set the
Transparency slider to zero. Then double-click anywhere on the fundus image to make
it appear full screen.

Drag triangles
to center scan lines

Central black square

contains white cross
=alignment target

Figure 2-20: Fundus Viewport Full Screen With 0% Transparency (Opaque)

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Note the checkerboard pattern and in particular the smallest black square in the cen-
ter of the target. The alignment target is the central white cross within the center
square. The white cross defines the acceptable range of alignment between the fun-
dus image and the OCT scan image, as explained below.
Note: When the blue and magenta lines are correctly centered, you may find it difficult to
see the central white cross in the center square, because the scan lines are nearly as thick
as the white lines that comprise the central cross.
9. With Transparency set at 0% (opaque), use the triangles to drag the horizontal and
vertical scan line indicators until they intersect in the very center of the central small
black square. Centered this way, they should mostly cover the central white cross,
which is the alignment target.

Figure 2-21: Blue and Magenta Lines Centered on Alignment Target

Note: For the Model 400 only, the checkerboard pattern may be faint. Right-click the
checkerboard to access a list of image display options. Click Brightness/Contrast. To darken
the image, move the cursor horizontally to change the contrast and/or move it vertically to
change the brightness.

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10. Click Back at upper right (or double-click anywhere) to exit full screen mode.

Change Transparency
from 0% to 100%

11.Now move the Transparency slider to 100% (transparent) and double-click again to
make the fundus image appear full screen. Now you are ready to evaluate the test.

Pass Condition
• Pass: After changing the Transparency to 100%, if both scan line indicators pass
partially or wholly within the white cross portion of the center square, the system
passes the check. This means the co-alignment of the fundus image and the OCT scan
image is within the acceptable range. Some examples of pass conditions appear
below.

Pass—both lines centered Pass—horizontal line marginal, but OK Pass—vertical line marginal, but OK
Figure 2-22: Examples of Pass Conditions

Failure Condition
• Fail: After changing the Transparency to 100%, if one or both scan line indicators
pass clearly within the black portion of the center square, the system fails the check.
Some examples of failure conditions appear below.

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In effect, when there is a failure condition, you can clearly see that one or both of the
scan line indicators fail to pass within, even marginally, the central white cross in the
center square.

Fail—horizontal line clearly within black Fail—vertical line clearly within black
Figure 2-23: Examples of Failure Conditions

Note: Evaluation is somewhat subjective. We offer the examples above as guidelines. If you
drag the scan lines, you will observe that there is only a two or three pixel range of
movement while still within the pass condition, and only a one pixel difference between a
marginal pass and a failure. The central white cross defines a stringent range of tolerance.
Therefore, you should confirm a failure only if the scan line indicators lie wholly within the
black of the central square.
• To confirm your observation, you should switch back to 0% Transparency.
• If your observation is confirmed initially, you should remove and re-install the test
tool to ensure it is seated properly and then run the check again.
• If the system still fails the test, contact ZEISS customer service. In the U.S., call
800-341-6968. Outside the U.S., contact your local ZEISS distributor.
If you want to repeat the test, we recommend you first remove and re-install the test tool.

Anterior Segment Module Calibration for Anterior

Chamber and Cornea External Lenses (licensed option)
The Anterior Segment Module Calibration application acquires calibration values for the
internal, Anterior Chamber, and Cornea lenses that are required for anterior segment scans
on 400 and 4000 instruments.

Install the Set Screws on the Imaging Aperture

Before calibrating the external lenses, ensure the set screws that came with the external
lenses box are installed on the imaging aperture. The small vial included with the external

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lenses box contains two set screws, a short-handle screwdriver, and a instructional
pictorial.

To install the set screws

• On the imaging aperture of the instrument,
insert one screw in the top right mounting
hole and the other screw in the bottom left
mounting hole, as shown
• Use the short-handle screwdriver to tighten
each screw fully into the mounting hole so
the screw head is flush with the imaging
aperture exterior, as shown.

To calibrate the internal, Anterior Chamber, and Cornea lenses

1. On the Windows desktop, click the Microsoft Windows Start button , and then
click All Programs.
2. In the Carl Zeiss Meditec folder, double-click the Anterior Segment Module Calibration
Wizard file.
3. In the LENS CALIBRATION welcome dialog, click Next to start hardware initiation.
4. When the application completes hardware initialization, follow the displayed
instructions to mount the calibration tool, and then click Next.
Note: For the initial calibration, all three lenses must be calibrated. Calibrate the
internal lens first, and then repeat the procedure for the external lenses. For CIRRUS
HD-OCT 400 and 4000 external lenses, mount the lens you want to calibrate before
selecting it in the SELECT LENS TO CALIBRATE dialog box.
5. In the SELECT LENS TO CALIBRATE dialog box, check the lens you want to calibrate, and
then click Next.
Note: The status column of the dialog box indicates the calibration status for each of
the lens options.
6. When the calibration of a lens is complete, in the COMPLETING THE ANTERIOR SEGMENT
CALIBRATION WIZARD dialog:
• Click Next to return to the SELECT LENS TO CALIBRATE dialog box to repeat the
calibration for another lens.
or
• Click Finish to close the application.

Power Down the System

You can power down the system either through hardware or through software.
CAUTION: We strongly recommend you power down through software to permit
automatic archiving on shutdown and to avoid abrupt shutdowns that could result
in loss of patient data.

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Power Down Through Software

1. Click Logout at the upper right on the ID PATIENT screen.
2. If archive is set to occur upon shutdown in both Native and DICOM Archive modes
(see the CIRRUS HD-OCT User Manual, Chapter 9), the system will prompt you to
archive.

Figure 2-24: Archive Prompt Dialog – Native Archive Mode

Execute the desired option to advance to the EXIT DIALOG.

3. When you archive or close the ARCHIVE dialog (see above), the EXIT DIALOG will ask if
you are sure you want to exit.

Figure 2-25: Exit Dialog

4. Click Yes to exit the CIRRUS software.

• If you click No, the LOGIN dialog will appear.
After you exit the system software through the soft shutdown sequence, you will have
access to the computer operating system underlying the system software. To conclude
system shutdown, you must click Start > Shut Down, select Shut Down, and then OK, as
with any PC.

Power Down Through Hardware

CAUTION: We strongly recommend you power down through software to permit
automatic archiving on shutdown and to avoid abrupt shutdowns that could result
in loss of patient data.

To power down through hardware, press the system power switch. The system will
automatically close the operating system and power down the system. You will not have
access to the computer operating system.

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(3) Acquire Scans

Chapter Overview
This chapter explains in detail how to acquire CIRRUS HD-OCT scans. It covers the
following steps:
• Prepare the Patient
• Identify a Patient
• Select Scan Type
• Preparing the Patient for the Exam Experience
• Select the Fixation Method
• Acquire Scan
• Guidelines for Obtaining Good Quality Scans
• Acquire Screen for Posterior Segment Raster Scans
• Guidelines for Obtaining Good Quality Scans

Prepare the Patient

Note: The forehead and chinrests should be cleaned between each examination with an
alcohol prep wipe.

Precautions
CAUTION: When you complete scan acquisition and before you click the Finish or ID
Patient button in the ACQUIRE screen, always prompt the patient to sit back and
move the head away from the chinrest. Clicking either of these buttons in the
ACQUIRE screen causes the chinrest to reposition itself beyond the point where the
patient’s face would contact the lens if the head remained in the chinrest. Failure to
observe this warning could result in injury to the patient.

In the ACQUIRE screen, have patient sit back before you click Finish or ID Patient.

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CAUTION: The operator should check that the patient is not holding on to the
instrument before or during tests. Although movement of the motorized chinrest is
slow, giving plenty of warning for patients to remove their fingers, there is potential
for fingers to be squeezed and possibly injured if left in the area shown below.

Keep fingers
clear of this area
(on both sides)

Identify a Patient
Scanning and analysis are disabled until you identify a patient. Use the ID PATIENT screen to
identify (select or add) a patient. After system start and login, the ID PATIENT screen appears
by default. (From other modes, click ID Patient to return to the ID PATIENT screen.) You can
identify a patient using any of the three tabs provided. For details on using these tabs to
identify a patient, see the indicated sections.
• Find Existing Patient Tab, page 3-3
• Add New Patient Tab, page 3-5
• View Today’s Patients Tab, page 3-7
On any of the three tabs, once you identify the patient, click Acquire to initiate a new exam
for that patient. The ACQUIRE screen appears. Proceed to Select Scan Type on page 3-8.

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Find Existing Patient Tab

On the Find Existing Patient tab (the default setting), you can select a patient from the
patient list displayed.
Note: The list is blank until you search.

Figure 3-1: ID Patient Screen – Find Existing Patient

Note: To change your default setting, go to Records > Preferences > Display Options and
click the Today’s Patients radio button, then click OK (see Figure 3-2 below).

Figure 3-2: Display Options Dialog

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To populate the patient list:

1. Click Search to return all patients in the index database. In DICOM Archive mode,
patients from both local and DICOM databases are returned.
2. To search for patients by Last Name or Patient ID, type in the corresponding fields
and click Search or press Enter. You can search using partial information, and you can
use one or both fields. You may also search by entering a wildcard in the Last Name
field. The table below shows examples using the letter “s”.

To retrieve all names Enter

ending with the letter s *s
• starting with the letter s s*
• containing the letter s *s*

Note: Searches in local and DICOM databases that contain large numbers of records may
exceed configured limits. When this occurs, the user is notified via a Status Bar message
that the list of displayed patients has been truncated. In this case, narrow your search
parameters. Click Advanced Search if you want to search using additional parameters—
see the CIRRUS HD-OCT User Manual, Chapter 8.
• The search returns all patients that match all defined parameters, sorted
alphabetically.
• When you search by Last Name, the search returns all patients that match from the
beginning of the last name.
• In the Results list, you can select only one patient at a time. When you select a
patient, the Acquire button becomes active. If the patient has saved exams, the
Analyze button becomes active.

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Add New Patient Tab

To add a new patient, click the Add New Patient tab (Figure 3-3) and fill in at least
the required fields, which are indicated in bold type.

Figure 3-3: Add New Patient Tab of the ID Patient Screen

Note: The date of birth must be entered in the correct format that matches your Windows
regional settings, and always appears this way in the software and printouts.
• If you want to enter additional information, click More and continue. The PATIENT EDIT
dialog will appear. For details, see the CIRRUS HD-OCT User Manual, Chapter 8.
• A Patient ID is required for all patient files. No patient data can be saved without a
patient ID. If you choose not to assign an ID, you may click Generate ID to have the
system create a unique ID automatically for this patient. Patient IDs generated by
CIRRUS all start with the prefix “CZMI”. Because a Patient ID is required for
DICOM-compliant import and export of patient data, the system also creates a unique
Patient ID when you export data for any patient that was created without a Patient ID
(under previous software versions).
• Entering Patient Refractive Error: You may enter the refractive error in spherical
equivalents (Diopters) for each eye on the patient demographic entry screen if desired.
If you have entered a refractive error for a patient, the instrument will automatically
set the focus based on this information when you advance to the acquisition screen.
You may not need to use the Auto Focus feature if you entered a refractive error. You
may need to use the focus arrows to manually adjust the focus for optimal clarity.
• The CIRRUS HD-OCT instrument comes with a database called the Diversified
Database (see the CIRRUS HD-OCT User Manual, Appendices D, E, and F for more

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information) to which you may compare your patient’s scanned data. An additional
database, the Asian Normative Database1 (see the CIRRUS HD-OCT User Manual,
Appendix H for more information), is also available as a separately licensed feature. If
you have not licensed this feature it will not appear in the Add New Patient tab.
The system default normative database (see Archive Alert on page 2-6) is used
unless a specific normative database is selected for a patient. To select or change the
normative database used for a specific patient click the Normative Database
drop-down menu and select one of the two choices, Diversified or Asian (see Figure
3-4 below).

Figure 3-4: Selecting the Normative Database

Once the change is made for a given patient, the last chosen database is automatically
selected for subsequent exams for that patient. If the drop-down menu is blank, the system
default normative database is used, as shown to the right of the drop-down menu.
• When you click Save, the new patient information is saved to the database and to the
list of today’s patients. If data is missing from required fields, the Save button will not
be enabled.

1. The Asian Normative Database is an optional feature that may not be available in all markets, and when available in a market, may
not be activated on all instruments. If you do not have this feature and want to purchase it, contact Carl Zeiss Meditec. In the U.S.A.,
call 1-877-486-7473; outside the U.S.A., contact your local ZEISS distributor.

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View Today’s Patients Tab

To select a patient from the list of today’s patients, select the View Today’s Patients
(Figure 3-5) tab.

Figure 3-5: View Today’s Patients tab of the ID Patient Screen

How Today’s Patients List Is Populated

Today’s patients list is populated automatically with the following:
• New patients added today on local CIRRUS instrument.
• Patients with new exams completed today.
If in DICOM Archive mode, and FORUM is being used as the DICOM Archive, this
includes exams completed today from all CIRRUS instruments connected to your
network.
• Patients scheduled for this CIRRUS instrument (DICOM Archive mode only).
• Imported exams (see the CIRRUS HD-OCT User Manual, Chapter 10).
The list is sorted alphabetically by last name.
Note: If the selected patient is retrieved from the DICOM server and has more than one visit
scheduled today, a study selection dialog (Figure 3-6) asks the user to select the desired
visit from the list.

