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METROVISION - Visual field user manual

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1. sssssssssssssssssssssssssssssssssssssssssssssssas 19 SOT PERAI A E usa 21 FO E oes A ET Y u uu xu sus 22 RNC ns umu G uu u 23 BLUE YELLOW PERIMETRY RON u D u ana a a da 24 MOTION PERIMETRY ccccccccscscececcccacscececeacecscecsaencecececeaeacsceceaeacncececeaeacecececsaeacscecsaeaeececeeeaeacsceseeeatacecseeaeacsceseeeaeaees 25 KINETICAND MIXED u nu du 26 REALIZATION OF AN EXAM a a u u u an ini u 27 PATIENT u s 28 REALIZATION OF STATIC PERIMETRY 6 30 QUALITY CONTROL DURING THE EXAMINATION 31 REALIZATION OF KINETIC PERIMETRY EXAMS Duae Cay uae Y ava P 32 EXPLOITATION OF RESULTS qA aout dance cha conne bee lee 33 io EE E AE E E E AEE A E E E EE 818 ARIES 1j 2 iu mk Saree xs DISPLAYOPTIONS Q uuu u u u u uu
2. 50 EARLY GI COI AA SE D seais KON HE 52 ESTABUSHED GLAUCOMA STAGE de u i asa 54 ESTABLISHED GLAUCOMA STADE awana qk ed 56 ADVANCED GLAUCOMA STADE 4 scaviaccnnanannsiactwiscurcatinndescnienennsthnaaadandasaasaauinasiatieinasnmaibansas E 58 ADVANCED GLAUCOMA EVOLUTION FOLLOW DP U SNE Eaa 60 ADVANCED GLAUCOMA STADE S Lu LL l ul u u E ua aqu Qusa asiya E SS 62 PU GIVI OS uuu EEE 64 ATROPHIC MACULAR DEGENERATION uuu uu u l l aaa uu Saw 66 HYDROXYCHLOROQUINE INTOXICATION sseccccsecccesccccensceceeececausececeuecessunececeuseceseecessueceseuseceseuecesseneceseusecessuecessenecetseeeetees 68 MEIOSIS MEN a 70 TOXOPLASMOSIS SCAR ull 72 74 sI E 76 TI IN 78 LEBER OPTIC NEUROPATHY AT AN EARLY sse 80 COMPRESSIVE OP
3. EEE E NS LZ uuu a Rd li et ii tu SES ER RE NET CON EE E E A TN ANALYSIS NEUROLOGICAL VISUAL FIELDS a a ad cuia 41 3 94 Copyright 2014 Metrovision Visual field PINAL YSIS OF THE INCAPACITY ND 5 i UM UON ERU tensa URN TIPO 42 iio TRS Ege u uuu 42 SUPERIMPOSITION WITH THE EYE FUNDUS cceccescseceeccecceecsceneeeeeeeeeeeseeseeseeeeeeeeeeeeeeseeseeseeseeeeeeeeesseesesaeseeceeceeeseeeesaesaeceeeeeees 43 SVS CIONES 44 PATENT INFORMA NON 45 45 PRUNING DI fe T tT 45 TECHNICAL u ERE M 47 MONCY uR da e we uu ee aa 48 NIONGV SAND MONPACKSPEQIHICATIONS sessio spo TUER b TS u aas0squssuqasashaqaqasqaskuqasqastanaqasakqanaqhaqakaqqshiqaassqusqahasissqhasaakakayaspsstaqa 48 EQUIVALENCES OF GLOBAL INDICES SS ones eau aa ne a EU ee aie aan ini nn 48 CLINICAL EX AMPLES 7 49 NORMALCY CAE u uu uu seen vere esp
4. Corrected Mean Deficit 2 Deficit Variance Spatial Fluctuation 2 6dB Temporal Fluctuation 2 4dB Mean Time Response 603 ms Fixation Losses 0 17 Attention Losses 2 19 Duration of Exam 7mn 125 E p gt 5 Correction of Reference Map 14 2 m p lt 5 Pupil diameter uu m p lt 2 Stimulus Probabilities lt 1 Probabilities 1 sumof global and local deficits of deficits g p lt 0 5 of corrected deficits 2 local deficits only 70 94 Copyright 2014 Metrovision Clinical examples 58 years old emmetropic patient Right eye examined with the MIX24 procedure and a 3D optical correction Good quality exam There is no fixation loss and only 2 attention losses over a total of 19 controls Analysis of the visual field alterations No diffuse deficit The alteration of the visual field is in correspondence with the bleedings visible on the eye fundus The foveolar threshold is altered 20 dB sensitivity because of the presence of a macular oedema der METR VISION 71 94 Copyright 2014 Metrovision Visual field Toxoplasmosis scar Reference toxo001 patient s ID toxo001 DOC E dI file number exam date 21 02 2006 11 46 birth date 22 06 1947 exam FAST24 comments VISUAL FIELD EXAM 2D sensitivity map 3D sensitivity map SENSITIVITY M ODE 0 8 2 5 20 24 28 32dB Deficit dB Deficit V
5. ooo ooo 0 8 2 5 20 24 28 32dB Deficit dB Deficit Volume 335dB deg2 Values Values of deficits Tested Points 36 Mean Deficit 1 Corrected Mean Deficit 2 ERE Es Ry A Deficit Variance Ry A Spatial Fluctuation 1 7dB B Temporal Fluctuation 1 5dB Mean Time Response 512 ms m Fixation Losses 0 22 Attention Losses 0 22 Duration of Exam 12mn 32s E p gt 5 Correction of Reference Map 2dB p lt Pupil diameter lt 2 Stimulus Probabilities lt 1 Probabilities 1 sum of global and local deficits of deficits g p lt 0 596 of corrected deficits 2 local deficits only 74 94 Copyright 2014 Metrovision 54 years old emmetropic patient Right eye examined with the FAST24 procedure and a 3D optical correction Good reliability of the exam No attention or fixation losses The foveolar threshold is within the normal limits Analysis of the visual field deficits Absence of diffuse deficit Important relative deficit of the temporal hemifield The fact that it is relative is in favor of an alteration which is not of a neurological origin 75 94 Copyright 2014 Metrovision OVISION Visual field Reference myopia001 patient s ID myopia001 RE file number N192818 birth date 28 03 1956 VISUAL FIELD EXAM 2D sensitivity map S 75 30 BENBITMITY M a 4 B 20 24 28 3248
6. EDITION PROCEDURES Mon2008H chainage 5 effacement proc dure c TEST STRATEGY Strategy FAST z Deficit detection dB 4 El Reference map REFTVHR VISUALIZATION Visualization option Triangulation distance 4 Mos 2 00 42 0 0 0 0 EXPORT IMPORT VALIDATION Copyright 2014 Metrovision 9 10 11 91 94 Now you have to select the page of the menu where you will save the new procedure Click on the corresponding button The program lists the tests available in that page and opens a small window to allow you to enter the name of the test If you want to create a new test enter a new name limited to 8 characters capital letters without character After entering the name click on the OK button After saving the new procedure the program returns to the editing menu From there you can repeat the procedure to create modify another procedure or you can go back to the examination menu by clicking on EXAM MENU Copyright 2014 Metrovision Edition de proc dures EXAMEN DU CHAMP VISUEL EDITION PROCEDURES lecture proc dure A chainage B effacement proc dure B 7 METROVISION 92 94 Copyright 2014 Metrovision BibliographY BIBLIOGRAPHY e BEKT Accurate superimposition of visual field data onto fundus photogra
7. Values of deficits Values of corrected deficits B p gt 5 m p 5 Q _ lt 2 Probabilities 1 Probabilities of deficits m p lt 0 5 of corrected deficits 76 94 Copyright 2014 Metrovision Rx 12D exam date 23 06 2006 12 00 exam MIXTE24 comments 3D sensitivity map Deficit Volume 271dB deg2 Tested Points 9 Mean Deficit 1 Corrected Mean Deficit 2 Deficit Variance Spatial Fluctuation 2 5dB Temporal Fluctuation 0 9dB Mean Time Response 514 ms Fixation Losses Attention Losses Duration of Exam Correction of Reference Map Pupil diameter Stimulus 1 sumof global and local deficits 2 local deficits only Clinical examples 50 years old patient high myopia 14D Right eye examined with the procedure MIX24 and a 12D optical correction Excellent quality of exam No fixation loss and only one attention lost for 20 controls Analysis of the visual field deficits Absence of diffuse deficit The atrophy visible on the inferior eye fundus corresponds to a relative scotoma on the upper visual field There is no sign of glaucoma because the visual field deficit does exactly superimpose over the eye fundus alteration der N METROVISION 77 94 Copyright 2014 Metrovision Visual field Papillary oedema Reference papillaryoed001 patient s ID papillaryoed001
8. Example visual field in a pituqry Congruent deficits have the same localization for both eyes which is likely to indicate of post chiasmatic lesion The analysis covers the results of both eyes if they exist For this the program automatically searches on the data base the result of the exam performed on the other eye with the same patient s name and date of birth The analysis is performed separately for results obtained with static or kinetic perimetry visuel 41 94 Copyright 2014 Metrovision B For results of static exams The average deficit is determined for each quadrant and hemi field Congruence is computed as the geometric mean of congruent deficits of both eyes For example SQUARE ROOT Dsgre Dsgie with e Cs congruence of the upper left quadrant e Din average deficit of the upper left quadrant of right eye The value of congruence varies between 0 no correspondence between the visual fields of both eyes to 10096 perfect correspondence average deficit of the upper left quadrant of left eye Results are summarized in the following table with 3 columns that correspond to the left eye right eye and congruence and 3 lines that correspond to the quadrant analysis right left hemi field analysis and upper lower hemi field analysis Left Right Congruence Upper Nasal Upper Nasal Upper Tempora Upper left Upper right 05 19 5 0 0 Lowe Temporal
9. Selection criteria Results of demo cine Patient s Name 11 02 1998 File s number L Exam Procedure Kinetic 7 demo cv suivi2 L Stimulated eye HS 0703 1995 Date ofbith p fag Date of exam F z VS Correction o demo cv suivi2 L Observations 07 09 1905 Action modes CMD 2 048 DISPLAYRESULTS L 2307 1997 Selection modes Jone AT A TIME 1 848 Fast 24 fast thresholds i EXECUTE EXECUTE WITH SORT To display an exam result simply indicate the name of the patient in the Selection criteria and then click on button Pee to get the results in alphabetical order or __EXECUTETHSORT_ in chronological order Then the program displays the list of results corresponding to the selection criteria This list appears like a book whose pages can be turned by clicking on buttons and lt To visualize one result of this list just click on its icon The bar located below the visual field result provides information allowing a rapid assessment of the quality of the exam Items that are displayed in GREEN color indicate satisfying quality those in RED color indicate an inadequate quality r 3 EXAMEN DU CHAMP VISUEL oo 28 3296 0 4 8 12 16 20 24 OPTIONS V ENREGISTR IMPRESSION ANALYSE VISUALISATION QUALITY CONTROL T
10. E Bi m Mean Deficit 1 0 088 g Corrected Mean Deficit 2 0 098 Eg m Hg m Defra variance Ei m Spatial Fluctuation 0 5dB E E T gu E E T m Temporal Fluctuation C m E Mean Time Response 532 z E E m E Fixation Losses 02 m m Attention Losses g T m T x Duration of Exam 5mn 08 m B p gt 5 H m E Hag E p E Hag 8 Correction of Reference Map 08 1 5 Pupil diameter BD 2 Stimulus M Probabilities Probabilities MEME of deficits m P lt 0 5 of corrected deficits 2 local deficits only 50 94 Copyright 2014 Metrovision 43 years old emmetropic patient Left eye examined with FAST30 procedure and a 1 25 optical correction The quality of the exam is excellent no attention and fixation losses These indicators are all green The fovea has a normal threshold and the blind spot is well localized No diffuse alteration the average deficit and the corrected average deficit are identical Absence of localized deficit it is highlighted by the topography and the corrected average deficit which is nil OVISION 51 94 Copyright 2014 Metrovision Visual field Early glaucoma stage 1 Reference glaucoma003 patient s ID glaucoma003 RE Rx non file number N219041 exam date 28 06 2007 14 11 birth date 05 05 1957 exam FAST24 comments VISUAL FI
11. Measured value dB of sensitivity same as age matched norm SET YALUE EE VALIDATE C If the new measurement is in agreement with the YALIDATE previous one click on C SN to start the examination If several trials have not been successful in achieving a reproducible result or if the visual field presents a SET VALUE ial central defect click on to enter 0 from the keyboard it corresponds to the patient s age Thereafter click on W s to start the examination It can be useful to impose a higher value than the one found by the program when dealing with a tired or poorly cooperating patient The quality bar located below the visual field result provides information allowing a rapid assessment of the quality of the on going exam Items are displayed in green when the results quality is satisfactory and red when a problem occurs 8051037103 number of tests that have been validated with respect to the total number of tests that have been programmed 31 94 Copyright 2014 Metrovision 1 19 Fixation quality is indicated by the number of fixations errors 1 in this example relative to the total number of controls 19 in this example Attention quality is regularly tested with false tests that are not seen by the patient Responses to these tests are counted as attention losses 2 in this example relative to the number of controls 22 in this example
