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Eye and Vision Condition Education from Dr’s Doug & Lisa Cook

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Recharging Smartphones During Multiday Scouting Events – Part 1: Disposable Battery Ideas

February 24th, 2013 · Fun and After-Hours Whimsical Stuff

There are several ways to use smartphones during multiday outdoor or Scouting events with your smartphone and have it fully charged and available every day.

Recharging a phone overnight in the tent offers the most convenience.

I present some ways you can have access to your phone in the daytime and recharge it in your tent at night. It incorporates the use of a USB recharger.

1It’s a battery that supplies a built-in USB port with the 5 volts of power needed to allow a smartphone to plug in and recharge.

For example the iPhone 5 has a 3.8V, 5.45 Wh battery that should offer 1440 mAH of capacity.  You will need much more than 1440 mAH to recharge that battery however.

Why is a higher capacity recharge battery needed?  Recharging using batteries solely is not a one to one transfer of energy.  All batteries give off heat during recharging.  This means a recharger must be able to supply more than the rated capacity of the battery undergoing a recharge.  A rating double your smartphones battery rating acts as recharge insurance to insure a full recharge.  It also helps to insure against the gradual capacity reduction that develops over time with rechargeable batteries.

I present a series of blog articles on recharging options.  I’ll start with the simplest and continue to renewable but more expensive solutions.

USBnoPowerRecharge

Gadget Recharging When You Have No 110V access

Smartphones and other gadgets offer convenient ways to capture images and video while out in the wild.  They often require overnight recharging that would use a 110 V line.  When these are not available we need another solution.USB2

USB Port recharging

If your gadget can recharge through the use of a USB connector, you have options.  The symbol above is the USB symbol.  The connector that plugs into the power source looks like this.

USB rechargers

There are many USB rechargers that allow you to recharge your gadget.  The problem is that most of them require a 110V to recharge themselves.  An outdoor activity longer than one night requires a different solution.

Tekkeon MP1580 TEKCHARGE

Tekkeon1

Tekkeon2The feature that allows this gadget to work is it uses replaceable AA batteries.  You should be able to buy these at the trading post.  For traditional weekend adventures, you can also use Nickel Metal Hydride (NiMH) rechargeable AA batteries.  To recharge them, just plug the Tekkeon into a traditional 110V to USB converter like what comes with your gadgets.  The MP1580 supplies a neat adapter cable that converts to different sizes of USB A, B mini and micro sizes.

The Minty Boost – A Build it Yourself Option

Building a recharger offers a neat and simple solution that can be more customized.  It offers an educational value for adult or youth in electronics building that wont be too intimidating. It also doubles the efficiency due to it’s circuit design.

ElectronicsMBIn Boy Scouting this project can also complete up to 70 percent of the Electronics merit badge.

In Venturing, this may be considered useful towards the Arts & Hobbies bronze award & Outdoor bronze award (emergency preparedness).

VAHO

The first component functions similar to how the Tekkeon Tekcharge mentioned elsewhere in my Jamboree power series but you get the fun of building it yourself.  Adafruit supplies all the parts that you solder onto a circuit board.  This design will fit into an Altoids tin that you supply or you can order one for $2.00.

AdafruitMB

MB2Soldering takes about a half hour.  An AA battery holder comes with the kit.  You can substitute D or C cells for more recharges.  My tests reveal that a 9 day event like a Jamboree reduces the AA cell count of 48 down to 13 D Cells for complete recharges nightly with no power access at all.

MB3

MB4You can substitute D cells for more capacity.  Do not place more than 3 together.  The circuit is designed only to handle an input voltage of 5 volts or less.  Each battery cell supplies 1.5 volts.

The recharger circuit produces some heat that can get hot which is expected.

Batteries recharging other batteries is inefficient.  There will be some energy loss due to resistance – up to one half of the energy will be lost to heat.

Costs

Minty Boost               $19.50
Altoids tin                   $2.00 (or free)
D cell holder               under $2.00 (AA cell holder supplied in Minty Boost kit)

You can get D-Cell holders from your local or online Radio Shack.  Jameco is another popular electronic component supplier.

2D battery holder   http://www.radioshack.com/product/index.jsp?productId=2062241

Jameco 2D battery holder  http://www.jameco.com/webapp/wcs/stores/servlet/Product_10001_10001_216390_-1

Results

In testing, 2 AA batteries brought an iPhone 5 that was 95% discharged to about 75% recharge state.  This compares to 4 AA batteries using the Tekkeon MP150 Tekcharge.  It appears the Minty boost is twice more efficient.

D-Cell output with the Minty Boost

Testing underway – results to be edited here soon.

