K Number
K153239
Device Name
LSFG-NAVI
Manufacturer
Date Cleared
2016-05-12

(185 days)

Product Code
Regulation Number
886.1120
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The Laser Speckle Flowgraphy LSFG-NAVI system is intended to capture and display the blood flow distribution in the human retina in real time, and to monitor the blood flow in retinal vessels for their quantitative evaluation.
Device Description
The LSFG-NAVI can visualize and measure the distribution of blood flow in the human retina in a broad area from macular to the optic nerve head. The most useful feature of the instrument is the ability to non-invasively observe varying blood flow synchronized with the heartbeat as a series of 2D blood flow maps. The LSFG-NAVI consists of following major units: - (1) LSFG-NAVI Camera Unit: including an emitter of a diode laser, retinal camera imaging system, imager, CCD camera (video capturing) - (2) Personal Computer (PC): including LSGF-NAVI System Software (Measurement Software and Analysis Software - (3) 3D-Stage Unit: The LSFG-NAVI Camera Unit is attached to the 3D-Stage unit and a patient places his/her head and face at Chin Rest and Head Rest of the 3D-Stage Unit. - (4) Electronic Unit: including the AC Adapter and Isolation Transformer.
More Information

None

No
The summary describes image analysis based on laser interference patterns but does not mention AI, ML, or any related concepts like neural networks or training data.

No
The device is described as an imaging system used to capture, display, and monitor blood flow distribution in the retina for quantitative evaluation. Its intended use focuses on diagnosis and monitoring, not on treating a disease or condition.

Yes
The device is intended to capture and display blood flow distribution in the human retina and monitor blood flow for quantitative evaluation, which are activities performed to identify or characterize medical conditions.

No

The device description explicitly lists multiple hardware components (Camera Unit, PC, 3D-Stage Unit, Electronic Unit) in addition to the software.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In Vitro Diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections.
  • Device Function: The LSFG-NAVI system directly captures and displays blood flow in the human retina in vivo (within the living body) using laser speckle flowgraphy. It does not analyze samples taken from the body.
  • Anatomical Site: The device operates on the retina, which is an internal part of the body, not a sample taken from the body.
  • Input Modality: Laser Speckle Flowgraphy is an imaging technique applied directly to the eye, not a method for analyzing biological samples.

Therefore, the LSFG-NAVI system falls under the category of an in vivo diagnostic imaging device, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The Laser Speckle Flowgraphy LSFG-NAVI system is intended to capture and display the blood flow distribution in the human retina in real time, and to monitor the blood flow in retinal vessels for their quantitative evaluation.

Product codes

HKI, HLI

Device Description

The LSFG-NAVI can visualize and measure the distribution of blood flow in the human retina in a broad area from macular to the optic nerve head. The most useful feature of the instrument is the ability to non-invasively observe varying blood flow synchronized with the heartbeat as a series of 2D blood flow maps.

The LSFG-NAVI consists of following major units:

  • (1) LSFG-NAVI Camera Unit: including an emitter of a diode laser, retinal camera imaging system, imager, CCD camera (video capturing)
  • (2) Personal Computer (PC): including LSGF-NAVI System Software (Measurement Software and Analysis Software
  • (3) 3D-Stage Unit: The LSFG-NAVI Camera Unit is attached to the 3D-Stage unit and a patient places his/her head and face at Chin Rest and Head Rest of the 3D-Stage Unit.
  • (4) Electronic Unit: including the AC Adapter and Isolation Transformer.

Mentions image processing

The LSFG-NAVI is based on image analyses of the so called 'speckle' pattern produced by random laser interference.

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Laser Speckle Flowgraphy

Anatomical Site

Retina

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

Non clinical performance data:
LSFG-NAVI has been tested and met the standards for Electrical safety testing of IEC 60601-1, electromagnetic compatibility testing of IEC 60601-1-2, laser safety testing of IEC 60825-1, optical radiation levels of ISO 15004.

The LSFG-NAVI software was also verified and validated according the "Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices" issued by FDA in 2005. Risk mitigation of LSFG-NAVI software was also carried out based on ISO 14971.

Furthermore, the 3 non-clinical testing were performed to establish its effectiveness and performance, namely, Validation of blood flow index measurement, validation of time variation of blood flow index measurement, and validation of perfusion map of retina.

The LSFG-NAVI also complies with the radiation safety regulation and the radiation safety report (product report, 21CFR 1002.10) has been submitted and the accession number assigned (#1310447-000).

It is of importance to note that the LSFG-NAVI has not been tested clinically where this statement is included in the User Manual to inform the end user.

