International Standards

ASB
dB
FT/L
 ASB

0 (Dimmest) – 10,000 (Brightest)

A measurement of light, dealing
with the brightness of the
surface of the bowl

ApoStilB

International Standard
 FT/L
HFA Range
0 (dimmest) – 929 (Brightest)
FT/L
Higher number = Brighter light

Foot Lambert

International Standard
 dB

HFA Range
0.1 dB (Brightest) – 51dB (Dimmest)
Higher number = Dimmer Spot

Decibel

International Standard
 International Standards Comparison
Dimmest
Brightest
0 ASB
10,000 ASB

0 FT/L
929 FT/L

51 dB
0.1 dB
Goldmann Perimeter
Standards of Perimetry

Background
Illumination

Spot
Intensity

Spot Size

Spot
Duration

Spot Speed
Background Illumination

The illumination in the bowl must remain

constant throughout the test.

The standard value is 31.5 ASB.

Background Illumination

Why 31.5 ASB?

Originally used by Goldmann Perimeter
Adopted as standard by International Perimetric Society
(International Council of Ophthalmology 1979)
Approximates minimum level for photopic or daylight vision
Photopic vision relies on retinal cone function instead of rods
Cones – Object Contrast Rods – Absolute Brightness
Small changes in pupil size or clarity of media do not have an
effect on Contrast, so have little effect on test results.
Spot Intensity

The Spot intensity is controlled by filter wheels

Glass Wedge/Film Wedge

The spot intensity is directly related to the

bowl intensity.
Spot Size

The size of the spot can be size I,II,III,IV,or V

Size V spot is the largest

Mr. Default
to you!
The default spot size is size III
Spot Size

Spot size 3 is .43 degrees

Spot Size is smaller in the HFA II bowl

than in the HFA I, because the bowl
radius is smaller.
Spot Duration

How long the spot is displayed

The default time duration is 200mS

(milliseconds) + or – 10mS

Duration can be changed to

500 mS for older patients.
Spot Duration

The principle of temporal summation holds that for

very short durations, the visibility of a stimulus
increases with duration; when a stimulus lasts more
than about 0.5 seconds, on the other hand, its visibility
is basically independent of duration.

200 ms – long enough for visibility to not be affected

by small variations in duration. But less than …
250 ms – latency for voluntary eye movement
Spot Speed

How fast the spot moves

This only applies to Kinetic testing.

Default speed for the HFA is 4 degrees per second.

 Goldmann vs. Humphrey Parameters

Goldmann Humphrey
Spot Size I,II,III,IV, V I,II,III,IV,V
(V is the largest) (V is the largest)
Filters 1,2,3,4 Glass Wedge
(4 is the brightest) Film Wedge
a,b,c,d,e
(e is the brightest)
Kinetic Testing

Single intensity; Moving Target

A light spot (Stimulus) is introduced along a
particular meridian, following a straight line until a
patient response (sees the light spot) is indicated.

Patient Response

Meridian
Static Testing

Variable Intensity; Stationary Target

Varies the intensity of the spot

over the entire Hill of Vision.
Patient does not see the spot
move. The spots are projected at
different positions on the bowl,
but the instrument will return to
the spots at different intensities.
Hill of Vision

A Static test on a
normal eye will produce
a pattern similar to the
one here. Fovea

Dim Blind Spot

Nasal Temporal

Bright
Scotomas

Definition: A defect on the Retina. An area or spot on

the Retina that is not as sensitive to light as it should
be.
There are two types of Scotomas:
1. Relative – An area or spot on the Retina that can detect light,
but not as good as when compared to a normal eye at that same
spot.
2. Absolute – An area or spot on the Retina that cannot detect
light, no matter how bright it is.
 Scotomas

Is this Scotoma Relative Blindspot

or Absolute?

Relative!!
Quiz

The Blind spot exhibits the same characteristics as an

________ Scotoma?

Absolute
Scotoma!
Thresholding and Bracketing

What is thresholding?

Threshold (or Threshold Level) is the minimum amount

of light that the eye can detect at a particular point on
the retina.

Bracketing is the process of determining the

Threshold value.
Thresholding by Bracketing

For our purposes, we will assume that the instrument begins the
threshold test with a spot of 36db. The spot or stimulus is
presented at a particular spot on the bowl to see if there is a
patient response.

Indicates a negative (did not see) response

Indicates a positive (did see) response

55 dB 36 dB 0 dB

Dimmer Brighter
 Thresholding by Bracketing

The patient did not respond, indicating that he/she did NOT see the
spot. The instrument will now introduce a spot of 32dB (a 4dB change)
at the exact same location.