AA cells are rated to about 2850 mAH while a single D cell can output up to 15000 mAH.

On the surface it would appear that a single D cell could replace up to 5.26 AA cells – lets round that down to 5.

In testing however the D cell did not seem to offer this great a capacity.  An explanation here might involve the observation by Duracell that:

  • The AA format offers the greatest energy density.
  • Hi loads decrease efficiency with more energy lost to heat and resistance.

Source (http://media.duracell.com/media/en-US/pdf/gtcl/Technical_Bulletins/Alkaline Technical Bulletin.pdf)

This compounds my previous observation that batteries recharging other batteries is an inefficient process.

Advantages

  • AA cells can be bought nearly everywhere worldwide.
  • This solution requires no electricity access.
  • Recharging successful independent of weather conditions.
  • Works for general travel power needs as well.

Disadvantages

  • A 9 day event like a National Scout Jamboree would require 48 AA cells.

48AAsIf this seems wasteful, I would have to agree.  Not exactly conservation-minded is it?

Scouting embraces sustainability as we strive to be conservation minded.

This solution ends up being more expensive if you go to two of these multiday events due to the cost of disposable batteries.

I explore in another post a more sustainable solution using solar power and rechargeable options in my Part 2: Renewable and Sustainable Solar Ideas.

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Recharging Smartphones During Multiday Scouting Events – Part 2: Renewable and Sustainable Solar Ideas

February 24th, 2013 · Fun and After-Hours Whimsical Stuff

In part 1 of this series, I describe ideas on recharging USB rechargeable gadgets using a USB power port.  Section 1 deals with disposable batteries.

This section explores solar rechargeable options.

The workflow for this option involves setting out a solar panel to collect energy during the daytime storing the energy in a rechargeable batteries.  At night, you recharge your gadget using the power stored inside the solar-recharged battery.

This series offers build it yourself solutions to offer educational guidance about electronics projects.  For this section the complexity of the project increases compared to part 1’s Minty Boost project.  It’s still obtainable however for the do-it-yourself solution.  However it appears to cost a little more than a commercial product now available.

Commercial solar station option

Goal Zero Guide 10 Plus Adventure Kit (MRSP $159.95) (street price $105.00 +)

GZ1GZ2

This may offer a workable solar solution.  Reviews show acceptable performance but I have not personally tested this device.  Get the Plus unit as it has more capacity than the standard unit for just a little extra cost.

The solar cells hook up to a 4 AA cell battery pack that seems to offer similar functions as the Tekkeon MP1580 Tekcharge.

The iPhone 5 has a 3.8V, 5.45 WH battery that should offer 1440 mAH of capacity. I recommend a rechargeable solar storage battery capacity twice that rated for your smartphone.   The Guide Plus seems to have that capacity.

However, since it uses 4 AA’s I worry that it may not be able to recharge a fully depleted smartphone if its battery unit behaves similar to the Tekkeon.

Recharging using batteries solely is not a one to one transfer of energy.  All batteries give off heat during recharging.  This means a recharger must be able to supply more than the rated capacity of the battery undergoing a recharge.  A rating double your smartphones battery rating acts as recharge insurance to insure a full recharge.  It also helps to insure against the gradual capacity reduction that develops over time with rechargeable batteries.

Jamboree Solar Minty Boost

This is a great build-it-yourself project that gives you a backpackable solar power solution for your smartphone or USB rechargeable gadget.

This project is a collection of two projects available from Adafruit.com.

Part one

First build the minty boost project.  Part one of my series covers this project.  It provides USB port power via disposable or rechargeable AA batteries.

From there…

Adafruit.com supplies solar components that can convert the energy of the sun into battery power.

The USB / DC / Solar Lithium Ion / Polymer charger is easy to assemble.

AdafruitSolarThe circuit board is nearly complete with just a capacitor left to solder.  A solar cable connection and another cable connects the circuit board to a battery or your Minty Boost.

AdafruitSolar2

You can solder the capacitor so it’s straight up. I folded my over to keep a flatter profile in storage.

AdafruitSolar4

The circuit board has connectors that allow the attachment of (clockwise from top center): micro USB slot, solar panel, Load (leading to your minty boost) and a battery.

AdafruitSolar5Three LED’s give information.  A red LED on the top left indicates if the solar panel has current incoming.  An amber LED between the two bottom connectors, closer to the battery outlet indicates charging status while a green LED adjacent to the Load for the Minty Boost indicates when charging is complete.

The battery I chose was a Lithium polymer 3.7V 6600 mAH – the largest.  Larger is better as well when it comes to solar panels.  The largest panel outputs 3.4 watts at 6 Volts.

