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Humphrey gpa overview training edition.v.2

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  • 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. Introducing Humphrey® Glaucoma Progression Analysis™ Software
    • The Humphrey® GPA TM 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 Study 1
        • Mean Deviation Slope Plot Helps Identify Rapidly Progressing Patients
      • Software Design
        • User Friendly Interface
        • Automated test selection
        • GPA Results on Single Field Printouts
    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 variability 2,3 :
      • 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 Retested Threshold Impaired Vision Not Progressing Perfect Test Resul t Test-Retest Variability Normal Vision Identifying Progression in Visual Fields Progressing Impaired Normal
    • 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
    • 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
    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