automated perimetry
DESCRIPTION
Automated perimetryTRANSCRIPT
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Automated Perimetry
Dr.Vikram.S.NakhateDr.Vijay.Shetty
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Automated way of mapping the visual fieldImportant diagnostic test in glaucomaDiagnosing and monitoring progression of
other disease
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Traquair described it as a field of vision in a sea of darkness
It has a shape of a hillPeak representing fovea2 slopes representing nasal and temporal
field of vision
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Kinetic perimetryStimuli is moved from a non seeeing area to a
seeing area along a set meridianAim is to find points in the visual field of
equal retinal sensitivityLister perimetryCampimetryGoldman perimetry
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Static perimetryIntensity of the stimuli at the same pre
determined spot is varied Find out threshold at those locationsMore accurate than kinetic perimetryGives a 3D picture of the hill of visionPicks up field defects more accurately
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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 proportionalIt is a relative measure varies from machine
to machine
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Testing strategyFull threshold Threshold Suprathreshold
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Full threshold strategyStaircase method (4-2 bracketing strategy) Used to detect threshold
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4-2 bracketing Intensity of stimulus is decreased in 4-db step
till stimulus is no longer seenIncreasing the stimulus in 2-db step till
stimulus is seen again
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Threshold perimetryThreshold found at predetermined pointsTime consuming process
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Suprathreshold perimetryIntensity of stimulus shown at a spot much
higher than threshold at that spotMainly for screeningPicks up gross visual defects
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Newer threshold strategyFastpac:Decreases the test time by 40%3-db increment instead of 4-dbThreshold crossed only once
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Sita standard: Takes half time than full threshold method
Sita fast:Takes half time than fast pac threshold
method
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30-2Number of test points:76Density :6 degreeOnly 3 degree bare area is left surrounding
the fixation spot
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24-2 Number of test points:54Density: 6 degreeOnly 3 degree bare area is left surrounding
the fixation spot
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10-2 central threshold testNumber of test points: 68Density: 2 degreeOnly 1 degree bare area is left surrounding
the fixation spot
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Macular programmeNumber of test points: 16Density: 2 degreeOnly 1 degree bare area is left surrounding
the fixation spot
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Reliabilty indicesFixation losses:Indicates steadiness of gazePresenting stimuli at blind spotloss.>20% is unreliable
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False positivesTrigger happy patientsResponds to an audible stimuli when no
target is presented>33% is unrelible
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False negative:Fails to respond to a suprathreshold stimuli Indicates fatigue,inattentiveness>33% is unreliable
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Zone 1Colour of the stimulusBackground illumination: 31.5 asbStimulus size: IIITesting strategy
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Zone 3
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Zone 4 total deviationDepicts difference between patients
threshold fom that of age matched normalsReveals generalised depression Cannot confirm scotoma
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Zone 5 pattern deviationReveals focal defects after adjusting for
overall depressionConfirms scotoma
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Global indicesMean deviation:Indicates overall deviation of the visual field
from normalPositive number indicates an elevated fieldNegative number indicates a depressed fieldCannot confirm scotoma
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Psd Derived from total deviationIndicates the degree to which the numbers
differ from each otherHighlights pot-holes in hill of visionCalls attention for scotoma
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Short term fluctuationMeasure of intra-test variabilityThreshold at 10 pre selected points is testedDifference between 1 & 2 measurement
noted
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Cpsd is psd corrected for sfIf sf is due to unreliabilityThen cpsd is betterIf sf is due to pathologyThen psd is better
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GHT 5 set of points above horizontal meridianCompared to mirror image below horizontal
meridian
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Zone 8 Numerical display:Gives the threshold for all points checkedValue in () indicates that the point has been
tested twice
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Never rely on first reportAlways correlate clinicallyCorrect any significant refractive error
before proceeding
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Sources of errorMiosis: decreases the threshold sensitivity in
peripheral field Increases the variability in central fieldUncorrected refractive errors: Threshold sensitivity appears lessHyperopic patient with contact lens: Defect gets magnified & vice versa
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Spectacles can cause rim scotomasPtosis : Suppression of superior visual field
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Principle Is there a field defect ?Is it due to glaucoma ?Is the defect progressing ?
Compare to selected baselineDiscard learning fields from baselineRecognise false progression
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False progressionLearning curveLong term fluctuationPupil size
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Pupil: 1 mm
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Pupil: 2.5 mm
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Andersons criteria1. pattern deviation plot:3 non-edge points with p<5%One point with p<1% Cluster in arcuate area
2.cpsdAbnormal with p<5% on 2 consecutive
occasion
3.abnormal GHT
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CATARACT
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GLAUCOMA
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CATARACT & GLAUCOMA
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Detecting progressionOverview printoutGlaucoma change probability analysis
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Overview print outSequential series of field of same patient over
a period of timeDisplays gray scales,total &pattern deviationStatistical analysis is however not provided
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This patient developed cataract,which was extracted later
Pattern deviation plot remained clear
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Glaucoma progression
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Glaucoma change probability analysis
Compares rate of change in patients visual field,with that of stable glaucoma patient
Clear triangle represents improvementsSolid ones shows points of deteriorationProgression represented by a cluster of black
triangles in same area increasing in size with time
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2 or more points deteriorate on 2 consecutive test
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3 or more points deteriorate on 3 consecutive test
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Advanced field defectsWhy pattern deviation plot not showing
defect
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Not enough points with sensitivity to produce pattern deviation plot
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Follow up with 10-2Enough sensitive points to produce pattern
deviation
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Advanced defect f/u with a size V target(64mm2)
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Macular programme in advanced defects
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Size V target:macular splitMacular split (0 db) next to fovea may
indicate wipe out
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Thank you