Take your Minty Boost project and solder in the power connecter supplied in the solar kit to the Minty Boost power supply leads.

AdafruitSolar6You will still be able to use your minty boost with disposable AA batteries.  I would not recommend attaching it to the circuit board as I haven’t tested to see if the circuit might drain the batteries in some way.

The usual configuration would be set up to store the collected solar energy in the Lithium polymer cell.  At night it recharges via the attached Minty Boost.  This allows you to use your smartphone during the day and recharge at night.  I should note that if the gadget can be attached directly during the daytime it would be more efficient to charge into the minty boost directly.  You lose the flexibility of using the smartphone so we store those converted photons into a battery.

The minty boost and a rechargeable separate battery can be attached simultaneously as shown in the illustration below.

AdafruitSolar7The circuit sends priority current to the load (the minty boost).  When done the circuit then automatically switches to send the excess into the lithium polymer battery.  It’s smart and well designed this way.

Costs for the kits

Minty Boost Kit                                                                                                      $19.50
USB / DC / Solar   Lithium Ion /Polymer recharger                              $24.95
Medium 6 V 3.4 W solar panel                                                                         $25.00
Lithium Ion Polymer battery pack 3.7V / 6600 maH                            $39.50
                                                                                                                                      $123.45

Note that the recharger circuit produces some heat that can get hot which is expected.

Advantages versus the Goal Zero solar product.

Jamboree Solar Minty Boost may have advantages of:

  • Better solar panels
  • Lithium polymer battery versus NiMH storage
  • A project useable for Scouting Advancement
    • Boy Scouting – Electronics merit badge
    • Venturing – Arts & Hobbies bronze award & Outdoor bronze award

AdafruitSolar8Other Advantages

  • The cost of disposables eventually outweighs the cost of either the Goal Zero of the Jamboree Solar Minty Boost after about 20 days of use.
  • These offer a lightweight energy source for backpacking

Disadvantages

  • Bright sunny days are required else little to no power is generated.  Packing disposable batteries as an emergency source of power may be needed.
  • Make sure to pack the Lithium ion battery in carry-on luggage if flying due to FAA rules.

In part 3 of this series I explore a larger scale solar energy station idea that has much more capacity but will cost 3 to 4 times more.

I also explore a solution unique to the BSA’s National Scout Jamboree where recharging stations are present during daytime hours.

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Recharging Smartphones During Multiday Scouting Events – Part 3: Larger Scale Renewable and Sustainable Solar Ideas

February 24th, 2013 · Fun and After-Hours Whimsical Stuff

In part 2 of this series, I describe ideas on solar recharging USB rechargeable gadgets on a small scale, most economical basis.

If you are willing to invest $350 to $600 or more, you can upsize your solar power plant.  Larger panels offer more power.  Newer solar cell technologies offer more efficient energy production.

Solar Power Station

SolarflyI used this design at the 2005 National Scout Jamboree.

A Brunton SolarRoll 14 ($300+) connects to a circuit overcharge protection / solar controller ($35).  The controller prevents overcharging of the battery when complete.  This panel can produce a maximum of 12V @ 14 watts over 10 hours (14 / 12) x 10 = 11.67 AH  It’s shown draped on the edge of a dining fly in this image.

solarsystemI have an AGM gel-cell battery ($25) to store it’s output.  I chose the battery based on what I need for replacements with an uninterruptable power supply protecting my computers at home.solarcontroller  A typical gel cell has a capacity of 7.2 AH, 12V or more.

Size matters, the bigger the solar panel the more power you can generate.  The size comes at a greater $ cost, sometimes significantly $$$ greater.

Storage battery

If you use uninterruptable power supplies (UPS) at home I recommend you buy a battery that will also serve as a UPS replacement.  This allows you to eventually put the battery into service and keep one spare ready and in use as needed for your solar project.

AGMbatteryConsider AGM gel cells if practical (source).  AGM stands for absorptive glass mat and are also known as valve-regulated lead-acid battery (VLRA), sealed battery or gel cells.  Regular addition of water is not needed.

 

Costs

Brunton Solar Roll 14                       $250
Recharge voltage controller          $  20
AGM Gel cell battery                         $  20

Commonly Available Technologies

Amorphous thin film is the usual technology used in panels that can be rolled up.  The efficiency of these panels is around 10.1 to 12.5 %.

CIGS (Copper Indium Gallium deSelenide) is another thin film technology with an increase efficiency to a range of 11 to 14% and are roughly double the cost of amorphous thin film.

Monocrystalline solar cells are in common use as well and come in panels with efficiencies ranging from 10.5 to 25% with most cells in between 18 to 24%

By using a 12V battery, you can use car charger style electronics to recharge your gadget.