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Figure 3-6: Study Selection Dialog

Select Scan Type

After you identify a patient and click Acquire, the ACQUIRE screen appears, as in Figure
3-8 on page 3-12. At the top of the screen, two scan lists contain the list of scans—the
left list is for the right eye, and the right list for the left eye. CIRRUS HD-OCT detects the eye
being scanned using a sensor in the chinrest. Unless the patient’s chin is in the chinrest for
the left eye (white line on chinrest), the first scan type for the right eye is selected by
default. You may select any scan type by clicking it—scroll down to see more scan types.
As you acquire and save scans, the scan list indicates scan acquisition with a green
checkmark to the left and shows the number of saved scans of that type to the right of the
scan name.
Note: For 400/4000 instruments, if a scan type requires an external lens, it does not
appear in the scan type list until the lens required for the scan is selected from the lens
menu.
Before the patient puts his or her head in the chinrest, click to select the desired scan type
for either eye. The automated chinrest will go to the default position for the selected scan
type and eye. By selecting an anterior segment scan, the CIRRUS HD-OCT will bring the
internal lens into position (you may hear a click while this occurs) and dim the illumination
to avoid pupillary constriction by default.
Note: The first scan selection and scan of the day will run slightly slower than all later
scans.
The same scan types for each eye are listed near the top of the screen. CIRRUS HD-OCT
provides the following scan types for posterior and anterior segment scans.

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Posterior Segment Scans

Cube Scans

Macular Cube 512x128 Macular Cube 200x200 Optic Disc Cube 200x200

• Macular Cube 512x128: This scan generates a cube of data through a 6 mm square
grid by acquiring a series of 128 horizontal scan lines each composed of 512 A-scans.
• Note: The Macular Cube 512x128 is the default scan. Compared to the 200x200, this
scan has greater resolution in each line from left to right, but the lines are spaced
further apart, giving less resolution from top to bottom.
• Macular Cube 200x200: This scan generates a cube of data through a 6 mm square
grid by acquiring a series of 200 horizontal scan lines each composed of 200 A-scans.
• Optic Disc Cube 200x200: This scan generates a cube of data through a 6 mm square
grid by acquiring a series of 200 horizontal scan lines each composed of 200 A-scans.
The Optic Disc Cube 200x200 has the same scan dimensions as the Macular Cube
200x200, except there are no high-definition scans acquired with the cube data and
the fixation target is offset to one side to allow the center of the optic nerve to move
to the center of the scan pattern. Also, the scan pattern overlay consists of concentric
rings to assist in the alignment of the optic disc (see Figure 3-10).

Raster Scans

HD 5 Line and 5 Line Raster HD 1 Line 20x from HD 5 Line Raster

• HD 5 Line Raster and HD 1 Line 20x: This scan generates 5 parallel B-scans using
1024 A-scans with an additional HD 1 Line 20x option that collapses the 5 lines into a
single high-definition scan. The scan can be positioned anywhere on the fundus
image and has an adjustable line length of 3, 6, or 9 mm, an adjustable angle of -89
to 90 degree, and adjustable spacing from 0 to 1.25 mm in increments of 0.025 mm.
• 5 Line Raster: This scan is the original version of the 5 line raster with less resolution
than the HD 5 Line Raster. The scan can be positioned anywhere on the fundus image

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and has an adjustable line length of 3, 6, or 9 mm, an adjustable angle of -89 to 90

degree, and adjustable spacing from 0 to 1.25 mm in increments of 0.025 mm.

Anterior Segment Scans1

See Chapter 4, Anterior Segment Scan Acquisition, for more information on anterior
segment scan acquisition, analysis, and reports.

Preparing the Patient for the Exam Experience

The patient’s exam experience with the CIRRUS HD-OCT is normally brief and comfortable.
An experienced operator can acquire several scans from each eye in the space of 5-7
minutes. An exam usually requires the patient to look inside the imaging aperture for 1-3
minutes at a time for each eye, depending on the number of scans desired. The instrument
acquires most scans in 1-5 seconds. The additional time is required to align the patient
before scanning and to optimize scan quality. The patient may sit back between scans as
needed. Note that the CIRRUS HD-OCT is never to contact the patient’s eye.
Note: It is not necessary for the patient to put their head on the chinrest until after the
desired scan type is selected. If you are using a prior scan (see Repeating Scan Setup
and Alignment on page 3-37) on a patient, the patient must wait until the prior scan
has been selected and the chinrest motions are complete before placing their head in the
chinrest. Reducing the amount of time the patient spends in the chinrest improves patient
comfort.

Optional Eyelid Elevation

To get a scan unobstructed by the eyelids, especially for vertical scans, you may find it
necessary to tape the eyelids of either eye or manually elevate the eyelid during scan
acquisition in accordance with standard medical practice. For many patients, it is sufficient
to ask them to open their eyes wide during scan acquisition.

Optional Dilation of Patient’s Eye(s) for Posterior Segment Scans

The minimum pupil size for CIRRUS HD-OCT is 2 mm. This can usually be achieved without
dilation. If dilation is performed on a subject for an exam, we recommend that dilation be
used on subsequent visits if quantitative comparisons will be made. Dilation should not
directly affect the quantitative measurements, but it may affect them indirectly by allowing
more variability in how the OCT beam enters the eye. Although such an effect should be
small, optimal repeatability will be achieved by imaging the patient in the same way at
every visit.

1. Anterior Segment Scan Acquisition and Analysis is an optional feature that may not be available in all markets and, when available in
a market, may not be on all instruments. If you do not have this feature and want to purchase it, contact ZEISS. In the U.S.A., call
1-877-486-7473; outside the U.S.A., contact your local ZEISS distributor.

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Select the Fixation Method

CIRRUS HD-OCT provides for internal fixation as the default method. This method is
preferred for its reproducibility and ease of use. However, if the patient’s visual acuity in
the subject eye precludes internal fixation, you have the option of attaching and using the
external fixation device, which is a light-emitting diode on the end of an adjustable arm.
The subject should be asked to fixate on the tip with the other eye in a way that the gaze
remains straight. Attach it to the port on the top of the instrument, and bend the flexible
arm to place it manually in the desired position.

What the Patient Sees

Before scan acquisition, the patient looks into the imaging aperture and sees a green
star-shaped fixation target (see Figure 3-7 below).

Figure 3-7: Fixation Target (Models 400/4000)

Instruct the patient to look at the center of the green target, and not at the moving red
lights (the scan beam). Normally, the patient can look inside the imaging aperture for
several minutes at a time without discomfort or tiredness.
Note: When the focus of the instrument has been set correctly by entering the refractive
error for the patient and/or using the Auto Focus button on the ACQUIRE screen of a posterior
segment scan, then the fixation target will appear approximately in focus for the patient.
On Model 400 instruments, for posterior segment scans, the patient sees the green fixation
target against a black background with a thin horizontal red line repeatedly scrolling from
the top of the screen to the bottom, which is the scan beam moving across the field of
view. When the scan beam reaches the bottom of the screen, thin red lines briefly flash,
showing the scan pattern of the selected scan type.
On Model 4000 instruments, for posterior segment scans, the patient sees the green
fixation target against a flashing red background. Flashing red lines show the scan pattern
of the selected scan type.
For the Optic Disc Cube 200x200 scan, the fixation target is offset to one side to allow the
center of the optic nerve to move to the center of the scan pattern.
For all anterior segment scans, the patient sees the green fixation target against a black
background. The flashing red lines of the scan pattern of the selected scan type are blurry.

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For all anterior segment scans, the fixation target cannot be moved from center. For
anterior segment scans that require an external lens, the fixation target is blurry.
When scan acquisition starts, the patient may notice the red lines scrolling and in some
cases at a different angle, depending on the selected scan type.
Moving the Fixation Target
To drag the fixation target, on the ACQUIRE screen (Figure 3-11), click and drag the
fixation target towards the desired position in the Fundus Viewport.

Acquire Scan
When you select Acquire, the ACQUIRE screen appears.
Note: See Chapter 4, Anterior Segment Scan Acquisition, for additional acquire
scan information for anteriors segment scans.
The the following example shows a Macular Cube 512x128 scan.
1 2 3 4 52 6 7 8

22

21

20
19
18 9

17
16
15

14 13 12 11 10
1 Patient information 11Reset center and enhance settings button 16 Fixation target
2 OD and OS scan lists and B-scan contrast and brightness 17 Scan pattern
3 Auto and manual diopter adjustment controls 18 Fundus viewport
4 Chinrest controls 12 FastTrac buttons 19 Prior scan link
5 Auto and manual B-scan enhancement 13 Reset fundus focus and fundus brightness 20Reset chinrest position button, iris
and contrast controls viewport manual brightness, contrast,
6 Left or right eye scan indicator
14 Reset scan pattern and reset fixation and illumination controls, Lens menu
7 Menus
target buttons 21 Iris viewport center of interest indicator
8 Logged-in user
15 Saved and adjusted diopter values, prior 22Iris viewport
9 B-scan viewports scan overlay transparency slider, auto
10Auto and manual center B-scan controls optimize B-scans and capture
Figure 3-8:Sample Acquire Screen (Macular Cube 512x128)

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Beneath the scan list, the screen is divided into three working areas:
• The Iris Viewport is at upper left, where you see a live video image of the iris and
pupil. You use this to center the scan beam through the pupil by clicking the pupil
center and/or using the X-Y and Z controls to the right. X means left and right; Y
means up and down; Z means forward and back.) The circular X-Y control is for
centering the pupil; it provides 8 directional options for moving the chinrest. The Z
controls (left-right arrows or mouse scroll wheel) help you to reach the proper working
X, Y, and Z Controls Explained distance by bringing the iris image into focus. (The iris image must be in focus for the
Auto Focus button in the Fundus Viewport to work properly.
X, Y, and Z refer to plane of motion.
• The Fundus Viewport is at the lower left, where for posterior segment scans you see a
X means left and right movement.
live fundus image from either the line scanning ophthalmoscope (LSO) on the Model
Y means up and down movement.
4000, or created using Live OCT Fundus™ technology on Model 400 instruments.
Z means forward and back movement.
There is no fundus image for anterior segment scans.
The scan pattern for the scan type is overlaid on the fundus image and a small green
cross indicating the location of the fixation target is displayed. (This green cross may
be partially obscured by the scan overlay.) You can adjust the patient’s fixation by
moving the fixation target (for details, see Place Scan Using Fundus Viewport
(Posterior Segment Scans) on page 3-16). Click and drag the scan pattern to
adjust scan placement.
For posterior segment scans, the Auto Focus button and Z controls (left-right Focus
arrows) help you to focus the fundus image. They also focus the fixation target for the
patient. You may not need to use the Auto Focus feature if you entered a refractive
error for the patient (see Add New Patient Tab on page 3-5). The red mark on the
Focus bar indicates the saved refractive error for the patient (in Diopters). The blue
mark indicates the current adjustment using the Auto Focus button and Z controls.
The Transparency slider is active when a saved scan image overlay is present, which
occurs when you are using a prior scan (see Repeating Scan Setup and Align-
ment on page 3-37).
• The scan display is on the right. The number of viewports vary depending on the scan
type. Each viewport includes a color-coded scan marker at upper left, to identify each
scan line. The color and orientation of each marker correspond to the color and
orientation of the lines that make up the scan pattern overlay from the Fundus
Viewport (for posterior segment scans) or the Iris Viewport (for anterior segment
scans). The Enhance (polarization) and Center (Z-offset) (posterior segment scans only)
buttons and sliders to the left help you improve the scan image quality and center it
Left to Right Scan Display vertically.
Summarized
Scan Display Left to Right Orientation
For horizontal scans, left equals left
and right equals right. For vertical CIRRUS always displays left to right scan images as follows:
scans, left to right equals bottom • For horizontal scans, left of scan equals left of scan display and right of scan equals
to top. For diagonal scans, left right of scan display.
takes precedence over bottom.

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• For vertical scans, bottom of scan equals left of scan display and top of scan equals
right of scan display.
• For diagonal scans in 5 Line Raster, left takes precedence over bottom, so that left of
scan equals left of scan display and right of scan equals right of scan display.

Patient Setup
Ensure that the patient’s chin and forehead rest comfortably in the chinrest and against the
forehead fixture. Adjust table height (if available) for patient comfort.

Alignment Controls
Proper alignment of the scan beam to the pupil is required in three dimensions, X, Y
(transverse), and Z (axial). CIRRUS provides automated alignment controls by clicking the
2
Iris Viewport, as well as manual controls both on-screen and via the keyboard (X-Y). These
Z Align
Scroll up to move controls will adjust the chinrest and forehead rest so that the eye is properly aligned for the
eye closer, or OCT scan. We recommend you use the automatic controls primarily, applying them with
1 the mouse, as illustrated on the left. The manual controls are to be used secondarily, for
X-Y Align fine-tuning the alignment when desired. The keyboard arrow controls correspond to the X-Y
Left-click controls. Press the Ctrl key with the keyboard arrow keys for finer adjustments. Adjustments
to center occur in discrete steps when you click and release. When you click and hold the arrow, the
adjustment motion becomes continuous until you release.

Scroll down to move • If necessary, remind the patient not to press against the head rest too firmly, so the
eye away forehead glides more easily across it during X-Y movements of the chinrest.
• The video image of the eye is clearest when the axial position (Z alignment) is correct.
You will begin to see an iris image once the patient is positioned in the chinrest (although
the image may be poorly resolved until properly focused). Alignment progresses through a
series of steps, although the order in which many of the steps are performed (and whether
they are repeated) will vary depending on the cooperativeness of the patient (e.g., whether
patients can fixate steadily at a requested location, opacity of their eye, etc.). In general,
the sequence of user steps for non-repeat visits is as follows.

