Quick Guide - ZEISS CALLISTO eye 3.

5 matching the
reference image

Sylvia Andrea Schwarz

Training & Application Support Manager EN_32_012_0009I
Oberkochen, 2019-09-03
Quick Guide - ZEISS CALLISTO eye 3.5 matching the reference image
Introduction - Algorithm

vs.

• ZEISS CALLISTO eye® aligns the microscope image (colored picture) according to the reference picture (black & white,
captured by the ZEISS IOLMaster ®) regarding the position of the scleral blood vessels. Fine adjustment has to be done by the
user after successful matching to ensure reliable assistant functions.

• The good quality of the reference picture is the starting point of a successful toric IOL alignment. If the reference
picture is not in good quality, repeat the ZEISS IOLMaster measurement!

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Quick Guide - ZEISS CALLISTO eye 3.5 matching the reference image
Capture the IOLMaster reference picture

• Lids too close

• Use the side covers on the ZEISS IOLMaster headrest or put a • Defocussed
black rag over the patients head to avoid disturbing light • Nasally disturbing
reflections on the sclera light

• Advise the patient to blink once before starting the measurement • Lids too close
to ensure a proper tearfilm  keratometric values of anterior • Defocussed
• Nasally disturbing
corneal surface is measured again while capturing the reference light – scleral
picture. Use artificial drops if patient has tearfilm of bad quality blood vessels not
visible at all!

• Eyes opened widely – if patient cannot open the eyes widely by • Lids too close
his own (e.g. due to Ptosis), lift the upper lid by using a Q-tip. Be
carefull to not squeeze on the cornea while lifting the upper lid,
otherwise keratometric values will be falsified

• Too dark

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Quick Guide - ZEISS CALLISTO eye 3.5 matching the reference image
Capture the IOLMaster reference picture

• The green arrows, the traffic light and the color code help you to find the right
measurement position for focus & centration

• Check the image quality directly after the ZEISS IOLMaster measurement: focus,
centration, sharpness & the amount of scleral blood vessels. Repeat the
measurement if needed! defocussed

• The good quality of the reference picture ensures your success of the
matching on ZEISS CALLISTO eye!

decentered

lids too close

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Quick Guide - ZEISS CALLISTO eye 3.5 matching the reference image
Microscope requirements

a. White balance test was performed successfully on a piece of white paper *b)

b. Microscope head is not tilted above the patients eye – 2 small black lines
are coincident, if not adjust over the big black knob*

c. For an homogenous red reflex the microscope illumination should be set

up: 100% coaxial illumination (SCI) : 30 – 50% full field illumination*
*c)

d. No light sources switched on next to the microscope head, which can

produce dusturbing light reflections on the patients eye

Adjust directly at the microscope, or:

e. Light filters are deactivated (e.g. yellow filter)

SCI 100%
FF 30-50%

adjust under Lumera options at CALLISTO

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Quick Guide - ZEISS CALLISTO eye 3.5 matching the reference image
Check availability and quality of the reference image on CALLISTO eye

Attention – in case of poor image

quality, matching can fail!*

Check the quality of the reference

image under documents of the
activated patient:

- Focus on scleral vessels

- Eye open, lids not covering
- No disturbing light reflections
on the sclera
*Check for example the quick guide of IOLMaster 500: QUG IOLMaster 500 option reference image.pdf

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Quick Guide - ZEISS CALLISTO eye 3.5 matching the reference image
Preparation Phase

1
1. Select the patient

2. Prepare the treatment (1)

• Treatment position
• Apply ZEISS IOLMaster data
• Incisions & LRIs: size & position
• Rhexis size
• Z ALIGN: axis for toric IOL
alignment

3. Start the treatment under patient

2 administration (2)

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Quick Guide - ZEISS CALLISTO eye 3.5 matching the reference image
Centering of the eye - Parfocality

Parfocality: Live video & microscope

image are in the same focus

1. Microscope head is in default position

2. Move the microscope head above the

patients eye until it is sharp on the
video screen

3. Maximum magnification

4. Adjust the focus on the cornea on the

video screen

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Quick Guide - ZEISS CALLISTO eye 3.5 matching the reference image
Centering of the eye - Parfocality

5. Adjust the microscope

− Pupil distance
− Eye cups (turn out if not
wearing spectacles)
− Diopters (use far correction if
needed)
2/3 of total
Overall screen 6. Reduce the magnification and
screen height
height center the eye:
Pupil centered and limbus size
should be approximately ⅔ of the
screen height

7. Adjust focus on scleral blood vessels

if needed

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Quick Guide - ZEISS CALLISTO eye 3.5 matching the reference image
Requirements before the matching

8. No surgical instruments around the

eye

9. Incisions are not performed

10. Limbus is completely visible on the

video screen*

11. Sclera is 360° visible around the

limbus without occlusion of speculum,
lids or lashes

12. No liquid accumulation in the eye

*The video image section can be checked by means of the video frame of the integrated
data injection system. The video frame can be set under “Lumera 700 configuration –
Displays – additional settings”. The frame is then visible in the eye piece of the microscope
oculars.

Attention: The frame will not be visible on the video screen! This picture is just an example!

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Quick Guide - ZEISS CALLISTO eye 3.5 matching the reference image
Matching the reference image - markerless

Markerless option:

1. Click on “Reference“ to perform

the matching

2. Click on “Automatic“ (IOLMaster)

to perform the matching for
markerless alignment of the
reference axis

Attention -
matching can fail in case of
chemosis or bleeding!