Advantages

  • Higher power production abilities
  • Should be able to recharge multiple gadgets on sunny days.

Disadvantages

  • Much higher investment costs
  • AGM cells are heavy – too heavy for backpacking.  Lithium cell batteries may offer lightweight options but themselves add costs for large capacities.

Amateur Radio operators are frequent users of solar as well as other portable power sources. Images courtesy of Oscar Staudt (WB5GCX).

SolarAR1

Multiple panels can be set up to collect more power.

SolarAR2

Deep cycle batteries are designed to offer power over an extended period of time and can manage nearly full discharges and accept full recharges.  Standard automobile batteries on the other hand are designed to offer massive amounts of current / power in short discharges – necessary to start car engines but not ideal for extended use low current draws.  If you have ever experienced a dead battery while listening to the car radio during a weekend car cleanup, you’ve experienced the weakness that car batteries show when under a low current load over an extended period of time.

In part 4 of this series I explore a solution unique to the BSA’s National Scout Jamboree where recharging stations are present during daytime hours.

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Recharging Smartphones During Multiday Scouting Events – Part 4: Using Recharging Stations at Jamborees

February 24th, 2013 · Fun and After-Hours Whimsical Stuff

Recharge stations have appeared at National and World Jamborees.  Most smaller scout encampments may not offer this service.  Access to a electricity port in a restroom, cabin or building can serve this role too.

Most youth and adult participants will likely use a smartphone to take pictures and video during the jamboree. Jamboree planners assume this as well and have incorporated recharge stations located at each of the base camps.  Recharge stations are set up because these large events may host many tens of thousands of participants.

Recharging however takes several hours and you would like to use the device during the daytime.  Recharging a phone overnight in the tent offers the most convenience.

Here’s a way you can have access to your phone in the daytime and recharge it in your tent at night. It incorporates the use of a rechargeable USB recharger.

It’s a rechargeable battery that supplies a built-in USB port with the 5 volts of power needed to allow a smartphone to plug in and recharge.  The recharger battery itself requires a 110 V line to recharge later.

The workflow of the use of the battery is shown below.  After an overnight recharge cycle in your tent, drop off the USB rechargeable recharger battery to a recharge station located inside each base camp headquarters.  Bring it’s 110V adapter to plug it in.  Have fun and use your phone to take pictures and video.  Pick up the recharged USB charger battery and it’s adapter on your way back to your campsite.

Jamboree-Recharge-cycle

I would recommend a capacity twice that rated for your smartphone.

For example the iPhone 5 has a 3.8V, 5.45 Wh battery that should offer 1440 mAH of capacity.  A 2880 mAH or more USB Rechargeable battery rating should have enough capacity to fully recharge a fully depleted phone battery.

Why is a higher capacity recharge battery needed.  Recharging using batteries solely is not a one to one transfer of energy.  All batteries give off heat during recharging.  This means a recharger must be able to supply more than the rated capacity of the battery undergoing a recharge.  A rating double your smartphones battery rating acts as recharge insurance to insure a full recharge.  It also helps to insure against the gradual capacity reduction that develops over time with rechargeable batteries.

A quick review of retail pricing shows many USB rechargeable chargers exist with 2500 mAH or greater capacities between $28 to $50.

HyperJuice1Some manufacturers sell batteries designed to supplement notebook batteries for extended run times.  If these products offer USB ports then you have a large capacity multi-function battery.  One example is the HyperJuice product for Macbooks.

HyperJuice2

Advantages

  • The cheapest solution that keeps your smartphone going while you get to use it during the day.
  • Efficient use for general travel as well.

Disadvantages

  • Present only at large encampments unless you have special access to a single 110V outlet somewhere.

UPDATE (April 2013)

95311

Monoprice.com has introduced an external battery that is the  best value I’ve tested  among USB rechargeable rechargers.  It has a huge capacity at 9000 mAh for only $29.19.  Its called the External Battery Pack and Charger for  iPad®, iPhone®, iPod®, and other USB Mobile Devices (9000mAh).  In my tests, I was able to achieve the equivalent of 4 complete zero to 100% recharges on one battery charge.  It comes with a special cable with a USB type A to round earphone type plug to recharge it’s battery.  Connect it to a powered 5V USB port and expect a full night to 12 hours to recharge.

There are probably many more ideas that work just as well if not better than some of the ones presented in this series.  I invite you to explore your creativity in making a system that works for you.

USBnoPowerRecharge

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Vision Care Plans

December 19th, 2012 · Uncategorized

Each doctor in this husband / wife team graduated first in their class – summa cum laude (Dr. Doug in 1989 and Dr. Lisa in 1991).  Over forty percent of our practice is ocular disease management.  This includes glaucoma (with over 400 patients), diabetic retinopathy, macular degeneration and corneal diseases amongst other disorders.