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Align Eye Using Iris Viewport

1. Adjust the region of the iris visible in the Iris Viewport. Typically, make coarse adjustments
using the X-Y controls (that move the chinrest) as needed until the pupil is visible.
2. Focus the iris image using the controls to the right of the viewport. For focusing,
primarily use the Z controls. The mouse scroll wheel works well for fine adjustments.
Try to get the iris as clear as possible before proceeding to the next step.

Posterior segment centering target X-Y Controls

Align

Anterior Segment 5 Line Raster scan pattern Z Controls

Focus

Anterior Segment Cube 512x128 scan pattern

Click pupil center to align
Figure 3-9: Iris Viewport (Posterior Segment Scan) and Anterior Segment Scan Patterns

3. Center the pupil in the Iris Viewport by clicking the center of the pupil. (Clicking
anywhere in the Iris Viewport centers the field of view of the camera over the click
point). A centering target overlays the video image for posterior segment scans. For
anterior segment scans, a graphical scan pattern appears to show the alignment scan
pattern position, size, shape, and orientation (see Figure 3-9 above). It remains in
the center of the image and illustrates the path of the scan beam.
Note: For Model 4000 instruments only, you may see a reflection of a rectangular band
over the pupil, as seen in Figure 3-9 above. This artifact has no significance.

Options and Reset Buttons

The Iris Viewport area has a pair of buttons. The Options button opens to additional
controls, which allow adjustment of the image settings for that viewport. These controls
alter contrast (left vertical slider), brightness, and illumination (right vertical slider). The
area also has a Reset button , which resets the chinrest position to default. The reset
button within the options screen resets the contrast, brightness, and illumination.

Use Prior Scan Settings

The Auto Repeat function and Prior Scan links (see example links on the left) are available
if previous scans are available for this patient and eye. These functions repeat the chinrest
alignment and other parameters used during a prior scan for this patient and eye. This
should get you close to the correct alignment for the current scan, although you still may
need to make small adjustments. See Repeating Scan Setup and Alignment on page
3-37.

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Place Scan Using Fundus Viewport (Posterior Segment Scans)

Focus Fundus Viewport: For posterior segment scans, the Auto Focus button will attempt
to compensate for the patient’s refractive error by automatically changing the focus
adjustment. This may help clear up a dim fundus view and will also help clear up the
fixation target for a patient whose refractive error is considerable. In addition to improving
the overall focus, the Auto Focus feature will do an additional adjustment on the
brightness and contrast of the fundus image.
The focus arrows allow you to manually compensate for the patient’s refractive error. Click
the left arrow to add minus (-) power to compensate for myopic corrections; click the right
arrow for adding plus (+) to compensate for hyperopic corrections. Asking the patient if
the fixation target has cleared up after making a focus adjustment can help in some cases.
When optimized, these focus settings will be retained and can be used in the future via the
Auto Repeat function or Prior Scan links.

Auto Focus
and
Z focus controls

Focus bar

Overlay Transparency
control for prior scans

Click and drag scan pattern and/or fixation target to adjust their placement.
Double-click the point you wish to center. The fixation target moves accordingly.

Figure 3-10: Fundus Viewport (Optic Disc Scan)

Note: Ask the patient to hold their gaze and head steady during Auto Focus, as the
chinrest assembly moves during this procedure. After Auto Focus, it may be necessary to
check the Iris Viewport to ensure that the pupil is still centered. If the Fundus Viewport
turns dark following Auto Focus, center the pupil, click , then click the Auto B/C
button. If additional brightness and contrast changes are necessary, use the appropriate
slider controls (see Options and Reset Buttons on page 3-18).
(Optional) – Adjust scan pattern placement: To do this, move the mouse so the cursor
hovers within the space of the scan pattern or the alignment target. The cursor will turn
When you mouse over the fixation into a move symbol. Hold the left mouse button down and drag the mouse to control the
target or the scan pattern, the position of the scan pattern box. Release the mouse button to set the scan pattern in its
cursor becomes a hand or move new position. If the cursor hovers over the fixation target icon, the cursor turns into a hand
symbol, indicating that you can with a pointing finger. For Model 400 instruments, when moving the scan pattern box, the
click and drag to move it. Live OCT Fundus technology view also moves with the scan pattern box.(Optional) – Adjust

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region of view: There are a number of ways to adjust the region of the fundus image visible
within the Fundus Viewport. You can change the patient’s fixation by either
double-clicking anywhere on the fundus image to bring that point into the center of view,
or click and drag the fixation target. To drag the fixation target, on the ACQUIRE screen
(Figure 3-11), click and drag the fixation target towards the desired position in the
Fundus Viewport.

Fixation
target

Figure 3-11: Acquire Screen with Fixation Target in Fundus Viewport

To change positions, click and drag the fixation target towards the next desired position.
The fixation target that allows imaging of that part of the retina will be selected. You may
need to adjust the scan position to capture the exact location of interest.
In either case, instruct the patient to follow the fixation target, which has the effect of
changing the region of view. It is desirable to center the area of interest in the field of view
so that you always are scanning the deepest part of the bowl of the retina, which helps
maintain the scan image in the vertical center of the display.
To reset either the scan pattern or the fixation target that had been moved from the default
position, press the appropriate button below:
• Reset scan pattern Reset fixation target
Note: If you adjust the scan pattern placement, check the OCT scan display at right to
make sure that the retinal images are not too high in the viewport. When the edges of scan
images are near the upper boundary, they tend to “fold over,” reflecting a “mirror image”
back into the viewport. If this occurs, or if the scan image is completely inverted, you must
adjust the image using the Optimize button or Center controls. See Optimize the Scan
Display on page 3-19.

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Note: For Optic Disc Cube 200x200 scans, it is not necessary to precisely center the optic
disc in the scan image because the analysis algorithm can correctly place the Calculation
Circle around the optic disc even when it is not well centered. Though it is sufficient to keep
the optic disc within the outer dashed circle, it is best to center the scan on the optic disc
as well as possible.

Options and Reset Buttons

The Fundus Viewport area has a pair of buttons. The Options button opens to
additional controls, which allow adjustment of the image settings for that viewport. These
controls alter contrast (left vertical slider) and brightness (right vertical slider). An example
appears at the left for the fundus image. You can also select the Brightness/Contrast
button when the cursor is over the Fundus Viewport area. When selected, brightness
(B) and contrast (C) values appear numerically on the image. Click and drag the mouse
over the viewport horizontally to change the contrast (noise) and vertically to change the
brightness (OCT color range). They also work in combination when you click and drag the
mouse diagonally. The area also has a Reset button , which resets the focus position
to default. The Reset button within the options screen resets the contrast and brightness.
In addition to the contrast and brightness controls, the fundus image options window also
contains these features:
• Select Auto B/C to have CIRRUS automatically adjust the brightness and contrast
levels of the fundus image. You can also select the Auto Brightness/Contrast button
when the cursor is over the Fundus Viewport area.
• An optional Show Alignment checkbox is available among the Fundus Image options.
For either Macular Cube Scan, this checkbox toggles display of an alignment tool that
is locked in position relative to the scan pattern; the alignment tool moves when you
move the scan pattern and vice versa. This tool is designed to be placed over the optic
disc to assist in accurately repeating scan pattern placement for future scans of the
same eye. For macular scans, placing the alignment tool over the optic disc results in
the scan center being within 1 mm of the fovea for most patients. This tool is helpful
when the fovea is difficult to find in extreme edema, cataract, or floater situations. For
optic disc scans, the alignment tool is centered on the scan pattern and on by default.

Figure 3-12: Fundus Images showing Alignment Tools: Macula and Optic Disc

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Note: For Model 400 instruments, the Live OCT Fundus view can be seen in Figure 3-13.
For patients with unsteady fixation, you may change the rate in which the screen refreshes
by right-clicking the image and selecting Rapid Refresh View. When moving the scan
pattern box, the Live OCT Fundus technology view also moves with the scan pattern box.
You may also select Auto B/C from the same right-mouse click menu as shown on the left.

Figure 3-13: Standard Viewport on the Model 400

Optimize the Scan Display

For posterior segment scans, click Optimize, just above the Capture button.
This automatically optimizes first the scan image centering (Z-offset), and
then optimizes the scan image quality (polarization). Instruct the patient
not to blink during optimization. For posterior segment scans, you can use
the Center and Enhance buttons to optimize each aspect
independently. The associated up and down arrow buttons enable you to
adjust each manually.
Note: The Center and Enhance buttons attempt to automatically find the
optimal positions for Z-offset and polarization, respectively. Use Center first,
since you must see the scan image before you can enhance it.

Options and Reset Buttons

The scan display area has a pair of buttons. The Options button opens
to additional controls, which allow adjustment of the image settings for
that viewport. These controls alter contrast (left vertical slider) and
brightness (right vertical slider). You can also select the Brightness/Contrast button
when the cursor is over an image in the scan display area. When selected, brightness
(B) and contrast (C) values appear numerically on the image (as shown on the left). Click
and drag the mouse over the viewport horizontally to change the contrast (noise) and
vertically to change the brightness (OCT color range). They also work in combination when
you click and drag the mouse diagonally. The reset button within the options screen resets

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the contrast and brightness. The area also has a Reset button , which resets the
Center and Enhance settings to default.
Note: You can switch between color and grayscale globally, for all viewports, by selecting
or deselecting Colored OCT in the Tools menu (or by pressing F9 on the keyboard). Colored
OCT is the default.

FastTrac Retinal Tracking System (Model 4000 and Posterior Segment

Scans)
The FastTrac retinal tracking system1 tracks eye movement and enables tracking of the
current scan to the position of a prior scan. The FastTrac retinal tracking system on CIRRUS
HD-OCT uses multiple channels of concurrent imaging to monitor the motion of the eye in
real-time. During acquisition, proprietary algorithms automatically detect motion and track
the eye. The motion of the retina is observed at a high rate to ensure higher efficiency in
reducing the effects of motion. Most importantly, FastTrac ensures faster data acquisition
by only re-scanning data affected by motion. FastTrac also allows precise scanning at
follow-up visits to acquire data at the same region of the eye allowing for better
progression analysis.
For a first time scan, the instrument tracks alignment via registration of the blood vessels
during the scan. For subsequent visits, by default, tracking positions the scan in the same
location as the last scan taken of the same type (example: 512x128 Macular Cube).
Once the user clicks the Capture button, an on-screen progress bar indicates how the data
acquisition is progressing (see Performing a Posterior Segment Scan with
FastTrac (Model 4000) on page 3-23). Acquisition time depends on the fixation
stability of the eye. If the instrument has difficulty tracking, the progress bar stalls and the
user will have the option to either realign the eye or to turn tracking off (see
Troubleshooting when FastTrac Progress is Stalled on page 3-26).
Note: The license for the FastTrac retinal tracking system will not activate on Model 4000
instruments with a Dual Core processor or on any Model 400 instruments.
Note: A performance verification check should be performed before using the FastTrac
feature for the first time. For information on this check, see Performance Verification
Check for Models 400/4000 on page 2-18.
Note: FastTrac is not available for anterior segment scans.
Note: Users may find it difficult to conduct a scan with FastTrac for patients with certain
pathologies or confounding factors. FastTrac can be turned off at any time and a
non-tracked scan can be performed.
Patients who may be difficult to scan with FastTrac include, but are not limited to, those with:

1. Tracking is an optional feature that may not be available in all markets and, when available in a market, may not be on all instru-
ments. If you do not have this feature and want to purchase it, contact ZEISS. In the U.S.A., call 1-877-486-7473; outside the U.S.A.,
contact your local ZEISS distributor.

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• strongly tilted or curved retinas, which may include high myopes

• media opacities
• small pupils

FastTrac Settings – Tools Menu

Before using FastTrac, open the Tools menu and make sure both the Auto Repeat and
Tracking features are checked as shown on the left.
Note: FastTrac can be turned on and off as a global choice for all scans in the Tools menu.

FastTrac Controls – Acquire Screen

There are several FastTrac controls on the ACQUIRE screen.

Figure 3-14: Acquire Screen (FastTrac Enabled)

There is a border around the Capture button which turns from red to green when the scan
can be performed with FastTrac.
Three buttons are located beneath the Capture button. When FastTrac is turned on, the
button on the left is green . Clicking this button toggles FastTrac on and off for the
current scan. The button turns gray when tracking is off.
Clicking the button in the middle provides information on how to ensure the scan can
be performed with FastTrac.

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The button on the right is the Track to Prior toggle button. When a previous scan is
available, the button is green . If the user does not wish to track to a prior scan, this
function can be turned off by clicking this button, which will turn from green to gray.

Track to Prior
The user may select a different scan to track to by using the Prior Scan link.
Note: Track to Prior is possible for scans acquired before the tracking license was activated
or for which tracking was not turned on. However, optimal results can be obtained by
selecting a prior scan for which tracking had been on.
Note: When the Track to Prior feature is turned off and a Prior Scan is chosen, the CIRRUS
operates as described in Repeating Scan Setup and Alignment on page 3-37.

