This document provides an overview of visual field testing and interpretation. It begins with definitions of key visual field terminology. It then discusses the history of visual field testing and describes common testing methods like kinetic and static perimetry. Goldmann perimetry and automated perimetry are explained in detail. The document reviews how to interpret visual field results, including expected normal limits and descriptions of common visual field defects. It provides guidelines for visual field testing and plotting isopters. Overall, the document serves as a comprehensive guide to visual field assessment.
To know Humphrey visual field analyser
To know about various types of perimetry
To identify field defect
To recognize that field defect is due to glaucoma or neurological lesion
To know that field defect is progressive or not
Interpretation of HVFA
To know Humphrey visual field analyser
To know about various types of perimetry
To identify field defect
To recognize that field defect is due to glaucoma or neurological lesion
To know that field defect is progressive or not
Interpretation of HVFA
The presentation I have made and uploaded provides you with an in-depth insight into the patterns the strabismus may take following anomalies of extraocular muscles, deformities of the orbital structures,innnervational disturbances.
The author does not assume responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work.
No copyright infringement, or plagiarism intended.
Amrit Pokharel
The presentation I have made and uploaded provides you with an in-depth insight into the patterns the strabismus may take following anomalies of extraocular muscles, deformities of the orbital structures,innnervational disturbances.
The author does not assume responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work.
No copyright infringement, or plagiarism intended.
Amrit Pokharel
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
NVBDCP.pptx Nation vector borne disease control program
Visual field testing and interpretation
1. Visual Field
Testing and Interpretation
Raman P Shah
Optometrist
B. P. Koirala Lions Center for Ophthalmic Studies
2. References and recommended readings
• Walsh TJ. Visual fields Examination and
Interpretation, Ophthalmology monographs, AAO
• J Boyd Eskridge. Clinical procedures in Optometry.
Mosby
• Automated Perimetry; Visual Field Digest: 5th
edition
• David O. Harrington, Michael V. Drake. The visual
fields .7th
edition
3. Presentation layout
• Introduction on Visual field
• Normal limits of Visual field
• Short overview on history of VF
• Terminologies related to VF
• Visual field testing methods
– Kinetic, static
• Interpretation of VF reports
9. Short History of Visual Field
• In B.C 150, Ptolemy: used some form of
perimetric device to measure extend of VF
• First clinical investigation of VF defect –
Hippocrates in 5th
century, hemianopic field
defect
• Finally in 1604 Kepler explained the principle of
sight in term of an inverted retinal image –
– an stage for modern investigation of VF
10. History….
• In 1666, Mariotte discovered
physiological blind spot
• In 1801, Young stated the normal
extend of VF of an eye
• Von Graefe mapped out blind spot,
central scotomas, construction of
isopter.
– Introduced VF in clinical medicine
for the first time
• Until 1869, Foerester invented arc
perimeter, till then VF plotted on
flat surface
Thomas
Young
Von
Graefe
11. History……
• In 1880, Bjerrum
developed Tangent screen
• In 1940, Marc Amsler
introduced Amsler grid
• In 1939 Sloan described
static perimetry
• In 1945 Goldman
Perimeter
• In 1960 Tubinger- manual
testing of both static and JannikPetersonBjerrum
HenningRønne
Dr.HansGoldman
12. Few Terminologies
• Threshold: The weakest test stimulus that is just
visible in a particular location under the specific
testing condition.
– Varies across the visual field.
• Sensitivity: most subtle characteristics of a
stimulus that is visible at a specific point in space.
• Fixation: that part of visual field corresponding
to fovea centralis.
13. Terminologies…
• Isopter:
– Line connecting all points in the visual field with the same
threshold ( for a given test spot)
– Boundary between area of visibility to the area of non-
visibility for a particular stimulus
14. Terminologies…
• Scotoma: Localized defectsdepressions surrounded by
normal visual field.
– Absolute: defect that persists when the maximum stimulus is
used e. g blind spot.
– Relative : defect that is present to weaker stimulus but
disappears with brighter stimulus.
15. Location of Visual field defects
• Central
– 5 degrees or less from the point of fixation
• Paracentral
– >5 degress – 30 degrees
– Ceacal, paraceacal, periceacal
– Centrocecal
• Peripheral
– >30 degrees
16.
17. Descriptive components of VF
defects
• Monocular descriptions
– Density
• Absolute (no visual sensation) or relative (depressed visual sensation)
– Area
• General or local
– Shape
• Sectorial (hemianopic) or non-sectorial (regular or
irregular)
– Extent
• Total or Partial
– Position
• Rt. Or Lt. . Temporal, nasal, superior, inferior
18. Descriptive components of VF
defects
•Binocular description
• Laterality
•Unilateral or bilateral (homonymous/heteronymous)
•Equalness
•Congruous or incongruous
•Additional description
•Awareness
•Positive (defect perceived) or negative (defect not perceived)
19.