As such, we may not see as many healthy eyes as other providers.  Vision care plans only cover some things (and nearly no coverage for disease-related conditions) and not many other options.  Unhappy encounters can occur with many of the bottom feeder type vision care plans when the doctor has to explain why their third party plan won’t cover what the patient assumed.

Patients build a trust with their eye care provider.  Patients assume if my name appears listed under a plan, we endorse or recommend it – which we can not.  For that reason, we are not members of the largest plan out there.

Vision Service Plan (VSP)

We carefully consider each plan whose offer appears on our desk.  We can evaluate the net benefit to the patient and the doctor.  Putting the numbers into a spreadsheet reveals a net pay as low as $8.50 per hour for the doctor.

If this rate of pay seems less than what you make at your job, you can understand why we are not providers.

You can be seen out of network with VSP.  They will reimburse you to see any eye care provider you choose.  We will provide you with a complete receipt, a form for filing reimbursement, and a stamped addressed envelope we can provide.

Bottom feeder vision care plans have their market, but they aren’t for every patient.

Which one is the best?

If you are seeking a plan, We would recommend Vision Care Oklahoma (also known as Vision Care Direct).  This nonprofit entity has a board of directors run entirely by optometric physicians – including Dr. Doug Cook.

Having trusted colleagues on the panel insures in our opinion highest quality of care with happy patients not upset that their plan covers a few things but leaves most items on as expensive copay upgrades.

Other plans

Other vision care plans we are providers include:

Vision Care Oklahoma / Vision Care Direct

Primary Vision Care Services

SoonerCare / Oklahoma Medicaid / Insure Oklahoma

Vision care benefits exist for children only through age 20. No adult benefits exist except for eye medical conditions.

Humana HumanaVision VCP

Blue Cross / Blue Shield

Note: some BC/BS plans farm out their vision care to other plans.  They do have their own plan for which we are providers.  The only way to know is to care the plan to find out.  We are on BC/BS managed panel but may not be on a panel if it is subcontracted to another plan.

We strive to offer an experience far better than what a lowest bidder can provide with your most important sense.

Checking Coverage 

There are over 60 different vision care plans.  Due to privacy policies, many plans have now eliminated the ability for doctors offices to call to check coverage.  These plans need a patient physically present or themselves call to confirm their coverage and discover if we are on that panel or not.  Don’t feel disappointed if we are unable to check for you due to these privacy policies.

Medical Eye Care / Health Insurance coverage

We are on many health insurance plans including Medicare, Most of the Medicare Advantage plans, Medicaid / SoonerCare / Insure Oklahoma and Blue Cross / Blue Shield. Other insurance plans may also help.

Traditional health insurance covers eye medical diseases such as glaucoma, cataracts, dry eye, ocular allergies.  They do not cover vision testing, testing for glasses, testing and fitting services for contact lenses nor the lenses themselves.  See our other post on Vision Care versus Eye Medical Care for more details on the differences.

When health insurance is applied it is because a diagnosis of an eye disease can be applied and is the reason for the visit.  Most insurance plans will not cover routine visits, annual checkups or complaints based on blurred vision resulting from a change in glasses prescription.

Trust eyes lowest bidder blog

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A New Sign

July 24th, 2012 · Fun and After-Hours Whimsical Stuff

About ready to fall apart, our first sign will be restored and mounted on our new office as additional signage.

One of the benefits of starting a practice is the opportunity to design your own sign.  We did just that in 1992.

Twenty years pass and now the sign shows it’s age.  In addition to weathering the sign was just too small for drive-by traffic to notice.  The fonts were too small, the color faded and the wood framing was falling apart.

Consider that a future potential patient probably has blurred vision, there was no way this sign could deliver it’s message. A new sign was needed.

I used 3D modeling software SketchUp originally developed by Google to create a 3D mockup of our vision for a new sign.  This tool allows one to visualize and easily change parameters and explore it’s shape, size and color from different perspectives.  In the design I worked to incorporate concepts involving the geometry of the golden rectangle and incorporated its ratio of 1:1.618 in the layout and dimensions of  many of its design elements.  This helped to create an aesthetic balance pleasing to the eye.

The design can be described as a monument sign –  a black slab onto which our lettering and graphics shine from 1/2″ acrylic graphics pushed through aluminum panels that make up the sides of the slab.  Monument signs are often built on the ground with a brickwork foundation supporting and surrounding it.  We wanted ours elevated to help it stand out.  We envisioned a grid like tower that was offset to visually pull the attention of the viewer towards it.

