visual field interpreation from Humphrey's printout

1. INTERPRETATION OF
SINGLE FIELD PRINTOUT
(HUMPHREY’S)
DR RITA DASH
CONSULTANT OPHTHALMOLOGIST,
AMRI HOSPITALS,BBSR

2. HFAHFA-Most Preffered Automated-Most Preffered Automated
PerimeterPerimeter
Glaucoma
Neuro-ophthalmology
World wide usage in All Major clinical trials.

3. Automated Perimeter
 Dim background illumnation
 Stimulus size & duration
constant(Goldman size III, 200ms)
 Brightness is varied to estimate the
threshold.

4.  Automated perimetry is the current
gold standard in Glaucoma
diagnosis&management
 VF Testing provide information about
the
- degree of functional loss.
- Progression in established glaucoma.
INTERPRETATION OF SINGLE
FIELD PRINTOUT (HUMPHREY’S)

5. Humphrey single field
print out

6. Choice Of Test-Choice Of Test-HFAHFA
Suprathreshold
THRESHOLD- Test of choie
THRESHOLD SUPRATHRESHOLD
Central 30-2 C-40 Screening
Central 24-2 C-76 Screening
Central 10-2 P-60 Screening
Periphery 60-4 FF-81 Screening
Macula FF-120 Screening

7. Test Pattern And Strategy
Always specify the test pattern & test strategy
Central 30-2 / SITA Standard
 Central 30-2
 Central 24-2
 Central 10-2
 Macular programme
 Full threshold
 Fast PAC
 SITA Standard
 SITA Fast

9. INTERPRETATION OF SINGLE FIELD
PRINTOUT (Humphrey’s)
Field defect is there or not
Field defect is due to glaucoma or not
If it is due to glaucoma see for progression in
subsequent fields

13. Zone – I (Patient Data & Test Data)

14. Zone – I (Patient data &
Test data)
Name of the patients
Date of birth & age
Pupil diameter
Visual acuity
Refractive error
correction for NV
Fixation monitor (Blind
spot)
Fixation target (central)
Color of the stimulus
Background
illumination-31.5 asb
Stimulus size
Test pattern
Test Strategy

15. Zone – I (Patient Data & Test Data)

16. Zone II
(Foveal Threshold And Reliable
Indices)

17. Zone II
(Foveal Threshold And Reliable
Indices)
Corelate foveal threshold with VA
Fixation loss
 5% of total stimulus is presented to blind spot
 >20% reliability questioned
False positive
 Response without stimulus
 > 33% unreliable
False negative
 With 9dB more intense stimulus no respond
 >33% unreliable
 Advanced damage high false negative errors

18. Zone III
(Raw Data)

19. Zone IV (Gray Scale)
Not for diagnosis
High false positive
 White scotoma in mid
periphery
High false negative
 Clover leaf pattern

20. Clover Leaf
Pattern

21. Zone V (Total deviation plot)
Total deviation
numerical plot
Point by point
difference of patient’s
threshold from age
corrected normals
Total deviation
probability plot with ‘P’
value

22. Total Deviation Plot
Any overall sinking of
hill of vision
- Media opacity
- Refractive error
- Miosis

23. Zone –VI (Pattern Deviation Plot )
Numerical plot
Probability plot with a
‘P’ value

24. Pattern Deviation Plot
Machine adjusts for
overall depression of
visual field
Unmasks localized
scotomas

25. Zone – VII (Global Indicies)
Mean deviation (MD)
Pattern standard
deviation (PSD)
SF
CPSD

26. Mean Deviation
Derived from total deviation plot
Average number of total deviation numerical
plot

27. Pattern Standard Deviation
Indicates any irregularity of hill of vision

28. Zone –VIII
(Glaucoma Hemifield Test )
Outside normal limits
Borderline
Abnormally high
sensitivity
Abnormally low
sensitivity
Within normal limit

29. Glaucoma Field Defect
(Anderson’s Criteria)
3 None edge points (Central 30-2) in cluster
depressed to a point with p-value <5% in which at
least 1 point should be p<1%
CPSD or PSD<5%
GHT outside normal.

30. Normal Visual Field

31. Visual Field
Defect In
Case Of
Cataract

32. Visual Field Defect In Case
of Cataract & Glaucoma

39. Visual field defectVisual field defect
in case Advancedin case Advanced
GlaucomaGlaucoma

40. Lens Rim Artifact

41. SUMMARY
 Verify patient data/ Test Data
 Decide whether field is reliable or not
 Co-relate foveal sensitivity and visual acuity
 Analyze total deviation or pattern deviation plots
 Interpretation of MD and PSD
 GHT analysis report

42. Disc Features Must Match The
Visual Field Defect
To Be Clinically Significant A Visual
Field Defect Must Be Real
To Be Real, It Must Be Confirmed
On Repeated Examinations.
Rule out other occular causes of
visual field

43. How Severe It Is??!
Hodapp Anderson Parrish (HAP) visual field
severity score:
 Mean deviation
 PSD
 Depressed points in central 5 degrees and/or
severely depressed points in one or both hemi-fields

44. Early Defect
MD <-6db
Less than 25% of the points(18) are depressed
below the 5% level and less than 10 points are
depressed below the 1% level on the pattern
deviation plot
All points in the central 5 degrees must have a
sensitivity of at least 15db

45. Moderate Defect
MD<-12db
Less than 50% of the points (37) are depressed below the 5%
level and less than 20 points are depressed below the 1% level on
the pattern deviation plot
No points in the central 5 degrees have a sensitivity of 0db
Only one hemi-field may have a point with sensitivity of <15db
within 5 degrees of fixation

46. Severe Defect
(any of the following results)
MD>-12db
More than 50% of the points (37) are depressed below
the 5% level or more than 20 points are depressed
below the 1% level on the pattern deviation plot
At least one point in the central 5 degrees has a
sensitivity of 0db
Points within the central 5 degrees with sensitivity
<15db in both the hemi-fields