12. file number 02092429 birth date 06 04 1989 VISUAL FIELD EXAM 2D sensitivity map 20 0 0 20 SENSITIVITY MODE _ 0 4 8 2 6 20 24 28 32dB i E T E 4 Values Values of deficits of corrected deficits m E 1 5 E lt 5 m p lt 2 E Probabilities lt 1 Probabilities of deficits g p lt 0 596 of corrected deficits 78 94 Copyright 2014 Metrovision LI ERES Ww Am EN lt ZZ HE ZL SS a Rx SC exam date 24 09 2002 11 58 exam CVT 6 comments 3D sensitivity map gt SS cy Deficit dB Deficit Volume 307dB deg2 50 75 100 Tested Points Mean Deficit 1 KALII REA Corrected Mean Deficit 2 dns Ey A Deficit Variance es Ry A Spatial Fluctuation 2 6dB Temporal Fluctuation 1 5dB Mean Time Response 543 ms Fixation Losses 2 14 Attention Losses 2 17 Duration of Exam 12mn 25s Correction of Reference Map 0 Pupil diameter Stimulus 1 sum of global and local deficits 2 local deficits only Clinical examples 13 years old emmetropic patient Right eye examined with the FAST24 procedure and without optical correction Good quality exam Low number of attention and fixation losses Analysis of the visual field deficits No diffuse deficit Local deficit approaching at 2 degrees from t
13. 2014 Metrovision Clinical examples 77 years old emmetropic patient Left eye examined with the FAST24 procedure and a 3D optical correction Good quality exam Low number of fixation and attention losses Normal foveolar threshold Analysis of deficits No diffuse alteration Absolute annular deficit in the lower visual field area and relative in the upper area linked to the blind spot Nasal step The deficit approaches less than 5 degrees from the fixation point TROVISIO ME jj T TNI 59 94 Copyright 2014 Metrovision Visual field Advanced glaucoma evolution follow up patient s ID glaucoma007 LE Rx 3D file number N23846 exam date 24 07 2008 13 55 birth date 13 09 1930 exam FAST24 comments VISUAL FIELD EXAM LAST EXAM EVOLUTION VELOCITY over the last 3 exams SENSITIVITY MOLDE 4 a E 20 24 76 32dB 42 a 02 16 16 3 IMPROVEMENT 5 3 AE 68 0 DETERIORATION from 30 03 2000 to 24 0 7 2008 EVOLUTION OF GLOBAL INDEXES U gui OR a ak aga ac J nmn 1 4 60 94 Copyright 2014 Metrovision Clinical examples 69 years old patient followed for 24 years for glaucoma The follow up of the visual field evoluti
14. 4 8dB 3 9dB 5 5dB 3 1dB Lower Hemifield Lower hemifield 84 94 Copyright O 2014 Metrovision Clinical examples 34 years old emmetropic patient Exam realized with the FAST24 procedure without optical correction The neurological analysis allows the direct comparison of the visual fields of both eyes It reveals the bi temporal deficit T ROVISIO 85 94 Copyright 2014 Metrovision Visual field Keratoconus and glaucoma Reference kera001 patient s ID kerato001 file number 254600 birth date 07 06 1955 2D sensitivity map 0 8 2 5 20 24 28 Values of deficits m E E m Bi m 2 u ua m m E E y p gt 5 p lt 5 m m p lt 2 Probabilities m E lt 1 of deficits gg p lt 0 5 86 94 VISUAL FIELD EXAM 20 SENSITIVITY MODE 32 dB Values of corrected deficits m HB m m m a B im m a T Bi m E B B m B Hi m m Probabilities of corrected deficits Copyright 2014 Metrovision Rx oul exam date 05 04 2011 12 56 exam Motion 24 movement comments XZ keratocone glauco 3D sensitivity map ep Deficit dB Deficit Volume 1114dB deg2 25 50 75 100 Tested Points 96 Mean Deficit 1 KEMI Corrected Mean Deficit 2 KEWLI Deficit Variance 74 Ry A Spatial Fluctuation 4 7dB Temporal Fluctuation Mean Time Response 626 ms Fixation Losses 3
15. Cases when the patient responds abnormally fast after the presentation of the stimulus are also counted as losses of attention METROVISION Visual field This item indicates the type of equipment used to perform the examination In the present example the stimulator was a cupola c with Realization of kinetic perimetry exams test sizes equivalent to Goldmann lll The color of the display indicates whether the stimulator was calibrated properly GREEN color or not RED color B Peripheral isopter Frequently the first responses of the patient are not satisfactory because he or she has not properly understood the examination s principle In that case you may after a few tests restart the isopter by clicking on button HETEST at the same level If tests are not perceived because their luminance is too low you may restart the isopter with a higher luminance i e a lower sensitivity level by clicking on uetus RETEST at 1 dB ft Control measurements manual mode The entire evaluation of the isopter is normally performed automatically by the program However in some circumstances the user may want to perform additional controls about the validity of responses For that purpose click on button CONTROL x during the examination of the isopter The program indicates that this command has been memorized by displaying a mark on the same
16. displays an histogram with the average deficit for each CORRECTED MEAN DEFICIT dB of the selected zones as well as the gray density map where the selected zones can be identified from the color of the tested points The result can be printed by clicking on PRINT then print analysis of zones Patient s information This command gives access to the patient s information It can be useful for adding comments before recording Nom serastien SS or printing the result N dedosser Date naissance 12 02 1995 Date examen EN Oeil Stimul on ES Correction Observations exemple Storing the results Click on button Y SAVE ocoietheresults appears on top of the screen The crossed sign on the button indicates that the result has been stored on the hard disk The reference number of the record Printing the results The print command allows to print the visual field result PRINT analysis rint visual Field and the different analysis 2 print global analysis P print Follow up analysis print neurologic analysis i print analysis of incapacity index You can also print the results and the different analysis print Goldmann analysis print vision simulation print analysis of eye Fundus print analysis of zones directly from the results menu 45 94 Copyright O 2014 Metrovision 46 94 Copyright 2014 Metrovision Technical specifications TECH
17. 1 sum of global and local deficits of deficits p lt 0 5 of corrected deficits 2 local deficits only 82 94 Copyright 2014 Metrovision 44 years old emmetropic patient Complains for the last few months about a partial loss of words with his right eye when reading His visual acuity is 20 20 OD and OS Right eye examined with the MIX24 procedure Good quality exam No fixation or attention losses Analysis of the visual field deficits Diffuse alteration of 4 dB centro cecal scotoma inferior fascicular deficit On the eye fundus global papillary palor in the lower part Source ZANLONGHI X Electrophysiologie visuelle examens fonctionnels et neuropathie optique g n tique R flexions ophtalmologiques 2010 15 132 20 27 METRC VISION 83 94 Copyright 2014 Metrovision Visual field Pituitary adenoma Reference piturayad001 patient s ID pituaryad001 Rx file number exam date 28 01 1988 23 19 birth date 14 11 1954 exam FAST30 comments JCH VISUAL FIELD EXAM LE VISUAL FIELD RE VISUAL FIELD 20 0 0 LU 20 20 0 0 0 20 SENSITIVITY MODE SENSITIVITY MODE 0 4 8 2 6 20 24 28 32dB 0 8 2 6 20 24 28 32dB AVERAGE DEFICITS dB Left Right Congruence Upper Temporal Upper Nasal Upper Temporal Lower Temporal Lower Nasal Lower Temporal Temporal Nasal Temporal 11 4dB OdB T 4dB Upper Hemifield Upper Hemfield
18. 15 Attention Losses 1 16 Duration of Exam 7mn 42s Correction of Reference 0dB Pupil diameter Stimulus Motion 1 sum of global and local deficits 2 local deficits only Clinical examples 55 years old patient Examination of the left eyerealized with the MOTION 24 procedure motion perimetry The exam could not be realized with classical contrast perimetry due to the presence of a keratoconus Average quality exam 3 fixation losses for a total of 15 controls Analysis of visual field deficits Severe absolute arcuate scotoma connecting with the blind spot and approaching at 2 degrees from the fixation point T TROVISIO ME y T TNI 87 94 Copyright 2014 Metrovision 88 94 Copyright 2014 Metrovision Edition proc dures EDITION DE PROCEDURES This program allows permanent modifications of the examination tests N WARNING The use of the editing program requires advance training The use of this program without appropriate training is not recommended as it may produce alterations of examination procedures and erroneous results der METR VISION 89 94 Copyright 2014 Metrovision Visual field 90 94 in the main menu click on yellow icon for access to preferences a small window opens with the message Enter password for procedures enter the password and click on the button this will validate the access to proc
19. 30 tests 44 points between 30 and 60 degrees of 4 2 eccentricity NOTE this test must realized PEAR without optical correction to avoid masking the peripheral fied with spectacle frames METROVISION 23 94 Copyright 2014 Metrovision Visual field BLUE YELLOW PERIMETRY available only on models MonCv3 MonPack PRO version BY 30 Blue over yellow EVE dI evaluation of deficits of central perimetry over the c tb PIN field central field Fast 24 over yellow FEN gt i AU detection and follow up of perimetry over the t ET A glaucoma in young patients central field o OMNES Fast 12 evaluation of maculopathies with a visual acuity better than 0 2 Blue over yellow perimetry over the macular area Fast strategy BY fovea Measure of the foveolar 2 threshold can be P evaluation of deficits in young realized as a patients with glaucoma complement of LEA 2 previous tests Staircase strategy 24 94 Copyright 2014 Metrovision Which exams to choose MOTION PERIMETRY only available on models MonCV3 and MonPack PRO version Motion 30 Motion perimetry E T 7 n fast detection of visual field covering the central ss alterations field with 92points NS ah PS Fast st
20. 4 dB for the central field e Staircase strategies The staircase strategy consists in a first phase of rapid search with a 4 dB step by step progression starting from not seen to seen 1 2 3 When a response is obtained the progression is reversed and the step size decreased to 2 dB until no response is obtained 4 5 For strategy 4 2 the threshold value is estimated as the average of the test lt METROVISION Visual field luminance when a change of progression is made this example points 3 and 5 With strategy 4 2 2 testing is continued until 3 changes of progression are made and with strategy 4 2 2 2 4 changes of progression This last strategy is used to determine the value of temporal fluctuations from the spread of luminance of points that correspond to a change of progression in this example 3 5 7 and 8 Speedy strategies Speedy strategies optimize the examination time to make it compatible with clinical constraints The visual field is evaluated in several phases allowing a significant reduction of the examination duration phase 1 determination of the global component of the deficit On the Vision Monitor the determination of the global component of the deficit is performed at the beginning of the exam This allows the early detection of technical errors such as patient misunderstanding wrong optical correction having a global influe