Indicates a negative (did not see) response

Indicates a positive (did see) response

55 dB 36 dB 32 dB 0 dB

Dimmer Brighter
Thresholding by Bracketing

The patient responded positively, indicating that he/she DID see

the spot. The instrument will now introduce a spot at the same
exact position, at a brightness of 34dB. (A 2dB change)

Indicates a negative (did not see) response

Indicates a positive (did see) response

55 dB 34 dB 0 dB

36 dB 32 dB

Dimmer Brighter
Thresholding by Bracketing

Once again, the patient did not see the spot. The instrument has
determined by BRACKETING that the threshold for this spot is 32dB.
(NOTE: Some tests may closer define the threshold by testing at 1 dB
steps.)

Indicates a negative (did not see) response

Indicates a positive (did see) response

55 dB 34 dB 0 dB
36 dB 32 dB

Dimmer Brighter
 Starting a Test
What happens when you start a test?

Bracketing begins at 24dB

1. One spot in each
quadrant will be
bracketed to determine
the Threshold level.

At the same time, the

location of the Blind
Blindspot
Spot will be determined.
What happens when you start a
test?
Dimmer
36dB (CEN)
2. Once the threshold
value for a spot in each
quadrant has been
found, an Expected Hill
of Vision is determined.

Expected “Hill of Vision”

 Starting a Test

What happens when you start a test?

The “CEN” is defined as
the Central Reference Dimmer
Level, or the Expected 36dB (CEN)
Foveal Sensitivity, or the
Expected Foveal
Threshold.

Expected “Hill of Vision”

 Starting a Test

What happens when you start a test?

Dimmer
36dB
3. As the test is run, the
patients “Actual”
readings are plotted. Blind Spot

Expected “Hill of Vision” Actual Patient plots

 Types of Tests

1. Screening Tests – A QUICK overview of the patient’s field of

vision. Most screening tests tell only if the patient did or did not
see the spot. In general, screening tests do not quantify. That is,
they do not determine how bad a scotoma is.

Now you see it…….. Now you don’t!!!!!!!!!

Types of Tests

2. Threshold Tests – Quantifies each spot. That is, it finds the threshold
level. Determines how bad the scotoma is by calculating the exact light
level the patient can see at a particular spot on the Retina.

No
wI
see I don’t see
i t! ! it…
!!!
SWAP

Short Wavelength Automated Perimetry (SWAP)

Blue Goldmann Size 5 Stimulus on bright Yellow background
Yellow Background reduces responsiveness of the red and green cone
system
Blue Stimuli are seen primarily by the Blue Cone System
SWAP can detect progression of field loss earlier in patients than
standard White on White perimetry
SWAP eliminates the redundancy in the visual system by reducing
responsiveness from non blue cones and the rod system
Reliability Factors

After a Field Test has been completed, a determination

must be made if the test is accurate and therefore
reliable. Several Reliability Indicators appear on the
test printout:

 Fixation Losses
 False Negative Errors
 False Positive Errors
 Gaze Tracking
 Fixation Losses

During the test, the patient is told to

Fixate (Stare) at a central LED. The
instrument records the number of times
that the patient lost this fixation and
reports it on the printout.
Excessive fixation losses can render a
test invalid.
Fixation Monitoring

The HFA uses two systems for measuring patient

fixation: the standard Heijl-Krakau blind-spot
monitoring and the IR Gaze Tracking System. Both
methods can be used, either together or alone, or
they can both be turned off, as required.
Heijl-Krakau Blind Spot Monitoring

 
Gaze Tracking

Location of Corneal Reflex Marker

Corneal Reflex marker Location Digitized and Stored

in Memory
Gaze Tracking

The direction of a patient's gaze is

determined in two steps:

1. A reflex marker is established

on the corneal surface.

2. The location of the pupil center is

determined.
Gaze Tracking

Patient Fixating – Corneal

Reflex Marker and Pupil in Proper
Relationship

Patient Not Fixating –

Corneal Reflex Marker and Pupil
Not in Proper Relationship

Determining the Pupil Center

Gaze Tracking

Gaze Graph

Upward spikes indicate that the patient has lost fixation;

• a spike that reaches the top horizontal line (or higher) indicates 10 degrees (or
more) off fixation;
• a spike that extends halfway to the top line indicates 5 degrees off fixation.
P Downward spikes indicate as follows:
• a short spike downward indicates that the gaze at that time cannot be
determined by the software.
• a long spike downward indicates that the patient blinked at the time fixation
was checked.
The absence of marks on the graph indicates proper fixation.
Gaze Tracking
Gaze Tracking
Gaze Tracking
False Negative Errors

Let us say that a Stimulus (Spot) is presented at 26dB,

and the patient responds that the spot was seen. Later in
the same test, at the same location, a brighter spot, say
22dB, is presented, and the patient does not respond, that
is, the patient does not see the spot.

“Yessir, I see it!”

“Nosir, I didn’t see that one!”
False Positive Errors

The patient responds that a spot of light was seen

when none was presented. This sometimes can occur
when the motors move on the Humphrey Field
Analyzer, or a patient gets into a rhythm and anticipates
spots.

Spots