Key Metrics

Not Found

Predicate Device(s)

K062416

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

Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized caduceus symbol, which features three human profiles facing right, overlaid on top of each other. The profiles are connected by a flowing, ribbon-like element. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular fashion around the symbol.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

May 12, 2016

Softcare Co., Ltd % Mr. Takahiro Haruyama President Globizz Corporation 1411 W. 190th St., Suite 200 Gardena, CA 90248

Re: K153239

Trade/Device Name: LSFG-NAVI Regulation Number: 21 CFR 886.1120 Regulation Name: Opthalmic Camera Regulatory Class: Class II Product Code: HKI, HLI Dated: April 8, 2016 Received: April 11, 2016

Dear Mr. Haruyama:

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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

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 of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set

1

forth in the quality systems (OS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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/MedicalDevices/Safety/ReportaProblem/default.htm 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 Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Kesia Alexander

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

Enclosure

2

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration
Indications for Use
Form Approved: OMB No. 0910-0120
Expiration Date: January 31, 2017
See PRA Statement below.
510(k) Number (if known)K153239
Device NameLaser Speckle Flowgraphy LSFG-NAVI
Indications for Use (Describe)The Laser Speckle Flowgraphy LSFG-NAVI system is intended to capture and display the blood flow distribution in the human retina in real time, and to monitor the blood flow in retinal vessels for their quantitative evaluation.
Type of Use (Select one or both, as applicable)Prescription Use (Part 21 CFR 801 Subpart D) Over-The-Counter Use (21 CFR 801 Subpart C)
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

CONTINUE ON A SEPARATE PAGE IF NEEDED.

This section applies only to requirements of the Paperwork Reduction Act of 1995.

DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

Department of Health and Human Services

Food and Drug Administration

Office of Chief Information Officer

Paperwork Reduction Act (PRA) Staff

PRAStaff@fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

FORM FDA 3881 (8/14)Page 1 of 1
-----------------------------------

3

510(k) Summary

Submitter's Name:

Software Co., Ltd. 243-5 Yatsunami Fukutsu City, Fukuoka 811-3201 JAPAN Phone: +81-940-36-9693

Contact Person:

Noriyoshi Takahashi Phone: +81-940-36-9693 Email: takahashi@softcare-Itd.co.jp

Official Correspondence:

Takahiro Haruyama Globizz Corporation 1411 W. 190th St. Suite #200 Gardena, CA 90248

Date of 510(k) summary preparation: November 3, 2015

Trade/Proprietary Name: Laser Speckle Flowgraphy LSFG-NAVI Common/Usual Name: Ophthalmic Camera Device /Ophthalmoscope Classification Name: Camera, Ophthalmic, Ac-powered (21CFR 886.1120, Product Code HKI) Ophthalmoscope, Ac-powered (21CFR 886.1570, Product Code HLI)

Device Description:

The LSFG-NAVI can visualize and measure the distribution of blood flow in the human retina in a broad area from macular to the optic nerve head. The most useful feature of the instrument is the ability to non-invasively observe varying blood flow synchronized with the heartbeat as a series of 2D blood flow maps.

4

The LSFG-NAVI consists of following major units:

  • (1) LSFG-NAVI Camera Unit: including an emitter of a diode laser, retinal camera imaging system, imager, CCD camera (video capturing)
  • (2) Personal Computer (PC): including LSGF-NAVI System Software (Measurement Software and Analysis Software
  • (3) 3D-Stage Unit: The LSFG-NAVI Camera Unit is attached to the 3D-Stage unit and a patient places his/her head and face at Chin Rest and Head Rest of the 3D-Stage Unit.
  • (4) Electronic Unit: including the AC Adapter and Isolation Transformer.

Intended Use:

The LSFG-NAVI system is intended to capture and display the blood flow distribution in the human retina in real time, and to monitor the blood flow in retinal vessels for their quantitative evaluation.

The LSFG-NAVI Technology:

The LSFG-NAVI is based on image analyses of the so called 'speckle' pattern produced by random laser interference. The system consists of an emitter of a diode laser, retinal camera imaging system, imager, hardware for video capturing and a personal computer (PC). The light from the diode laser is expanded and illuminates the retinal surface with a large spot. The laser is scattered from the moving blood cells flowing in the vessels and the capillary network, and comes back to the image plane of the camera, where the random interference pattern or laser speckles are produced. According to the motion of the blood cells, the structure of the image speckles varies over time, and the rate of variation at that point is proportional to the average flow velocity at the corresponding objective point. The image intensity is captured by a highly sensitive CCD camera and the rate of time variation is calculated at each pixel point. By displaying the results in 2D form, the time varying blood flow maps of the retina become observable as a motion picture.