Monitor Z Position
When tracking on the macula, FastTrac automatically monitors whether the OCT B-Scans
are centered vertically—called Z monitoring—and stops the tracking progress when some
or all of the tissue is outside the B-Scan window. In some patients, it may be difficult to
align the tissue within the B-Scan entirely, such as those with high myopia or other kinds of
atypical anatomies; for example, tilted retinas or posterior staphylomas. For these patients,
the user may turn off Z monitoring. To turn this option off, click the wand button next
to the B-Scan in the lower right of the ACQUIRE SCAN screen. Uncheck Monitor Z Position at
the bottom of the dialog.
Click checkbox to Note: Monitor Z position is turned off for optic disc scans.
turn Z monitoring
on and off
Guidelines for Obtaining Good Quality Scans
Before capturing an image, follow these guidelines to optimize image quality.
1. Iris image:
• Center the iris image within the pupil (may be offset slightly depending on tilt of
retina or to avoid opacity).
• Focus on the iris detail.
2. Fundus image:
• The focus should be sharp and clear, preferably with good visibility of the
branching blood vessels. Use Auto Focus or adjust manually.
• Center the scan overlay on the fovea for macular scans and on the optic nerve
head for optic disc scans.
• Ensure uniform illumination without dark corners.
• Eliminate or reduce artifacts that may cast shadows on the OCT scan (if possible).
• Floaters may often be moved by asking subject to shift eyes around prior to image
capture.
• Corneal opacities may be minimized by realignment of the pupil.
3. OCT scan: To optimize signal strength for the best possible OCT images, follow these
guidelines:

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• Center the OCT scan in the mid to upper part of the scan acquisition screen.
Click Optimize or Center to aid in placement.
• The OCT B-scan should be complete in all windows without missing data.
• A tilted retina may be corrected for by moving the pupil alignment off-center to
allow for a more level OCT scan.
• Media opacities may be minimized by searching different pupil positions for the
brightest OCT image.
• Adjust the enhancement setting to achieve the brightest and clearest scan.
• Ask the patient to blink once before obtaining the scan. Patients with severe dry
eye should use artificial tears prior to scanning.

Obtaining Images Suitable for Advanced RPE Analysis

In order to detect sub-RPE illumination, CIRRUS looks for contrast in a slab created below
the RPE. If the retinal tissue is captured too low in the axial field of view of the scan, then
the algorithm will not produce a good result, because there will not be enough sub-RPE
pixels to create good contrast. See Figure 3-15 below for an example of a scan with
sub-RPE illumination, with the retina too low in the scan for acceptable detection of
sub-RPE illumination. If you obtain an image like this, it is best to retake the scan before
running Advanced RPE Analysis (see the CIRRUS HD-OCT User Manual, Chapter 4).

Figure 3-15: Example of Scan with Retina Too Low in Field

Capture the Image

Instruct the patient to blink first and then open eyes wide during scan acquisition. Click
Capture—or press Enter on the keyboard—to capture the images. The system processes
the images and automatically presents them on the REVIEW screen, where you can decide to
either save the scan or try again. To proceed, see Review Scan and Save or Try
Again on page 3-27.

Performing a Posterior Segment Scan with FastTrac (Model 4000)

Acquire Screen
From the ACQUIRE screen (Figure 3-14), follow the same alignment steps as for a
non-tracked scan.

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When the border around the Capture button is green, FastTrac is ready and the Capture
button may be pressed. When the border around the Capture button is red, the scan is not
ready to be performed with FastTrac and the capture cannot be initiated. The user can turn
off tracking by clicking the button and then click Capture to take a non-tracked scan.
Or, the user can take further actions to prepare for a tracked scan, including:
• Ensure the B-Scans are centered
The user can click the up and down arrows or use the mouse scroll wheel to make fine
adjustments to center the scan. Clicking the Optimize or Center buttons automatically
adjusts the vertical position of the B-Scans.
Note that for optic disc scans, the Capture button may still be green if the scan is not
completely centered.
• Maximize fundus image quality
FastTrac is most robust and efficient when the fundus quality is high. Fundus quality is
also important for ensuring accurate and successful tracking to the same location in
subsequent scans. High quality fundus images are well focused with sharply delin-
eated blood vessels and have uniform illumination without dark corners.
To achieve uniform illumination, ensure the scan beam is aimed through or near the
center of the pupil and the iris and pupil are in focus. Corneal opacities may be mini-
mized by realignment of the pupil. This can be assessed and adjusted in the iris cam-
era viewport.
Proper focusing is essential for a good fundus image. This is accomplished by using
Auto Focus or by manually adjusting focus. The user may also set the patient's spheri-
cal equivalent values when adding or editing the patient demographic information.
• Track to Prior
If the border around the Capture button remains red, alignment may not be working.
Change which prior scan to track to or disable Track to Prior for this scan.
When the border around the Capture button is green, the scan can be performed with
FastTrac. Click Capture.
Note: Avoid a blink right when clicking Capture. The patient may blink before and during
the scan, but the scan initiation can be impacted if the blink is right at the moment the
operator clicks Capture. Once the scan has been initiated and tracking is progressing,
allowing the patient to blink freely can help maintain a good tear film and may improve the
quality of the OCT image.

Scan in Progress Screen

During acquisition, after the user clicks Capture, a screen appears that shows the scan in
progress and provides controls to make adjustments to help complete the scan.
A tracked scan may take additional time as compared to a non-tracked scan. During this
period, adjustments may be necessary to maintain the success of tracking and the quality
of the acquired scan.

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Note: After five minutes on the SCAN IN PROGRESS screen with no scan being acquired, the
system will return to the ACQUIRE screen.
Note: Unlike non-tracked scans, once scanning has started, you may advise the patient to
blink normally, as needed, while maintaining focus on the fixation target. Additional tear
film may improve the signal of the scan.

Figure 3-16: FastTrac Scan in Progress

The FastTrac™ in Progress bar appears on the upper right of the screen, indicating the
progress of the scan.
The information box below the progress bar has two indicators to clarify if the conditions
for a successful FastTrac scan are being met. When FastTrac is interrupted, information box
indicators and the progress bar turn red and the progress bar stops.
The user can stop the scan for any reason from this screen by clicking Cancel one time. The
progress bar will complete but the scan will not be captured. The user is then returned to
the ACQUIRE screen to try again or finish.

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Troubleshooting when FastTrac Progress is Stalled

Indicator Potential Problem What you should do

OCT image The OCT image is not centered Use the up and down arrows (or
centered properly and the scan is too high mouse wheel) to center the scan.
or too low in the window.
For patients with certain Cancel the scan. On the ACQUIRE
pathologies or anatomical SCAN screen, turn off the
features, it may be difficult to monitoring of the Z position. Then,
ensure centering across all B-scans initiate a new scan with FastTrac.
in a cube.
Other factors Iris image – scan may not be Adjust the scan position in the Iris
for tracking aimed through the pupil. Viewport.
Fundus image – focus has drifted Manually adjust using the Focus
away from patient’s refraction. controls.
Patient fixation issues. Communicate with the patient to
ensure they are fixating in the
same position as at the start of the
scan.
Excessive blinking or moving. Communicate with the patient to
reduce blinking and movement.

Figure 3-17 and Figure 3-18 illustrate cases where tracking is not progressing due to
several of the reasons mentioned above.

Figure 3-17: Scan Too High on Screen

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In the example above, the scan is too high on the screen. If this occurs, use the up and
down arrows next to the scan window or the mouse wheel to center the scan.
In this case (Figure 3-18), the fundus image quality is reduced.

Figure 3-18: Poor Fundus Image Quality

Review Scan and Save or Try Again

Review the captured data to ensure it is of acceptable quality. See To switch between
EDI and standard scanning mode, select the EDI checkbox below the
fundus image. on page 3-30, and Criteria for Reviewing Good Quality CIRRUS
HD-OCT Scans on page 3-36 for more information.
Note: Besides the observed image quality, an important element of acceptable quality is
the Signal Strength indicator, which should be 6 or higher.
Note: Signal strength and image quality can be significantly reduced when the imaging
aperture (the lens) is dirty or smudged. If you suspect this problem, follow the instructions
to clean the Imaging Aperture Lens and External Lenses (page 5-6).
If the captured scan is of good quality, click Save and continue. (You will return to the
ACQUIRE screen to acquire another scan, if desired.) If it is not, click Try Again to return to
the ACQUIRE screen.
When you are finished acquiring scans, click Finish in the ACQUIRE screen. You will return to
the ID PATIENT screen.

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Acquire Screen for Posterior Segment Raster Scans

This section describes basic features of the ACQUIRE Screen that apply to posterior
segment raster scans. For purposes of illustration, the HD 5 Line Raster scan is used.

Figure 3-19: HD 5 Line Raster Acquire Screen

HD 5 Line Single and Multi-Line Views

For HD 5 Line scans, to switch between the HD 1 20x single line and multi-line views, click
the Toggle Spacing button located below the fundus image.
The toggle button remains available until the Single Line scan pattern is moved in the
acquisition window. To move the scan pattern and keep the button active, switch to 5 Line
mode before moving the scan pattern, and then switch back to Single Line mode. If you
move the Single Line pattern and want to switch back to 5 Line mode, use the scan pattern
settings button to access full controls.
Note: If the OCT images are displayed in color, you can switch to grayscale to more easily
see details in the high-resolution scan and can also make adjustments to brightness and
contrast using existing menus.

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Scan Pattern Adjustments

Single and multi-line raster scans have adjustable scan patterns. You can use the image
pattern controls on the live fundus image, depending on scan type, to manually change
line length, line spacing, or angle of rotation, or you can use the Custom Scan Pattern
dialog box. Adjustments apply to all scan lines.
Note: If you adjust the scan pattern position, check that the retinal OCT B-scan images are
not too high in the viewport. When the edges of scan images are near the upper boundary,
they tend to fold over, reflecting a mirror image back into the viewport. If this occurs, or if
the scan image is completely inverted, adjust the image position using the Center controls.

Image Pattern Controls

Drag blue bar left or right to

adjust line length

Drag rotation icon to adjust

the angle of rotation

Drag blue bar up or down to

adjust line spacing

Figure 3-20: HD 5 Line Raster Scan Pattern On Acquire Fundus Image

Scan Pattern Adjustments with the Custom Scan Pattern Dialog Box
To make adjustments to the scan pattern using the Custom Scan Pattern dialog box, click
the Adjust Rotation and Size button below the Fundus Viewport. In the Custom Scan
Pattern dialog box, do any of the following:
• For Rotation, click the up arrow (for counterclockwise rotation) or down arrow (for
clockwise rotation) or enter a value to adjust the angle in the ranges of 0 to 360
degrees. Values entered from 91 to 269 are automatically transposed 180 degrees to
correspond with scan direction. The default 0 degree position is horizontal.
• For Length, depending on the scan, you can select 3, 6, or 9 mm.
• For line Spacing, depending on the scan, you can select between 0.00 and 1.25 mm
in increments of 0.025 mm.
• To reset the scan pattern to the default length, rotation, spacing and center position,
click the Scan Pattern button , and in the dialog box, click the Reset button .

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Enhanced Depth Imaging (EDI)

Enhanced Depth Imaging (EDI) is an optional mode for single and multi-line raster scans
that improves visibility of structures at the bottom of B-scans.
The signal to noise ratio in OCT scans varies across the axial range. The default CIRRUS
setup is such that the best signal is obtained at the top portion of the scan. Enhanced
Depth Imaging allows you to change the acquisition settings for the raster scans so that
the best signal to noise ratio is obtained at the bottom of the B-scan. This allows you to
obtain an HD image that is optimized in the region that is of interest for a particular scan.
To switch between EDI and standard scanning mode, select the EDI checkbox
below the fundus image.

Review Screen for Posterior Segment Scans

Note: See Chapter 4, Anterior Segment Scan Acquisition, for REVIEW screen
information for anterior segment scans.
After you acquire a scan, the REVIEW screen appears. The REVIEW screen format depends on
which posterior segment scan type you have acquired and if tracking was enabled.
On the REVIEW screen for posterior segment scans:
• Signal Strength Indicator: This appears in the center near the top. It ranges from 0 to
10, with 10 being maximum signal strength. When values are less than 6, the
indicator color is red (below acceptable threshold); when 6 or higher, the color is
green (acceptable). Click the Information button for additional suggestions on
how to obtain better signal strength.
Note: The Signal Strength indicator applies to the scan as a whole.
• Fundus Image: For FastTrac scans, in addition to Signal Strength, there is a quality
rating for the acquired Fundus Image for the posterior segment scans. A Fundus
Image Quality score 6 or above confirms that the quality is satisfactory to be used for
a future scan (see Tracked to prior below).
• Tracked during scan: A green dot indicates tracking was successful during the scan.
• Tracked to prior: A green dot indicates tracking to a prior scan was successful. An
Information button provides information on the prior scan.
• Transparency: For posterior segment cube scans, use this slider to adjust the transparency
of the overlay. Default is 0% transparency (opaque); 100% is fully transparent.

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Review Screen for Posterior Segment Cube Scans

1 4

5
2
6

1 Iris image 5 Color, Brightness/Contrast, and Reset

2 Brightness/Contrast, Auto B/C, and Reset buttons when mouse cursor is over image
buttons when pointer is over image area
3 Fundus image with scan cube overlay 6 Current Y slice through side (slow B-scan)
4 Current X slice through front (fast B-scan) 7 X slices through front and back (fast
B-scans)
Figure 3-21: Review Screen for Cube Scans (Macular Cube 512x128, FastTrac)

For cube scans, the REVIEW screen presents the captured iris and fundus images, along with
an interactive multi-planar reformat (MPR), which enables you to view image
cross-sections through two dimensions (see Reviewing Image Data using
Multi-Planar Reformat (MPR) below). The eye and name of the scan appear at the
upper left.

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Review Screen for Posterior Segment Raster Scans

1 Iris image 3 Center viewport (third

2 Fundus image with 5 line line)
overlay
Figure 3-22: Review Screen for HD 5 Line Raster Scan (FastTrac)

For raster scans, the REVIEW screen (Figure 3-22) displays the iris and fundus images,
along with a number of line scans depending on the scan type selected. The eye and name
of the scan type appear at the top left of the screen. The upper left viewport shows the iris
image, while the lower left displays the fundus image with a scan image overlay that
shows the placement of the line scans. The line scans displayed in the viewports on the
right depend on the type of scan.