20. Significance of Visual field testing
• Find out the extent of VF
• To diagnose and detect diseases as well as
extent of damage caused in VF by the disease
• To locate possible lesion in neurological
disorder
• To find out the progression of diseases
22. Perimetry
• Systematic measurement of VF by the use of a
perimeter
• Modern Perimeter
– Consist of a bowl positioned at a fixed distance
from the eye,
• enable the controlled presentation of stimuli with in the
bowl
• Enables assessment of the visual function through out
the visual field
• Detection & quantification of damage to the visual
field
• Monitoring the change over a time
23. Perimetry types
Kinetic Static
• measures extent of visual field
by plotting isopters ( locus of
retinal points having same
sensitivity)
•Stimulus moves from non-
seeing to seeing area.
•Result depends upon the
experience of the operator.
• e.g, Goldman perimetry,
confrontation, Tangent screen,
Arc perimetry
• measures the sensitivity of
each retinal points.
•The stimulus is stationary but
increases in luminance.
• Mostly automatic, very little
role of the operator.
•e. g, Automated perimetry,
Goldman perimetry
24. Goldman Perimetry
• The most widely used instrument for manual
perimetry.
• Has a calibrated bowl projection instrument
– with a background intensity of 31.5 apostilbs (asb),
• Test Targets: dots
– Varying size and illumination
26. Goldmann Targets
• The stimuli (Dot) used to plot an isopter
denoted by
– Roman numeral, a number, and a letter.
• Roman Numerals = 0 to V (Size)
• Number = 1 to 5 (Luminance) use of Filter
• Alphabet = a to e ( ‘’) use of filter
V4e , I4e, IV3e
27. Goldmann Perimetry: Roman numeral
• Sizes of Stimuli [0...V scale]
• Each size increment equals
• a twofold increase in diameter and a fourfold
increase in area.
Diameter (mm) Area (mm2
)
0 0.28 1/16
I 0.56 ¼
II 1.13 1
III 2.26 4
IV 4.51 16
V 9.03 64
28. Target illumination
• Luminance settings
• Expressed in units called Apostilbs
(candela/m2
)
• 2 sets of filters – 5 each
– 10 steps
• Standard Vs Fine settings
• (1...5 and a...e scales)
• 1, 2, 3, 4 settings represent 0.5 log
unit changes = 5 db
• a, b, c, d and e settings represent 0.1
log unit changes = 1db
29. Target Range in Goldmann
• More than 100 combinations of size and intensity
of test targets are Possible
– but only a few isopter are needed to define the visual
field.
• Size “0” generally is omitted
– because results of the plots are inconsistent.
• The fine-intensity filter is usually set to the letter “e”
– which eliminates the small-increment light filters.
– Test target : Denoted by – Size + (Std. + fine)
Luminance
• Eg: V4e, I4e, II3e
30. Some interesting facts
• A change of one number of intensity
– is roughly equivalent to a change of one Roman
numeral of size i.e. III4e = IV3e
• Isopter plotted with Targets of equal Sum of
– Roman Numerals (size) & Number (Intensity)
• are considered equivalent.
– For example,
• the I4e isopter is roughly equivalent to the II3e isopter.
• I + 4 = 5, II + 3 = 5
35. Guideline to Plot
• First demonstrate the procedure
to patient
– by statically presenting large test
General rules for plotting
“Isopters”
– An isopter is mapped for the
particular stimulus size and
intensity
• move from NON-SEEING TO
SEEING while presenting stimulus
• move at a rate of 5 degrees per second
inside
• present kinetically every 15 degrees
interval
36. Guidelines for plotting
• Begin in the far periphery and kinetic plot isopter in
all meridians
–Use a V4e, I-3e , I-2e or target (depending
upon age
–Plot the Blindspot
• only 4 meridians are required( more if irregular or
Large)
– Use the I-4e for the blind spot
• within isopter of I-2e or I-3e
37. Guidelines
• Central static test with I-2e
– Explore for any scotomas
• Kinetic plot with I-3e stimulus only in suspected defect
area
• Static test between I-3e and I-2e isopters with the
I-3e stimulus (scotoma search)
38. Guidelines
• Special case plots
– Glaucoma suspects
– Plot more points along the nasal edge of the isopter
– Plot approximately
• every 3-5 degrees,
• 15 degrees above and below the horizontal raphe
Repeat for central, intermediate and peripheral plots
• Suspected neurological lesions
– Plot more points on either side of the vertical meridian
– Repeat for central, intermediate and peripheral plots
39. Recording
• All recording should be done on
the Goldmann recording paper
– Patient name,
– Date,
– Rx used,
– Pupil size,
– Eye tested and
– Patient cooperation / Fixation
– Indicate the target sizes used in
the bottom right hand block (color
marker)
40. Color coding of Isopters
• I-2e Blue
• I-3e Orange
• I-4e Red
• II-4e Green
• III-4e Purple
• IV-4e Brown
• V-4e Black
41. Expected findings for normal Isopters
• Patients under 50 years of age
i. Peripheral I-4e (size=same, brighter luminance)
ii. Intermediate I-3e
iii. Central I-2e (size=same, dimmer luminance)
42. Expected findings for normal
Isopters
• Patients 50 years or older
i. Peripheral II-4e (size=larger, brighter luminance)
ii. Intermediate I-4e
iii. Central I-2e or I-3e (size=smaller, dimmer luminance)
43. Interpretation
• The visual field is considered abnormal if:
– the threshold values are significantly brighter
(0.5 log units or more) than the expected values
AND / OR
– Scotomas or depressions are present
47. Automated Perimetry ( Static)
• Machine constructed along the basic lines of
a Goldman perimeter + sophisticated software
programs.
