K Number
K091683
Device Name
KOWA VX-10 A
Manufacturer
Date Cleared
2009-07-02

(22 days)

Product Code
Regulation Number
886.1120
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The KOWA VX-10a is intended for taking pictures of fundus images with mydriatic or without mydriatic.
Device Description
The KOWA VX-10a is a simplified version of the predicate device [KOWA VX-10i (k062021)] by removing the indocyanine green (ICG) angiography mode, removing the use of Polaroid film as a recording media, and changing the availability of the data card for writing patient information as an optional accessory. In addition the lens coating was changed.
More Information

Not Found

No
The document explicitly states "Not Found" for mentions of AI, DNN, or ML, and the device description focuses on hardware changes and removal of features compared to the predicate.

No
The device is described as taking pictures of fundus images, indicating it is an imaging device for diagnostic purposes, not a therapeutic one.

No

The device is described as taking pictures of fundus images, which is an imaging function, not a diagnostic one. It does not analyze or interpret these images to provide a diagnosis or aid in diagnosis.

No

The device description explicitly mentions hardware components like a lens coating and the removal of hardware features (Polaroid film, data card), indicating it is a physical device, not software-only.

Based on the provided information, the KOWA VX-10a is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is "taking pictures of fundus images". This describes a device used to capture images of a part of the body (the fundus of the eye).
  • Device Description: The description focuses on the physical characteristics and functionality related to capturing images.
  • Lack of IVD Characteristics: An IVD is a medical device used to perform tests on samples taken from the human body (like blood, urine, tissue) to provide information for diagnosis, monitoring, or screening. The KOWA VX-10a does not perform any tests on biological samples. It is an imaging device.

Therefore, the KOWA VX-10a falls under the category of an ophthalmic imaging device, not an IVD.

N/A

Intended Use / Indications for Use

The KOWA VX-10a is intended for taking pictures of fundus images with mydriatic or without mydriatic.

Product codes

HKI

Device Description

The KOWA VX-10a is a simplified version of the predicate device [KOWA VX-10i (K062021)] by removing the indocyanine green (ICG) angiography mode, removing the use of Polaroid film as a recording media, and changing the availability of the data card for writing patient information as an optional accessory. In addition the lens coating was changed.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

fundus

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies

The following tests were performed:

  1. Test Report for ISO10940, 1998: Ophthalmic instruments - Fundus cameras
  2. Test Report for ISO 15004-1, 2006: Ophthalmic instruments-Fundamental requirements and test methods Part 1: General requirements applicable to all ophthalmic instruments
  3. Test report for ISO 15004-2:2007 Ophthalmic instruments-Fundamental requirements and test methods Part 2: Light hazard protection

The test results demonstrated that the KOWA VX-10alpha conforms to the above listed standards. which confirmed that the change in the lens coating did not raise any safety concerns.

Key Metrics

Not Found

Predicate Device(s)

K062021

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 886.1120 Ophthalmic camera.

(a)
Identification. An ophthalmic camera is an AC-powered device intended to take photographs of the eye and the surrounding area.(b)
Classification. Class II (special controls). The device, when it is a photorefractor or a general-use ophthalmic camera, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 886.9.

0

-- СНУО КН. ТОКУО 193 8432 ИРА ਕ ਨ

K091683
4-14, NIHONBASHHONCHO 3-CHOME
CHUO-KU, TOKYO 103-8433 JAPAN

Applicant:Kowa Company, Ltd.
4-14, Nihonbashi-honcho 3-chome
Chuo-ku, Tokyo 103-8433 Japan
Contact:Akihiro Fujita
Date Summary Prepared:May 15, 2009
Device Trade Name:KOWA VX-10α
Classification name:Camera, Ophthalmic, AC-powered
Product code:HKI

Intended use:

The KOWA VX-10a is intended for taking pictures of fundus images with mydriatic or without mydriatic.

1

Comparison:

The KOWA VX-10i was chosen as the predicate device.

The KOWA VX-10a is a simplified version of the predicate device [KOWA VX-10i (K062021)] by removing the indocyanine green (ICG) angiography mode, removing the use of Polaroid film as a recording media, and changing the availability of the data card for writing patient information as an optional accessory. In addition the lens coating was changed.