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Quick Guide - ZEISS CALLISTO eye 3.5 matching the reference image
Alignment of the microscope image

Verify alignment of microscope image (colored) with the

reference image (black & white) and correct the position
by using the arrow buttons if needed. Use the overlay,
side by side or grid option to check the position of the
blood vessels

If surgeon confirms the alignment of the microscope

image, press “OK“ under confirmation. A good
alignment of both pictures is mandatory to ensure
reliable assistant functions!

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Quick Guide - ZEISS CALLISTO eye 3.5 matching the reference image
Alignment of the microscope image

Check position of
the blood vessels

• After pressing the button for the matching, the software is The two image
prealigning the microscope image to the reference image by modes
rotation until the scleral blood vessels are on the same position “side_by_side” and
“overlay” help you
• The fine adjustment has to be done by the user by using the for the alignment
arrow buttons

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Quick Guide - ZEISS CALLISTO eye 3.5 matching the reference image
Alignment of the microscope image

• Use the unrolled pictures (1 +2) of the scleral blood

vessels around the limbus under the reference picture &
the microscope image for easier fine adjustment of the
matching

• Complete visibility of the scleral blood vessels in

the green & the pink area is needed for stable data
injection and reliable tracking during the surgery

• Good quality of the microscope image is also

1 mandatory for stable data injection and reliable tracking
 Right magnification
 Scleral blood vessels focused
 No liquid on the eye

2  No instruments in the picture

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Quick Guide - ZEISS CALLISTO eye 3.5 matching the reference image
Matching the reference image - markerbased

Markerbased option:

1. Only 2 blue markings are visible on the

sclera (1)

2. Click on “Automatic“ or “Manual“

1 (Markers) to set the reference axis (2)

Attention –
Manual marking of the reference axis
works on CALLISTO eye only if the
eye of the patient was previously
marked with blue ink!

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Quick Guide - ZEISS CALLISTO eye 3.5 matching the reference image
Matching the reference image - markerbased

Markerbased option

If you choose the “Manual“ option:

Tap on the blue markings. Two

green dots appear to define the
orientation of the reference axis

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Quick Guide - ZEISS CALLISTO eye 3.5 matching the reference image
Treatment Phase

The reference axis is set according to the

alignment.

The overlays for incisions / LRI, rhexis and

Z ALIGN are now visible, if “DIS“ is
activated (1)

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Quick Guide - ZEISS CALLISTO eye 3.5 matching the reference image
Do’s & Don’ts

Do’s Don’ts
Reference picture:
Reference picture: • Eye lids too narrow
• Eye wide open • Scleral blood vessels defocused
• Homogeneous • Nasal disturbing light reflections
illumination
• Focus on scleral
blood vessels
Live image:

1) Focus on eye lids – scleral blood

Live image: vessels blurred & limbus
• Focus on scleral decentered
blood vessels
• Limbus centered & ⅔
of screen height 2) Magnification too high & limbus
decentered

3) Lids & eye lashes covering the

scleral blood vessels, too much
liquid in the eye

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Quick Guide - ZEISS CALLISTO eye 3.5 matching the reference image
FAQs

The quality of my reference picture is not good. What can I do?

• Repeat the ZEISS IOLMaster measurement and export it again. Use the side covers on the ZEISS IOLMaster headrest or put a
black rag over the patients head to avoid disturbing light reflections on the sclera. The green arrows and the traffic light help you
to find the right measurement position for focus & centration: .
.

Advise the patient to blink once before starting the measurement and to open the eye widely. Check the image quality directly
…..after the ZEISS IOLMaster measurement and repeat the measurement if needed.

The IOLMaster did not export the reference picture on the USB stick
• Always use the empty USB stick that was delivered with the device for the export
• ZEISS IOLMaster 700: Click on to open the settings. Go to “Advanced settings”  “Export” and choose “File” for DICOM
export. Clicking on “Export” after performing the measurement safes the printout and the reference picture now to the USB stick.
• ZEISS IOLMaster 500: Click on button after measuring the reference picture to export the image & the ZEISS
IOLMaster report to the stick. Do not use the USB stick symbol from the tool bar

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Quick Guide - ZEISS CALLISTO eye 3.5 matching the reference image
FAQs

Which button do I have to press to import the patient from USB stick or from Forum?
• Click on “Import patient” in the patient administration screen. A menu opens:

Imports patients from the USB

stick

Imports patients from Forum

Overlays are not visible on the screen and in the oculars after successful matching of the reference picture

• Confirm the alignment of the microscope image always by pressing the “OK” button. Make sure that the data injection system is
activated:

Export of patient data from FORUM to ZEISS CALLISTO eye is not possible

• Make sure that you only marked the ZEISS IOLMaster report you want to export to ZEISS CALLISTO eye

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Quick Guide - ZEISS CALLISTO eye 3.5 matching the reference image
Documents

1. User manual of ZEISS CALLISTO eye version 3.5.1 (G-30-1933-en)

• Usage of the assistant function, page 110 ff

• Description of the tabs of the assistant functions, page 212 ff
• Recommendations for best results when using the Assistant functions (Clinical Guidelines), page 313 ff

2. Quick guide ZEISS IOLMaster 500 – option reference image: QUG IOLMaster 500 option reference image.pdf
(000000-1865-713-KurzGA01-GB-040713)

3. ZEISS IOLMaster 700 - quick guide (000000-1692-983-KurzGA01-DE-191012)

4. Quickguide ZEISS CALLISTO eye 3.5 V01.pdf (MM # EN_32_012_0001I)

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