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Optom. Rawaa A. El Dous
Lecture Overview
Perimetry Definition
Visual Field Definition
Perimetric Techniques
Important Issues in Humphrey Visual Field Analyzer
Systemic Interpretation Of Visual Field Printout
Optom. Rawaa A. El Dous
What’s Perimetry
Is a procedure for measurement of an individual’s visual field; what they are able to see peripherally as well as Centrally. It aims to:
Detection of field defects (screening programs)
Quantitation of the size, shape, and depth of all defects
Optom. Rawaa A. El Dous
≈ ≈60º60º
100-110100-110 ºº
70-7570-75 ºº
≈≈ 6060 ºº
Central field
Peripheral field
Optom. Rawaa A. El Dous
Techniques of Perimetry
Kinetic - a moving stimulus of fixed intensity and size is moved at a constant rate from non– seeing to seeing regions, identifying points of initial perception.
These points map out an isopter, a defined locus of identical retinal sensitivity.
Optom. Rawaa A. El Dous
Goldman stimulus sizes
0(0.0625 mm² ), I (0.25 mm²), II( 1 mm² ), III (4 mm² ), IV (16 mm²), and V (64 mm² ).
Optom. Rawaa A. El Dous
Techniques of Perimetry Cont…
Static - a stationary stimulus at a fixed location is gradually increased in intensity or size until the stimulus is initially perceived.
This initial perception determines the retinal threshold sensitivity at that point and the presence and depth of a scotoma may thereby be determined.
Static testing at various points along a meridian defines a profile, or vertical cross-section of the hill of vision
Optom. Rawaa A. El Dous
100-110100-110 ºº≈≈ 6060 ºº
≈ ≈60º60º
70-7570-75 ºº
Point of fixation
blind spot (Absolute scotoma)
Horizontal section
Vertical section
Optom. Rawaa A. El Dous
I. Threshold testing strategies
1. Full threshold strategy2. Faster threshold strategies
Fast threshold strategy Full from prior data strategy Swedish interactive threshold algorithm (SITA) FAST PAC
II. Screening (suprathreshold) strategies
Strategies
Optom. Rawaa A. El Dous
Swedish interactive threshold algorithm (SITA)
it’s a new strategy that dramatically reduces test time.
It is available as either SITA standard or SITA fast.
The SITA standard test was intended to gather the same information as a full threshold field in much less time.
The SITA strategy is designed to use data in a more intelligent fashion so that less information has to be gathered from the patient.
Optom. Rawaa A. El Dous
The SITA test calculates expected thresholds and is thus able to begin testing close to the actual threshold.
This strategy uses the patient's age, normal and abnormal databases, and the patient's responses to calculate the expected results for each point. These calculations are constantly updated as more information is gathered.
The SITA strategy employs frequency of seeing curves to shorten the time required to threshold each point. The SITA also customizes the interval between test stimuli to the patient's response time.
Swedish interactive threshold algorithm (SITA)
Optom. Rawaa A. El Dous
Screening (suprathreshold) strategies (SITA)
• Although screening strategies are faster than full threshold strategies, they are generally inadequate for following patients with glaucoma.
• The simplest strategy, called the "threshold related screening" strategy, tests the point a second time and shows only whether a point is normal or not.
• A second, more complex, strategy, called the "three-zone screening" strategy, tells whether the defect is relative or absolute by projecting the brightest possible light into the abnormal area.
• The most complex screening strategy, called a "quantify defects screening" strategy, calculates a threshold on each abnormal point
Optom. Rawaa A. El Dous
Issues in perimeter design
Stimulus size and intensity
Background illumination
Stimulus duration
Stimulus location and fixation monitoring
Optom. Rawaa A. El Dous
STATPAC
STATPAC is a computerized analysis package that is included in the operating system of all Humphrey perimeters.
STATPAC greatly simplifies visual field interpretation by differentiating between normal and abnormal visual fields, and by identifying significant change in a series of visual fields.
STATPAC determines if a patient's visual field results fall within the range normal for his or her age.
Optom. Rawaa A. El Dous
A STATPAC analysis may also involve comparing test results with the patient's own baseline from earlier tests in order to determine if the observed change is larger than that typically seen when stable patients return for follow-up testing.
Standard threshold test results may be printed out in any of four formats:
Single Field Analysis Overview Glaucoma Change Probability And Change Analysis
STATPAC
Optom. Rawaa A. El Dous
Systemic interpretation of visual field printout
1. What type of visual field test was performed?
2. What are the patient demographics and clinical characteristics?
3. How reliable is the visual field?
4. Is the visual field abnormal?
5. What is the pattern of abnormality?
6. Is the field worsening?
7. Is the abnormality or worsening due to disease or artifact?
Optom. Rawaa A. El Dous
Systemic interpretation of visual field printout
1. What type of visual field test was performed?2. What are the patient demographics and
clinical characteristics?3. How reliable is the visual field?4. Is the visual field abnormal?5. What is the pattern of abnormality?6. Is the field worsening?7. Is the abnormality or worsening due to disease
or artifact?
Optom. Rawaa A. El Dous
Systemic interpretation of visual field printout
1. What type of visual field test was performed?2. What are the patient demographics and
clinical characteristics?3. How reliable is the visual field?4. Is the visual field abnormal?5. What is the pattern of abnormality?6. Is the field worsening?7. Is the abnormality or worsening due to disease
or artifact?
Optom. Rawaa A. El Dous
Systemic interpretation of visual field printout
1. What type of visual field test was performed?2. What are the patient demographics and
clinical characteristics?3. How reliable is the visual field?4. Is the visual field abnormal?5. What is the pattern of abnormality?6. Is the field worsening?7. Is the abnormality or worsening due to disease
or artifact?
Optom. Rawaa A. El Dous
Systemic interpretation of visual field printout
1. What type of visual field test was performed?2. What are the patient demographics and
clinical characteristics?3. How reliable is the visual field?4. Is the visual field abnormal?5. What is the pattern of abnormality?6. Is the field worsening?7. Is the abnormality or worsening due to disease
or artifact?
Optom. Rawaa A. El Dous
Systemic interpretation of visual field printout
1. What type of visual field test was performed?2. What are the patient demographics and
clinical characteristics?3. How reliable is the visual field?4. Is the visual field abnormal?5. What is the pattern of abnormality?6. Is the field worsening?7. Is the abnormality or worsening due to disease
or artifact?
Optom. Rawaa A. El Dous
Systemic Interpretation Of Visual Field Printout
1. What type of visual field test was performed?2. What are the patient demographics and
clinical characteristics?3. How reliable is the visual field?4. Is the visual field abnormal?5. What is the pattern of abnormality?6. Is the field worsening?7. Is the abnormality or worsening due to disease
or artifact?
Optom. Rawaa A. El Dous
Are the abnormality or worsening due to disease or artifact?
Lens rim artifact