1

Humphrey® Glaucoma Progression Analysis™ (GPA™) Software

for the Humphrey® Field Analyzer

2

Issues facing visual field progression analysis today

Variability in patient test taking

Multiple exams required to detect change

Many schools of thought or “rules of thumb” on how much change confirms change

Estimating “rate” of progression is difficult with today’s tools

Need for Glaucoma Progression Analysis Using Visual Fields

3

The Humphrey® GPATM Solution• Algorithms and Criteria

Enrolled Hundreds of Glaucoma Patients in Multi-Center Trial to Quantify Visual Field Variability

Uses SITA and Pattern Deviation to Identify Glaucoma-Specific Progression

Employs Strict Progression Criteria from EMGT Study1

Mean Deviation Slope Plot Helps Identify Rapidly Progressing Patients

• Software Design• User Friendly Interface• Automated test selection• GPA Results on Single Field Printouts

Introducing Humphrey® Glaucoma Progression Analysis™ Software

1. Heijl, Leske,Bengtsson, Bengtsson,Hussein, and the Early Manifest Glaucoma Trial Group. Measuring Visual Field Progression in the Early Manifest Glaucoma Trial. Acta Ophthalmol Scand. 2003; 81:286-293

4

• Contributors to variability2,3:• Field and Point Status

(deviation from normal) • Eccentricity of field• Patient test-taking

experience• Strategy chosen – SITA or

Full Threshold

• Large glaucoma database defines expected variability

• GPA flags progression at points exceeding expected patient variability

Tested Threshold

Ret

este

d T

hre

sho

ld

Impaired Vision

Not Progressing

Perfect Test

Result

Test-Retest Variability

NormalVision

Identifying Progression in Visual Fields

Progressing

Impaired

Normal

2. Bengtsson B, Heijl A., Inter-subject variability and normal limits of the SITA Standard, SITA Fast, and the Humphrey Full Threshold computerized perimetry strategies, SITA STATPAC. Acta Ophthalmol Scand. 1999; 77(2): 125-129

3. Bengtsson B, Heijl A, Evaluation of a new perimetric threshold strategy, SITA, in patients with manifest and suspect glaucoma. Acta Ophthalmol Scand. 1998; 76(3): 268-272

5

• Minimum of three tests required: 2 baseline and 1 follow-up exam

• Each follow-up compared to averaged thresholds of 2 baseline exams

• Additional follow-up compared both to baseline and to 2 most recent follow-ups

• Symbols:

• Three in one exam denotes “Possible Progression” and three equals “Likely Progression”

Criteria For Identifying Progression in Visual Fields

= Progression at 95% significance level

= Progressing point repeated in two consecutive exams

= Progressing point repeated in three consecutive exams

6

Applying GPA To Your Practice:Setting Up An Analysis

• Doctors can access the GPA from four different directions:

•View Test

•Recall Test

•Print Test

•Immediately After An Exam

• All Options will take the doctor to the “Threshold Printout Selection” Menu

7

Applying GPA To Your Practice:Selecting GPA

• Doctor or technician selects the Glaucoma Progression Analysis Printout

8

Applying GPA To Your Practice:Selecting Your GPA Print Options

• If GPA has not yet been set up for the current patient, the doctor will be taken straight to the “Exam Selection” screen

• If GPA has been set up for this patient, the following screen appears.

• If Progression is confirmed, it is recommended that the doctor view the full GPA Analysis (Baseline & Follow-Up Printouts)

9

Applying GPA To Your Practice:Baseline and Follow-Up Exam Selection

• For current patients, during next visit, set up GPA for each patient• For challenging cases, retrospective analysis is available• GPA assists with Set Up and remembers settings for patient’s next

visit Note: GPA automatically identifies tests with questionable reliability indices

• Once set up is completed, new exams are automatically added to the analysis

Exam Selection - GPA

Rev 3.2 (0011) 02-03-2003 10:14 AM

Disk Options Patient Search Select All Proceed

Source: Hard Drive Order: Name Range: Restricted

SITA SAMPLE

SITA SAMPLE

SITA SAMPLE

SITA SAMPLE

SITA SAMPLE

SITA SAMPLE

SITA SAMPLE

Name DOB Eye Test Date

*

*

02-02-1922

02-02-1922

02-02-1922

02-02-1922

02-02-1922

02-02-1922

02-02-1922

R

R

R

R

R

R

R

SS-24-2

SS-24-2

SS-24-2

SS-24-2

SS-24-2

SS-24-2

SS-24-2

01-06-2003

01-06-2002

07-06-2001

01-06-2000

01-06-1999

01-06-1998

01-06-1997

Full Threshold tests are allowed to be used asbaseline only.

> Follow-up * Baseline? Low Reliability Follow-up

>

>

?

>

Baseline

Follow-up

Exam with High False Positive Rate

10

Typical GPA Result

11/27/97 4/18/01 12/15/98

4/18/02 11/20/02

Baseline Follow-up

Multiple Exams

Rate of Progression Plot

11

GPA Follow-Up Printout Overview

, , and identify change and repeatable change

Gray Scale Plot

Pattern Deviation Probability Plot

Deviation from Baseline (Pattern Deviation dB)

Plain Language Interpretation of Analysis: “Possible Progression” or “Likely Progression”

Reliability Indices for each exam

**Low Test Reliability**

Sample warning: Check reliability indices

12

Single Field Analysis with GPA Results

The new look in the standard of care!

Once GPA is set up for a patient, progression is automatically analyzed after each new visit

Original single field analysis will be printed if GPA has not been set up

GPA on Single Field

Printout

13

Case Study 1: Finding Progression

GPA confirms repeatable, consistent change is seen at five points in the field

Pattern Deviation Probability Plot appears variable or even improving

14

Case Study 2: Sorting Out Variability

GPA Identifies Changes, but not at consistent points in the field and therefore not Confirmed Progression

Pattern Deviation shows variability, but maybe some consistency between Follow-up #1 and #3

15

Availability

Commercial Release:

October 15, 2003

Instrument Compatibility: – 730, 735, 740, 740i, 745, 745i, 750, 750i models– 720 and 720i models ONLY after upgrade to Model 730