Perimetry you can trust. Haag-Streit The technology leader in perimetry. Your reliable partner....

Perimetry you can trust.

Haag-StreitThe technology leader in perimetry.

Your reliable partner.

Octopus & Goldmann Kinetic

Perimetry Perimetry

Matthias MonhartProduct Manager

20092009


Matthias J. MonhartEngineer FH (BSc)

in Electronics, Measurement and Control Product Specialist in Perimetry

HAAG-STREIT AG

The instructor has a financial interest in the subject

Octopus & Goldmann

Kinetic Perimetry


• Kinetic Perimetry Principle

Examination

Results

Agenda


Onset End stage

Functional Test:B/Y-SWAP, FDT, Flicker

Structural Test:Stereo Fundus-PhotographyImaging (HRT, OCT, GDX)

Standard W/W PerimetryLow Vision

StrategyKinetic perimetry

HFA 10-2

Methods

Progression of the disease

Role of Perimetry

Application fields


Sensitivity distribution in the eye:

Sensitivity drops steeply towards the periphery

In the macula, there is a sensitivity peak.

Hill-of-vision

Anatomy of the eye


Static perimetry is ideal for measuring the rather flat shape of the central 30° field and is more sensitive than the kinetic method to detect early visual field loss.

StaticStimulus

KineticVector

90° 30° 0° 30° 90°

Sen

sitiv

ity

Kinetic perimetry is ideal for the periphery and deep local defects.

Static or Kinetic Perimetry

Application fields

Cross section through the hill-of-vision


Multiple responses connect to one isopterline(Line of equivalent sensitivity)

Isopters

Kinetic Perimetry


OSOS ODOD

Stimulus size III and the maximum Intensity (4e) in an average normal subject yield these eccentricities.

Theoretic eccentricity

Kinetic Perimetry


Practical eccentricity

Kinetic Perimetry


Prof. Hans Goldmann invented the

Haag-Streit Goldmann Perimeter and

set the standard for kinetic perimetry

since 1945.

Instruments: Goldmann

Kinetic Perimetry


“Drawing” the test

Goldmann Perimetry


“Drawing” in Windows

Octopus 101 GKP


“Drawing” in Windows

Octopus 900 Goldmann


1. Prepare the form

Goldmann Examination


Stimulus size 0..V, @ Octopus I..V

Stimulus-Intensity 4,3,2,1 in 5dB stepsStimulus-Intensity a,b,c,d,e in 1dB steps

Maximum 4e = 0dB = 1000asb

Minimum 1a = 19dB = 13asb

2. Stimulus intensity



Blind spot location:

X = +15° for OD, -15° for OSY = -1° for OS and OD

Recommendations

I Blind spot, scotoma

III Periphery

V End stage / remaining vision

Comparison of stimulus size III with the sensitivity map of the blind spot(approx. 5° Horizontal, 6° Vertical)

3. Stimulus size



Identification of Patients: Identification of Patients:

Examination date:Examination date:

Pupil diameterPupil diameter

Small pupils influence the isopter sizeSmall pupils influence the isopter size

OS: left eyeOS: left eyeOD: right eyeOD: right eye

Use near correction for Use near correction for isopters and testing within 30°isopters and testing within 30°

4. Patient information



„Drawing“ of the examination on the Goldmann form

5. “Drawing” the exam



Only coarse calibration of stimulus and background intensities

Quality influenced by experience

Limited Repeatability

Different standards in every clinic

Limitations

Goldmann Perimetry


The pantograph is replaced by the mouseThe pantograph is replaced by the mouse

assisted kinetic perimetry

From manual to computer


The template „travels“ to the screen The template „travels“ to the screen

Octopus shows age matched norms for orientationOctopus shows age matched norms for orientation




Near correction for points (isopters) < 30°Near correction for points (isopters) < 30°same principle as in static perimetry same principle as in static perimetry

Goldmann und Goldmann und Octopus 900 Octopus 900 (30cm)(30cm)

30-40J30-40J +1.0+1.040-45J40-45J +1.5+1.545-50J45-50J +2.0+2.050-55J50-55J +2.5+2.555-60J55-60J +3.0+3.0>60J>60J +3.25+3.25

Octopus 101 GKP Octopus 101 GKP (42.5cm)(42.5cm)

40-44J40-44J +1.0+1.045-49J45-49J +1.25+1.2550-54J50-54J +1.75+1.75>55>55 +2.0+2.0




Stimulus size and -intensityStimulus size and -intensity

GoldmannGoldmann Octopus 101Octopus 101 Octopus 900Octopus 900




Constant velocities result in better reproducible test results

Recommendation <30°: 2°/Sec. >30°: 5°/Sec.

