1. 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

2. 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

3. Optom. Rawaa A. El Dous Now… What's Visual Field ?

4. ≈ 60º 100-110 º 70-75 º ≈60 º ≈ 60 º Central field Peripheral field

5. Optom. Rawaa A. El Dous Techniques of perimetry  Kinetic  Static

6. 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.

7. 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 ).

8. Optom. Rawaa A. El Dous isopter Fixation point

9. Optom. Rawaa A. El Dous Techniques of Perimetry Cont…  S tatic - 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

10. Optom. Rawaa A. El Dous Stimulus intensity

11. 100-110 º ≈60 º ≈ 60 º ≈ 60º 70-75 º Point of fixation blind spot (Absolute scotoma) Horizontal section Vertical section

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13. What does it measure? How? Automated static perimetry

14. Optom. Rawaa A. El Dous Threshold determination

15. Optom. Rawaa A. El Dous Retinal threshold determination

16. Optom. Rawaa A. El Dous I.Threshold testing strategies 1.Full threshold strategy 2.Faster threshold strategies  Fast threshold strategy  Full from prior data strategy  Swedish interactive threshold algorithm (SITA)  FAST PAC II.Screening (suprathreshold) strategies Strategies

17. Optom. Rawaa A. El Dous Full threshold strategy 4/2 dB

18. Optom. Rawaa A. El Dous Fast threshold strategy

19. Optom. Rawaa A. El Dous Full from prior data strategy

20. Optom. Rawaa A. El Dous FAST PAC

21. 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.

22. 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)

23. 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

24. Optom. Rawaa A. El Dous Screening (suprathreshold) strategies

25. Optom. Rawaa A. El Dous Automated Perimeters

26. Optom. Rawaa A. El Dous Humphrey visual field analyzer

27. Optom. Rawaa A. El Dous Issues in perimeter design  Stimulus size and intensity  Background illumination  Stimulus duration  Stimulus location and fixation monitoring

28. 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.

29. 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

30. Optom. Rawaa A. El Dous Single visual Field printout

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32. 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?

33. Optom. Rawaa A. El Dous What type of visual field test was performed?

34. 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?

35. Optom. Rawaa A. El Dous What are the patient demographics and clinical characteristics?

36. 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?

37. Optom. Rawaa A. El Dous 3. How reliable is the visual field?

38. Optom. Rawaa A. El Dous

40. 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?

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42. 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?

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44. Glaucoma Hemifield Test

45. 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?

46. Optom. Rawaa A. El Dous 6.Is the field worsening?

47. 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?

48. Optom. Rawaa A. El Dous Are the abnormality or worsening due to disease or artifact? Lens rim artifact

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50. After1month Learning effect

51. Optom. Rawaa A. El Dous Optometrist:Rawaa A. El Dous