While creative in concept, this made for a more challenging engineering fabrication compared to most signs that use a simple pole mount placed in the center. I approached several sign makers in our area.  Metro Sign rose to the challenge.  Researching some of their work revealed they create custom signage without cornering their customers into a cookie cutter template.  The company president, Jess, appreciated the look of our design and focused his company’s talents to engineering a structure to make this concept a reality.

I took a look inside the sign when during it’s installation.  The inside was well thought out – engineered and fabricated with welded steel square tubing for strength against Oklahoma’s weather.  The tower welded with square tubing supports the sign with a gridwork of bracing leading down into a cemented base underground.

Inside an LED array of lights sit adjacent to each graphic element.  LED lighting is gaining ground as the reliable choice given its 20,000 hour life rating and incredible efficiency.  Power costs are estimated to be one-fourth or less when compared to traditional halogen or fluorescent lighting in a typical sign.

In the image below, I was amazed how our signmaker matched the sign design to our 3D mockup.

Practice management experts say that investing in one’s sign offers the quickest return on investment when compared to other forms of media exposure such as yellow pages, newspapers or billboards.

Our name is visible from a much further distance – an important asset for an optometrist.  Coupled with an easy to remember phone number a new patient has all they need to set up their appointment.

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A 21st Century Retinal Camera

June 8th, 2012 · Ocular Disease

This is a review of the Nidek AFC-230 retinal camera. I had been waiting for years for a company to develop a retinal camera design that would be future-proof. I think Nidek has done it.

The trend for so many opthalmic instruments over the past 20 years was to build an all encompassing product that produces clean sleek lines that project state of the art in it’s outward appearance. This required compromises as the imaging technology would quickly lag behind soon after a purchase when the megapixel count or more important the imager sensitivity improved as they quickly do in regular commercial photography equipment. The result is a sleek looking 2.5 megapixel (or insert your outdated feature here) imaging box that quickly becomes obsolescent.

Nideks AFC 230 & Dell Vostro sits an ARK-530A Autorefkeratometer

Nidek designed their retinal camera right. They adopted a strategy of utilizing the best of prosumer grade photography imaging capture devices. In this case, the Canon 5D mark II – a 21 megapixel camera body that became a darling for photographers and videographers alike. Nidek then did what I think they are best – designing a “lens” or more appropriate an “imaging system” For retinal cameras this is where the precise engineering should be focused. They adapted autotracking systems originally developed for refractive surgical lasers and autorefractors and applied them to their alignment system to keep the camera in alignment. Inside sophisticated optics work to keep the focus in sharp check and provide the user with a standard monochrome image for alignment.

Real World Use

After 70 days I would describe the learning curve as fast especially if you ever used a slide based fundus camera. Cameras got dumbed down in the 1990′s as digital imaging came into the scene. The settings for this camera are set by knobs and dials on the unit – you touch nothing on the camera body itself. A laminated cheat sheet supplied guides the user for the modes less often used. Nidek supplied an LED lite to illuminate the adjustment knobs down below – a well thought out addition. Practical peripheral use limits seems to reach the equator for most patients. I have on a few occasions gone further. Peripheral imaging requires the use of the supplied fixation stalk which is an adjustable cable stalk with an LED fixation light to get those extreme views.

One necessary engineering requirement in this design involves exterior cabling. In order to create a future upgradable product using the body of a prosumer SLR, cabling is needed to attach to the SLR, the supplied/attached adjustable video display and to the computer. This for me is much preferred compared to a one piece but obsolete white elephant after 10 years of use.

The model of notebook supplied was a Dell Vostro 1015 with Windows 7 Professional installed.  It’s not a powerhouse but it does what it is supposed to do efficiently and serves as the server to the practice for the images captured.  I easily integrated this computer into my daily backup routine for onsite and offsite backups.

A hot pixel was observed on all images since the day of first use.   It was a Canon problem – hot or dead pixels can occur with image sensors so a quick swap was the remedy covered under the warranty.

Imaging and Electronic Medical Records

Digital photography can integrate most likely with your current practice management software. It’s likely however you will have to pay an annual fee for this feature. This is a planned annuity that is a scheme of the practice management software folks who set up the hostage fees for every little nook and cranny their software should have supplied in the first place.. Nidek does have a very workable substitute that’s included free with their cameras. It’s called NAVIS-Lite. You will have to dedicate a PC to use with your retinal camera and Nidek offers a Dell Vostro along with their units. It’s sufficient to capture and store your images and act as a server to the rest of the practice for displaying or working with the images. I bought a laptop bracket to connect with our machine to get it secured from falling and raised to a users level for data entry. Because it does not link with your PM software, you will have to enter a chart number, patient first and last name and birthdate and gender. The later two entries are optional and configured via it’s setup software. After done, you will want to close the record so you can access images from other locations – just like many other database systems. Wireless networking works just fine with minimal lags (1 to 3 seconds) observed maybe 5 to 10 % of the time. This is most likely would be a wireless interference issue of your network more than a Nidek problem. Cabled ethernet would give flawless instantaneous responses all the time.