In order to evaluate the effects of the change of lens coating for any optical hazards, the following tests were performed:

  1. Test Report for ISO10940, 1998: Ophthalmic instruments - Fundus cameras

  2. Test Report for ISO 15004-1, 2006: Ophthalmic instruments-Fundamental requirements and test methods Part 1: General requirements applicable to all ophthalmic instruments

  3. Test report for ISO 15004-2:2007 Ophthalmic instruments-Fundamental requirements and test methods Part 2: Light hazard protection

The test results demonstrated that the KOWA VX-10α conforms to the above listed standards. which confirmed that the change in the lens coating did not raise any safety concerns. The test results are included in Appendix D.

A comparison of the KOWA VX-10a and the predicate device is shown below in Table B.

Table A. Predicate device

Predicate DeviceManufacturer510(k) NumberDate Cleared
KOWA VX-10iKOWA Company Ltd.K062021Nov. 1, 2006

Conclusion:

The KOWA VX-10a is equipped with the same fundamental technology features equivalent to the predicate devices, and also delivers the equivalent level safety and effectiveness. Therefore since there are no significant difference in the basic function, safety and effectiveness between the KOWA VX-10a and the predicate device, KOWA concludes that the KOWA VX-10a is substantially equivalent to the KOWA VX-10i (K062021).

2

Table B. Comparison table

Proposed DevicePredicate Device
KOWA VX-10aKOWA VX-10i (K062021)
Indications
For UseSameTake pictures of fundus images
with or without mydriatic.
Picture
magnificationsMydriatic : 50°/ 30°
Non-mydriatic : 45°/ 27°Mydriatic : 50°/ 30°
Non-mydriatic : 45°/ 27°
Photography modeNon-mydriatic
Mydriatic color
Fluorescein angiographyNon-mydriatic
Mydriatic color
Fluorescein angiography
Indocyanine Green angiography
Working distanceSame39 mm
CCD camera for
observationSameMonochrome CCD
Record media35mm film35mm film
/ Polaroid film
Video camera
connect abilityYesYes
Observation systemSameMydriatic : Finder
Non-mydriatic : LCD
Dioptric
compensationSame-32D ~ +35D
FocusingSameBy aligning the split lines
Filter for FAPresentPresent
Filter for ICGNot applicablePresent
Observation Light
SourceSameHalogen lamp
100W
Photographing Light
SourceSameXenon flash lamp
300WS
Power consumptionSame180VA
1800VA (Instantaneous)
DimensionSame400(W) x 520(D) x 752(H) mm
Weight35.5 kg
with power unit35.5 kg
with power unit

3

Image /page/3/Picture/0 description: The image is a black and white logo for the U.S. Department of Health and Human Services. The logo features a stylized eagle with its wings spread, and the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" are arranged in a circular pattern around the eagle. The eagle is composed of three curved lines that form the shape of the bird's body and wings. The text is in a simple, sans-serif font.

DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Kowa Company, Ltd. c/o Akihiro Fujita, General Manager Electronics and Optics Division 4-14. Nihonbashi-honcho 3-chrome Chuo-ku, Tokyo Japan 103-8433

JUL - 2 2009

Re: K091683

Trade/Device Name: Kowa VX-10a Fundus Camera Regulation Number: 21 CFR 886.1120 Regulation Name: Ophthalmic Camera Regulatory Class: II Product Code: HKI Dated: May 15, 2009 Received: June 10, 2009

Dear Mr. Fujita:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

4

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to http://www.fda.gov/cdrh/mdr/ for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (240) 276-3150 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours.

Kesia Alexander for

Malvina B. Eydelman, M.D. Director Division of Ophthalmic, Neurological, and Ear, Nose and Throat Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

5

Indication for Use

510(k) Number (if known):

Device Name: KOWA VX-10α

Indication For Use:

The KOWA VX-10a is intended for taking pictures of fundus images with mydriatic or without mydriatic.

V Prescription Use (21 CFR Part 801 Subpart D)

And/Or

Over the Counter Use (21 CFR Part 801 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE; CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

(División Sign-Off)

Division of Ophthalmic, Neurological and Ear, Nose and Throat Devices

510(k) Number_________________________________________________________________________________________________________________________________________________________________