Interpretation of fields

1. INTERPRETATION OF FIELDS

2. APPROACH 1 Check patient and test data Obtain general impression 2 Observe defects and defect curve 3 Review statistics 4 PATIENT DATA CORRECTED COMPARISONS PDNP COMPARISONS TDNP PROBABILITY TDPP CORRECTEDD PROBABILITY PDPP GLOBAL INDICES GREY SCALE VALUES RAW DATA BABIE’S CURVE TEST DATA

3. WANDER W hat was done? A ccuracy (Reliability) N ormal or abnormal D efect pattern E valuate compatible disease R eview

4. PATIENT DATA Name Age/sex Eye Pupil size V/A with refractive status EXAMINATION DATA Programme Strategy Stage/ Phase Test target/ duration ( Goldmann size III ) Background illumination ( 31.5 apostilb )

5. RELIABILITY Fixation loss False positive False negative Test duration Question / repetition

6. FALSE POSITIVES FALSE NEGATIVES

7. PITFALLS Performing perimetry Data entry Pupil size Refractive error Recognising artefacts Fatigue effect Reliability Co existing ocular morbidity Learning curve

8. GREY SCALE

9. NORMAL RETINAL SENSITIVITY PATIENT’S RETINAL SENSITIVITY DIFFERENCE HUMPHREY TOTAL DEVIATION NUMERICAL PLOT OCTOPUS COMPARISON

10. PROBABILITY PLOT

11. ELIMINATING GENERALISED DEPRESSION

12. ELIMINATING GENERALISED DEPRESSION HUMPHREY PATTERN DEVIATION NUMERICAL PLOT OCTOPUS CORRECTED COMPARISONS

13. BEBIE CURVE Ranking CO values

14. GLAUCOMA HEMIFIELD TEST RESULTS Outside normal limits p <1% Borderline p <3% Generalized reduction of sensitivity Abnormally high sensitivity Within normal limits

15. CPSD 4 dB P <5% GHT – outside normal limits ANDERSON’S CRITERIA 1 2 3

16. ANDERSON’S CRITERIA

17. GLOBAL OR STATISTICAL INDICES HUMPHREY MD PSD SF CPSD OCTOPUS MD LV RMS CLV

18. GLOBAL INDICES - MD A B

19. -2 (<-6dB) MILD GENERALISED DEPRESSION -7 (<-12dB) MODERATE GENERALISED DEPRESSION -13 (>-12dB) SEVERE GENERALISED DEPRESSION GLOBAL INDICES - MD MD -2.18 dB

20. GLOBAL INDICES – PSD OR LV 150 160 150 150 150 140 170 110 MEAN STANDARD DEVIATION 10 40

21. GLOBAL INDICES – PSD OR LV PSD 4.63dB p < 1 %

22. GLOBAL INDICES MD: NORMAL PSD: NORMAL MD: ABNORMAL PSD: NORMAL MD: NORMAL PSD: ABNORMAL MD: ABNORMAL PSD: ABNORMAL SHAPE (PATTERN STD DEVIATION) HEIGHT (MEAN DEVIATION)

23. SHORT TERM FLUCTUATION PATTERN STANDARD DEVIATION CORRECTED PATTERN STANDARD DEVIATION SF IN A RELIABLE FIELD: 1 – 2.5 dB

24. FIELD DEFECTS IN GLAUCOMA Generalised loss- Early and non-specific Localised loss- More specific Advanced field loss

25. THANK YOU

26. RAW DATA OR VALUES

27. RIM ARTEFACTS

28. SIZE OF THE PUPIL 2.2 mm 5.0 mm

29. DEVIATION OR COMPARISON PLOTS & PROBABILITY

30. 29 29 29 29 30 31 31 31 30 31 30 32 33 33 32 32 31 31 31 33 33 34 34 33 00 32 31 33 33 34 34 33 00 32 31 32 33 33 33 33 32 32 31 32 32 32 32 32 31 31 31 32 + + + + 9 + + + + + 7 + 7 + 5 + 5 + 5 + + + + + + + + + + + + + + + + 5 + + + + + + + 5 + + + + 5 + + + 28 27 28 29 21 27 29 29 26 27 23 28 26 30 28 28 26 28 24 27 29 30 31 32 29 00 30 27 27 30 32 33 32 32 00 30 27 27 31 32 30 31 30 30 28 27 29 30 28 29 26 29 28 29

31. Global Indices All the information from all the points tested is reduced to single numbers

32. MD - 2.18dB Global Indices : Mean Deviation or Mean Defect (MD ) Mean of deviation of the visual field from normal .

33. PSD 4.63dB p < 1 % Global Indices Pattern Standard Deviation ( PSD) / Loss Variance (LV) Standard deviation of deviation Indicates the degree to which the numbers differ from each other “Roughness” or “potholes” in the hill of vision

34. Sequential single field analysis’ Printed Data Name Test DOB Parameters (check for standard size III) Visual Acuity Refraction Pupil Diameter (>3mm)

35. Sequential single field analysis Reliability factors Fixation loss (< 20%) False positive (<33%) False negative (<33%) Foveal Threshold (acuity & MD) Gray scale Overall Depression Specific loci of defects

36. Sequential single field analysis Total Deviation plots Numeric Plot (scan briefly the numbers) Probability map (clustering of high p-value) Pattern deviation Plots Numeric plot (ignore) Probability map (compare to Total Deviation map)

37. Sequential single field analysis Numeric Data display Investigate suspicious area in total deviation map Review raw data in a geographic sequence Perifoveal values Arcuate regions Around blind spot Nasal step Vertical and Horizontal axes Peripheral areas

38. Sequential single field analysis Global Indices MD ( cf acuity and foveal threshold) PSD ( localised defect ) Glaucoma Hemifield Test

39. Glaucoma Hemifield Test 5 sectors in upper field are compared to 5 mirror images in the lower Nerve fibre layer defect occurs assymetrically between hemifield

40. 1 2 3 4 5

41. Glaucoma Hemifield Test Outside normal limits p <1% Borderline p <3% Generalized reduction of sensitivity Abnormally high sensitivity Within normal limits