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Humphrey gpa overview training edition.v.2


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Humphrey gpa overview training edition.v.2

  1. 1. Humphrey® Glaucoma Progression Analysis™ (GPA ™ ) Software for the Humphrey® Field Analyzer
  2. 2. <ul><li>Issues facing visual field progression analysis today </li></ul><ul><ul><li>Variability in patient test taking </li></ul></ul><ul><ul><li>Multiple exams required to detect change </li></ul></ul><ul><ul><li>Many schools of thought or “rules of thumb” on how much change confirms change </li></ul></ul><ul><ul><li>Estimating “rate” of progression is difficult with today’s tools </li></ul></ul>Need for Glaucoma Progression Analysis Using Visual Fields
  3. 3. Introducing Humphrey® Glaucoma Progression Analysis™ Software <ul><li>The Humphrey® GPA TM Solution </li></ul><ul><ul><li>Algorithms and Criteria </li></ul></ul><ul><ul><ul><li>Enrolled Hundreds of Glaucoma Patients in Multi-Center Trial to Quantify Visual Field Variability </li></ul></ul></ul><ul><ul><ul><li>Uses SITA and Pattern Deviation to Identify Glaucoma-Specific Progression </li></ul></ul></ul><ul><ul><ul><li>Employs Strict Progression Criteria from EMGT Study 1 </li></ul></ul></ul><ul><ul><ul><li>Mean Deviation Slope Plot Helps Identify Rapidly Progressing Patients </li></ul></ul></ul><ul><ul><li>Software Design </li></ul></ul><ul><ul><ul><li>User Friendly Interface </li></ul></ul></ul><ul><ul><ul><li>Automated test selection </li></ul></ul></ul><ul><ul><ul><li>GPA Results on Single Field Printouts </li></ul></ul></ul>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. 4. <ul><li>Contributors to variability 2,3 : </li></ul><ul><ul><li>Field and Point Status (deviation from normal) </li></ul></ul><ul><ul><li>Eccentricity of field </li></ul></ul><ul><ul><li>Patient test-taking experience </li></ul></ul><ul><ul><li>Strategy chosen – SITA or Full Threshold </li></ul></ul><ul><li>Large glaucoma database defines expected variability </li></ul><ul><li>GPA flags progression at points exceeding expected patient variability </li></ul>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 <ul><li>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 </li></ul><ul><li>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 </li></ul>
  5. 5. <ul><li>Minimum of three tests required: 2 baseline and 1 follow-up exam </li></ul><ul><li>Each follow-up compared to averaged thresholds of 2 baseline exams </li></ul><ul><li>Additional follow-up compared both to baseline and to 2 most recent follow-ups </li></ul><ul><li>Symbols: </li></ul><ul><li>Three in one exam denotes “Possible Progression” and three equals “Likely Progression” </li></ul>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. 6. Applying GPA To Your Practice: Setting Up An Analysis <ul><li>Doctors can access the GPA from four different directions: </li></ul><ul><ul><li>View Test </li></ul></ul><ul><ul><li>Recall Test </li></ul></ul><ul><ul><li>Print Test </li></ul></ul><ul><ul><li>Immediately After An Exam </li></ul></ul><ul><li>All Options will take the doctor to the “Threshold Printout Selection” Menu </li></ul>
  7. 7. Applying GPA To Your Practice: Selecting GPA <ul><li>Doctor or technician selects the Glaucoma Progression Analysis Printout </li></ul>
  8. 8. Applying GPA To Your Practice: Selecting Your GPA Print Options <ul><li>If GPA has not yet been set up for the current patient, the doctor will be taken straight to the “Exam Selection” screen </li></ul><ul><li>If GPA has been set up for this patient, the following screen appears. </li></ul><ul><li>If Progression is confirmed, it is recommended that the doctor view the full GPA Analysis (Baseline & Follow-Up Printouts) </li></ul>
  9. 9. Applying GPA To Your Practice: Baseline and Follow-Up Exam Selection <ul><li>For current patients, during next visit, set up GPA for each patient </li></ul><ul><li>For challenging cases, retrospective analysis is available </li></ul><ul><li>GPA assists with Set Up and remembers settings for patient’s next visit Note: GPA automatically identifies tests with questionable reliability indices </li></ul><ul><li>Once set up is completed, new exams are automatically added to the analysis </li></ul>Baseline Follow-up Exam with High False Positive Rate
  10. 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. 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. 12. Single Field Analysis with GPA Results <ul><li>The new look in the standard of care! </li></ul><ul><li>Once GPA is set up for a patient, progression is automatically analyzed after each new visit </li></ul><ul><li>Original single field analysis will be printed if GPA has not been set up </li></ul>GPA on Single Field Printout
  13. 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. 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. 15. Availability <ul><li>Commercial Release: </li></ul><ul><li>October 15, 2003 </li></ul><ul><li>Instrument Compatibility: </li></ul><ul><ul><li>730, 735, 740, 740i, 745, 745i, 750, 750i models </li></ul></ul><ul><ul><li>720 and 720i models ONLY after upgrade to Model 730 </li></ul></ul>