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    Camp Vizual

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    Alexandra Plahotniuc
    Camp Vizual

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    Camp Vizual

    Uploaded by

    Alexandra Plahotniuc
    6 views19 pages
    Camp Vizual

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    © © All Rights Reserved

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    Camp Vizual

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    6 views19 pages

    Camp Vizual

    Uploaded by

    Alexandra Plahotniuc
    Camp Vizual

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
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    Normal VF:

    S: 50deg - 60deg
    N: 60deg
    I: 70deg
    T: 90deg – 100deg

    Нормальная светочувствительность:
    - 40-30 дБ - нормальное восприятие
    - 20-30 дБ - средняя чувствительность по перифиерии
    центрального поля зрения, где-то на 30 гр
    - 10-20 дБ - сниженная чувствительность
    - 0 дБ - слепые точки, пациент не распознает при максимальной
    яркости для данного прибора

    Common VF defects
    - Non-specific/low reliability/inattention
    - Cloverleaf field
    - Blind spot enlargement (glaucoma, idiopathic intracranial
    hypertension, acute idiopathic blind spot enlargement syndrome)
    - Nasal step (early glaucoma
    - Superior/inferior arcuate defect
    - Severe constriction with a central island

    Blind spot: 15deg T to the point of fixation, size of 5 x 7deg.

    VF defects
    - Diffuse VF loss: generalized loss of sensitivity, pre-retinal opacities
    - VF contraction (the contraction of the isopters концентрические
    линии на поле зрения, которые обозначают зоны с одинаковым
    трэшхолдом), causes: retinitis pigmentosa, toxic retinopathies
    - Scotoma: absolute or relative area of depressed visual sensitivity

    Scotomas
    - Central: 0-5deg from the point of fixation
    - Paracentral: 5-30deg
    o Ceacal (blind spot), paraceacal, pericaecal
    o Centrocaecal
    - Peripheral: >30deg
    CATCH TRIALS (Reliability Indices)
    - Fixation losses: loss >20% is unreliable
    - False positives: trigger happy/anxious patients, >33% is
    unreliable
    - False negatives: fatigue, inattentiveness/clover leaf model. >33%
    is unreliable
    Worth noting: damaged areas of a VF can show increased variability
    leading to a high false negative rate, therefore false negatives may be
    elevated in abnormal VF regardless of attentiveness of the patient. Visual
    fields should not be disregarded because of a high false negative , several
    testing algorithms no longer measure this parameter

    When evaluating test reliability, the practitioner should be sure to look at


    the numbers printed on the Numeric Results (decibel [dB]) graph. A value
    of 40 dB or higher on this graph indicates that the patient may be "trigger
    happy." That is, the patient is anticipating the presentation of the stimulus
    and is responding before the stimulus is seen. Readings of 40 dB or higher
    indicate an unreliable field that will need to be repeated. It is best to catch
    these readings while the test is in progress and restart the test. A typical
    "normal" dB reading is around 30.

    30-2 strategy:
    - Прямоугольная сетка, математический принцип расположения
    стимулов
    - Number of test points: 76
    - Point density: 6deg
    - Only 3deg bare area is left surrounding the fixation spot
    - Measures 30deg in all directions from fixation point
    - Used for neuro-ophthalmology patients
    - Центральная зона исследуется наравне с другими: 0 точек в
    фовеоле (3 гр), 12 точек в макуле (10 гр)

    20-4 strategy:
    - Прямоугольная сетка, математический принцип расположения
    стимулов
    - Number of test points: 56
    - Point density: 6deg
    - Measueres 30deg nasally, 24deg elsewhere from fixation point
    - Used for glaucoma patients
    - Центральная зона исследуется наравне с другими: 0 точек в
    фовеоле (3 гр), 12 точек в макуле (10 гр)

    10-2 strategy:
    - Number of test points: 16
    - Point density: 2deg
    - Measures 10deg in all directions from the fixation point
    - Used for macular4 diseases and advanced glaucoma

    SWAP – Short Wavelength Automated Perimetry:


    - Коротковолновая автоматизированная периметрия
    - Синий стимул большого размера на ярком желтом фоне
    - Избирательно стимулирует кониоцеллюлярный путь
    - Подходят для ранней диагностики
    - Хуже переносится пациентом
    Преимущество белого света заключается в способности
    стимулировать все типы фоторецепторов сетчатки. Поэтому
    исследование поля зрения с помощью белого света возможно на
    любой стадии заболевания, т.е. ему свойственен широкий
    динамический диапазон.

    FDT – Frequency doubling Technology:


    - Периметрия с иллюзией удвоения пространственной частоты
    - Избирательно стимулирует магноцеллюлярный путь
    (регистрирует изменение контраста и движение)

    G-Program (Octopus):
    - Физиологический принцип распределения стимулов, по ходу
    нервных волокон
    - Зона тестирования в 30 гр
    - Короткая программа: 59 точек
    - Внимание к центральной зоне: 5 точек в фовеоле (3 гр), 17
    точек в макулярной зоне (10 гр)
    - Не исследуется зона слепого пятна

    The Grey Scale


    - Highlights areas which need to be looked indetail
    - For gross false positive or false negative errors
    - Should not be used for diagnosis

    The numeric dB graph should be studied next. The dBs tested by the
    Humphrey analyzer range between 0 and 50 dB (0 is the brightest and 50
    is the dimmest). A value of 0 means the patient could not see the
    brightest target, and a 50 means the dimmest target was seen. Most
    values are around 30 dB, and any numbers below this range imply a
    possible visual field defect.