21. Lower left Lower right Temporal Nasal Temporal Right 20 5dB 0 198 OdB TAdB 0 13 7 Upper Hemifield Upper Hemifieis Upper Hemifieid 12 848 3 9dB 55 2 11 698 3 148 51 6 Lower Hemifield Lower Lower w p 5 2 1 05 B For results of kinetic perimetry The program determines the surface area of each isopter in degrees 2 Congruence is determined as the geometrical mean of congruent surface areas of each eye for example Csg SQUARE ROOT SsgRE x SsgLE with METROVISION Visual field e Csg congruence of the left upper quadrant e SsgRE surface area ofthe left upper quadrant of the right eye e SsgLE surface area ofthe left upper quadrant of the left eye Results are summarized in the following table with 3 columns that correspond to the left eye right eye and congruence and 3 linesthat correspond to the quadrant analysis right left hemi field analysis and upper lower hemi field analysis Left Eye Right Eye Congruence Lower left 1929 268 67 Upper left 1621 223 39 Upper Upper Upper 1892 124 1493 371 107 76 389 22 1 Lower right Right 69 342 3655 Lower Temporal 85 47 428 1514 1476 Lower nasal Lowernasal _ 59 363 382 3407 2322 Lower Temporal Upper right Left 76 Temporal Nasal Nasal U Temporal 5757
22. VAN CASTEELE J Le champ visuel clinique Acta belgica de arte medicinali et pharmaceutica militari 18 35 205 1972 VIGHETTO GROCHOWICKI M AIMARD Altitudinal hemianopia in multiple sclerosis Neuro ophthalmology 1991 11 1 25 27 e WALSH T J Visual fields Examination and interpretation Ophthalmology Monographs American Academy of Ophthalmology 1990 e WESTCOTT M C FITZKE F W CRABB D P HITCHING R A Characteristics of frequency of seeing curves for a motion stimulus in glaucoma eyes glaucoma suspect eyes and normal eyes Original Vision Research 1999 39 3 631 639 e WORKING GROUP 39 First interprofessional standards for visual field testing Adv Ophthalmol 1980 40 173 224 e WU J COFFREY M REIDY A WORMALD R Impaired motion sensitivity as a predictor of subsequent field loss in glaucoma suspects the Roscommon Glaucoma Study British J Ophthalmol 1998 82 534 537 94 94 Copyright 2014 Metrovision
23. a storage media such as a USB key etc Ouvrir Regarder dans mages y E3 CTRLFIX1 jpg disqueE bmp icone 1 bmp E CTRLFIX2 jpo A disqueF bmp icone2 bmp disqueA bmp exemple_DMLA_OD jpg N icone3 bmp disqueB bmp N exemple_fond_OD bmp N icone4 bmp N icone11 disqueC bmp exemple_fond_OG bmp N icone5 bmp N icone 12 N icone0 bmp N icone6 bmp N icone 13 gt Fichiers de type mage files Annuler The image of the eye fundus should then appear in the superposition window The next step is to define the position of the fovea and the papilla that are used as references for a precise superposition of the visual field map METROVISION Visual field In order to better identify these features the red component of the image can be eliminated by clicking Corrections on button __witHout the position of the eye fundus image can finely adjusted with the arrow keys of the keyboard up down right and left the magnification of the eye fundus image can be finely adjusted by pressing simultaneously the SHIFT key and the arrow keys of the keyboard up down right and left the image can also be rotated by pressing the keys page up and page down wc SANS ntl IMAGE So 2 TI A De f click on button SSSR and then click on Axis m
24. are available VISUALIZATION 2D sensitivity map 3D sensitivity map sensitivity profile 2D deficit map 3D deficit map deficit profile 36 94 Copyright 2014 Metrovision 15 30 45 60 MODE SENSIBILITE a 0 4 8 12 16 20 24 28 32dB 2D sensitivity map Exploitation results Easy way use the keyboard arrows right and left to change the angle of the meridian The field orientation is indicated by the icon situated on the upper right of the image CTE oo aa 25 20 rrsan rFF 0 4 8 12 16 20 24 28 3246 Sensitivity profile The profile is realized by cutting the visual field mountain along meridian Abscissas the eccentricity of measures Ordinates the sensitivities of measures in dB MODE SENSIBILITE y 0 4 8 12 16 20 24 28 32dB 3D sensitivity map ANALYSES ANALYSIS Click on the ANALYSIS button to obtain the display visual field analysis global Fr analysis Follow up E analysis neurologic analysis incapacity index E DAMES analysis vision simulation You can also use keyboard shortkeys analysis eye fundus menu of the various available analysis analysis Goldmann T for global analysis analysis zones inFormations on patient E evolution follow up gt patient s information GLOBAL ANALYSIS The global analysis provides a complete status of the These 3
25. corrected deficits 68 94 Copyright 2014 Metrovision Rx 3D exam date 27 05 2004 14 22 exam FAST24 comments 3D sensitivity map Deficit Volume 65dB deg2 Tested Points Mean Deficit 1 1 248 Corrected Mean Deficit 2 0 898 Deficit Variance Spatial Fluctuation 1 7dB Temporal Fluctuation 0 1dB Mean Time Response 546 ms Fixation Losses 1 14 Attention Losses 0 12 Duration of Exam 5mn 2s Correction of Reference Map 2dB Pupil diameter Stimulus III 1 sum of global and local deficits 2 local deficits only Clinical examples 57 years old emmetropic patient Left eye tested with the FAST24 procedure and a 3D optical correction Good quality exam There are no fixation and attention losses Analysis of the visual field alterations No diffuse deficit Relative perifoveolar alteration between 5 and 7 degrees of eccentricity Global indices remain normal TROVISIO ME y T TNI 69 94 Copyright 2014 Metrovision Visual field Venous occlusion Reference venousocclu001 patient s ID venousocclus001 RE x eD file number 157807 exam date 18 10 2005 09 18 birth date 24 08 1947 exam MIXTE24 comments VISUAL FIELD EXAM 2D sensitivity map 3D sensitivity map SENSITIVITY M ODE a 0 8 2 20 24 28 3248 Deficit Volume 349dB deg2 ay REZ Values of deficits Mean Deficit 1
26. deficit variance characterizes the dispersion of deficits e Spatial fluctuation characterizes local threshold variations it is the average of sensitivity difference between each measurement point and its neighbors e Temporal fluctuation characterizes short term threshold variations It is calculated only for those points measured with a staircase strategy e The average response time provides evaluation of the quality of patient s responses The global analysis also determines a histogram of the distribution of deficits area in orange color in the Exploitation of results example hereby This histogram shows the number of tested points with a deficit larger than a given value The area in green color represents the normal limits for an age matched population Note The area in orange color that characterizes the patient takes into account the uncertainty of each measurement The true curve of the patient should be in between the upper and lower limits of the orange area D ficit dB 45 Volume du d ficit 70548 4 42 Follow up analysis This analysis allows the evaluation of the evolution of the visual field over several consecutive exams The analysis is performed by displaying the last examination result and then selecting the analysis of the visual field evolution The program automatically searches on the hard disk all the exams performed with the same patient s name with the same tes
27. global and local deficits of deficits gp 05 of corrected deficits 2 local de icis only 62 94 Copyright 2014 Metrovision 50 years old patient with 2D myopia Left eye examined with the MIX24 procedure without optical correction Good quality exam Only one fixation loss on 19 tests and no attention loss The flattening on the upper nasal 15 not due to the optical correction it also appears on the peripheral isopter which is realized without optical correction According to the orthoptist it is not due either to a ptosis Analysis of the visual field alterations No diffuse deficit The foveolar threshold is slightly altered Ring deficit largely absolute A 10 degrees diameter central island of vision remains with a peripheral crescent on the temporal side 63 94 Copyright 2014 Metrovision N x METR 4 V S ON Visual field Retinitis pigmentosa Reference rp001 patients ID rp001 RE Rx non file number exam date 18 07 2003 12 37 birth date 18 02 1982 exam MIXTE24 comments VISUAL FIELD EXAM 2D sensitivity map 3D sensitivity map 75 90 BENET HITY MODE 2 4 B L 20 14 28 3298 Deficit Volume 1267 dB deqz values of deficits Mean Deficit 1 Corrected Mean Deficit 2 Deficit Variance Spatial Fluctuation Temporal Fluctuation Mean Time Response Fixation Losses Attention Losses Duration o
28. of eccentricity FAST fovea Measure of the foveolar threshold with staircase strategy 22 94 Copyright 2014 Metrovision follow up of all pathologies affecting the central visual field glaucoma optic neuritis vascular diseases macular and papillary oedema evaluation of deficits within the macular papillary and centro caecal areas of the visual field glaucoma follow up follow up of chloroquine treatments evaluation of maculopathies with a visual acuity better than 0 2 can be realized as a complement of previous tests Which exams to choose OTHER TESTS Visual aptitudes G1 Binocular exam designed a EE to evaluate the ability to 0 245859 evaluation of driving aptitudes drive e e group G1 Supraliminal strategy Visual aptitudes G2 Binocular exam designed al a ai to evaluate the ability to evaluation of driving aptitudes drive group G2 Supraliminal strategy Assessment Binocular exam designed to evaluate the visual incapacity evaluation of visual incapacity Esterman score Supraliminal strategy Low vision status Visual field performed r 4 evaluation of patients with with a size V test 5 are Prem visual acuity below 0 2 Supraliminal strategy evaluation of periphery in neuro 9 ophthalmic diseases be Fast 60 Os used as a complement of X NUT previous FAST 30 or STAT
29. windows can be displayed one by one by visual field exam clicking on the Vision Monitor control bar This analysis is displayed on the as 3 separate windows which are printed single page ET Click here to display the analysis windows A METROVISION 37 94 Copyright 2014 Metrovision Visual field Statistical analysis 9 arte SEFE NT att oa semen Operator Dupont Merei The 2D sensitivity map includes the values of the threshold measurements superimposed upon the grey scale map This map highlights the visual field topography EN Doe ee iama DELE s O 0 4 8 12 16 20 24 28 32dB The same data is represented in 3D to make easier the understanding of the topography NR 0 4 8 12 16 20 24 28 3246 Deficit values obtained by subtracting measures performed on the patient from normal age matched values Corrected deficit values are obtained by subtracting measures performed on the patient from normal values referenced to the individual base level of the patient The map of deficit probability indicates the probability of deficits with respect to age matched normal values The map of corrected deficit probability indicates the probability of deficits with respect to normal values referenced to the individual base level of the patient Values Values of deficits of correc
30. 10 0 10 20 MODE SENSIBILITE A AXAXAA A A AAAA YV XXASD BOAAAZZT 0 4 8 12 16 20 24 28 32dB The representation of the same result in 3 dimensions 3D map makes the interpretation of the visual field topography easier l 0 4 8 12 16 20 24 28 32dB 18 94 Copyright 2014 Metrovision Which exams to choose WHICH EXAMS TO CHOOSE This chapter describes the various exam protocols available with the Vision Monitor METROVISION 19 94 Copyright 2014 Metrovision FAST30 FAST24 FAST12 FAST fovea STAT30 STAT24 STAT12 STAT fovea Visual aptitudes G1 Visual aptitudes G2 FAST30 FAST24 FAST12 FAST fovea STAT30 STAT24 STAT12 STAT fovea Visual aptitudes G1 Visual aptitudes G2 The table below summarizes the various protocols available according to the device configuration FAST30 FAST24 FAST12 FAST fovea STAT30 STAT24 STAT12 STAT fovea Visual aptitudes G1 Visual aptitudes G2 Incapacity index Incapacity index Incapacity index Low vision status Low vision status Low vision status FAST 60 FAST 60 FAST 60 BY 30 BY 24 BY 12 BY fovea Motion 30 Motion 24 Motion 12 Other protocols can be performed on request or thanks to ther program for the edition of procedures proposed with 3 kinetic isopters 1 isopter for the blind spot Mix 30 Mix 24 Mix 12 the EXPERT vers