Reviewing Image Data using Multi-Planar Reformat (MPR)

The viewports are interactive: For cube scans, drag the blue or magenta triangle of the slice
navigators, or click a scan viewport and use the mouse scroll wheel to move through the
active plane of the scan. You will see the resulting cross-sections update simultaneously in
the other viewports. This functionality enables you to quickly search through the data cube
and stop when you see an area of interest.
The upper left viewport shows the iris image, while the lower left shows the fundus image
with the high-definition en face scan image overlay that shows the area scanned. Note

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that the Model 4000 instruments display the LSO fundus image, while the Model 400
instruments display the captured Live OCT fundus image.
Drag slice
navigators to change
current slices

Data Cube Orientation

Top of cube = Blue line and slice number
en face imag Z
e indicate current fast B-scan
X (X slice) seen in
Side of cube = top scan viewport
Front of cube = slow B-scan plane
fast B-scan plane magenta line
middle viewport
blue line
upper viewport Y
Magenta line and slice number indicate current
slow B-scan (Y slice) seen in middle scan viewport
Figure 3-23: Fundus Image with Overlay in Review Screen

The overlay on cube scans also has two lines that are centered by default, called slice
navigators. These lines indicate the currently selected cross-sections (slices) seen in the
upper two viewports on the right. The horizontal blue line in the overlay corresponds to the
top scan viewport, which presents the fast B-scan. The vertical magenta line in the overlay
corresponds to the middle scan viewport, which presents the slow B-scan. You can drag
these slice navigators by the triangles on the edge to change the currently selected slices.
To better understand the perspectives, think of the data as a cube. The top and middle
(larger) viewports show the data in planes parallel to the front of the cube and the side of
the cube, respectively. The X slice parallel to the front of the cube (top viewport) is also
known as the fast B-scan because this is the direction in which each line of A-scans is
acquired extremely quickly (in milliseconds). (This is the direction of a horizontal line scan
in first-generation OCT.) The Y slice parallel to the side of the cube (middle viewport) is also
known as the slow B-can because this scan comprises a reformatting of vertically parallel
A-scans acquired in successive line scans. These re-combined lines are acquired relatively
slowly, one per line of horizontal A-scans, in comparison to the fast B-scans. The smaller,
bottom two scan viewports are static and show the front and back X slices of the cube.

Scan Display Left to Right Orientation

Left to Right Scan Display CIRRUS always displays left to right scan images as follows:
Summarized • For horizontal scans, left of scan equals left of scan display and right of scan equals
For horizontal scans, left equals right of scan display.
left and right equals right. For • For vertical scans, bottom of scan equals left of scan display and top of scan equals
vertical scans, left to right equals right of scan display.
bottom to top. For diagonal scans, • For diagonal scans in 5 Line Raster, left takes precedence over bottom, so that left of
left takes precedence over bottom.
scan equals left of scan display and right of scan equals right of scan display.

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Image Display Options During Review

Image Display Menu Options
Right-click on the fundus image or on a scan image to access the available image display
menu options A checkmark beside a menu option indicates the option is selected.
Depending on the image, one or more of the following image menus are available when
the mouse pointer is over an image area:
• Adjust brightness/contrast: When selected, brightness (B) and contrast (C) values
appear numerically on the image (as shown on the left). Click and drag the mouse
over the viewport horizontally to change the contrast (noise) and vertically to change
the brightness (OCT color range). They also work in combination when you click and
drag the mouse diagonally. Brightness and contrast can be adjusted in two different
screens during the acquisition process: On the acquisition screen and on the review
screen.When you enter the acquisition screen for the first time, Brightness/Contrast
values for both fundus and OCT images are set to default values. These values may be
adjusted manually or by Auto Focus and Auto B/C (Fundus Viewport only), as desired.
Any user-initiated changes made on the acquisition screen become the new
instrument default settings, which are persistent for all new scans for all operators
until the settings are changed again.
Brightness/Contrast values adjusted in scan review for both fundus and OCT images
are saved and later used when displaying those images during analysis. Note: CIRRUS
may override adjusted extreme values that could compromise image quality by saving
default values. No further adjustments will be saved after the user saves the scan; for
example, adjustments made on an analysis screen will not be saved.
• Auto B/C: Optimizes brightness and contrast settings of the fundus view (Fundus
Viewport only). You can also select the Auto Brightness/Contrast button when
the mouse cursor is over the Fundus Viewport.
Transparency Slider
• Available for cube scans in the area to the right of the fundus viewport. Use to adjust
the transparency of the cube scan overlay.
Movie Controls
Available for cube scan and multi-line raster scans in the area to the left of the scan
viewports. Use to view a movie of the fast B-scans or sequence through them one image at
a time.

Previous
Play/Stop
Next
Adjust speed

Image Tools
Depending on the scan type and image displayed, one or more of the following image
tools are available when the mouse pointer is on an image. (see Figure 3-21):

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• Fovea Finder: For Macular Cube 512x128 and 200x200 posterior scans, click to
center the scan pattern over the fovea.
• Brightness/Contrast: Click to put the image in interactive brightness/contrast
mode. To adjust contrast, drag the pointer horizontally over the image. To adjust
image brightness, drag the pointer vertically.
• Auto Brightness/Contrast Click to automatically adjust brightness/contrast
(fundus display only).
• Color: Click to switch the image display between color and grayscale modes
(OCT scan display only).
• Reset: Click the Reset button to reset the image display to its default settings.
Note: Brightness/Contrast and Color adjustments apply simultaneously to all OCT scan
viewports.
Note: Between the fundus image and its overlay, Brightness/Contrast operate
independently. Select one or the other to apply such changes. Click the Reset button to
return to the original brightness and contrast settings.
Note: You can switch between color and grayscale globally, for all viewports, by selecting
or deselecting Colored OCT in the Tools menu (or by pressing F9 on the keyboard). Colored
OCT is the default.
Note: Additional right-click menu options are available when viewing saved images in
Analyze mode. See CIRRUS HD-OCT User Manual, Chapter 4 for details.
Reviewing the OCT Fundus image for Quality
FastTrac minimizes, but does not completely eliminate, the possibility of saccades. For cube
scans, the operator should review the OCT fundus image to ensure there are minimal
saccades and no saccades through the area of interest (macula, for example). A saccade
can be detected by discontinuities in the appearance of the blood vessels (for example, a
horizontal shift of the vessel at a specific location).

Example: Saccades

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During the course of a scan with FastTrac, the individual B-scans in a cube may be
acquired at different positions in the Z-direction (for example, tissue varies in vertical
position in the B-Scan window from B-Scan to B-Scan). CIRRUS corrects for this motion
when assembling the data for analysis. However, the OCT fundus image can have artifacts
from gradations in the intensity of each B-Scan. These gradations appear as horizontal
lines or bands in the OCT fundus image, as shown in the OCT fundus image banding
examples (A and B) below. As long as there are no saccades, scans with OCT fundus
images like these should be acceptable for analysis and the operator is advised to save
them.

Example A: OCT Fundus image banding Example B: OCT Fundus image banding

Criteria for Reviewing Good Quality CIRRUS HD-OCT Scans

During scan review, use the following criteria to ensure that an image you have captured is
suitable.
1. The fundus image:
• The focus should be sharp and clear, preferably with good visibility of the
branching blood vessels.
• The scan overlay should be centered on the fovea or optic nerve head.
• The fundus image should have uniform illumination without dark corners.
• There should be few, if any, artifacts that may cast shadows on the OCT scan.
• The OCT en face image should have minimal saccades and no saccades through
the area of interest (macula, for example).
2. The OCT scan image:
• OCT scan should be complete in all windows without missing data.
• Color density should be the same from end to end.
• Signal strength should be 6 or greater.

Review and Save or Try Again

The purpose of the REVIEW SCREEN is for you to evaluate the scan image quality, whereupon
you can either save the scan or delete it and try again:

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• To save the scan, click Save (or press Enter on the keyboard). You will return to the
ACQUIRE screen, where CIRRUS marks the scan as complete with a checkmark on the
left, and puts a number on the right showing how many of that scan you have saved.
or
• Click Try Again (or press the Esc key on the keyboard) to delete the captured images
and return to the ACQUIRE screen to capture another scan using the same scan type.
• If you click Finish without saving first, a prompt will appear asking you if you want to
save before returning to the ACQUIRE screen.

Repeating Scan Setup and Alignment

Tools menu CIRRUS HD-OCT contains automatic and manual functions to repeat scan setup and
alignment during follow-up patient visits. Auto Repeat is available if you have saved the
same scan type for a patient and eye on a previous visit.
Auto Repeat is a global setting available in the Tools menu. When enabled, the instrument
automatically adjusts the ocular lens and chinrest to the previous settings for the same
patient, eye, and acquisition scan type. The repeated parameters include chinrest
alignment, scan pattern and fixation target placement, Enhance (polarization) and Center
(z-alignment) settings, focus, brightness, contrast, and illumination settings. These
adjustments occur with the patients chin in or out of the chinrest. It takes a few moments
for the chinrest to move and all parameters to be applied. You cannot use Auto Repeat to
repeat a scan you have saved today, nor to repeat a scan type other than the one currently
selected. If a prior scan is found, its scan setup parameters are used, and a Prior Scan link
is created (showing the eye, and exam date and time) as shown on the left and in Figure
3-24 below.

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Figure 3-24: Sample Acquisition Screen showing Prior Scan Link

You can use this Prior Scan link to manually select a different prior scan. Click this link (or
press F6 on the keyboard) to open the REPEAT SCAN dialog (Figure 3-25).

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Figure 3-25: Repeat Scan Dialog

The REPEAT SCAN dialog lists all previous scans in the same scan type category for this
patient by exam date and eye and shows the fundus image for the scan you select. This
option allows you to select a scan taken on the same day. This is especially useful when a
scan had been captured away from the central fixation area or if a patient had been
scanned previously with a Macular Cube 200x200 scan but now will be scanned using the
Macular Cube 512x128 scan. The previous Macular Cube 200x200 scan can be used as
reference in this manner whereas it could not be referenced with the Auto Repeat function.
When you click OK on the REPEAT SCAN dialog, you return to the ACQUIRE screen and the
system applies the parameters of the scan you selected to repeat and displays the selected
exam. It takes a few moments for the chinrest to move and all parameters to be applied.
You can use the repeated parameters as a starting point for further adjustments you may
wish to make.
If Auto Repeat is off or there are no prior scans of the current type and eye, click Please
select prior scan on the ACQUIRE screen, as shown on the left (or press F6 on the keyboard),
to open the REPEAT SCAN dialog and select a prior scan, if any exist.
Auto Repeat and Prior Scan should get you close to the correct alignment for the current
scan, although you still may need to make small adjustments. Both options also load the
fundus image and scan pattern from the prior scan and display the prior fundus image and
scan pattern statically within the Fundus Viewport.

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For posterior segment scans, when you use Prior Scan, the previously saved OCT fundus
image of the scan you wish to reference is overlaid in the scan pattern box on the live
fundus image (see Figure 3-26). This helps you align the previous scan to the one you are
attempting to acquire. Click the scan pattern box to drag it to the desired position. The
Transparency slider activates when you are repeating a scan, so you can adjust the
transparency of the opaque overlay and view the correspondence of the underlying live
fundus image with the saved overlay. You may need to increase the overlay transparency to
see the fixation target location.

Figure 3-26: Acquire Screen Displaying Overlay

The factory default setting for Auto Repeat is off. If you activate the Auto Repeat feature,
the system will automatically position the chinrest and ocular lens according to the
position used in the previous visit for the given scan type selected. Depending upon the
patient's current position, adjustments may need to be done to obtain optimal focus of the
LSO and OCT scan. When you switch to another scan type, the chinrest and ocular lens
position will move accordingly to align with the previous visit scan. This may require more
adjustments to obtain the correct patient position.

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Auto Repeat can aid your workflow in the following situations:

• You perform only one type of scan per visit.
• You perform multiple scans and scan types but in different scan areas, for example
Macula Cube 512x128 followed by Optic Disc Cube 200x200.
• The patient is able to maintain head position between scans.
Auto Repeat may not be desirable for use in the following situations:
• You perform multiple scans using different scan types in the same scan area per visit,
for example: Macula Cube 512x128 followed by HD 5 Line Raster, or Macula Cube
512x128 followed by Macula Cube 200x200. In this instance, using settings from the
current visit is more efficient.
• The patient has difficulty or is unpredictable in maintaining head position. In this
instance, the repeat scan may be very different from the current position.
If you do not want the chinrest and ocular lens to move from the currently aligned position
when switching to another scan type, you have the following options:
• Leave the factory default setting of Auto Repeat off. A Prior Scan link is available if
you want to use previous scan settings for any scan you wish to acquire.
• Turn off Auto Repeat prior to scan acquisition by deselecting Auto Repeat in the Tools
Menu.
• Turn off Auto Repeat after the initial chinrest and focus adjustments are in place, or
after acquiring the first scan, and prior to choosing the second scan. This will ensure
that the settings used for the first scan will be maintained.