Preset of constant velocitiesPreset of constant velocities




Automatic and accurate calibration

Good quality exams based on constant velocities / stimulus movements

Automatic repetition of examination allows for follow up

General standards can more easily be applied and exchanged

Advantages

Octopus Goldmann Kinetic


Test vectors for general examination

Guided vectors for special conditions, like the nasal step, where still a

constant velocity shall be maintained

Vectors define the path a stimulus movesVectors define the path a stimulus movesVector types



The RT (Reaction Time) vector must be visible right from the

start. The delay in response to an RT vector can be

compensated in regular responses.

stimulus visiblestimulus visible

response button pushedresponse button pushed

corrected responsecorrected response

Reaction time compensation



Only in Octopus 101:Only in Octopus 101:A perpendicular line A perpendicular line at the beginning of at the beginning of the vector indicates the vector indicates an early response. an early response. This means, it might This means, it might have been seen from have been seen from the start – or – the the start – or – the patient did produce a patient did produce a false positive false positive response.response.

Only in Octopus 101:Only in Octopus 101:A perpendicular line A perpendicular line at the beginning of at the beginning of the vector indicates the vector indicates an early response. an early response. This means, it might This means, it might have been seen from have been seen from the start – or – the the start – or – the patient did produce a patient did produce a false positive false positive response.response.

Possible early responses



Fluctuation:Fluctuation:Response fluctuation Response fluctuation exists in kinetic exists in kinetic perimetry just the perimetry just the same as in static same as in static perimetry. Repeating perimetry. Repeating vectors lead to vectors lead to responses that vary to responses that vary to a certain extent.a certain extent.

Fluctuation:Fluctuation:Response fluctuation Response fluctuation exists in kinetic exists in kinetic perimetry just the perimetry just the same as in static same as in static perimetry. Repeating perimetry. Repeating vectors lead to vectors lead to responses that vary to responses that vary to a certain extent.a certain extent.

Fluctuation



Search for scotoma with static points Search for scotoma with static points Stimulus I4e, 0°/Sec. (static), Example blind spot Stimulus I4e, 0°/Sec. (static), Example blind spot

1. search horizontal extent 1. search horizontal extent 2. search vertical extent 2. search vertical extent

Examination procedure



Define the size and shape with kinetic vectors Define the size and shape with kinetic vectors Stimulus I4e, 2°/Sec., example blind spotStimulus I4e, 2°/Sec., example blind spot

Draw vectors from inside of a scotoma to outside Draw vectors from inside of a scotoma to outside Vectors are placed starting in non-seeing area and ending in seeing area, ideally Vectors are placed starting in non-seeing area and ending in seeing area, ideally perpendicular to the border of the scotoma or visual field border perpendicular to the border of the scotoma or visual field border




Reaction time testing and compensation Reaction time testing and compensation Stimulus I4e, 2°/Sec., example around the blind spot:Stimulus I4e, 2°/Sec., example around the blind spot:

RT-Vectors have to be visible all the time, they thus must start RT-Vectors have to be visible all the time, they thus must start in areas of preserved vision.in areas of preserved vision.Responses on the right side include reaction time compensation.Responses on the right side include reaction time compensation.




The operation of the Goldmann pantograph can The operation of the Goldmann pantograph can be reproduced by moving the mouse. be reproduced by moving the mouse. Stimulus I4e, „free“, example of manual spiraling at the blind spot:Stimulus I4e, „free“, example of manual spiraling at the blind spot:

Drawing spirals is one method of searching remaining visionDrawing spirals is one method of searching remaining vision

0-1°/sec black

2-3°/sec blue

4-7°/sec green

≥ 8°/sec red

Manual operation



Setting anchor vectors to judge the quadrantsSetting anchor vectors to judge the quadrants

Vectors towards the center (Meridians) on 45,135,225Vectors towards the center (Meridians) on 45,135,225and 315° from outside to inside the normal range.and 315° from outside to inside the normal range.