Markup and Analysis Features

The biggest value I find here is the ability to create delineation circles around the edge of the disc and cup. This offers accuracy of a cup/disc ratio down to the .01 decimal point. So an objectively doctor assessed C/D of 4 may end up as a 4.21 with NAVIS-Lite. Time will tell if this offers improved long term sensitivity for detecting cupping changes but my hunch is that it will. Text and drawing features seem rudimentary and go unused in our office.

Stereo Optic Nerve Head Imaging

I first began taking stereo images in the early 1990′s thanks to my video slit lamp and a 60 D lens. You translate the joystick left and right to get the parallax you need to construct an image. Nidek makes it easy with a stereo mode on their camera. You move the fixation target with a woggle type of input device that can move the flashing greed dot LED in any direction. After each capture you can proceed or retake until you have the two necessary views for a stereo image. From there, you can use NAVIS-Lite to autocrop the images to build a convenient stereo image. Nidek supplies a stereoscope to view the image on your PC. For printouts one can try free fusion technique (see my post on Free Fusion of Stereo Optic Nerve Head Images)

Stereo Optic Nerve Head image created by NAVIS-Lite. Click to view larger image. Read my other post linked in the article to learn how to free fuse stereo images

Panorama Retinal Images

Composition is easy with NAVIS-Lite. You should acquire images which sufficient overlap so you can self guide the images one atop the other using retinal landmarks such as vascular bifurcations as reference points. The software then constructs a composite result of your collected images. NAVIS-Lite makes easy work of this. I’ve used panorama stitching software by itself and as plugins in Photoshop and NAVIS Lite seems the most adept at layering and merging the combined images. I was able to get a superimage of about 186 megapixels on a volunteer that agreed to sit as a subject while I collected about 12 snapshots covering most of her retina.

This two image panorama was as easy as stereo photography using the free NAVIS-Lite database and editing software that comes with the camera.

Tricks and Tips

  • This camera has an undocumented anterior segment mode that works better than the published method of capturing external images.  I’ll detail this function in a future post.
  • Capturing images can occur with pupils 3.8 mm or smaller,  diffraction and glare become more obvious.  One may have to increase the illumination from a 9 to a 10.  If cataracts are present, the glare becomes excessive – go ahead and dilate anyway.
  • Buy a notebook desk attachment bracket to elevate your computer so you can type and access the PC from a standing position.
  • The fixation target projects to the left of center for the right eye and right of center for the left eye.  In low vision cases, wave your hand to the left or right of the display screen to emphasize where the fixation target should be or to align the eye if the patient can not see the target.
  • NAVIS-Lite displays the whole patient database by default upon bootup.  Once you have more than a dozen patients saved, finding the most recent pics takes more time.  It will streamline your routine significantly if you just display a list today’s patients by default.  From the top menu bar click on Setup > Patient List top tab > click on Tree View and enable the Today checkbox and click OK.  This may be the most important timesaving tip I can offer for current users.

Field of View Inside the Eye – a less technical illustration

Image Resolution

is so keen that the display surpasses what I can get through a direct ophthalmoscope, 60 to 90 D lenses on a slit lamp, or binocular indirect ophthalmoscopy.  While the standard of care involves directly viewing the fundus and I still do, I am seeing more of the posterior pole now better than ever.

Viewfinder Interface

You don’t use the SLR’s optical viewfinder.  Instead, Nidek’s hardware supplies an infrared based image on your screen after you have lined up the Purkinje image reflected from the cornea.  The display has an adjustable view angle and shows good detail and information for image capture.

Summary

For retinal cameras, we are completely happy with the 230.  Sharing images on the computer in each exam room helps with patient education while projecting a 21st century professional image. Nonmydriatic performance is excellent.  While task delegation may not be as simple as 1990′s click and shoot machines it is real close by one or two days of extra staff practice.  Nidek has enabled the user to control more functions with real knobs and dials instead of menu selections – akin to mydriatic cameras used for angiography.

Image resolution is outstanding – far better than slit lamp based funduscopic lenses. It promises to enhance the quality we strive to deliver for eye care.