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(4) Anterior Segment Scan Acquisition

This chapter explains how to use the Anterior Segment Scan Acquisition and Analysis1
features.
For general scan acquisition instructions, see Chapter 3, Acquire Scans.
Note: Anterior segment measurements are invalid for patients wearing contact lenses.
Please ensure patients are not wearing contact lenses.
Note: The CIRRUS HD-OCT is used primarily for imaging and measuring structures in the
posterior eye. By changing the focus of the OCT beam, it can also be used to image and
measure structures in the anterior segment such as the cornea. This chapter provides
instructions and information about imaging and measuring the anterior segment with the
CIRRUS HD-OCT.

Anterior Segment Scans

The following anterior segment scans are available:
• Anterior Chamber: This scan generates a wide field, speckle-reduced raster scan of the
front of the eye at a depth of 5.8mm with higher contrast than the Anterior Segment 5
Line Raster scan. It uses 20 B-scans, each composed of 1024 A scans, and is 15.5mm
in length when oriented horizontally. The scan is adjustable from -89 to 90 degrees,
though rotation may reduce the field to 11.0mm vertically for 400/4000 instruments.
The 5.8mm scan depth is achieved by allowing the source and mirror images to
overlap. Note that in the overlap region (indicated by blue overlay), source image
detail may be compromised. This scan requires the Anterior Chamber external lens.
• Anterior Segment Cube 512x128: This scan generates a volume of data through a
4-millimeter square grid at a depth of 2mm by acquiring a series of 128 horizontal
scan lines each composed of 512 A-scans. It also acquires a pair of high-definition
scans through the center of the cube in the vertical and horizontal directions that are
composed of 1024 A-scans each. The Anterior Segment Cube 512x128 has the same
scan characteristics as the Macular Cube 512x128. This scan can be used to measure
the central corneal thickness and create a 3-D image of the data.
• Anterior Segment 5 Line Raster: This scan generates 5 parallel lines of equal length for
viewing high resolution images of the anterior chamber angle and cornea. The line
length is fixed at 3mm, but the rotation and spacing are adjustable. By default, the
lines are horizontal and separated by 0.25mm, so that the 5 lines together cover
1 mm in width.
• HD Angle: This scan generates a speckle-reduced raster scan at a depth of 2.9mm
using 20 B-scans, each composed of 1024 A scans. The scan is 6.0mm in length, with

1. Anterior Segment Scan Acquisition and Analysis and Anterior Chamber, HD Angle, HD Cornea, Pachymetry, and Wide Angle to Angle
scans are optional features that may not be available in all markets and, when available in a market, may not be on all instruments. If
you do not have these licensed options and want to purchase them, contact ZEISS. In the U.S.A., call 1-877-486-7473; outside the
U.S.A., contact your local ZEISS distributor.

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an adjustable angle from -89 to 90 degrees. The scan highlights one iridocorneal
angle.
• HD Cornea: This scan generates a single high-definition scan with a depth of 2.0mm
that has a wider field of view than the Anterior Segment 5 Line Raster. The scan uses
20 B-scans, each composed of 1024 A scans. The scan is 9.0mm in length when
oriented horizontally and has a depth of 2.0mm. The scan is adjustable from -89 to 90
degrees, though rotation may reduce the field to 7.0mm for 400/4000 instruments.
This scan requires the Cornea external lens.
• Pachymetry: This scan consists of 24 radial scan lines with a scan depth of 2.0mm that
are used to generate a color-coded thickness map of the cornea. The scan uses 24
B-scans, each composed of 1024 A scans. For CIRRUS HD-OCT 400/4000 instruments,
the scan diameter is approximately 7.0mm. This scan requires the Cornea external
lens.
• Wide Angle to Angle: This scan generates a wide field, speckle-reduced raster scan
with a depth of 2.9mm. It uses 20 B-scans, each composed of 1024 A scans and is
15.5mm in length when oriented horizontally. The scan is adjustable from -89 to 90
degrees, though rotation may reduce the field to 11.0mm for 400/4000 instruments.
The scan simultaneously highlights both 0 and 180 degree iridocorneal angles. This
scan requires the Anterior Chamber external lens.

Anterior Segment Scan Specifications

The HD-OCT imaging specifications for anterior segment scanning are described in Chapter
6, Specifications. As with posterior segment scans, The best imaging performance for
anterior segment scans occurs in the center of the imaging region.

Anterior Segment Scan Instrument Imaging Process

When an anterior segment scan is selected or external lens mounted:
• The LSO illumination of the retina is turned off (Model 4000).
• The internal fixation target is centered. For all anterior segment scans, the patient sees
the green fixation target against a black background. The flashing red lines showing
the scan pattern of the selected scan type are blurry.
• The iris illumination is dimmed by default to avoid causing pupillary constriction.
• The internal lens audibly clicks as it is brought into position.

Anterior Segment Scan Acquisition Controls

Not all posterior scan acquisition controls are available for anterior segment scans. For
anterior segment scans:
• There is no fundus image, and therefore the Auto Focus button and Z controls
(left-right Focus arrows) are not displayed. However, the Focus bar is still displayed,
showing the last focus for the patient.

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• FastTrac is not available for anterior segment scans, and therefore the three FastTrac
buttons below the Capture button are not displayed.
• The Optimize button is available only for Anterior Segment Cube 512x128 and Anterior
Segment 5 Line Raster scans.
• The Auto-Enhance button, the Auto-Center button, and manual-center controls are
not available. The OCT display can be centered vertically in the live OCT window by
using the chinrest control buttons or the mouse scroll wheel. However, the shift key +
mouse scroll wheel does not bring the scan into the acquisition window for anterior
scans as it does for posterior scans. The following table shows acquisition controls
available for each anterior scan.
Anterior Segment Scans Acquisition Controls for OCT Display

Acquisition Controls for OCT Display

Manual Auto and

Scan Optimize Enhance Manual Center
Anterior Segment Cube 512x128   X

Anterior Chamber X  X

Anterior Segment 5 Line Raster   X

HD Angle X  X

HD Cornea X  X

Pachymetry X  X

Wide Angle to Angle X  X

 indicates the feature is available

X indicates the feature is not available

Custom Scan Pattern for Anterior Segment Scans

The scan pattern for anterior scans is displayed on the iris image. The scan pattern cannot
be moved, and scan length is not adjustable. Rotation and line spacing are adjustable for
the Anterior Segment 5 Line Raster scan. Rotation is adjustable for the HD Angle, HD
Cornea, Anterior Chamber, and Wide Angle to Angle scans. For information on
customizing the scan pattern, see Scan Pattern Adjustments on page 3-29.The
following table shows custom scan pattern controls available for each anterior scan on the
ACQUIRE and REVIEW screens:

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Anterior Scans: Adjustable Features on the Acquire Screen

Scan Acquire Screen

R S W

Anterior Chamber  X X

Anterior Segment 5 Line Raster   X

HD Angle  X X

HD Cornea  X X

Pachymetry X X X

Wide Angle to Angle  X X

R=Rotation, S=Spacing, W=Width,

 indicates the feature is available
X indicates the feature is not available

Aligning Anterior Segment Scans Corrected for Beam

Scanning Geometry and Corneal Refraction
Anterior Chamber, Wide Angle to Angle, HD Cornea, HD Angle, and Pachymetry scans are
corrected to account for beam scanning geometry and refraction on the corneal surfaces.
These corrections are most accurate when acquired corneal scans are centered on the
corneal vertex, which generates a strong central reflection line on the live OCT image.
Typically the corneal vertex is just to the nasal side of the pupil center.

To ensure the corneal scans are centered on the corneal vertex

1. Instruct the patient to fixate on the center of the fixation target, even though it may not
appear to be in focus.
2. Follow the alignment guidelines for each scan to position the scan in the OCT viewport,
making adjustments until there is a strong central reflection line indicating the scan is
centered on the corneal vertex.
Note: HD Angle scans are not aligned to the corneal vertex.

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Attaching an External Lens to the Instrument Lens Mount

Four anterior segment scans require an external lens. Anterior Chamber and Wide Angle to
Angle scans require the Anterior Chamber external lens. HD Cornea and Pachymetry scans
require the Cornea external lens.

Anterior Chamber and Cornea External Lenses

Anterior Chamber Lens Cornea Lens

Lens symbol Lens symbol

English lens English lens

label label

To attach an external lens and select a scan

1. For 400/4000 instruments, select the lens type from the Lens menu to the right of the
iris viewport.

Lens menu

The scans that require the lens are displayed in the scan list and ocular lens
positioning is automatically adjusted.
A prompt is momentarily displayed showing how to mount the selected external lens
2. Mount the selected external lens.
3. Select the scan from the scan list for the eye you want to scan.

Anterior Chamber Angle Scans

The HD Angle is the preferred scan for imaging the anterior chamber angle. It gives the
highest resolution and greatest detail of the iridocorneal angle. Wide Angle to Angle and
Anterior Chamber scans may also be used for anterior chamber angle analysis. All three

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scans have an angle measurement tool. The HD Angle and Wide Angle to Angle scans also
have an iridocoroneal (IC) angle tool to measure iridocorneal angle features.

Anterior Scan Acquisition

Anterior Chamber Scan Acquisition

The ACQUIRE screen displays the position of the Anterior Chamber scan pattern on the live
iris image. The OCT B-scan image on the right displays the cornea and mirror image of the
scan. The Anterior Chamber scan requires the Anterior Chamber external lens.

1 1
2

3
4 4
5

1 Mirror iris image 3 Mirror cornea image 5 Lens of the eye

2 Cornea image 4 Iris image

Figure 4-1: Acquire Screen, Anterior Chamber with Cornea and Mirror Images Correctly Aligned

Guidelines for Anterior Chamber Scan Acquisition

• Select ANTERIOR CHAMBER from the Lens menu, and attach the external Anterior
Chamber lens to the instrument lens mount, see Attaching an External Lens to
the Instrument Lens Mount on page 4-5.
• Instruct the patient to fixate on the center of the fixation target even though it may
not appear to be in focus.

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• Click the center of the pupil and use the screen X-Y and Z controls or keyboard arrow
keys and mouse scroll wheel to center the scan on the corneal vertex with the anterior
chamber visible in the B-scan viewport.
A strong vertical central reflection line on the B-scan indicates the scan is centered on
the corneal vertex.
• Center the image to see the lens of the eye and the anterior chamber angles.
• If the anterior chamber seems tilted, instruct the patient to shift his/her gaze slightly to
the left or right as needed to horizontally orient the anterior chamber.
• Separate the cornea image and mirror image as much as possible, without letting the
cornea images touch the iris images.
The correct position of the scan is shown in Figure 4-1. Three incorrectly aligned images
are shown in Figure 4-2: one with the iris touching the cornea, one with the cornea too
close, and one with an off-center image that obscures the eye lens.

Figure 4-2: From left to right: iris touching cornea, not centered, cornea too close

Anterior Segment Cube 512x128 Scan Acquisition

The ACQUIRE screen displays the position of the Anterior Segment Cube 512x128 scan
pattern on the live iris image. The OCT B-scan images on the right correspond to the
horizontal and vertical scan lines of the selected slice in the cube, with the smaller images
corresponding to the top and bottom horizontal cube slices. The scan does not require an
external lens, and NONE should be selected in the Lens menu.

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1 1
1 1

1 Gray bar for aligning OCT scan

Figure 4-3: Acquire Screen, Anterior Segment Cube 512x128

Guidelines for Anterior Segment Cube 512x128 Scan Acquisition

• Instruct the patient to fixate on the center of the fixation target.
• Use the screen X-Y and Z controls or keyboard arrow keys and mouse scroll wheel to
center the scan on the corneal vertex with the anterior chamber visible in the B-scan
viewport.to center the scan between the gray bars on either side of the B-scan display,
as shown in Figure 4-3.
• If the patient’s cornea is perfectly centered, a strong reflection from the anterior
cornea can produce bright artifacts in the OCT scan display (Figure 4-4). The scan
alignment should be slightly offset from the center by adjusting the chinrest to avoid
the corneal reflection.

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Figure 4-4: Strong reflection from the anterior cornea

Note: For the Anterior Segment Cube 512x128 and Anterior Segment 5 Line Raster scans,
the instrument focuses the OCT beam onto the anterior segment. The OCT beam scans in
an arc to allow the curved cornea to better fit into the 2mm scan depth. This will cause the
cornea to appear flat in the display during alignment and acquisition. This effect is partially
corrected for after acquisition, so the cornea will appear with the expected curvature
during review and analysis.

Anterior Segment 5 Line Raster Scan Acquisition

The ACQUIRE screen displays the position of the Anterior Segment 5 Line Raster scan pattern
on the live iris image. The OCT B-scan images on the right correspond to the 5 scan lines,
with the middle scan line corresponding to the larger middle OCT B-scan image. The scan
does not require an external lens, and NONE should be selected in the Lens menu.

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1 1 11

1 Gray Bar for aligning OCT scan

Figure 4-5: Acquire Screen, Anterior Segment 5 Line Raster

Guidelines for Anterior Segment 5 Line Raster Scan Cornea Acquisition

• Instruct the patient to fixate on the center of the fixation target.
• Use the screen X-Y and Z controls or keyboard arrow keys and mouse scroll wheel to
center the scan between the gray bars on either side of the B-scan display, as shown
in Figure 4-5.

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HD Angle Scan Acquisition

The ACQUIRE screen displays the position of the HD Angle scan pattern on the live iris image
and displays the OCT B-scan image on the right. The scan does not require an external
lens, and NONE should be selected in the Lens menu.

