VISUAL FIELD

INTERPRETATION

DR AHMAD HASSAN RANA

PGR EYE -2
BVH BAHAWAL PUR
VISUAL FIELD:
• Island of vision surrounded by sea of darkness
• Three dimensional hill
• Peek being fovea
• Extends superiorly 50°
• Nasalay 60°
• Inferiorly 70°
• Temporarily 90°
INDICATIONS FOR VF ASSESSMENT
Detects retinal sensitivity

• Detection of early glaucoma

• Monitoring of glaucoma
• Neurological diseases
TETS FOR VF ASSESSMENT
• Confrontational VF assessment
• Amsler grid
• Kinetic perimetery
• a .tangent secreen
• B.goldman perimetery
• Static perimetery
HUMPHREY VISUAL FIELD ANALYZER
INTERPRETATION
 TEST PATTERNS
• 3 types
• 30-2
• measures 30° Temporarily and nasaly
tests 76 points.
Used for general screening, early glaucoma and neurological conditions

24-2
Measures 24 degrees temporally and 30 degrees nasally
A tests 54 points.
Early detection of glaucoma

10-2
Measures 10 degrees temporally and nasally and tests 68 points. Used for ma cula, retinal and neuro-ophthalmic
conditions and advanced glaucoma
THRESHOLD AND ITS TYPES

1. Threshold test-using threshold stimulus for diagnosis of glaucoma and

neurological lesions

2. Screening test- using suprathreshold stimulus for detection of glaucoma

SITA ALGORHITHMS

.faster way to ChecK thresholdS

. Uses a database of normal and glaucomatous fields to estimate
threshold values
• SITA-Standard
• Uses 4-2db steps
• Paces the Test according to pt response
• SITA FAST
• Uses 4db steps
 FIXATION TARGETS

Central target: Yellow light in the bowl’s centre

Small diamond: For patients who cannot see the central target such as those with
macular degeneration. The patient looks into the centre of the four lights
• Large diamond: For patients who cannot see the above two
RELIABILITY INDICES

Fixation losses: Recorded when a patient responds to a stimulus that is projected on to area of
their blind spot. Fixation losses exceeding 20%, are denoted with an ‘XX’ next to the score, and deems
results unreliable

False positives: Recorded when a patient responds when there is no stimulus present. This patient
is often referred to as ‘buzzer happy’. False positives exceeding 15% are denoted with an ‘XX’ and results
are considered unreliable.
False negatives: Recorded when a patient does not respond to brighter stimuli where a duller
stimulus has already been seen. High false negative scores indicate that the patient is fatigued, inattentive.
GAZE-TRACKER

• This monitors eye movement, com-paring the centre of the pupil to the first
Purkinje reflection from the cornea whichchanges if the eye moves. Ideally
the eye should becompletely still and the trace shoul be flat.
NUMERICAL DISPLAY

The numerical display represents raw values of patient’s retinal

sensitivity at specific retinal points in dB. Higher numbers equate to
higher retinal sensitivities. Sensitivity is greatest in the central field
and decreases towards the periphery.
 GREY SCALE

• The grey scale is a graphical representation of the numerical display,

allowing for easy interpretation of the field loss. Lower sensitivities are
indicated by darker areas and higher sensitivities are represented with a
lighter tone.
TOTAL DEVIATION

demonstrates the difference between measured values and population age-

norm values.
Negative values indicate lower than normal sensitivity
Positive indicates higher
• 0 equals no change
STATISTICAL DISPLAY CHART

• Statistical display demonstrates the percentage of abnormality in the

normal population at each point. The probability display provides this
percentage a key for interpreting the statistical display.
PATTERN DEVIATION PLOT

• Exposes localized defects masked by generalized depression/elevation

• Accounts for general reductions of vision caused by media opacities (e.g.
Cataract), uncorrected refractive error, reductions in sensitivity due to age
and pupil miosis. This highlights focal loss only
• Main plot referred to when making a diagnosis.
GLOBAL INDICES
• These provide a statistical summary of the field

Mean deviation (MD): Derived from the total deviation and represents the overall mean departure from
the age-corrected norm.
A negative value indicates field loss,
a positive value indicates that the field is above average.

Pattern standard deviation (PSD): Derived from the pattern deviation and thus highlights focal loss
only. A high PSD is more useful indicator of glaucomatous progression, than the MD
GLAUCOMA HEMIFIELD TEST
• It compares five corresponding and mirrored areas in the superior and inferior visual fields.
• gives five comments
•
• 1. GHT outside normal limit,if difference Found in 1% population
•
• 2. GHT-borderline, if difference found in upto 3% population
•
• 3. GHT-abnormally low sensitive, best sensitive part is seen in less than 5% of the
population
•
• 4. GHT-abnormally high sensitive, best sensitive part is seen is more that found in 99.5%
population
•
• 5. GHT-within normal limit, when none of the above 4 conditions are seen
VISUAL FIELD INDEX

• The visual field index (VFI) reflects retinal ganglion cell loss and function
• VFI is a reliable index on which glaucomatous visual field severity staging
can be based