RCM Curso Basico VF 2011

8/7/2019 RCM Curso Basico VF 2011

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Humphrey Visual Field Tests:A workshop for beginners.

Natalio J. Izquierdo, M.D.

Presidente Electo Asociacin Mdica de PR


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I ntroductionI ntroduction

VF defects due to glaucoma

Gold Standard Dx & TxF ull Threshold versus SITAOwners ManualMy interpretation format

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S ingle Field AnalysisS ingle Field Analysis

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Top of the PageTop of the Page

Patient dataReliability indicesNumeric results

Gray tone results

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L ower Half of the PageL ower Half of the Page

Total deviation plot

Pattern deviation plotProbability symbolsGlobal Indices

EOM (SITA)

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Patient DataPatient Data

W hich eye?Patients name; ID; DOB

Strategy & StimulusPupil size & DateV A & Refraction

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R eliability I ndicesR eliability I ndices

F ixation lossesF alse positivesF alse negatives

XX = unreliable

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R eliability I ndices: Fixation L ossesR eliability I ndices: Fixation L osses

Pt did not fixateLosses per stimuliExceed 20%

XX sign

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Example 1Quantify LossesIs it Reliable?

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Example 2Quantify lossesIs it reliable?

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R eliability I ndices: False PositivesR eliability I ndices: False Positives

40 points rechecked & >40dB

Movement & SoundAnswers without stimuli?XX sign when 15 - 33%

Low reliability message

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False Positives Example 3False Positives Example 3

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If 40 dB in Numerical ThresholdW hite in Gray tones graph


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R eliability I ndices: False NegativesR eliability I ndices: False Negatives

Shows a bright stimulus in an area

of known sensitivity.If Pt does not respond a F alse

Negative response is recorded.

Unreliable if > 33%

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False Negatives CausesFalse Negatives Causes

Inattentive patientPoor fixationPhysical Condition


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False NegativesFalse Negatives

Example 4

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False NegativeFalse Negative

Example 5

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R eliability Clinical PearlsR eliability Clinical Pearls

Test is unreliable if:Test is unreliable if:

F ull 30-2 takes > 55 0 questionsF ull Threshold lasts > 20 minutesIf SITA lasts > 6-8 minutes

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R eliability Clinical PearlsR eliability Clinical Pearls

Example 6: Questions Asked

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G ray Tone Threshold PrintoutG ray Tone Threshold Printout

10 shades of gray tone symbolsEach tone represents dB changes0 dB Highest intensity

Not in SITA

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Threshold Test PrintoutsThreshold Test Printouts

Blind spot shown as a triangle in theNumeric Threshold Printout

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Numeric Threshold PrintoutNumeric Threshold Printout

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Numeric grid gives

thresholds in dBRechecked if 5 dB

+/- than expected

Rechecked value isshown within ( )


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Example 9

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< 0 = pt did not see stimulus at 0 dB0 = pt saw the stimulus at 0 dBExample 10

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G laucoma Hemifield TestG laucoma Hemifield Test

Comparesupper & lower hemi-fields

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G laucoma Hemifield TestG laucoma Hemifield Test

Identifies localized VF D as abnormalW ithin / Outside / BorderlineReduction or High Sensitivity


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Example 11

G HT Within Normal L imitsG HT Within Normal L imits

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G HT AbnormalG HT AbnormalExample 1 2

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G HT R eduction of S ensitivityG HT R eduction of S ensitivity

Example 14

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G HT High S ensitivityG HT High S ensitivityExample 15

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Total deviation PlotTotal deviation Plot

Left Lower Half Upper: Numeric values

(Patient vs normal)Lower: Probability

(darker is less likely to be

normal)Color symbols as %

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Pattern Deviation PlotPattern Deviation Plot

Right Pair

Adjusted for cataractsShades = ProbabilityExample 17

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G lobal I ndicesG lobal I ndices

F ar Right Side

Mean Deviation (MD)Pattern Standard Deviation (PSD)Short-term F luctuation (S F )Corrected Pattern Standard Deviation

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G lobal I ndicesG lobal I ndices

F ar Right Side

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G lobal I ndicesG lobal I ndices - - Mean DeviationMean Deviation

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MD Values (dB) Description

-2 to 2 Normal

-2 to -6 Mild

-6 to -12 Moderate

-12 to -16 Severe

< -16 Profound


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Example 18MD?Describe

P value

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Example 19 - MD

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G lobal I ndices:G lobal I ndices:

PatternS

tandard DeviationPatternS

tandard Deviation

Pts VF departs from nlNormal: 0 to 4 dBLow PSD = smooth hill of vision

High PSD = irregular hill

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G lobal I ndices: P S DG lobal I ndices: P S D

Example 20High PSD =

irregular hill

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G lobal I ndices:G lobal I ndices:S hort Term Fluctuation ( S F)S hort Term Fluctuation ( S F)

Index of consistencyPoints Tested twiceNormal 0 to 2 dBExample 21: 3.20 dB

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G lobal I ndices:G lobal I ndices:Corrected Pattern S tandard DeviationCorrected Pattern S tandard Deviation

How the shape of the pts hill of vision deviates

Unreliable responsesVF losses or Both

Normal 0 to 4 dBExample 22

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S ection 2S ection 2VF 2 .1VF 2 .1

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VF 2 .2VF 2 .2Page 39


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VF 2 .3VF 2 .3Page 41


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VF 2 .4VF 2 .4Page 43


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VF 2 .5VF 2 .5Page 45


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Progression: 5Progression: 5- -77--99--11 @ Pattern11 @ Pattern

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New depression = 2 adjacent points 5 dBDeepening of an existing point 7 dBEnlargement with an adjacent point 9 dBDevelop a new scotoma 11 dB


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Change Analysis PrintoutChange Analysis Printout

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Box plot:

Median,ElongationMD

PSD


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Patient 3. 2Patient 3. 2

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Patient 3.3Patient 3.3

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NeuroNeuro vsvs G laucoma VFD?G laucoma VFD?

ON appearanceV ertical MeridianCongruousQuad vs Hemianopsias

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NeuroNeuro vsvs G laucoma: M RI ?G laucoma: M RI ?

HistoryV ertical MeridianBitemporal HemianopiaQuadrantanopsias

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Mrs. R oseMrs. R ose

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ConclusionsConclusions

VF needed for Dx & TxSingle F ield AnalysisProgressionChange Analysis

Glaucoma vs Neuro


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Documents

RCM Curso Basico VF 2011