Figure 4-6: Acquire Screen, HD Angle

Guidelines for HD Angle Scan Acquisition

• For an HD Angle scan, you may need to use the external fixation device if the patient
has difficulty fixating without the internal fixation target, which is not in view when
the limbus of the scan eye is optimally exposed. The external fixation device may help
the patient fixate with the non-scan eye for correct angle alignment.
• Adjust the area of the eye visible in the iris viewport until the iris is in clear focus, and
make coarse adjustments with the X-Y controls to move the chinrest until the
corneoscleral junction is in view.
• Use the mouse scroll wheel to bring the angle into view on the B-scan, centering it in
the lower quadrant of the B-scan viewport and maximizing exposure of the cornea.
• If the angle recess in the B-scan appears shadowed by the sclera, move the scan
slightly along the limbus to minimize the effect, or ask the patient to adjust fixation
further away from center.

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• Align the scan at the desired location on the limbus, and then align the B-scan so that
the anterior chamber angle falls in the lower left and lower right quadrant,
respectively. Figure 4-6 shows a well-aligned scan and live OCT image of an HD
Angle scan.

HD Cornea Scan Acquisition

The ACQUIRE screen displays the position of the HD Cornea scan pattern on the live iris
image and displays the OCT image of the scan on the right. The HD Cornea scan requires
the Cornea external lens.

1 Upper red line 2 Corneal reflex line

Figure 4-7: Acquire Screen, HD Cornea

Guidelines for HD Cornea Scan Acquisition

• Select CORNEA from the Lens menu, and attach the external Cornea lens to the
instrument lens mount, see Attaching an External Lens to the Instrument
Lens Mount on page 4-5.
• Instruct the patient to fixate on the center of the fixation target even though it may
not appear to be in focus
• Click the center of the pupil and use the X-Y and Z controls to center the scan on the
corneal vertex, positioning the anterior corneal surface to the upper red line in the

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B-scan viewport as shown in Figure 4-7.

Note: A strong vertical central reflection line on the B-scan indicates the scan is
centered on the corneal vertex.

Pachymetry Scan Acquisition

The ACQUIRE screen displays the position of the Pachymetry scan pattern on the live iris
image. The images on the right display the temporal/nasal and inferior/superior scans of
the selected meridian. The Pachymetry scan requires the Cornea external lens.

Figure 4-8: Acquire Screen, Pachymetry

Guidelines for Pachymetry Scan Acquisition

The Pachymetry scan is similar to the HD Cornea scan, but you must align two scans rather
than one.
• Select CORNEA from the Lens menu, and attach the external Cornea lens to the
instrument lens mount, see Attaching an External Lens to the Instrument
Lens Mount on page 4-5.
• Instruct the patient to fixate on the center of the fixation target even though it may
not appear to be in focus.

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4- 14 Anterior Segment Scan Acquisition

• Click the center of the pupil and use the X-Y and Z controls to center the scan on the
corneal vertex until the cornea is visible in the B-scan viewports.
• Align the images in the two B-scan viewports by fine adjustment of the X-Y controls
using the keyboard arrow keys. To center both images, first center the bottom image
with the keyboard arrow keys until you see the corneal reflex in the upper image. The
up arrow brings the image down and to the right. The down arrow brings the image
up and to the left. Press the Ctrl key with arrow keys for finer adjustments.
• The horizontal B-scan is correctly positioned when it fits between the two red lines on
the viewport with the anterior corneal surface aligned with the upper red line, as
shown in Figure 4-8.
Note: Minimize eyelash and eye interference as much as possible.
Wide Angle to Angle Scan Acquisition
The ACQUIRE screen displays the position of the Wide Angle to Angle scan pattern on the
live iris image and the OCT image of the scan on the right. The Wide Angle to Angle scan
requires the Anterior Chamber external lens.

Figure 4-9: Acquire Screen, Wide Angel to Angle

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 Anterior Segment Scan Acquisition 4- 15

Guidelines for Wide Angle to Angle Acquisition

• Select ANTERIOR CHAMBER from the Lens menu, and attach the external Anterior
Chamber lens to the instrument lens mount, see Attaching an External Lens to
the Instrument Lens Mount on page 4-5.
• Instruct the patient to fixate on the center of the fixation target even though it may
not appear to be in focus.
• If the anterior chamber seems tilted, instruct the patient to shift his/her gaze slightly to
the left or right as needed to horizontally orient the anterior chamber.
• Click the center of the pupil and use screen the X-Y and Z controls or keyboard arrow
keys and mouse scroll wheel to center the scan on the corneal vertex with both
iridocorneal angles, iris, and pupil visible in the OCT scan display area and the anterior
of the cornea extending slightly out of the field of view, as shown in Figure 4-9.
Note: A strong vertical central reflection line on the B-scan indicates the scan is
centered on the corneal vertex.
Note: For the Wide Angle to Wide Angle scan, the iris will be slightly out of focus even
when correctly aligned.

Anterior Segment Scan Review Features

Scan review of anterior segment images is similar to that of posterior scan images, but with
the following differences:
• FastTrac is not available for anterior segment scans; therefore, there are no “Track to
prior” and “Tracked during scan” indicators.
• The fundus (LSO) image is not displayed; therefore, there is no Fundus Image quality
indicator.
• The signal strength indicator is not displayed for anterior segment review.

Review Scan and Save or Try Again

Review the quality of the captured scan on the REVIEW screen. If the captured scan quality
is acceptable, click Save to save the scan and go back to the ACQUIRE screen. If the
captured scan is not acceptable, click Try Again to go back to the ACQUIRE screen.
When you are finished acquiring scans, click Finish to go to the ID PATIENT screen.

Image Layout on the Review Screen

The iris and OCT B-scan images displayed on the ACQUIRE screen for each scan are also
displayed on the REVIEW screen. The Anterior Segment Cube 512x128 scan displays an
additional cube pattern with slice navigators in the area below the iris image for
sequencing through cube slices displayed in the OCT B-scan viewports. The Pachymetry
scan displays 24 radial scan lines on the iris image of the REVIEW screen, which are
selectable.

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4- 16 Anterior Segment Scan Acquisition

Image Controls During Review

Image Full Screen Display During Review
To view iris or OCT images in full screen mode, double-click the image. Double-click the full
screen image to return to the normal screen view.

Image Buttons
Three Image buttons are displayed when the mouse pointer is on an OCT image:
• Color/Grayscale: Click to switch the image display between color and grayscale.
• Adjust brightness/contrast: Click to put the image in interactive
brightness/contrast mode. To adjust contrast, drag the pointer horizontally over the
image. To adjust image brightness, drag the pointer vertically. Click the
Brightness/Contrast button again to turn off the interactive brightness/contrast mode.
• Reset: Click to reset the image display to its default settings.
Right clicking the mouse on an OCT B-scan image also displays image control menu
options. For OCT B-scan images on the REVIEW screen, the only menu option is Adjust
brightness/contrast.

Cube Slice and Raster Line Navigation

To sequence through slices of an Anterior Segment Cube 512x128 scan or the radial scan
lines of a Pachymetry scan, do any of the following:
• For Anterior Segment Cube 512x128 scans, use the slice navigators of the cube
displayed in the area under the iris image.
or
For Pachymetry scans, click one of the 24 radial scan lines displayed on the iris image.
• Click an OCT B-scan image and use the mouse scroll wheel.
• In full screen mode, use the scroll bar at the right side of the image.
• Use the movie controls.

Movie Controls
• Movie controls are available for Anterior Segment Cube 512x128 and Pachymetry
scans on the REVIEW Screen. Use the movie controls to view a movie of or sequence
through the cube slices of the Anterior Segment Cube 512x128 scan or the radial scan
lines of the Pachymetry scan.

Previous
Play/Stop
Next

Adjust speed

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 Routine Maintenance 5-1

(5) Routine Maintenance

Chapter Overview
ZEISS designed the CIRRUS HD-OCT (and the optional power table) to require very little
user maintenance. Most maintenance activities covered here are required only
occasionally, except for routine cleaning between patients.
Note: Except for the top fan filter, the CIRRUS HD-OCT has no user-replaceable parts. The
user must not attempt hardware repairs without consulting ZEISS service personnel. To do
so voids the instrument warranty. However, we may provide software updates that users
can install.

Note Regarding Warranty

Note: Except for the main power fuses (Models 400/4000) and the top fan filter, the
CIRRUS HD-OCT has no user-replaceable parts. The user must not attempt hardware
repairs, except fuse replacement, without consulting ZEISS service personnel. To do so
voids the instrument warranty. However, we may provide software updates that users can
install.

Fuse Replacement (Models 400/4000)

The Models 400/4000 instrument has two fuses. Instructions to check and replace the
fuses are included below. First we offer help in determining the source of power problems.
Note: Except for fuse and top fan filter replacement, only authorized ZEISS service
engineers may disassemble the instrument and replace parts. If fuse replacement does not
repair the problem, or if another sort of problem prevents normal operation, contact ZEISS
customer service. In the U.S., call 800-341-6968. Outside the U.S., contact your local ZEISS
distributor.

Determine the Source of the Power Problem

This section assumes that the instrument will not power on. Troubleshooting your power
problem depends on whether or not you power the instrument through the optional power
table.

If Not Using the Optional Power Table

If you power the instrument directly from a wall outlet (not through the optional power
table), check the following to determine the source of the power problem, in order:
1. Is there power available everywhere in your office?
• If not, there may be a localized power outage in your office or a general power
outage in your neighborhood.
• If so, proceed to Step 2.
2. Is the instrument power cord plugged in at both ends?
• If not, plug in the cord and try to power up the instrument.

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5-2 Routine Maintenance

• If so, check the instrument fuses and replace them if necessary. See Check and
Replace Instrument Fuses (Models 400/4000) on page 5-2 for instructions.

If Using the Optional Power Table

If you are using the optional power table, the instrument is powered through it. Check the
following to determine the source of the power problem, in order:
1. Is there power available everywhere in your office?
• If not, there may be a localized power outage in your office or a general power
outage in your neighborhood.
• If so, proceed to Step 2.
2. Does the table have power (while the instrument does not)? You can test the table by
trying the lift.
• If the table has power, the power problem is within the instrument. First, check
that the instrument power cord is plugged in at the power table and at the
instrument. Next, check the instrument fuses and replace them, if necessary. See
Check and Replace Instrument Fuses (Models 400/4000) below for
instructions.
• If the table does not have power, the power problem is likely within the table.
First, check that the table is plugged in at both the wall outlet and at the table.
Check and replace fuses as directed in the applicable Power Table User
Instructions.

Check and Replace Instrument Fuses (Models 400/4000)

Two fuses are located in the rear of the Models 400/4000 just above the instrument power
cord inlet.

WARNING: Carefully follow these instructions to safely check and replace

fuses. Always power down the instrument and unplug the power cord
before proceeding. At all times, use the minimum force necessary to
accomplish each step so as to prevent damage or injury.

1. Power down the instrument. Unplug the power cord.

2. To remove the rear cover, depress the two snaps at its top edge. Unplug the power
Depress both snaps to remove rear cover. cord from the rear of the unit.
• The fuse assembly can be found under the rear cover at upper right, just above the
power cord inlet. It is very difficult to open until you perform the next step.

Figure 5-1: Removing Rear Cover

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 Routine Maintenance 5-3

3. For better access, the bottom portion of the instrument pulls out like a large tray. To
pull it out:
A. Note the large silver handle. When unlatched, you can use this handle to pull out
the tray.
B. Below the silver handle, apparently resting on the bottom cover, two flat, dark
metal brackets splay out toward you like an inverted V. These can be compressed
easily together to unlatch the tray.

Compress splayed metal brackets Grab handle and pull out tray
Figure 5-2: Unlatching and Pulling Out Computer Tray (Model 4000)

C. With one hand compressing the brackets together, use the other hand to pull the
silver handle and slide out the entire tray until it is clears the outer edge of the
instrument, as shown below.

Fuse assembly
cover

Power cord inlet

Pull tray out until clear of outer edge.

Figure 5-3: Computer Tray Fully Out, Giving Access to Fuse Assembly (Model 4000)

You will now have easy access to the fuse assembly.

Note: Do not pull out the tray more than a few inches beyond this point. If you do, it may
disengage the rails, making it more difficult to reinstall.

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5-4 Routine Maintenance

4. Using a narrow-bladed screwdriver, gently pry open the cover of the fuse assembly,
from the top, to expose the fuse holders.

With screwdriver, pry open cover from top. Cover open; fuse holders exposed. Remove fuse holders with fingers.
Figure 5-4: Opening Instrument Fuse Assembly and Removing Fuse Holders (Model 4000)

Information about the proper replacement fuses is found adjacent to the fuse holder.
Note: Fuse type and rating for Models 400/4000 instrument fuses: T 5A 250V.

WARNING: Always replace fuses with the same type and rating. Failure to
do so may create a risk of fire.

WARNING: Do not rotate the drum immediately above the fuses, since this
changes the instrument power voltage setting. Powering the instrument
with the incorrect setting could result in electrical shock to users and
patients and severe damage to the instrument.

5. Slide out each fuse holder (marked with a white arrow pointing to the right) and check
the filament for breakage. Dispose of any defective fuses.
6. Insert the new fuse in the holder. Slide the holder back into the housing with white
arrows pointing to the right. Push the cover up and in until it snaps closed.
7. Push the tray fully back into the unit. Plug in the power cord at both ends.
Replace the rear cover: position bottom first, then tilt up and push in top until both snaps
engage. Your instrument is now ready to be powered on.

Handling Error Messages

In normal instrument start-up, the User Login dialog appears. If the system fails the system
check, or if some other error prevents the system’s normal function, document the
circumstances and any associated error messages, and report it to ZEISS customer service.
In the U.S., call 800-341-6968. Outside the U.S., contact your local ZEISS distributor. Often
error messages can be resolved with solutions provided over the telephone.
Please be prepared to provide CZM the serial number of your instrument. It is located on
the label affixed to the back of the instrument, under the rear cover.

