Eye Lett Single Field Analysis

DO Name

ID-

Central 24-2 Threshold Test

Fixation Monitor Gaze/Bend Spot

Fixation target Central co Fixation Losses. 0/13

Stimulus III White

Background 31 5 ASB

Strategy SITA -Standard

Pupil Diameter 46 mm

Visual Acuity

RX DS DC X

Date 10-13-2011

Time 10 46

Age 39

False POS ErrOrs 0% RELIABILITY INDICES Faise NEG Errora 0%

Test Duration- 0421

Fovea OFF

21

NUMERICAL TOTAL DEVIATION MAP

I 1

-7 -2

2 1

I -1 GLAUCOMA HEMIFIELD TEST

-1 1 -2 -II -2 -2 -2 -1 -2 / 0 GHT 3 0 -3 -3 3 2 -2 t

Within Normal Limits I -2 -3 -2 -3 -I 0 0

0 0 -I -3 -I 3 -2 -3 -1 VF1 99%

-3

.4 .4 3 -2 MO -0 72 dB

NUMERICAL PATTERN PSD 1 41 dB

DEVIATION MAP Pattern Dev,ation 0\

VISUAL FIELD INDICES

\ o

I 0 -2 -2

-1 0 -2 -t 0

3 2 t 0

1 0 0

-2 -1

2 -2 0

2 -1

-2 0 0

THRESHOLD VALUES

D 21 33 II /0

26 33 21. 3! 31 30

33 33 a 32 31 32 32 29

32 29 r 2 37 3? 2 .31 2

33 93 31 31 V 2 .32 a

V 32 33 2 31 2 33 33

33 2 A 33 31 31

33 3, • 23 29

Total DeVattion

0 TOTAL DEVIATION PROBABILITY MAP

< 2%

1<1% PROBABILITY 1c05% SYMBOLS

PATTERN DEVIATION PROBABILITY MAP

GAZE TRACKING ip

\

GRAYSCALE MAP

0

... • .... •

....... • • • • . ‘•.7•H ..

Humphrey® Field Analyzer 114 Single Field Analysis A Guide to Interpretation

SAMPLE CASE 1: 39-year-old patient with normal visual field.

Single Field Analysis Eye Left

Na DOG

ID

Central 24-2 Threshold

Fixation Monitor Gaze/Blind

Fixation Target. Central

Fixation Loasea. 0/17

False POS Errors. 0%

False NEG Errors- 6%

Test Duration- 07 06

Fovea OFF

3°

NUMERICAL TOTAL DEVIATION MAP

0 \

-6 -3 -5

-0 -0 -0

Test

Spot Stimulus.

(io Background

RELIABILITY INDICES

IS 2

29 b 23

23 19 23 21

232 r 2432f

Strategy

III, White

316 ASB

SITA-Stanclard

- THRESHOLD VALUES

21 21 / 0

71 71 10

21 20 21 10

21 1 3 9 1

23 (0 10 IQ 13

(0 (0 (0 W

(0 (.0 6

15 lo

-3 -9

0 3 0

-I -I 0

0 -1 -I

Pupil Diameter 5.6mm

Visual Acuity.

RX .3 SODS DC X

I

• -VW-

Date 10-21-2008

Time. 09.25

Age 78

' GRAYSCALE MAP

0

.1

- .--- "

21 i 23 A

19 9 (0 W

9 17 12

,-,c) 12

-7 -I -11

-0 -7 -9 -39.41

3..:,...L3.4... •-.

HEMIFIELD TEST

0 /

normal limits

67%

-16.41d8 P ii 05%

11 91 d8 P<053

0 \

FIELD INDICES

MAP

0 2 GLAUCOMA I -1 -5

0 -5 -2 -5 GHT

0 -I -I -19-11

-1 -7 -7

-10-63 -32 -33-33

20 -13-1

-31 -I

v 0 v. VINii

: , IINININN

Total Deviation

e NNINNIN

-9 12 33- -33 -21 i -1 -1

-33 -32 -33 -I -15 -23 -27

-37 -32 -73 0

-112 -12

-II -36 -a-ti

NUMERICAL PATTERN DEVIATION MAP

Pattern

1 i

- I S

e •

Outside 3 -V -V -29-fl

2 -27 -20 -21 VFI

70 -70 -17

16 -t3 MD

Pso

Deviation

- VISUAL

e

- • VS

OOMOOMOO 11011111111 /1111

/ 0 TOTAL DEVIATION PROBABILITY MAP

O 111111111100 - 11111111111.1111

SOSO <52 14:,

Q < 2Y.

3 < 1% PROBABILITY 0 <0 51 SYMBOLS

OOOO1111\

• IONE

0

PATTERN DEVIATION PROBABILITY

TRACKING . ' ' It 11 • t ti • .i . • I 1 . UV -'A GAZE

SAMPLE CASE 2: 78-year-old patient with probable glaucomatous field, showing

indications of a cataract, and an arcuate scotoma.

