Traquair difined the visual field as the island of vision surrounded by the sea of darkness

Axis X, Y (parallel to the sea level) Axis Z (perpendicular to the sea level)

 The visual field is measured in two ways Kinetic and Static perimetry

The visual field is plotted as the patient sees it

Units of light intensity

The light intensity expressed in apostilb (asb) or decibel (dB) units Retinal sensitivity expressed in decibel As the dB value is decreasing, the light intensity is increasing

As the dB value is decreasing, the light intensity is increasing

In Humphrey Field Analyzer

0 dB no attenuation 10 dB is 1/10 x 10.000 20 dB is 1/102 x 10.000 30 dB is 1/103 x 10.000 40 dB is 1/104 x 10.000 =10.000 asb = 1.000 asb = 100 asb = 10 asb = 1 asb

Definition of threshold
Threshold sensitivity is defined as the stimulus intensity at which the patient respond 50% of the time

Humphrey Visual Field Analyzer

2 4

ANALYSIS OF VISUAL FIELD DATA

To understand and interpret the single field printout it is divided in 8 zones Zone 1 : Patient and test data Zone 2 : Reliability indices and foveal treshold Zone 3 : Raw data Zone 4 : Gray scale Zone 5 : Total deviation plot Zone 6 : Pattern deviation plot Zone 7 : Global indices Zone 8 : Glaucoma hemi field test (GHT)
(Gupta AK,et al,2007)

Zone 1 : Patient and Test Data

Zone 1 : Patient and Test Data Patient name and identity number Age and date of birth
Wrong patients age can alter results of field test

Eye tested Visual acuity and refractive correction used Pupillary size
Pupillary size should remain constant in follow up fields

The test data has the following information

Test pattern and strategy performed. Fixation monitor (Blind spot) * Stimulus size : Goldmann size III Background illumination : It is a constant at 31.5 asb. * Color of the stimulus : White * Fixation target

Zone 2 : Reliability parameter and foveal threshold

Reliability parameter Unreliable .XX Patient Fixation > 20% False Positive errors > 33% False negative errors > 33%

Zone 2 : Reliability parameter and foveal threshold

False positive > 33% gray scale : white scotoma GHT : abnormaly high sensitivity False negative >33% lack of attentive, fatique, advance damage
Low patient reliability does not necessarily mean lack useful information It is just that such field are not included in the database, such field must be interpreted with more caution.

Zone 3: Raw data

Actual threshold value Even if all zones are normal, but the clinical picture are very suspicious, inspect zone 8. One may pick up a scotoma

Zone 4: Gray scale

Conversion of the raw data to gray tone symbols Do not make any diagnosis on the basis of gray scale

It give an impression and draw attention to an area

Useful to explain the condition to the patient

Zone 4: Gray scale

Useful when there are Gross False positive (white scotoma) False negative error (clover leaf) Explain the seriousness of the condition to the patient

Paracentral Scotoma

Arcuate Scotoma

Temporal Wedge

Nasal Step

Zone 5: Total deviation plot

numeric values
probability plot

symbols that indicate the statistical significance of each measured deviation

Zone 6: Pattern deviation plot

Provided as numerical and probability plot To expose localized defect It adjust for any overall sinking of hill of vision

Normal Hill of vision

Zone 4: normal no depressed point Zone 5: normal no depressed point

(courtesy of Prof. Ravi Thomas)

Generalized depression (cataract) Zone 4: many depressed point Zone 5: normal No localized defect
(courtesy of Prof. Ravi Thomas)

Localized scotoma

There are depressed point in zone 4 that persist in zone 5

(courtesy of Prof. Ravi Thomas)

Zone 7: Global indices

Each global index summarized and characterizes one aspect of the test as a single value

Zone 7: Global indices

MD (mean deviation) shows how much, on average, the whole field depart from normal PSD (Pattern Standard Deviation) reflects irregularities in the field caused by localized defects SF (Short term Fluctuation) is index of intra test variation SF is removed from PSD to produced CPSD (Corrected Pattern Standard Deviation)

Hoddap Classification
Early Glaucomatous Loss
a. MD > -6 dB b. Fewer than 18 points depressed below the 5% probability level and fewer than 10 points below the p<1% level c. No point in the central 5 degrees with a sensitivity of less than 15 dB

Hoddap Classification
Moderate Glaucomatous Loss
a. -6>MD > -12 dB b. Fewer than 37 points depressed below the 5% probability level and fewer than 20 points below the p<1% level c. No absolute deficit (0 dB) in the 5 central degrees d. Only one hemifield with sensitivity of < 15 dB in the 5 central degrees

Hoddap Classification
Advanced Glaucomatous Loss
a. MD < -12 dB b. More than 37 points depressed below the 5% probability level or more than 20 points below the p<1% level c. Absolute deficity (0 dB) in the 5 central degrees d. Sensitivity < 15 dB in the 5 central degrees in both hemifields

Zone 8: Glaucoma Hemifield Test

Five possible message of GHT Outside normal limit Borderline General reduction of sensitivity Abnormally high sensitivity Within normal limits

Zone 8: Glaucoma Hemifield Test

Five zones in the upper field are compared its mirror-image in the lower field

Early glaucoma:
1.Pattern deviation probability plot shows a cluster of > 3 non-edge points with p< 5% and one points has p<1%.

2.PSD or CPSD with p< 5%

3.GHT outside normal limits

FIGURE 1 : HFA 30-2 CONSTRICTED FIELD

FIGURE 2 : HFA 30-2 of the same patient as in figure 1 with the field repeated with an appropriate contact lens

TRY TO INTERPRET THIS PRINTOUT...

CASE 1
Zone 1: entered correctly Zone 2 : reliable field false neg NA Zone 3 : central island Zone 4 : all depressed point Zone 5 : better than deviation plot Zone 6 : MD and PSD flag as abnormal GHT : outside normal limit

Advance field loss

Order for 10-2 and macula program

CASE 1

The result of 10-2

CASE 2
Zone 1 and 2: Ok Zone 3 : arcuate defect Zone 4 : depressed point superiorly Zone 5 : arcuate scotoma Zone 6: MD and PSD abnormal Zone 7: GHT outside normal limits It is consistent with typical glaucomatous defect Then correlate with fundus finding

CASE 2
Inferior retinochoroid coloboma

Never interpret the field alone!!

Case 3
Zone 1: 30-2 program

Zone 2: reliable field

Zone 4: many depressed point p<0.5% Zone 5 : many depressed point persist with p< 0.5% in arcuate area Zone 6 :MD and PSD flag as abnormal Zone 7: GHT outside normal limit This is a Juvenile OAG, post trabeculectomy, IOP 12 mmHg, cd 0.7

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