 

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Free Fusion of Stereo Optic Nerve Head Images

March 17th, 2012 · Fun and After-Hours Whimsical Stuff, Ocular Disease

How to Free-Fuse Stereo Imaging

Each stereo view consists of two images, one for each eye. Free viewing is the technique that will allow you to direct each of these images separately and simultaneously into each eye without using a stereoscope.  If you have presbyopia and need reading glasses, put them on.

The image to free fuse looks like this:

Cross your eyes, so that the pair of images will double to four, and it may be out of focus. At some point, the two pairs of images you are seeing will begin to overlap.  Another way to accomplish this is to use a pencil or fingertip laid on the paper at the black bar.  Bring the pencil forward while focusing on the tip keeping it clear.  The background images will blur:

The part of the image in color indicates the beginning of an overlapping view.  That area of overlap is where you will fuse the left and right images of the pair. Continue to bring your pencil or fingertip towards you until the fusion effect (while still blurry) looks like below:

At this stage below, your eyes are crossed just the right amount (convergence) but the focus is off (accommodation). 

You must dissociate the focus (accommodation) from the convergence while keeping the center image fused together.  Try tracing the details such as blood vessels or the rim of the optic nerve head to help you gain a clear focus.  Continue to keep your eyes crossed.  In a few moments your visual system will redirect your eyes to focus on these details without uncrossing.  When you have achieved it, you should be able to perceive the 3 dimensional depth of this optic nerve head cup.

This technique can create eyestrain as accommodation and convergence are not designed to work at differing distances.  Some people cannot simply achieve the stereopsis effect.  If you have amblyopia, strabismus, are monocular or suppress one eye then you won’t be able to see in 3D.

Stereo viewers with variable prism greatly assist fusing these images.  With practice this free fusion technique develops more quickly.

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Exam Chair Kerbangs

September 1st, 2011 · Fun and After-Hours Whimsical Stuff

Sometimes one needs to lift up the footrest to allow best access to your exam chair for the disabled or elderly.  At the end of the exam some folks forget they are on a platform and risk a fall off the footrest as they get up.  So I’ll lift up the footrest for them to exit.

 

 

 

The trouble begins with the heel of their foot catching the back side of the footrest.  Theres a little ledge under the pivot bar that the heel can push.  The platform pivots forward so that if crash lands behind them in with a loud metallic clunk after the first step away.

I invented a fix that prevents this unwanted surprise.  The chairs we use are the Topcon OC-20T.

 

A Magnetic Solution

After experimentation I found that N40 magnets from a business called “MagnetMan” on Amazon creates the perfect blend of attraction without requiring too much force to disengage.  These are strong neodynium magnets and you will need to take caution with this size or larger.  Skin caught in between two magnets can cause a blood blister or a bruise due to the strong magnetic forces attracting to each other.

The footrest on my chair is attached by a wingnut.  The back side has slots to allow the upholstery seam to attach.

 

 

 

 

 

 

Slip a magnet into the wooden slot and continuing through the padding to reach the backside of the upholstery.

 

 

 

You can use another magnet to guide it to where it’s best.

After positioning the 2 chair magnets behind the upholstery, determining where to place the magnets for the footrest is easy.  They will self center.  Keeping the placement high like shown may offer the best leverage  for keeping the footrest in place when raised.

The footrest is made of aluminum so the magnets won’t stay by themselves when when the footrest is lowered.  A dab of double-sided sticky foam tape holds them in placed when deployed.

Their may still be some instances of “kerbangs” but my solution should prevent most of them now.

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Hot Weather Affects Photochromic Lens Darkening

July 12th, 2011 · Eyewear

Photochromic lenses are lenses that can ge®t darker as one goes into brighter light.  Inside or on the lens a component (either a silver halide crystal in the case of glass  or an organic molecule in the case of plastic) gets dark depending on the amount of UV light in the area.

Hot temperatures decrease the darkening effect.  As an example, we took a glass photochromic lens called Photogrey Thin and Dark ® (link).  This lens is the darkest glass photochromic we are aware and gets down to 14% transmittance – a good sunglass grade.  This means that 86% of the visible light is filtered.

We measured the lens at 40 degrees F after a 3 minute exposure on a clear sunny day.  The lens performed as expected (see illustration – lower white graph).  We next measured the same lens at 100 degrees after a 3 minute exposure.  The transmittance only reached 54% (upper grey graph).  We used our Humphrey Instruments automated lensometer which has a spectrometer to measure the absorbance of light in the visual and UV range.

Hot lenses transmit more light (top) than cool lenses (bottom)

All photochromic lenses exhibit this behavior called temperature dependency.  The process is most efficient for skiers on snowfields than sunbathers on a beach on a hot sunny day.

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