31. 3149 2994 537 860 903 101 228 229 Lower hemifield Lower hemifield Analysis of the incapacity index This analysis provides an automated determination of the incapacity index from the visual field exam In the example hereby the incapacity index is of 46 Tested fed 100 AnBywus on brosar vines ane Borups spread 118 degrees Fig Less 85 omg Vertical spread 75 degrees Up 34 Down 41 Number defective areas 46 over 05 Percentage of defective areas S Vision simulation The purpose of this analysis is to simulate the influence of the patient s alteration of vision It allows explaining to the patient or his her relatives the possible benefits from a treatment or a surgery or the risks involved in situations such as driving a car It is only a simulation and is provided only as such It does not take into account parameters such as eye movements or completion phenomena The program proposes a choice of 8 photographs that can be selected with a single mouse click The program displays 2 windows The first window shows the image as it is seen by a normal subject zones which are not tested by the visual field procedure no not appear The second window shows a simulation of what is seen by the patient calculated from the result of his her exam 42 94 Copyright 2014 Metrovision The printout of the vision simulation pres
32. ELD EXAM 2D sensitivity map 3D sensitivity map 30 20 LU 0 0 20 30 gt Y a 28 32dB Deficit Volume V 97dB deg2 k Values Values of deficits of corrected deficits Tested Points 96 Mean Deficit 1 0 248 Corrected Mean Deficit 2 1 248 Deficit Variance 1 74 es Ry A m a Spatial Fluctuation 2 0dB Temporal Fluctuation m Mean Time 493 ms E Fixation Losses 4 44 m m Attention Losses 2 12 Duration of Exam 6mn 445 0 B p gt 5 Correction of Reference Map 1dB 2 m 5 Pupil diameter uu m p lt 2 E Stimulus Probabilities mp lt 1 Probabilities 1 sumof global and local deficits of deficits m p lt 0 5 of corrected deficits 2 local deficits only 52 94 Copyright 2014 Metrovision Clinical examples 50 years old patient with 3D myopia Examination of the right eye performed with the FAST24 procedure and without optical correction The eye fundus shows a localized loss of fibers Quite good quality exam Only one loss of fixation and two losses of attention on 12 controls The foveolar threshold is normal and the size of the blind spot is within normal limits defined by a vertical ellipse on the plot Alterations of the visual field No diffuse alteration Relative fascicular alteration in the upper field in relation with the alteration of the eye fundus The scotoma does not approach less th
33. However time limitations of everyday clinical practice require an optimization of examination procedures This document will first recall the basics of modern perimetry before presenting the different approaches available on the Vision Monitor system METROVISION 7 94 Copyright 2014 Metrovision Visual field CLINICAL INTEREST OF THE VISUAL FIELD EXAM Theisland of vision The visual field is usually represented as an island of vision that corresponds to the domain of perception of light for a steady eye In a normal subject sensitivity to light is best at the fovea It decreases regularly as a function of eccentricity until the absolute limits that are defined by the morphology of the head 60 degrees on the nasal side 95 degrees on the temporal side e 60 degrees superior There is one accident within these limits the blind spot 70 degrees en inferior that is located 15 degrees away from fixation on the temporal side Detection analysis and follow up of pathological alterations The interest of the visual field exam results from the R tine nasale R tine temporale Wii anatomic organization of the visual system particularly from the pathway of nerve fibers and Lieu de la l sion SS from the vascularization Nerve fiber bundles and blood vessels of the retina in the retina nerve fibers follow well defined courses A damage of the opt
34. Manufactured by Metrovision under ISO9001 2008 ISO13485 2003 certified quality system AW XOVISION af 7 5 MANUAL METROVISION 4 rue des Platanes 59840 PERENCHIES FRANCE Tel 33 3 20 17 19 50 Fax 33 3201719518 export metrovision com http www metrovision com B E Version 03 02 2014 2014 Metrovision B GENERAL CONTENT GENERAL CONTENTT sssssssssassassssssssssssssssssssssssssssssssssssssssssssssassssssssssssssssssa 3 GENERALINTRODUCTION sa ss ssssssssssssssssssasasssapasasanasasasssssassssssaasasanasasasa 5 CR 7 CLINICAL INTEREST OF THE VISUAL FIELD EXAM o oo ec cece ce ccccncecececccecsceceaccecececececececeasaceceeeeeacnceceesaeaceceseetaeaceeees 8 APPLICATION TO VISUAL FUNCTION ASSESSMENTS HANDICAPS sccccceeeccccccccsceecececeuceseeeecseeeuecseeuecseeeuecseeeessseueesseeueceseunesseens 10 I I a u u 10 u E EA uuu uuu uuu a TUE ERN 15 PERIIVIETRY E 15 MOTON PE A T u un nun uuu 16 BLUE YELLOW PERIMETRY 16 REPRESENTATION OF TRE VISUAL D ei u a u ua de nive 17 WHICH EXAMS CHOOSE
35. NICAL SPECIFICATIONS METROVISION 47 94 Copyright 2014 Metrovision ET TT Visual field MonCvONE specifications N 70 T 100 D 70 MonCv3 and MonPackONE specifications Equivalent Goldmann I HI IV V Equivalences of global indices Average MD mean defect MD mean deviation deficit Not available PD pattern deviation average Spatial CPSD corrected pattern standard CLV corrected loss variance fluctuation deviation Temporal SF short term fluctuation SF short term fluctuation fluctuation Average response time Variance PSD pattern standard deviation LV loss variance of deficits variance square root 48 94 Copyright 2014 Metrovision Clinical examples CLINICAL EXAMPLES Acknowledgements to Dr Defoort Dhellemmes Lille Pr Hache Lille Dr Zanlonghi Nantes METROVISION 49 94 Copyright 2014 Metrovision ET TT Normal visual field Reference normal001 patient s ID normal001 LE Rx file number birth date 01 02 1966 125 exam date 15 12 2009 16 47 exam Fast 30 fast thresholds comments VISUAL FIELD EXAM 20 sensitivity D 20 BENEM MTY MODE 24 IB 3248 3D sensitivity MEE Deficit Volume 12dB deg2 4 Values 4 values 3 of deficits of corrected deficits Tested Points B
36. Principe des examens If this global component is subtracted from the deficit the interindividual variations of the normal population are significantly reduced as well as the variations in pathological subjects From these considerations it follows that 2 different types of analysis can be made an analysis of deficits in which the patient s results are compared to the normal population of the same age and an analysis of corrected deficits in which the global component has been subtracted from the deficits Supraliminal strategies Many measurement strategies have been developed to meet the needs of the current clinic The supraliminal strategy is the fastest tests are presented at a luminance level well above the normal population threshold The test is recorded as normal if the patient answers and abnormal if he doesn t Therefore only one presentation is enough for each tested point The supraliminal level that is to say at how many dB above the normal threshold the presentation is done is the object of a compromise If it is too low many abnormal points will be detected by mistake If it is too high the exam will only detect important alterations In practice a supraliminal level of 10 dB is used for a rough screening research of severe deficits patients who are not very cooperative A supraliminal level of 6 dB is often used for the fast screening of deficits in the periphery beyond 30 degrees and
37. TIC NEUROPATHY u u u ann a uuu u aya E 82 POP AR ADEN aus u ane 84 RERATOCONUS ANID CLAW CCIW eee ne ce aun P 86 EDITION DE PROCEDURES uuu uu qaa 89 BIBLIOGRAPHY uu Sun a 93 4 94 Copyright 2014 Metrovision General introduction GENERAL INTRODUCTION This document describes the use of the Visual Field application available on the Vision Monitor system N WARNING Before reading this document you should be familiarized with the general information related to the hardware and software of the Vision Monitor This information is available in the following documents DOCUMENT CONTENT The Vision Monitor Introduction and General functions of the Vision Monitor software general operation Recommendations for the installation of I I Recommendations for the installation of equipment Vision Monitor Systems Installation of MonPackONE system Installation of MonCvONE system Installation and safety of the equipment Installation of MonCv3 system der METR VISION 5 94 Copyright 2014 Metrovision 6 94 Copyright 2014 Metrovision Examination basics EXAMINATION BASICS The visual field examination provides very useful information for the detection diagnosis follow up of patients
38. a parallels a 5 eccentricity added with simple click on button As Perform the same operation with button Printing the results exporting the results to other __PAPILLA and the corresponding point of the applications ep To print the final result click on PRM To save the result image click on button the corresponding point of the image The program automatically adjusts the image and displays the result of the superposition DOM lor on bouton gt to make An additional click on button RED allows the copy in the clipboard restoration of the red component of the image HLLILICLII X ER LAIIE E Analysis of zones First step click on the different test points to be selected for each zone Click button VALIDATE to validate and move to the next zone When the 5 zones have been defined the program proposes to save their definition as a file for future use Click on button RECOVER to recover the previous definition of zones 44 94 Copyright 2014 Metrovision Exploitation results VISUAL FIELD ANALYSIS selection of zones 2 Gw r C L C e IT l C aa T r g sr wTm Orr Tt WF 0 4 8 12 16 20 24 28 32dB 0 4 8 12 16 20 24 28 32dB RECOVER rl VALIDATE When the selection of zones is completed the program ANALYSIS OF ZONES
39. akia and important ametropias first exam of a new patient global evaluation including a kinetic evaluation of the periphery a static evaluation of the central field and as an option the foveolar threshold follow up of optic neuritis and glaucoma patients at an advanced stage unexplained loss of visual acuity neuro ophthalmology patients aphakia pseudophakia and important ametropias retinal pathologies diabetes retinitis pigmentosa retinal detachment venous occlusions evaluation of the macula with a rapid screening of the periphery Copyright 2014 Metrovision Realization exam REALIZATION OF AN EXAM METROVISION 27 94 Copyright 2014 Metrovision Visual field Patient s installation Once the visual field program for white white perimetry exams or PRO visual field program for Blue Yellow and Motion perimetry is started the control window shows the list of examination protocols available on the instrument EXAMEN DU CHAMP VISUEL MENU PAGE Mordi Fast 30 Fast 24 Fast 12 Fast fov seuils rapides I seuils rapides I seuils rapides Fast tov agf C Stat 30 Stat 24 Stat 10 Stat fov a seuils seuils seuils seuils Hj G Fast 60 Aptitudes Aptitudes _ Bilan S seuils ra Na y g basse vision Dj AUTRES PROCEDURES vl WARNING Note At first click on Patient s ID eye to access to t
40. al correction of the reference map The reference map of the Vision Monitor is taking into account the patient s age However there are several other factors that may affect globally the threshold values the opacity of ocular media the pupil size refraction the patient s response criterion etc These factors result in a deficit affecting the whole central visual field In order to determine this global component of the deficit the program measures the sensitivity threshold in 5 points of the macular zone 4 F N X rrt o gt h d A F lt j X X P7 N 7 d nn a X 4 4 If these measures are within the normal limits the program will continue the exam If it s not the program will display a message indicating that the value is abnormal Quality control during the examination Realization of an exam In that case you should search for the eventual cause of abnormality e the poor understanding or poor cooperation of the patient e the reduced transparency of the ocular media or very small pupil size e anincorrect optical correction e central deficit of the visual field covering the position of the 5 test points After having corrected the cause of error repeat the REF AIRE MESURE measurement by clicking on MESSAGE CORRECTION OF REFERENCE