    Total Deviation: сравнение с возрастной группой

    Pattern Deviation: сравнение с возрастной группой минус диффузный


    дефект

    Global Indices
    Provide inference of VF as a single value.
    - The Mean Deviation (среднее отклонение): Отражает
    среднее снижение светочувствительности. Representation of the
    depressed vision for each point when compared with age-matched
    controls. It does not account for global depression from other
    sources such as cataracts or vitreous hemorrhage. is the average
    difference from normal expected value in the patients' particular
    age group. Typically, an MD of -2.00 or less could indicate
    glaucoma.
    - The Pattern Standart Deviation (стандартное отклонение
    паттерна): Характеризует выраженность локальных дефектов.
    Нормальные значения < 2.0 dB. Provides information about
    localized loss. A high PSD indicates a nonuniform sensitivity loss (ie,
    not due to diffuse depression from cataract or vitreous
    hemorrhage). As glaucoma advances, the PSD may appear to
    improve due to global depression.
    - VFI (Visual Field Index) индекс поля зрения: Характеризует
    общее состояние чувствительности в процентах. Если дефекты
    при периметрии не выявлены равен 100%, снижение индекса
    характеризует прогрессирование патологии. Удобен для
    общения с пациентом, если человек спрашивает сколько у него
    осталось от поя зрения, можно озвучить этот индекс. Имеет
    малую диагностическую ценность.

    Cataracts may be a source of depression of the mean deviation. After


    cataract surgery, the mean deviation may decrease in magnitude, and the
    pattern deviation may increase as more focal glaucoma defects are
    revealed.

    Glaucoma Hemifield Test (GHT)


    - 5 sectors in the upper field vs 5 sectors in lower field which are
    mirror images
    - Outside Normal Limit: At least one sector pair's score difference
    > that found in 99% of the normal population or the individual zone
    scores in both members of any zone pair > than that found in 99.5%
    of normal population
    - Borderline: At least 1 zone pair difference exceeds that found in
    97% subjects
    - Generalized Reduction in sensitivity: If neither of the 2
    conditions of ONL are met by General Height Calculation shows the
    best part of the field to be depressed to a degree that occurs in
    0,5% of normal population
    - Abnormally High Sensitivity: The General Height Calculation
    shows that best part of the field has heigher sensitivity > that found
    in 99,5% population
    - Whithin normal limits: If none of the above 4 conditions are met

    Sources of error:
    - Miosis: decreases the threshold sensitivity in peripheral field,
    increases the variability in central field.
    - Uncorrected refractive errors: threshold sensitivity appears less.
    - Hyperopic patient with contact lens: defect magnified and vice
    versa
    - Spectacles can cause rim scotomas
    - Ptosis: suppression of superior visual field
    NERVE FIBER BUNDLE DEFECTS

    1. These scotomas indicate damage to the maculopapular bundles. When


    they appear in both eyes they are especially characteristic of toxic,
    nutriotional or hereditary optic neuropathy

    2. Indicates the damage to the bundles that originate in the temporal


    retina that arch over and under the maculopapular bundles to enter the
    superior and inferior poles of the d.o.
    Causes: ischaemic optic neuropathy, inflammatory, compressive and
    glaucomatos optic neuropathies.
    3. Indicates damage to the retinal bundles that originate in the nasal
    retina and travel radially into the nasal portion of the d.o.
    Causes: congenitally dysplastic optic neuropathy

    4. Signature of a chiasmal aria lesion


    5. Indicates a lesion in fromt of the chiasm in the intracranial part of the
    ipsilateral optic nerve.

    6. Indicates a lesion at the junction of the optic nerve and optic chiasm.
    7. Signature of the retrochiasmal lesion lying somewhere between the
    optic tract and the visual cortex.
    A complete homonymous hemianopia does not allow you to decide where
    within the retrochiasmal visual pathway the lesion lies.

    7.1. Localization: optic tract


    Causes: masses or inflammation
    7.2. Localization: Far posterior optic radiations or visual cortex
    Causes: strokes and tumors

    7.3. Localization: Meyer’s loop in the anterior temporal lobe


    Causes: Temporal lobectomy for intractable epilepsy
    7.4. Localization: inferior visual cortex
    Causes: stroke

    7.5. Localization: superior visual cortex


    Causes: stroke
    7.6. Localization: far posterior visual cortex
    Cause: stroke

    7.7. Localization: anterior visual cortex


    Causes: stroke
    7.8. Monocular defect that involves only peripheral crescent of the
    temporal field
    Localization: far anterior visual cortex
    Causes: stroke

    7.9. Localization: damage does not damage the anterior visual cortex
    Cause: stroke
    7.10. Stroke of the lateral geniculate body caused by occlusion of the
    anterior choroidal artery

    7.11. Stroke of the lateral geniculate body caused by occlusion of the


    lateral posterior choroidal artery
    CONSTRICTED FIELD
    The most common causes of constriected field:
    1. Improper testing procedure
    2. Reduced palpebral fissure height
    3. Patient inattention
    4. Optic neuropathy
    5. Bilateral visual cortex lesions
    6. Retinitis Pigmentosa
    7. Patient non-cooperation

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