Stimulus III4e (oder III3e), 5°/Sec., example quadrantanopiaStimulus III4e (oder III3e), 5°/Sec., example quadrantanopia




Outlining a quadrantanopia Outlining a quadrantanopia

Best accuracy is given when vectors cross the Best accuracy is given when vectors cross the scotoma borders perpendicularly scotoma borders perpendicularly




The nasal stepThe nasal step

Especially in glaucoma, a sensitivity difference slightly Especially in glaucoma, a sensitivity difference slightly above and below the nasal midline appears:above and below the nasal midline appears:The guided vectors can be used in this situation.The guided vectors can be used in this situation.




Suggested procedure:Suggested procedure:

1)1) Blind spot with I4e, 2°/Sec.Blind spot with I4e, 2°/Sec.2)2) Test reaction timeTest reaction time3)3) Outer periphery with III4e Outer periphery with III4e

(sometimes III3e) 5°/Sec.(sometimes III3e) 5°/Sec.4)4) Additional isopters, eg. Additional isopters, eg.

I3e, 5°/Sec.I3e, 5°/Sec.5)5) I2e, 3 oder 5°/Sek.I2e, 3 oder 5°/Sek.

Please refer to the Octopus 101 Please refer to the Octopus 101 GKP manual or Octopus 900 SOPGKP manual or Octopus 900 SOP(Standard Operating Procedure)(Standard Operating Procedure)

Conclusion Conclusion




Application example - 1



Blind spot size in 2 eyes, red isopter: not corrected




Without compensation With RT compensation: 2300ms (!)

55 yrs, female, OD




Testing the real visual field Testing the real visual field

Receiving reaction time as Receiving reaction time as additional information additional information

Better reproducibilityBetter reproducibility

Advantages



Automating testsUse an existing test or draw a generic oneUse an existing test or draw a generic one

When drawing a generic test, click „Pause“ firstWhen drawing a generic test, click „Pause“ first



Automating testsSaving an existing test as standard testSaving an existing test as standard test



Automating testsSelecting a test from the librarySelecting a test from the library



Automating testsRunning the test automaticallyRunning the test automatically



Standardization of tests within Standardization of tests within the clinic the clinic

Combination of intial standard testCombination of intial standard test and when needed individual and when needed individual continutation of the test continutation of the test

Simple to administer and delegateSimple to administer and delegate

Advantages

Automated testing


Follow up button

Automated testing


The previous test performed onThe previous test performed on a patient is automatically repeated, a patient is automatically repeated, no matter whether it was based on no matter whether it was based on a standard test or was individual a standard test or was individual Allows for progression analysis Allows for progression analysis Improves reliability Improves reliability

Simple to performSimple to perform

Follow up button

Automated testing


DescriptionGoldmann like templateAge matched normsReaction time

compensation Individual test libraryFollow up button Implementation of

„Complete examination“ and „Randomized sequence“ functions

Kinetic examination produces EMR response file

Features



DescriptionTurn on/off vectorsZoom function „What you see is what

you get“ print function

Display and printout



Ausdrucksfunktionen

Kinetic printout


Advanced visual field defects of any kind

Patients that require an interactive examination and cannot perform a purely automated test (when used in semi-automated or manual testing mode)

Neuro-Ophthalmic conditions

Peripheral visual field quantification and follow up for studying the medical safety of drugs

Application

Kinetic Perimetry


Static & kinetic perimetry

Application


Static & kinetic perimetry

Application

Example for the

remainin local

drop of sensitivity

years after a

Berlin edema


Glaucoma

OS

Aulhorn III, S.M., f, 1944


Glaucoma

OS

Aulhorn IV, S.L., f, 1933


Hemianopsia


Double Vision

Diplopia

Octopus & Goldmann kinetic perimetry can be used with different response criteria

In this case, the patient shall respond whenever seeing two targets instead of one


Training software downloadable free of charge on www.haag-streit.com

10 cases, partly with patient history

Full functionality

Learn, teach, repeat

Kinetic Training


Haag-StreitThe technology leader in perimetry.

Your reliable partner.

Octopus & Goldmann Kinetic

Perimetry

Matthias Monhart

Thank youThank you

Perimetry you can trust. Haag-Streit The technology leader in perimetry. Your reliable partner....

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