41. an 5 degrees from the fovea and it is not linked to the papilla Global indices are not yet altered in a significant way fhe METR VISION 53 94 Copyright 2014 Metrovision Visual field Established glaucoma stage 2 Reference glaucoma006 patient s ID glaucoma006 RE Rx 3D file number exam date 23 05 2002 09 39 birth date 14 06 1947 exam FAST24 comments VISUAL FIELD EXAM 2D sensitivity map 3D sensitivity map D SENSITIVITY MODE 28 32dB gt 8 a S Y Deficit dB Deficit Volume 302dB deg2 Values Values of deficits of corrected deficits Tested Points 96 Mean Deficit 1 Corrected Mean Deficit 2 ds Deficit Variance amp eis Ry B B Spatial Fluctuation 3 2dB Temporal Fluctuation 0 9dB Mean Time Response 493 ms E Fixation Losses 1 17 B m Attention Losses 0 16 Duration of Exam 4mn 45s m gt 5 Correction of Reference Map 088 m p lt 5 Pupil diameter m p lt 2 _ Stimulus Probabilities lt 1 Probabilities 1 sum of global and local deficits of deficits m p lt 0 5 of corrected deficits 2 local deficits 54 94 Copyright 2014 Metrovision Clinical examples 55 years old patient with 6 D myopia Right eye examined with the FAST24 procedure and a 3D optical correction The quality of the exam is good Almost no fixation and attention losses The foveolar
42. average Ominimum K THRESHOLD dB 45 45 fovea 15 45 ECCENTRICITY degrees Normal limits of sensitivity thresholds along the horizontal meridian In the normal population there are important interindividual variations of approximatly 10 dB for the central field and increasing beyond 15 degrees of eccentricity These variations are due to many factors age thresholds decrease beyond 45 years of age the patient s response criteria some patients want to be sure to see the test before answering the level of tiredness the ocular media transparency The age is an easily identifiable data and taking it into account allows reducing in a noticeable way the interindividual variations The graph below shows these variations after taking into account age for a point of the central visual field maximum minimum a o a 20 30 40 50 60 70 AGE years Normal limits of the sensitivity threshold as a function of age age for a point of the central visual field These variations are brought down to 4 dB for young subjects but remain relatively high 8 dB for subjects beyond 60 years of age An important part of these variations affects the whole visual field So the deficit in one point includes a global component affecting the entire visual field which is not specific of a pathological process as well as a local component 13 94 Copyright 2014 Metrovision
43. button Y CONTROL x Once the program has completed the evaluation of the isopter it enters the mode CONTROL MEASUREMENTS In this mode you can retest all the measurements of the isopter by clicking on one of the buttons LAT a which displayed nearby the different measurements When you have completed all control measurements click on button NEXT Smart ways e if you want to switch to the manual mode before the completion of the isopter after clicking on button CONTROL x click on Hesuls to stop the examination e you can modify the velocity of the stimulus by clicking on button PVELOCITY 5d sy 2450 ODstmu MESURES DE CONTROLE VITESSE 5d sy LI SUITE 32 94 Copyright 2014 Metrovision Realization exam EXPLOITATION OF RESULTS METROVISION 33 94 Copyright 2014 Metrovision ET TT Visual field ACCESS TO RESULTS N WARNING The access to results is not allowed during the progress of exams as it may lead to interactions between the data in process of acquisition and previous exam data However it is possible to read the results from a second PC linked to the exam PC through the computer network even during the realization of exams To access to exams results click on button situated in the Vision Monitor The access to results menu is displayed on the screen ACCESS RESULTS
44. central part of the visual field and a compression of the periphery Graduations are therefore more densely packed in the periphery The linear scale is constant over the entire visual field Graduations are the same for the central and the peripheral visual field The following example shows the same examination results with the different display options that are proposed OPTIONS mixed linear x1 linear x2 linear x3 linear x4 linear x5 linear x6 35 94 Copyright 2014 Metrovision 30 45 60 MODE SENSIBILITE T 0 4 8 12 16 20 24 28 32dB 70 60 50 40 30 20 40 10 20 3 4 5 60 70 MODE SENSIBILITE CY era 0 4 8 12 16 20 24 28 32dB Linear scale x1 METROVISION Visual field MODE SENSIBILITE p o J D qIo IE RS J 0 4 8 12 16 20 24 28 32dB Linear scale x2 30 20 10 0 10 20 30 MODE SENSIBILITE uras nc 0 4 8 12 16 20 24 28 32dB Linear scale x3 10 MODE SENSIBILITE ee a 0 4 8 12 16 20 24 28 32dB Linear scale x4 20 10 0 10 20 MODE SENSIBILITE uw T 75 w wa Vq gt 0 4 8 12 16 20 24 28 32dB Linear scale x5 VISUALIZATION MODES Click on button VISUALIZATION access the menu of the various visualization modes The following example shows the same result with the different visualization modes which
45. d rest moves automatically to position the eye at the center of the cupola Use the navigation button 1 to place the eye in the center of the rectangle of the video monitor Notes e For monocular exams the fixation point is positionned 15 degrees to the left for the right eye and 15 degrees to the rigth for the left eye e For binocular exams the fixation ids located at the center B Installation on MonCv3 and MonPackONE Adjust the vertical position of the chin rest with On the video control the tested eye should be within command button 1 so that the examined eye is at the the rectangular control area level of the eye marks 2 ROVISION 29 94 Copyright 2014 Metrovision Visual field Realization of static perimetry exams B Explanation to the patient Static tests are presented at maximum luminance in 4 different positions Explain to the patient that he she must fixate constantly the fixation target and press the button every time he she perceives a small light anywhere in the periphery If the fixation point is not well seen increase its luminance by clicking on FEAHDN 2 The program automatically proceeds to the next phase when 3 patient s responses are recorded or after the operator presses button INSTALLATION Fixation control Measurement of the pupil diameter option If the option automated fixation control is available initialize the fixation control by pre
46. e dB reduction in sensitivity corresponds to a test luminance multiplied by 2 1 25 x 1 25 x 1 25 e 10 dB reduction in sensitivity corresponds to a test luminance multiplied by 10 1 25 x 1 25 repeated 10 times 318 cd m B dB luminance sensibilit B 2 cd m 31 dB e Sensitivity thresholds in a normal patient Many measurement strategies of sensitivity threshold have been developed to meet the needs of the standard clinic Their aim is to detect and quantify the visual field alterations these alterations or deficits being defined with regard to a population of normal subjects The deficit in a point of the visual field is the difference between the threshold value measured on the patient and this threshold average value in normal subjects This deficit is significant only if its value is out of the normal limits for example if less than 596 of normal subjects have a deficit superior or equal to the obtained value Normal population Frequency 0 Deficit dB Therefore it is important to know precisely the normal values of sensitivity thresholds as well as their interindividual variations It is also usefull to control the different factors affecting the results so as to obtain the best possible discrimination The graph below shows the normal limits of sensitivity thresholds along the horizontal section of the visual field horizontal meridian 12 94 Copyright 2014 Metrovision Omaxmum D
47. edures click on the icon for Visual Field exams click on the button edition of procedures the menu for editing procedures opens what we will do next is read a test procedure modify it and then save it with a new name click on the button read procedure to read the menu of procedures is organized in pages you first get the list of pages which are available click on the button corresponding to the page of the menu you want to select now click on the icon of the procedure that you want to work on you get a new page with the list of parameters of that procedure If you change one parameter of the stimulation you will see the result on the stimulation unit When you have made the changes which are requested click on the button VALIDATION on the bottom right of the page You can also use the button COPY to make a copy of the page in the clipboard or the button PRINT to print the same page The lt EXPORT gt button allows the exportation of the table of stimulation parameters as a file named table txt This file defines the position X Y of the different test points It can be modified with a text editor or a spreadsheet application Once it has been modified it can be re imported with button IMPORT 5 gt MONITEUR OPHTALMOLOGIQUE o Entrer le mot de passe pour l acc s aux proc dures Champ visuel Sensi EXAMEN DU CHAMP YISUEL
48. ents page the result from the visual field exam the image as seen by a normal object and the simulation of the image seen by the patient Superimposition with the eye fundus Exploitation of results Fast 24 seuls apkles 2D en 2 Da p Fast 24 seuls rapides image normale Fast 24 seulis rapides Image vue par pallent OO Dec dat OD stimue This analysis allows the superposition of visual field map on the image of the patient s eye fundus or OCT image The superposition method is that proposed by Pr BEK BEK 1990 When the analysis is started a new window entitled SUPERIMPOSE IMAGE OF EYE FUNDUS is displayed with a map of the values of measured points and isopters equal response lines Note This map is reversed upside down with respect to the visual field map so that in can be superimposed over the image of the eye fundus Hrrmagr SAMSRDURE IMAGE _ IMPRISHOM The next step is to acquire the digital image of the eye fundus Click on the 222 button and a menu will be displayed to allow the selection of the image 43 94 Copyright 2014 Metrovision Note Use the button in the control bar of the Vision Monitor program to import a photograph in the results database The photograph can be imported either through a computer network or from
49. f Exam Bp 556 EN d Correction of Reference Map 6 p lt 596 p Pupil diameter m p lt 2 i Stimulus Probabilities I mp lt 1 Probabilities 4 sumar global and local deficit of deficits lg p 0 5 of corrected deficits 2 local deficits only 64 94 Copyright 2014 Metrovision Clinical examples 21 years old emmetropic patient Right eye examined with the MIX24 procedure without optical correction Good quality exam There are no attention or fixation losses The foveolar threshold is normal Analysis of the visual field alterations No diffuse alteration Alteration of the pericentral static field with a preservation of the peripheral isopter realized in kinetic perimetry TROVISIO ME y T TNI 65 94 Copyright 2014 Metrovision Visual field Atrophic macular degeneration Reference mac001 patient s ID 001 RE 3D file number exam date 22 06 2010 07 35 birth date 05 10 1930 exam Fast 30 fast thresholds comments baisse av OG DML VISUAL FIELD EXAM 20 sensitivity 3D sensitivity 20 BENBITNITY MODE a 4 B 20 24 28 3298 Deficit Volume 139dB deg2 Values 3 4 Values of deficits of corrected deficits Tested Points 54 Mean Deficit 1 Corrected Mean Deficit 2 Deficit Variance Spatial Fluctuation 3 44 Temporal Fluctua