• Key reason for increased interest in automated
perimetry has been due to the standardization
automated perimetry allows.
48. Automated Perimetry
• Visual threshold is measured at a series of
fixed points in the visual field.
• The brightness of the test spot is varied, but
not its location.
• Threshold is usually plotted relative to normal
fields, to reveal defects
53. Threshold determination
• Age matched normal data are used to compare
patient’s data
• Normal range determined by
– Sensitivity of each retinal points 10,000
individuals
– Upper 95% as normal
– Lower 5% as abnormal
54. Testing strategies
• Octopus
– Normal
– Dynamic
– TOP ( Tendency oriented perimetry)
• Humphrey
– SITA (Swedish Interactive threshold algorithm)
– SITA fast
– Full threshold
56. Factors affecting Automated
Perimetry
• Background luminance
• Stimulus size
• Fixation control
• Refractive errors
• Cataracts and other media opacities
• Miosis
• Facial structure
• Fatigue
• Experience of a perimeter
57. Validity of the test
• False positive response
– > 20% unreliable
• False negative
– >20% unreliable
• Short term fluctuation
– 1-3 dB normal fluctuation
• Fixation loss
– >33% unreliable
58. Choosing an appropriate program
Examination procedure
Test program(G1, G2, 32, M2)
+
Test strategy (Normal, dynamic, top)
+
Perimetry method( W/W, flicker, B/Y, kinetic)
59. Programs
G1/G2
• Central 30 degree
• Glaucoma screening
• 59 points
• Locations more closely with topography of
retina (in areas of concern of glaucoma)
• 2.8 deg spacing
60. Programs
32 ( general examination)= 30-2 in Humphrey
• introduced with early automated perimetry
• 76 test locations
• Wide spacing (6 degrees) ( not appropriate for
glaucoma)
61. Programs
Macula program(M2)
• Central and paracentral visual defects in
neurological and macular problems
• Central 10 deg
• 56 test locations
• spacing 2 degrees
• 0.7deg spacing in the macula
62. Programs
LVC (central low vision)
• To test how much sensitivity is remained in
the central foveal area.
• 77 locations
• 30 degrees
• End stage glaucoma
63. Strategies
• Normal strategy
– Standard
– 4-2-1 bracketing procedure
– 10-15 min
– Early and shallow defects
– Younger patients ( good condition in answering
the question till the end of a long program)
64. Strategies
• Dynamic strategy
– One threshold crossing
– Small steps in regions with Normal sensitivity and
large towards depressed field
– Test duration reduced by two
– Especially when focal defects are expected
65. Strategies
• TOP ( tendency oriented perimetry)
– Light sensitivity of the retinal is interrelated rather
than having an individual value
– 2 minutes
– For patients with depressed fields, for children,
elderly ones who are not capable of finishing a
longer examination
76. Glaucoma Hemifield test
• 5 sectors in the upper field are compared to
five mirror images in the lower
• If value in two sectors differ to an extent that
found in
– <0.5% of the normal population ( highly sensitive)
– <1% of normal population (outside normal limit)
– <3% of the normal population (Boderline)
– <5% of the normal population ( can be a normal
plot)
77.
78. Global indices
Octopus
• Mean sensitivity (MS)
• Mean deviation (MD) (–
2dB to +2dB)
• Loss variance (LV) (0-
6dB)
• CLV(0-4dB)
• SF (1.5dB- 2.5dB)
• RF < 15%
Humphrey
• GHT
• Mean deviation
• PSD
• CPSD
• SF
82. Recent advances in automated
perimetry
• Goldman kinetic module
• High-pass resolution perimetry - Uses thin rings instead of
spots
• Short wavelength sensitive perimetry - Blue on Yellow for S
cones
• Flicker Perimetry - Flickering targets instead of static flashes
• Aulhorn's Snow field campimetry - Uses TV “snow” and
pointing
• Motion perimetry - Detect moving targets instead of flashed
ones
• Rarebit perimetry- uses very small, bright spots
• Pupil Perimetry - measures pupil responses instead of subject
reports
• Multifocal VEP - measures cortical evoked potentials instead of
subject reports
83. Summary
• Principle of kinetic and automated perimetry
• Appropriate selection of visual field testing for
a particular patient
• Accurate interpretation of VF reports