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    Automatedperimetry 140701220537 Phpapp02

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    Automatedperimetry 140701220537 Phpapp02

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    5 views72 pages

    Automatedperimetry 140701220537 Phpapp02

    Uploaded by

    reddappa reddy

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    Automated Perimetry

    Dr.Vikram.S.Nakhate
    Dr.Vijay.Shetty
    Automated way of mapping the visual field
    Important diagnostic test in glaucoma
    Diagnosing and monitoring progression of
    other disease
    Traquair described it as a field of vision in a
    sea of darkness
    It has a shape of a hill
    Peak representing fovea
    2 slopes representing nasal and temporal
    field of vision
    Kinetic perimetry
    Stimuli is moved from a non seeeing area to a
    seeing area along a set meridian
    Aim is to find points in the visual field of
    equal retinal sensitivity
    Lister perimetry
    Campimetry
    Goldman perimetry
    Static perimetry
    Intensity of the stimuli at the same pre
    determined spot is varied
    Find out threshold at those locations
    More accurate than kinetic perimetry
    Gives a 3D picture of the hill of vision
    Picks up field defects more accurately
    Apostlib is an absolute measure of luminance
    and is equal to 0.3183 candela m2 or 0.1
    mililambert
    Decibel is a measure of sensitivity of retina
    Inversely proportional
    It is a relative measure varies from machine
    to machine
    Testing strategy
    Full threshold
    Threshold
    Suprathreshold
    Full threshold strategy
    Staircase method (4-2 bracketing strategy)
    Used to detect threshold
    4-2 bracketing
    Intensity of stimulus is decreased in 4-db step
    till stimulus is no longer seen
    Increasing the stimulus in 2-db step till
    stimulus is seen again
    Threshold perimetry
    Threshold found at predetermined points
    Time consuming process
    Suprathreshold perimetry
    Intensity of stimulus shown at a spot much
    higher than threshold at that spot
    Mainly for screening
    Picks up gross visual defects
    Newer threshold strategy
    Fastpac:
    Decreases the test time by 40%
    3-db increment instead of 4-db
    Threshold crossed only once
    Sita standard:
    Takes half time than full threshold method

    Sita fast:
    Takes half time than fast pac threshold
    method
    30-2
    Number of test points:76
    Density :6 degree
    Only 3 degree bare area is left surrounding
    the fixation spot
    24-2
    Number of test points:54
    Density: 6 degree
    Only 3 degree bare area is left surrounding
    the fixation spot
    10-2 central threshold test
    Number of test points: 68
    Density: 2 degree
    Only 1 degree bare area is left surrounding
    the fixation spot
    Macular programme
    Number of test points: 16
    Density: 2 degree
    Only 1 degree bare area is left surrounding
    the fixation spot
    Reliabilty indices
    Fixation losses:
    Indicates steadiness of gaze
    Presenting stimuli at blind spot
    loss.>20% is unreliable
    False positives
    Trigger happy patients
    Responds to an audible stimuli when no
    target is presented
    >33% is unrelible
    False negative:
    Fails to respond to a suprathreshold stimuli
    Indicates fatigue,inattentiveness
    >33% is unreliable
    Zone 1
    Colour of the stimulus
    Background illumination: 31.5 asb
    Stimulus size: III
    Testing strategy
    Zone 3
    Zone 4 total deviation
    Depicts difference between patients
    threshold fom that of age matched normals
    Reveals generalised depression
    Cannot confirm scotoma
    Zone 5 pattern deviation
    Reveals focal defects after adjusting for
    overall depression
    Confirms scotoma
    Global indices
    Mean deviation:
    Indicates overall deviation of the visual field
    from normal
    Positive number indicates an elevated field
    Negative number indicates a depressed field
    Cannot confirm scotoma
    Psd
    Derived from total deviation
    Indicates the degree to which the numbers
    differ from each other
    Highlights pot-holes in hill of vision
    Calls attention for scotoma
    Short term fluctuation
    Measure of intra-test variability
    Threshold at 10 pre selected points is tested
    Difference between 1 & 2 measurement
    noted
    Cpsd is psd corrected for sf
    If sf is due to unreliability
    Then cpsd is better
    If sf is due to pathology
    Then psd is better
    GHT
    5 set of points above horizontal meridian
    Compared to mirror image below horizontal
    meridian
    Zone 8
    Numerical display:
    Gives the threshold for all points checked
    Value in () indicates that the point has been
    tested twice
    Never rely on first report
    Always correlate clinically
    Correct any significant refractive error
    before proceeding
    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 gets magnified & vice versa
    Spectacles can cause rim scotomas
    Ptosis :
    Suppression of superior visual field
    Principle
    Is there a field defect ?
    Is it due to glaucoma ?
    Is the defect progressing ?
     Compare to selected baseline

     Discard learning fields from baseline

     Recognise false progression


    False progression
    Learning curve
    Long term fluctuation
    Pupil size
    Pupil: 1 mm
    Pupil: 2.5 mm
    Andersons criteria
    1. pattern deviation plot:
    3 non-edge points with p<5%
    One point with p<1%
    Cluster in arcuate area

    2.cpsd
    Abnormal with p<5% on 2 consecutive
    occasion

    3.abnormal GHT
    CATARACT
    GLAUCOMA
    CATARACT & GLAUCOMA
    Detecting progression
    Overview printout
    Glaucoma change probability analysis
    Overview print out
    Sequential series of field of same patient over
    a period of time
    Displays gray scales,total &pattern deviation
    Statistical analysis is however not provided
    This patient developed cataract,which was
    extracted later
    Pattern deviation plot remained clear
    Glaucoma progression
    Glaucoma change probability
    analysis
    Compares rate of change in patients visual
    field,with that of stable glaucoma patient
    Clear triangle represents improvements
    Solid ones shows points of deterioration
    Progression represented by a cluster of black
    triangles in same area increasing in size with
    time
    2 or more points deteriorate on 2 consecutive
    test
    3 or more points deteriorate on 3 consecutive
    test
    Advanced field defects
    Why pattern deviation plot not showing
    defect
    Not enough points with sensitivity to produce
    pattern deviation plot
    Follow up with 10-2
    Enough sensitive points to produce pattern
    deviation
    Advanced defect f/u with a size V
    target(64mm2)
    Macular programme in advanced defects
    Size V target:macular split
    Macular split (0 db) next to fovea may
    indicate wipe out
     Thank you

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