50. g other type of photoreceptors responses rods and cones M and L with a yellow background The potential interest is an early detection of patients with glaucoma the S cones system being particularly sensitive to early alterations because of the S cones low density SAMPLE amp WEINREB 1990 However many recent studies show that the results obtained with this exam present significant variations in the long term HUTCHING amp al 2001 and do not seem to detect glaucoma earlier than classic perimetry VAN DEN SCHOOT amp al 2010 16 94 Copyright 2014 Metrovision Representation of the visual field Principe des examens B How to find marks in the visual field peripheral field field macular field Geometric references are needed to identify the position of a deficit within the visual field The macular visual field covers the central 20 degrees eccentricity with respect to fixation less than 10 degrees This region is the most sensitive to luminance contrast and to small spatial details The central visual field covers the 40 central degrees up to 20 degrees of eccentricity The peripheral visual field covers the region over 20 degrees of eccentricity isopters and sensitivity profiles Traditional representations of the visual field are largely inspired from the techniques used by topographers maps of isopters Goldmann representation isopters are similar to the level curve
51. h alteration of the foveolar threshold The eye fundus does not show any optical atrophy Very discrete papillary hyperemia at the limit of significance Visual evoked potentials 60 pattern reversal delayed P100 125 ms 15 pattern reversal reduced amplitude and normal implicit time damier 60 3mn25s Val 60 Rej 0 PEV damier 15 445 Val 60 Rej 0 OD stimul OD stimul dat Source ZANLONGHI X Electrophysiologie visuelle examens fonctionnels et neuropathie optique g n tique R flexions ophtalmologiques 2010 15 132 20 27 der METR VISION 81 94 Copyright 2014 Metrovision Visual field Compressive optic neuropathy Reference opticneuro002 patient s ID opticneuro002 poc toe file number N208996 exam date 08 12 2006 17 33 birth date 06 07 1962 exam Mixte 24 comments VISUAL FIELD EXAM 2D sensitivity map 3D sensitivity map SENSITIVITY M ODE oo ooo eee ooo 0 8 2 5 20 24 28 32dB Deficit Volume 133dB deg2 of deficits Tested Points 96 Mean Deficit 1 Corrected Mean Deficit 2 1 198 Deficit Variance Spatial Fluctuation 1 7dB Temporal Fluctuation 0 1dB Mean Time Response 622 ms Fixation Losses 0 14 m Attention Losses 0 13 Duration of Exam 9mn 10s Correction of Reference Map Pupil diameter p Stimulus E p gt 5 m p lt 5 B p lt 2 Probabil ities m p lt 1 robabilities
52. he identification of the patient his date of birth and examined eye Then click on the icon which corresponds to the selected examination protocol if there are more than 16 different protocols available on your equipment use the lift bar on the right side of the window to display the next protocols Adjust the height of the seat and of the electric table if available to achieve the best possible comfort for the patient Place an occluder over the non tested eye It is very important to enter the date of birth following the requested format so that the program can calculate the age of the patient and determine the visual field reference map Place the optical correction for near vision 33 cm The optimal refractive correction takes into account the correction for distance vision sphere and cylinder with an addition depending on the age of the patient e The correction used during the exam can be computed automatically by clicking on button during the identification of the patient 28 94 Copyright 2014 Metrovision Enter the sphere and cylinder for distance vision and the program automatically fills the Correction gt with the value to be used during the exam 2 oupona N de dossier Correction en vision de loin Date naissance 12012000 Sph re Date examen 412206 Cylindre 0 Oeil Stimul op AES pupilles dilat es Correction 2 Observa
53. he fixation point OVISION 79 94 Copyright 2014 Metrovision Visual field Leber optic neuropathy at an early stage Reference opticneuro001 patient s ID opticneuro001 file number N250641 birth date 30 04 1979 2D sensitivity map RE RX exam date exam comments VISUAL FIELD EXAM non 23 06 2009 13 48 Mix 24 xz leber deb 3D sensitivity map Values of deficits p gt 5 m p lt 5 B p lt 2 Probabilities i p lt 1 of deficits m p lt 0 5 80 94 SENSITIVITY MODE 32dB 0 25 50 75 Deficit Volume 132dB deg2 100 Tested Points Mean Deficit 1 Corrected Mean Deficit 2 Deficit Variance Spatial Fluctuation Temporal Fluctuation Mean Time Response Duration of Exam Correction of Reference Map Pupil diameter Stimulus Probabilities of corrected deficits 2 local deficits only Copyright 2014 Metrovision 12 148 p lt 2 lt 2 423482 lt 0 59 2 048 1 0dB 372 ms Fixation Losses 1 5 Attention Losses 1 4 3mn 17s 1 sum of global and local deficits Clinical examples 30 years old emmetropic patient Reduction of VA on both eyes 1 month ago Right eye examined with the MIX24 procedure without optical correction Exam of average quality 20 attention and fixation losses Analysis of visual field alterations No diffuse deficit Centro caecal scotoma wit
54. he number of validated measures should be equal to the number of measures initially programmed 101 in the example hereby This number is different only when the examination was not entirely completed 34 94 Copyright 2014 Metrovision The reliability of the patient s fixation is indicated by the number of fixation losses 0 in this example relative to the number of controls 13 The quality of the patient s attention is assessed regularly throughout the exam by the presentation of tests that cannot be seen by the patient Responses to these tests are counted as attention errors 2 in this example with respect to the number of controls 14 Cases when the patient s response occurs within an abnormally short delay after the stimulus presentation are also counted as attention errors DISPLAY OPTIONS Exploitation of results The individual correction of the reference map is also an important parameter for the interpretation of results Its value is displayed in red color if it does not fit with the age of the patient The last item provides the identification of the stimulation used for the examination In the present example the stimulus is equivalent to the size Ill Goldmann tests This item is displayed in green color if the apparatus was correctly calibrated and in red color otherwise The display options allow selecting the display that is most suited to your needs The mixed display realizes a dilation of the
55. iations CHARLIER amp al 1989 In those cases it can be usefull to perform fully static and fully kinetic exams Motion perimetry Motion perimetry uses movement as a stimulus grating of vertical bars is displayed on the stimulator screen The local visual stimulus is obtained with the movement of one of the bars It moves horizontally for a short moment and thereafter returns to its initial position A measurement of the sensitivity threshold is obtained by changing the amplitude of the movement The patient task which is to press a push button when he perceives a movement of the stimulus is not really different from the task of static perimetry This technique has several advantages Motion stimulation has increased sensitivity for the detection of early deficits in glaucoma WU 1998 WESTCOTT 1999 BRUSINI amp al 2009 It is specifically affected by alterations of the magnocellular pathway DUARTE amp al 2013 Motion stimulation is much less sensitive than classic perimetry to optical problems such as refractive errors or diffusion of light at the level of cornea or crystalline lens e Movement amplitude The results obtained are displayed and analyzed in the same way as classic static perimetry Read the chapter Clinical examples for examples of clinical results Blue Yellow perimetry Blue Yellow perimetry aims at specifically testing the S cones system with blue stimulations while inhibitin
56. ic nerve head results in NSS concern e par SS les axones l s s an alteration of the visual field following the corresponding nerve fibers either under the form of Arcuate scotoma in glaucoma a paracentral scotoma or an arcuate scotoma Bjerrum 8 94 Copyright 2014 Metrovision concerning the vascularization of the retina and optic nerve head an impairment results in a local alteration in correspondence with the visual field in visual pathways The localization of damages located between the retina and the occipital cortex can be determined from the type of visual field alteration Visualfield visual aptitudes and quality of life The visual field is a determining factor for the quality of life The peripheral visual field allows detecting and avoiding obstacles when moving around or going down the stairs The macular visual field is essential for reading the recognition of faces and many other tasks of everyday life Role of the central and pericentral visual fields in reading Reading involves a sequence of eye fixations During each fixation a word is identified thanks to its image projected over the fovea zone with green circle while the text that follows is analyzed with the right pericentral field zone with blue dotted line to determine the position of the next fixation In the case of fast reading the number of fixations is reduced They are made directly near the center of words and
57. inetic perimetry is much faster than static perimetry in the case of severe deficits in the periphery In the previous example only one kinetic test allows a quick estimation of the alteration whereas a great number of presentations are necessary in static perimetry to obtain the same result In the case of central field deficit kinetic perimetry can hardly evaluate the depth of deficits So the evaluation of the central field is rather better performed with Static perimetry Mixed perimetry Mixed perimetry combines the evaluation of the peripheral field with kinetic perimetry an isopter and the evalution of central field with static perimetry 15 94 Copyright 2014 Metrovision It presents several specific characteristics a fast evaluation of the whole visual field e the determination of central deficits peripheral extent e significant saving of time in the case of severe deficit because zones of the central field found to present an absolute deficit with kinetic parimetry are only controlled with static METROVISION Visual field Example of mixed perimetry in glaucoma patient the peripheral isopter determines quickly the presence of an extended absolute deficit and shows the extension of the central deficit to the periphery breakthrough which is a sign of severity Note Some pathologies result in different responses for static kinetic stimulations stato kinetic dissoc
58. ion see chapter Edition of procedures 20 94 Copyright 2014 Metrovision Which exams to choose STAT PERIMETRY STAT perimetry corresponds to conventional automated perimetry It makes use of a grid of testing points with a regular spacing of 6 degrees for procedures STAT 30 and STAT 24 and 2 degrees for STAT 10 STAT 30 STAT perimetry up to 30 L EM 2 Les VIE e evaluation of deficits in glaucoma degrees of eccentricity 5 CPE 5 F a g 9 points staircase strategy and the rest in fast strategy STAT 24 STAT perimetry up to 24 rr E DETTA degrees of eccentricity d t io AS glaucoma 9 points in staircase strategy and the rest in fast strategy STAT 10 Ste A A follow up of chloroquine STAT perimetry covering ES AX AM S treatments the macular zone up to 3 10 degrees of eccentricity evaluation of maculopathies with a visual acuity better than 0 2 Staircase strategy STAT fovea ee can be realized as a complement of Measure of the foveolar DPA e a SLM previous tests threshold RENE E Staircase strategy 21 94 Copyright 2014 Metrovision Visual field FAST PERIMETRY FAST 30 FAST perimetry with 94 points over the central visual field FAST 24 FAST perimetry with 79 points over the central visual field FAST 12 FAST perimetry over the macular area up to 12 degrees