3. GRAYSCALE MAP The Grayscale Map is an intuitive way of presenting raw decibel sensitivity, with dark areas indicating reduced sensitivity. However, because the data are not compared to normal ranges, significant loss may be unrecognizable. Perhaps the most important use of this presentation is in depicting artifactual loss and profound visual field defects. 0!

We make it visible.

A Guide to Interpretation for HFA II-i Single Field Analysis

1. RELIABILITY INDICES Three indices are presented to assist in the evaluation of test reliability.

False Positive Response Errors The false positive (FP) response error score measures the tendency of patients to press the response button even when no stimulus has actually been seen— in order to identify so-called "trigger-happy" patients. Because FP rates depend strongly upon assessment of patient reaction time over the whole course of the test, the FP rate is not calculated until after testing has been completed. The FP index is the most important and useful of the three available reliability indices. We find FP rates exceeding 15% to be strongly associated with compromised test results, and usually it is best to repeat such tests.

False Negative Errors False negative (FN) rates are measured by occasionally presenting very bright stimuli at test point locations where threshold sensitivity already has been found to be reasonably normal. Note: FN rate estimates are elevated in glaucomatous visual field tests, even in highly attentive patients.

Fixation Loss Rate The fixation loss (FL) rate measures patient gaze stability—whether the patient is gazing straight ahead or looking from side to side during the test. FL rates are estimated by periodically presenting stimuli at the presumed location of the patient's blind spot—the Heijl-Krakau method. FL rates exceeding 20% may suggest compromised test results.

2. THRESHOLD VALUES This presentation simply shows the measured decibel sensitivity at each tested point, and is the basic information upon which all the other analyses and printouts are based.

CI! = HFA tip!

TOTAL AND PATTERN DEVIATION MAPS Be sure to compare the Total Deviation and Pattern Deviation Maps when evaluating cases. If the two maps look more or less the same, then there is little or no generalized depression (Case 1). On the other hand, a uniformly depressed Total Deviation Map combined with a Pattern Deviation Map showing more localized field loss, probably indicates a cataract (Case 2).

4-5. TOTAL DEVIATION MAPS The Numerical Total Deviation Plot (4) shows decibel deviations from age-corrected, normal sensitivities. The Total Deviation Probability Map (5) highlights deviations that fall outside the statistical range of normal sensitivity.

l useful STATPAC" analysis when glaucoma is a. suspected.

8. GLAUCOMA HEMIFIELD TEST (GHT) The GHT provides a plain language classification of 30-2 and 24-2 test results based upon patterns of loss commonly seen in glaucoma. Pattern Deviation scores in each of five zones in the upper hemifield are compared to findings in mirror-image zones in the inferior visual field. Scoring differences between mirror image zones are compared to normative significance limits specific to each zone pair.

9. VISUAL FIELD INDICES (VFI, MD, and PSD) Three summary indices of visual field status—VFI, MD, and PSD—appear on the SFA printout.

VFI" (Visual Field Index—) is a staging index, designed to be less affected by cataract and also to provide improved correspondence to ganglion cell loss compared to MD. VFI is approximately 100% in normal fields and approaches 0% in perimetrically blind fields.

MD (Mean Deviation) shows how much on average the whole field departs from age-normal. MD is primarily used to stage visual field loss and as a metric for rate of change over time.

PSD (Pattern Standard Deviation) reflects irregularities in the field, such as those caused by localized field defects. PSD is small, close to zero, both in normality and in blindness, and peaks at moderate levels of localized field loss; because of this nonlinear behavior, PSD should not be used as a staging or progression index.

10. PROBABILITY SYMBOLS Probability Symbols are shaded symbols which indicate the statistical significance of each decibel division. The darker the symbol the less likely it is that the field is normal in that location. For instance, a totally black square indicates that

<5%

the deviation from normal found at <2%

that point location occurs in fewer

§ <1%

than 0.5% of normal subjects. ▪ <0.5%

11. GAZE TRACKING In most Humphrey perimeters, an automatic dual-variable gaze tracker measures gaze direction every time a stimulus is presented. On the gaze tracking record, lines extending upward indicate the amount of gaze error during each stimulus presentation, with full scale indicating gaze errors of 100 or more. Lines extending downward indicate the unsuccessful measurement of gaze direction, for instance, because of a blink.

0!

0!

a!

6-7. PATTERN DEVIATION MAPS The Pattern Deviation Maps highlight localized loss after first correcting for any overall change in the height of the hill of vision, such as that caused by cataract. The Numerical Pattern Deviation Plot (6) shows decibel deviation while the statistical significance of those deviations is shown in the accompanying Pattern Deviation Probability Plot (7). The Pattern Deviation Probability Plot may be the single most

HFA.5268

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Humphrey, HFA, STATPAC, Visual Field Index, and VFI are either trademarks or registered trademarks of Carl Zeiss Meditec, Inc. in US and/or other countries. Printed in the USA. 0613