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 Routine Maintenance 5-5

Hard Disk Defragmentation

Defragmentation of the CIRRUS HD-OCT computer hard disk becomes necessary when you
begin to clear archived exams regularly. The process of deleting data and then writing
again to the hard disk fragments the hard drive, which degrades database and system
performance over time. To maintain peak performance, we recommend that you check if
the hard disk requires defragmentation after each five times archived exams are cleared.
Recall that the system can initiate clearance of archived exams automatically when
necessary.
Note: Since hard disk defragmentation usually requires several hours to complete, we
recommend that you start defragmentation at the end of the day and let the process run
overnight. If defragmentation is not complete in the morning, it does no harm to stop
defragmentation and continue using the instrument.
To defragment the hard drive, follow these steps:
1. Exit the CIRRUS system software (click Logout and select Yes in the EXIT DIALOG) to
enter the Windows environment.
2. Click Start > All Programs > Accessories > System Tools > Disk Defragmenter. The
Disk Defragmenter appears.
Note: The CIRRUS HD-OCT hard disk is partitioned into C: and D: or E: drives, C: for the
operating system and D: or E: for the database. It is necessary to analyze and defragment
each partition in succession.
3. Select the C:, D:, or E: drive and click Analyze to determine whether the drive requires
defragmentation. When analysis completes, a dialog will appear to inform you
whether or not the drive requires defragmentation. If it does, click Defragment. If it
does not, click Close.

Figure 5-5: Sample Defragmenter Analysis Outcome

4. Perform Step 3 again for the other partition (C:, D:, or E:).

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5-6 Routine Maintenance

Routine Cleaning
The forehead and chinrests, and to a lesser extent the imaging aperture and LCD screen,
are the only parts that require routine cleaning. Instructions are included below for
occasional cleaning of the instrument covers and optional power table.

CAUTION: The instrument has no special measures to protect against harmful

ingress of water or other liquids (classified IPX0—ordinary equipment). To avoid
damage to the instrument and a safety hazard, cleaning solutions, including water,
must be applied sparingly, with a non-linting cloth that is dampened only—not
dripping wet! You must not use aerosols on or near the instrument.

Forehead and Chinrests

The instrument parts that routinely contact the patient—the forehead and chinrests—
should be cleaned between each examination with an alcohol prep wipe. These parts are
not removable.

External Surfaces of the Instrument

To remove dust and oily smudges from the external surfaces of the instrument, periodically
clean plastic covers and housings with an alcohol prep wipe, and dry with a soft,
non-linting cloth.

CAUTION: Alcohol prep wipes may damage glass lens components of the imaging
aperture and external lenses. Do not use alcohol prep wipes to clean glass lenses.

Imaging Aperture Lens and External Lenses

To clean the glass lens components of the imaging aperture and external lenses, use the
dry camera lens wipes (2660100007673) and camera lens cleaner (2660100007672)
listed in the User Replacement Accessories table on page 11-5. Apply a small
amount of the camera lens cleaner to the dry lens wipe and gently clean the lens.
Note: If a patient’s eye inadvertently contacts any part of the imaging aperture or an
external lens, clean the imaging aperture or the external lens before proceeding with the
examination.

CAUTION: Wipe gently and carefully to avoid scratching the instrument and auxiliary
lenses.

LCD (Monitor) Screen

Clean the LCD screen when necessary to remove dust and oily smudges that impair
viewing. Turn off the monitor first. We recommend that you use a soft cotton cloth; if a dry
cloth does not completely clean the screen, you can dampen the cloth with water only and
wipe the screen with the damp cloth.

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 Routine Maintenance 5-7

Top Fan Filter

Periodically, inspect the top fan filter located under the removable cover on top of the
instrument (Figure 5-6). The filter should be checked, at least, twice a year. In dusty
environments, more frequently. Push on the snap connector and pull the cover back and
up. It will swing open and can then be easily removed.

Press on snap connector

Removable top
and pull the cover
cover
back to open

Top fan filter

Figure 5-6: Top Fan Filter Illustration

Clean and/or replace, as necessary. Brush off excess dust and dirt. Clean with a mild liquid
soap and water. Allow to thoroughly dry before placing it back in the instrument. Replace
cover after replacing the filter.

Occasional Cleaning of Instrument Covers and Optional Power Table

CAUTION: When dusting of the instrument or table is necessary, use a dry
non-linting soft cloth. Do not use aerosols, as these can penetrate the instrument
covers and damage the instrument.

CAUTION: When the instrument covers or table require cleaning or disinfecting,

wipe with a non-linting cloth or wipe, dampened only—not dripping wet!—
with water or alcohol. Wipe dry with a clean and soft non-linting cloth.

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5-8 Routine Maintenance

User Replacement Accessories

Part Number Description
0000001217033 Power Cord, IEC 320, 39 Inch
2660021115973 Power Cord, IEC 320 to NEMA, 12 Inch
2660021123062 Dust Cover, Instrument
2660021149361 Fixation Device (External)
3197519005000 Occluding Sleeve for Fixation Device
3013509052000 Red Fixation Lamp
2660021124008 Ocular Lens Cover
2660021144375 Cornea Lens (Models 500/5000)
2660021142906 Anterior Chamber Lens (Models 500/5000)
2660021150088 Anterior Segment Calibration Tool
2660100061991 Top Fan Filter
2660100006566 Alcohol Wipes
2660100007672 Camera Lens Cleaner
2660100007673 Camera Lens Wipes
2660100060344 Verification Test Tool
2660021121819 Cable, Network, CAT5e, 14FT
2660021116418 Cable, USB MA-MB, 6FT
2660021145283 Kit, Test Eye, includes:
• Verification Test Tool
• Fixation Device
• Occluding Sleeve for Fixation Device
• Red Fixation Lamp

Note: Item part numbers and descriptions are subject to change.

To order: In the U.S., call 800-341-6968. Outside the U.S., contact your local ZEISS
distributor.

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 Specifications 6-1

(6) Specifications
HD-OCT Imaging for Posterior Segment Scans
Model 400 Model 4000
Methodology Spectral domain OCT
Optical source superluminescent diode (SLD), 840 nm
Optical power Nominal 600+/-60 μW at cornea
Safety shutoff: maximum 825 μW at cornea

Scan speed 27,000 A-scans/sec 27,000 A-scans/sec

A-scan depth 2.0 mm (in tissue), 1024 points
Axial resolution 5 μm (in tissue)
Transverse resolution 15 μm (in tissue)

HD-OCT Imaging for Anterior Segment Scans

Model 400 and Model 4000
Anterior Segment Anterior Segment 5 Anterior Chamber HD Angle Scan HD Cornea/ Wide Angle to Angle
Cube 512x128 Line Raster Pachymetry Scan
Methodology Spectral domain OCT
Optical source superluminescent diode (SLD), 840 nm
Optical power Nominal 600+/-60 μW at cornea
Safety shutoff: maximum 825 μW at cornea
Scan speed 27,000 A-scans/sec
A-scan depth 2.0 mm (in tissue) 2.0 mm (in tissue) 5.8 mm (in tissue), 2.9 mm (in tissue), 2.0 mm (in tissue), 2.9 mm (in tissue),
1024 points 1024 points 2048 points 1024 points 1024 points 1024 points
Axial resolution 5 μm (in tissue)
Transverse resolution <20 μm <20 μm <45 μm <20 μm <25 μm <45 μm

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6-2 Specifications

Fundus Imaging
Model 400 Model 4000
Methodology Live OCT Line scanning
Fundus technology ophthalmoscope
Live fundus image During alignment During alignment and during
OCT scan
Optical source Superluminescent diode (SLD), Superluminescent diode (SLD),
840 nm 750 nm
Optical power Nominal: 600+/-60 μW at the < 1.5 mW at the cornea
cornea
Safety shutoff power: maxi-
mum 825μW at cornea
Field of view 36 degrees W x 22 degrees H 36 degrees W x 30 degrees H
Frame rate > 0.7 Hz > 20 Hz
Transverse resolution 45 μm (in tissue) 25 μm (in tissue)

Iris Imaging
Model 400 and Model 4000
Methodology CCD camera
Resolution 1280 x 1024
Live iris image During alignment

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 Specifications 6-3

Electrical, Physical and Environmental

Model 400 Model 4000
Weight 36kg (79 lbs) 38kg (83lbs)
Dimensions 65L x 44W x 53H (cm)
Fixation Internal, external
Internal fixation focus adjustment -20D to +20D (diopters)
Input devices Keyboard, mouse
Electrical rating (115V) Single Phase, 100/120V~ systems:50-60Hz, 5A
Line and Neutral are fused.
Fuse rating T 5A 250V
Electrical rating (230V) Single Phase, 220/240V~ systems:50-60 Hz, 2.5A
Line and Neutral are fused.
Convenience Receptacle output ratings 115V~, 0.5 A Max, 50-60 Hz
Temperature (transport and storage) –40º to +70º C
Relative humidity (transport and storage) 10% to 100%, including condensation
Atmospheric pressure (transport and storage) 500 hPa to 1060 hPa
Temperature (operation) +10º to +35º C
Relative humidity (operation) 30% to 75%, excluding condensation
Altitude (operation) Up to 3000 m above sea level.
Atmospheric Pressure (operation) 700 hPa to 1060 hPa
Computer • High performance multi-core processor
• Internal storage: > 80,000 scans
• USB ports, 5 to 7
• CD-RW, DVD-ROM drive
• Integrated 15” color flat panel display
• Windows 7 Ultimate, 64 bit

WARNING: For the Model 400 and 4000 instruments, always replace fuses
with the same type and rating. Failure to do so may create a risk of fire.

Maintenance
ZEISS recommends regular preventative maintenance.
Note: Only trained CZM personnel may perform calibration.

Measurement Units
All units on the CIRRUS HD-OCT are measured in the SI format. Unless otherwise noted,
measurements are made in micrometers.

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6-4 Specifications

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 Legal Notices 7-1

(7) Legal Notices

Software Copyright
The software program (“Software”) included with your CIRRUS HD-OCT is a proprietary
product of ZEISS and in certain instances contains material proprietary to Microsoft
Corporation. These proprietary products are protected by copyright laws and international
treaty. You must treat the software like any other copyrighted material.
Copyright © 2015 Carl Zeiss Meditec, Inc. All rights reserved.

Software License Agreement

This Software license agreement (“License”) is a legal contract between the Purchaser
(“You”, “Your” “Licensee”) and ZEISS governing Your use of the Software. Opening the
sealed package indicates Your acceptance of the terms and conditions of this License. If
You have any questions concerning this License, contact Carl Zeiss Meditec, Attention
Customer Service, 5160 Hacienda Drive, Dublin, CA 94568. Telephone 800-341-6968.

License Terms and Conditions

1. In consideration of payment of the License fee which is part of the price You paid for
Your CIRRUS HD-OCT, and Your agreement to abide by the terms and conditions of
this License and the Limited Warranty, ZEISS grants to You a non-exclusive,
non-transferable and non-assignable license to use and display this Software on a
single CIRRUS HD-OCT, under the terms of this License. If the CIRRUS HD-OCT on
which You use the Software is a multi-user system, this License covers all users on that
single system.
2. The license is granted solely for the use of Your own internal computing requirements
and does not grant You any right, title or ownership in the licensed software or its
documentation. You own the physical media, CIRRUS HD-OCT, on which the Software
is originally or subsequently recorded or fixed, but You understand and agree that
ZEISS retains title and ownership to the Software recorded on the original disk copies
and all subsequent copies of the Software.
3. This Software is copyrighted. Unauthorized copying of the Software, including
Software that has been modified, merged or included with other software, is expressly
forbidden. You may not, nor may You permit others to (a) disassemble, decompile or
otherwise derive source code from the Software (b) reverse engineer the Software, (c)
modify or prepare derivative works of the Software, (d) provide on-line or similar uses
to third parties, or (e) use the Software in any manner that infringes the intellectual
property or other rights of another party. You may be held legally responsible for any
copyright infringement that is caused or encouraged by Your failure to abide by the
terms of the License.
4. ZEISS may create updated versions of the Software, which You may purchase
separately.

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7-2 Legal Notices

5. This license does not include the right to make copies of software, nor to transfer the
software or copies from the Product(s) to third parties, nor to extract, modify or
incorporate any part of the software or source code, without prior written consent
from ZEISS and payment of licensing fees. Further, sales of CIRRUS HD-OCT
instruments may not include any software or software licensee transfers. You may not
sublicense, rent or lease the Software.
6. ZEISS warrants the operation of the Software only with the operating system for which
it was designed. Use of the Software with an operating system other than that for
which it was designed will not be supported by ZEISS. ZEISS does not claim that the
software provided is free from defects and shall have no obligation to supply software
upgrades (i.e., new versions, or new, or in-line releases).

Acknowledgment
You acknowledge that you have read all the provisions in this Chapter, including this
License and Limited Warranty, understand them, and agree to be bound by their terms and
conditions.

CIRRUS HD-OCT User Manual 2660021156539 Rev. B 2015-09

 Carl Zeiss Meditec, Inc.
5160 Hacienda Drive
Dublin, CA 94568
USA
Toll Free: 1 800 341 6968 2660021156539 Rev. B 2015-09
Phone: +1 925 557 4100 Models 400, 4000 Instructions for Use
Fax: +1 925 557 4101 CIRRUS Instrument and Review Software 8.1
info@meditec.zeiss.com
www.meditec.zeiss.com/us Specifications subject to change without notice