59. le on Metrovision devices under the names of STAT30 STAT24 and STAT10 Other maps are also proposed on Metrovsion devices with the following FAST examination procedures FAST30 FAST24 and FAST12 FAST 30 These procedures use a layout of test points corresponding to the most frequent alterations of the retina and optic nerve fibers hence the name FAST Fiber Adapted Static Testing These procedures have several advantages e Reduction of diagnosis errors risk which may result from the lack of tests in some strategical zones 11 94 Copyright 2014 Metrovision Principe des examens gt x REE vera D Deficit of the inter papillo macular fibers in optic neuritis This deficit is easily revealed with the FAST24 procedure but frequently not detected with a procedure such as STAT24 because of the absence of test points in the corresponding zone e More efficient detection and follow up due to the increase of test points density in sensitive zones eo Results obtained from a patient with glaucoma procedure FAST30 shows clearly that the deficit is connected to the blind spot which is a sign of the glaucoma severity whereas procedure 5 does not show this connection e Better evaluation of functional repercussions of alterations For example the presence of tests at 2 and 5 degrees eccentricity from the fovea in procedures FAST30 and FAST24 allows a best eva
60. luation of the impairment gravity AX 7 eo These two results have been obtained on the same patient The FAST30 procedure shows that the deficit is getting as close as 2 degrees from the fovea This may explain an alteration of reading capacities With the STAT30 classic procedure the test closest to the fovea is at an eccentricity of 4 5 degrees and the graphic representation may be misleading Visual field B Strategies for the measurement of sensitivity thresholds e Definition of sensitivity thresholds The curve below represents the response frequency of the patient according to the test luminance If the luminance of the test is low it is normally not seen except in the case of patient errors called false positive If the test is very luminous it is normally seen except in case of patient errors called false negative When the luminance increases the frequency of responses gradually increases The sensitivity threshold corresponds to the luminance level for which 50 percent of responses are obtained Response probability 96 Test luminance The sensitivity threshold is denominated according to a scale graduated in decibels dB The highest sensitivity level 31 dB corresponds to the lowest test luminance 0 2 cd m and the lowest sensitivity O dB to the highest test luminance 318 The scale is logarithmic e 1 dB reduction in sensitivity corresponds to a test luminance multiplied by 1 25
61. nce on thresholds The determination is performed by measuring the thresholds in 5 points located in the macular area In the case of an abnormally low value a message is displayed to inform the operator He may then check an eventual technical error and in case of an error restart the measurement after correcting the cause phase 2 seed points It consists in a pre evaluation of the visual field performed in 16 points judiciously chosen Each of these points is first tested to detect a deficit If there is no response for the 2 first presentations a 3rd presentation is made at maximum luminance If no response is obtained it is concluded that there is an absolute deficit If a response is obtained then additional presentations are made to determine the relative deficit e phase 3 neighbor points The results obtained with seed points are used for the evaluation of the other points of the visual field These points are initially tested at the same relative level than the nearest seed point If no response is obtained the luminance of the test is increased until the patient does respond If a response is obtained luminance is decreased until the patient no longer responds Comparison of the static perimetry strategies A compromise must be found between the goal of the examination detection analysis and quantification of specific deficits and clinical constraints such as the duration of the examination the patient
62. olume 129dB deg2 Values Values of deficits of corrected deficits Tested Points Mean Deficit 1 Corrected Mean Deficit 2 KE Deficit Variance 2 74 REA a B Spatial Fluctuation 2 8dB Temporal Fluctuation 0 1dB Mean Time Response 460 ms E Fixation Losses 0 12 B Attention Losses 0 12 Duration of Exam 4mn 56s mp 5 Correction of Reference 1dB 2 p lt Pupil diameter m p lt 2 T Stimulus Probabilities lt 1 Probabilities 1 sum of global and local deficits of deficits m p lt 0 5 of corrected deficits 2 local deficits only 72 94 Copyright 2014 Metrovision 58 years old emmetropic patient Left eye examined with the FAST24 procedure and a 3D optical correction Good quality exam No fixation or attention losses Analysis of the visual field deficits No diffuse deficit Absolute deficit approaching at 2 degrees from the fixation point The perfect superimposition of the eye fundus alteration and the visual field deficit below shows the absence of other pathologies METRC ISION 73 94 Copyright 2014 Metrovision Visual field Tilted disk Reference tdisk001 patient s ID tdisk001 RE oui file number N196360 exam date 14 03 2006 09 38 birth date 15 08 1952 exam FAST24 comments VISUAL FIELD EXAM 2D sensitivity map 3D sensitivity map 30 20 Y 0 0 20 30 SENSITIVITY MODE
63. omitting small words such as articles 9 94 Copyright 2014 Metrovision Principe des examens e quadranopsia impairment of a visual field quadrant e hemianopsia impairment of a visual field hemi field right or left e homonymous defect visual field defect found in the same location of the visual field of both eyes it is characteristic of post chiasmatic lesions Image of a text projected on the retina during reading As a consequence it is important to be able to determine the repercussions of a visual field defect on the visual aptitudes and on the quality of life Visual field e Application to driving For Group 1 ordinary motor cycles private cars the horizontal binocular visual field must not be less than 120 and must extend on at least 50 to the right and left and 20 up and down There must be no defect within a radius of 20 with regard to the central axis For Group 2 vehicles over 3500 kg professional vehicles The horizontal binocular visual field must not be less than 160 and must extend of at least 70 to the left and right and 30 up and down There must be no defect within a radius of 30 with regard to the central axis Application to visual function assessments handicaps The binocular visual field is estimated with test 11 4 without dissociation of both eyes Tests points are distributed according to the functional significance of the differen
64. on has been realized with the last 16 exams The evolution of global indices shows an increase of the average deficit and of the corrected average deficit after subtracting the global component The evolution velocity map has been calculated with the last 4 exams and shows zones deteriorating over time in red color In that case it shows that the progression is done over the pericentral points which is characteristic of glaucoma and eliminates the possibility of a visual field evolution due to cataract or ARMD T TROVISIO ME y 61 94 Copyright 2014 Metrovision T TNI Visual field Advanced glaucoma stade 5 Reference glaucoma003 patient s ID glaucoma003 LE Rx non file number N219041 exam date 28 06 2007 14 11 birth date 05 05 1957 exam MIXTE24 comments VISUAL FIELD EXAM 2D sensitivity map 3D sensitivity map 2h 60 BENEM MTY MODE 2 4 2 20 24 28 3148 Deficit Volume 1182dB deq2 Values of corrected deficits Tested Points Mean Deficit 1 Corrected Mean Deficit 2 Deficit Variance Spatial Fluctuation 5 2dB Temporal Fluctuation 0 1dB Mean Time Response 563 ms Fixation Losses 1 48 Attention Losses 0 20 Duration of Exam 6mn 54s p gt 5 Correction of Reference Mep 2 p lt 5 Pupil diameter mo t gm p lt 2 Stmulus Probabilities mp lt 1 EM Probabilities 1 sumof
65. phs Acta Ophthalmol 1990 68 11 18 e BEDWELL C H Visual fields A basis for efficient investigation Butterworths 1982 e BRUSINI P amp al Motion perimetry in glaucoma Communication at SOI 2009 e CHARLIER J DEFOORT S ROULAND J F HACHE J C Comparison of automated kinetic and static visual fields in neuro ophthalmology patients PERIMETRY Update 1988 1989 HEIJL A editor KUGLER and GHEDINI publisher 1989 3 8 e CHARLIER J MOUSSU HACHE J C Optimization of computer assisted perimetry Doc Ophthal Proc Series 1983 35 359 364 e CHARLIER J SACHY J VERNIER F HACHE J C Dynamic representation of the visual field Doc Ophthalmol Proc Series 1987 49 263 270 e DRANCE S M ANDERSON D Automatic perimetry in glaucoma A practical guide Grune and Stratton Inc 1984 e DUARTE I C CUNHA G CASTELHANO J SALES F REIS A CASTELO BRANCO M Developmental dissociation of visual dorsal stream parvo and magnocellular representations and the functional impact of negative retinotopic BOLD responses Brain and cognition 2013 83 72 79 DUBOIS POULSENS A Le champ visuel Masson et Cie Paris 1952 GROCHOWICKI M VIGHETTO A BERQUET S KHALFALLAH Y SASSOLAS Pituitary adenomas automatic static perimetry and Goldmann perimetry A comparative study of 345 visual field charts British J Ophthalmol 1991 75 219 221 GROCHOWICKI M VIGHETTO A 5 KHALFALLAH Y SASSOLAS G Pituitar
66. rategy Motion 24 Motion perimetry covering the central field with 78points detection of glaucoma Fast strategy Motion 12 Motion perimetry CEASE Ts detection of alterations of the covering the macular opea ESS E macula area Fast strategy METROVISION 25 94 Copyright 2014 Metrovision Visual field KINETIC AND MIXED PERIMETRIES only available on models MonCV1 Kinetic Complete evaluation of the visual field with a peripheral isopter an intermediate isopter and a central isopter together with the evaluation of the blind spot limits 30 Combines the evaluation of the peripheral visual field with kinetic perimetry to the evaluation of the central field with FAST perimetry 94 points Mix 24 Combines the evaluation of the peripheral visual field with kinetic perimetry to the evaluation of the central field with FAST perimetry 79 points Mix 12 Combines with evaluation of the peripheral visual field with kinetic perimetry to the evaluation of the macular area with FAST perimetry 26 94 evaluation of neuro ophthalmic disorders first exam of a new patient global evaluation including a kinetic evaluation of the periphery a static evaluation of the central field and as an option the foveolar threshold follow up of optic neuritis and glaucoma patients at an advanced stage unexplained loss of visual acuity neuro ophthalmology patients aphakia pseudoph
67. s fatigue his or her response capabilities his or her cooperation etc The duration of the examination depends on the response time of the patient and also on the volume and complexity of deficits The speedy strategy is generally about 3 times faster than the staircase strategy Speedy strategies are theoretically less precise because they perform a simplified measurement so as to reduce the exam duration However if the patient s decrease of reliability with the exam duration is taken ointo account the accuracy obtained is generally comparable To sum up staircase strategies are essentially recommended in case of a precise determination of thresholds in a reduced number of points foveolar threshold 14 94 Copyright 2014 Metrovision Principe des examens KINETIC PERIMETRY B Kinetic perimetry principles In kinetic perimetry tests are presented with a constant luminance so as to determine the limits or isopters of zones which are seen at this level of luminance Several isopters can be obtained by using different test luminances tests with low luminance being seen in normal subjects only in the central part of the visual field The same tests can be used to define the limits of zones having a deficit for example the blind spot Isopters obtained with kinetic perimetry in a normal subject Comparison of static and kinetic perimetries A 2 i s d zw Se 7 FE MOT 4 K