Non clinical performance data:

LSFG-NAVI has been tested and met the standards for Electrical safety testing of IEC 60601-1, electromagnetic compatibility testing of IEC 60601-1-2, laser safety testing of IEC 60825-1, optical radiation levels of ISO 15004.

The LSFG-NAVI software was also verified and validated according the "Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices" issued by FDA in 2005. Risk mitigation of LSFG-NAVI software was also carried out based on ISO 14971.

Furthermore, the 3 non-clinical testing were performed to establish its effectiveness and performance,

5

namely, Validation of blood flow index measurement, validation of time variation of

blood flow index measurement, and validation of perfusion map of retina.

The LSFG-NAVI also complies with the radiation safety regulation and the radiation safety report (product report, 21CFR 1002.10) has been submitted and the accession number assigned (#1310447-000).

It is of importance to note that the LSFG-NAVI has not been tested clinically where this statement is included in the User Manual to inform the end user.

Substantial Equivalent:

The Laser Speckle Flowgraphy LSFG-NAVI is considered to be substantially equivalent to the predicate device below:

  • י Retinal Functional Imager (K062416) - Optical Imaging, Ltd.
    The comparison of the technological characteristics between LSFG-NAVI and the Retinal Functional lmager (RFI) - K062416 is summarized below:
ItemLSFG-NAVIRFI
510(k) numberK153239K062416
Product Code /
ClassificationHKI/HLIHKI/HLI
Classification NameOphthalmic Camera Device; AC
powered.
OphthalmoscopeOphthalmic Camera Device; AC
powered.
Ophthalmoscope
ClassIIII
MethodImage using Diode Laser. A
mydriatic agent is not required in
a darkroom (displayed on PC
monitor).Similar to conventional fundus
camera with eye drop (displayed
on PC monitor)
ItemLSFG-NAVIRFI
Intended UseThe LSFG-NAVI system is to capture and display the blood flow distribution in the human retina in real time, and to monitor the blood flow in retinal vessels for their quantitative evaluation.The Retinal Functional Imager is a digital imaging and fundus camera system intended to observe, capture, display, and store images of patients' fundus (retina) under mydriatic conditions and provide information obtained from the images about blood flow (velocity) and path of flow in retinal vessels. The device is indicated for use as an aid in diagnosing or monitoring diseases of the eye that may be observed and photographed.
Modes of operationBlood flow Index and Perfusion map of retinaRed-free manual multiflash –blood flow velocity and path by flow
Target PopulationGeneralGeneral
Anatomical regionRetinaRetina
Light SourceLaser Diode (830nm)Halogen lamp 50W
Field angle(degrees)2150, 35, 20
Viewing Magnification1.2X12.1X, 17.1X, 29.9X
FocusingMatching two laser spotsMatching two oscillating points
Working distance44mm40mm
Record MediaDigital dataDigital data / 35 mm film
Principle of blood flow measurementLaser Speckle FlowgraphyFrame Mapping of Xenon Flash lamp illumination
Measurement duration30Hz for data acquisition125 ms for data acquisition
Measurement resultsGiven as relative valueGiven in mm / sec
Numerical dataBlood flow IndexVelocity flow rate
Graphically dataPerfusion map of retina,
Time variation of blood flow indexPath of flow
Illumination LightLED (940nm)12 V Halogen lamp
ItemLSFG-NAVIRFI
Flash ExposureContinuous exposureAutomatic, 1 ms pulse, train of up
to 8 pulses, repetition rate 17.5ms.
Electrical SafetyIEC 60601-1:2012
IEC 60601-1-2: 2007IEC 60601-1: 1st Ed.
IEC 60601-1-2: 1st Ed.
Performance StandardISO 15004-2:2007
ISO 10940: 1998
ISO 60825-1: 2007
ISO 14971: 2007ISO 15004: 1st Ed.
ISO 14940: 1998
ANSI RP-27-1-96: 1st Ed.

6

7

Although there is technological difference between two devices, the results of nonclinical testing, including electrical safety and electromagnetic compatibility along with the software validation and verification, demonstrated the safety and effectiveness of LSFG-NAVI with the predicate device and did not raise a new concern for safety and/or effectiveness.

Both devices are ophthalmic imaging management systems where intended use for both devices is to capture, display, and store images of the retina to monitor the blood flow in retinal vessels for their quantitative evaluation.

The comparison of the technological characteristics

LSFG-NAVI selected The Retinal Functional Imager (RFI) - K062416 as the predicated device, and examined the substantial equivalence to its predicate device. The intended use and function are primarily equivalent and did not identify any new problem in safety and effectiveness.