68. s of topographers and connect points with equal sensitivity d apres Verriest 1972 17 94 Copyright 2014 Metrovision parallel is the set of locations with the same eccentricity 30 degrees meridian horizontal meridian Meridians provide another important reference The horizontal meridian makes the separation between the superior and inferior visual fields the vertical meridian between the nasal and temporal visual fields Each meridian is characterized by its inclination angle with respect to the horizontal meridian Each position within the visual field can easily be identified by its meridian and its parallel e sensitivity profiles they are similar to topographic cuts and represent cuts of the visual field along a given meridian d apr s 1972 METROVISION Visual field B Sensitivity maps The Vision Monitor proposes a unique representation that combines the advantages of different representation modes by displaying on the same graph e sensitivity value of each tested point e the map of sensitivity levels the computer determines a smooth surface that fits the tested points e pseudo isopters the map of sensivity levels is made with true colors which are very easily distinguished and their separations are similar to isopters curves This type of representation makes easier the understanding of the deficits localization and of their topography 20
69. sion 58 years old patient with 3D myopia Left eye examined with the FAST24 procedure without optical correction Good quality exam Low number of fixation and attention losses Normal foveolar threshold Analysis of deficits Absolute deficit approaching at 5 degrees from the fixation point and linked to the blind spot Nasal step These deficits are in correspondence with the eye fundus alteration neuroretinal rim at 3h and 5h 57 94 Copyright 2014 Metrovision Clinical examples MET OVISION Visual field Advanced glaucoma stade 4 Reference glaucoma007 patient s ID glaucoma007 LE Rx 3D file number N23846 exam date 24 0 2008 13 55 birth date 13 09 1930 exam FAST24 comments VISUAL FIELD EXAM 2D sensitivity map 3D sensitivity map ep 30 20 u 0 0 20 30 BENBITIVITY MODE 2 4 B 20 24 28 3248 Deficit Volume 681dB deq2 Values Values of deficits of corrected deficits Mean Deficit 1 Corrected Mean Deficit 2 Deficit Variance Spatial Fluctuation 4 Temporal Fluctuation Mean Time Response Fixation Losses Attention Losses Duration of Exam B p gt 5 Correction of Reference Map 2 m p lt 5 Pupil diameter 2 _ Strrulus Probabilities mp lt 1 Probabilities 4 sumof global and local deficts of deficits 0 5 of corrected deficits 2 local deficits only 58 94 Copyright
70. ssing button INIT CtFIX The program takes several measurements of the eye gaze orientation which will be used during the exam to detect fixation errors A message is displayed in the video window to indicate the result of the initialization If the initialization is successful the responses of the patients will be validated only when fixation is correct If the initialization is not successful repeat the same command or use command INIT CtMOV which detects eye movements during the exam The pupil diameter can also be measured by pressing button on the right side of the video window INIT 5 CtHVT Measurement of the response time A series of tests is presented to allow the measurement of the patient s response time and adjust the time between 2 test presentations This duration is displayed on the button gt 115 2 and may be changed by clicking on that same button anytime during the examination mesure temps de r ponse Identification of the limits of the blind spot The program continues with the determination of the blind spot position and limits 16 positions situated at the presumed place of the blind spot are successively tested until obtaining two consecutive no answers Then the program determines the blind spot horizontal and vertical limits 30 94 Copyright 2014 Metrovision recherche t che aveugle B Determination of the individu
71. t visual field areas As proposed by Esterman there is a higher density of test points in the central field along the horizontal memeridian and within the lower hemi filed The incapacity index is equal to the addition all unseen points STATIC PERIMETRY Several techniques are available for measuring the visual field This paragraph presents the various techniques proposed on Metrovision s devices static perimetry kinetic perimetry mixed perimetry and motion perimetry Their applications advantages and drawbacks are also described Static perimetry consists in determining the smallest luminance level detected among a series of fixed dots Inside the visual field limits the sensitivity to lights depends on numerous factors background luminance stimulus luminance size color and the duration of the test These parameters have been standardized to achieve reproducible measurements of light sensitivity So the Vision Monitor parameters are identical to those of the GOLDMANN perimeter e an ambient luminance of 10 cd m2 low photopic level that reduces the time for light adaptation e standardized test sizes 11 26 arc minutes V 103 arc minutes e a white color 10 94 Copyright 2014 Metrovision Maps of measuring points Most perimetry devices use a map of points arranged according to a regular grid pattern for example every 6 degrees The corresponding exams procedures are availab
72. ted deficits 2 2 s Va Vo 4 a m P a xT a x 3 m 4 d a lt lt SU oh n S a s E B N s gt 5 m gt E m sp5 E S up 2 Probabilities mp lt 1 Probabilities of deficits gp 0 5 of corrected deficits The global analysis determines several global indices that characterize the visual field Mean Deficit 1 0 54B Corrected Mean Deficit 2 1 548 Deficit Variance Spatial Fluctuation 2 Temporal Fluctuation 1 4 Mean Time Response 599 ms Fixation Losses 143 Attention Losses 044 Duration of Exam 4mn 14s Correction af Reference Map 1 Pupil diameter Stimulus 13 zum af global and local deficits 2 local deficits only e The average deficit is defined as the average visual loss that is computed over the whole set of measuring points with respect to the normal data from age matched controls WARNING An alteration is characterized by a deficit with a positive sign Do not confuse with the sensitivity threshold deviation which has a negative sign in case of alteration 38 94 Copyright 2014 Metrovision e The corrected average deficit provides the average sensitivity loss of the patient with respect to his or her own normal map corrected by his own base level e The
73. ted eye and the same birth date The program displays last exam performed the list of exams sorted in chronologic order e the evolution of global indices e the map with the velocity of sensitivity variation over the last exams Evolution map Evolution of global erar indices exams 39 94 Copyright 2014 Metrovision Easy way These different windows can be displayed one by one by clicking on the Vision Monitor control bar ET Click here ta display the analysis windows Visual field List of exams LISTE DES EXAMENS The program displays the list of exams selected in chronological order A checkbox is associated to each exam of the list This checkbox can be used to invalidater unvalidate the results taken into account in the analysis Evolution of global indices This graph represents the evolution in time of each of the global indices e the average deficit e thecorrected average deficit the spatial fluctuation thetemporal fluctuation e average response time D MEAN DEFICIT Oe CORRECTED MEAN DEFICIT O X DEFICITS VARIANCE SPATIAL FLUCTUATION Ce TEMPORAL FLUCTUATION B of rates of evolution The program automatically determines the rate of evolution of sensitivity threshold in each point of the visual field e zones for which a loss of sensitivity is observed are displayed in red color e zones for which sensi
74. threshold is normal Large blind spot related to the myopia Analysis of visual field alterations No diffuse alteration Wide upper deficit linked to the blind spot and approaching at 2 degrees from the fovea The visual field is free from any deficit Global indices are significantly altered e METROVISI N g 55 94 Copyright 2014 Metrovision Visual field Established glaucoma stade 3 Reference glaucoma013 patients ID glaucoma013 LE Rx non file number N197523 exam date 05 04 2006 09 38 birth date 06 02 1948 exam FAST24 comments VISUAL FIELD EXAM 2D sensitivity map 3D sensitivity map BENEM EITT MODE 4 B 20 24 28 3245 Deficit Volume 552dB deq2 Values Values of deficits of corrected deficits Tested Points 55 E Hg Mean Deficit 1 Corrected Mean Deficit 2 a Deficit Variance m M Spatial Fuctuation 3 7dB B Temporal Fluctuation 0 998 E 3 T Mean Time Response 492 ms WB Fixation Losses 246 gj Attention Losses 146 KES Duration of Exam Tmn 44s 5 El dm H Correction of Reference Map 2 g p lt 5 B B Pupil diameter pen p lt 2 m Stimulus HI Probabilities mp lt 1 Probabilities 1 sumof global and local deficits of deficits 0 5 of corrected deficits 2 local deficits only 56 94 Copyright 2014 Metrovi
75. tion u Mean Time Response 558 ms E E Fixation Losses Attention Losses DMT Duration of Exam 35s H Correction of Reference Map 4 2 prr E NE mp 2 Stimulus III Proba bilities 8 Probabilities 1 sumof global and local deficits of deficits gp 0 5 of corrected deficits 2 local deficits only 66 94 Copyright 2014 Metrovision Clinical examples 79 years old emmetropic patient Right eye examined with the FAST30 procedure and a 3D optical correction Good quality exam There are no attention losses The numerous fixation losses 10 on 17 controls can be explained by the presence of a central scotoma and the fixation on the inferior edge of this scotoma The presence of a well delimited blind spot shows a good stability of the fixation Analysis of the visual field deficits There is no diffuse deficit Purely central deficit with steep slopes indicating a process without fast evolution METRC VISION 67 94 Copyright 2014 Metrovision Hydroxychloroquine intoxication Reference aps001 patient s ID aps001 file number N17655 birth date 25 09 1946 VISUAL FIELD EXAM 2D sensitivity map 30 20 0 0 0 20 30 SENSITIVITY MODE s rn wr rr 0 8 2 6 20 24 28 32dB Values Values of deficits a B E p gt 5 m p lt 5 m p lt 2 Probabilities lt 1 Probabilities of deficits m p lt 0 5 of
76. tions CALCUL Notes Visual field exams performed in automated static perimetry use size 111 stimulations which are far less sensitive to refractive errors than stimuli with smaller sizes 0 and Il Realization exam SLOAN Vision Research 1961 has refractive correction during the evaluation of demonstrated that a small refractive error the periphery but only when the program does not alter significantly the sensitivity starts the assessment of the central visual field thresholds with size III stimuli the program will pause at the appropriate RE time e The correction for astigmatism is taken into account by adding half the value of the e The correction value given by the program cylinder correction to the spherical correction corresponds to the nearest correction available in the set of large field lenses e When the pupils are dilated with a mydriatic provided by Metrovision However it is agent that paralyses the accommodation possible to obtain the exact spherical refractive correction does no longer depend VM correction putting in the configuration file the on age In that case select the option dilated P following lines pupils REFRACTION e f the examination protocol starts with the metrovision false evaluation of the periphery do not put the B Installation on MonCvONE After the identification of the patient and tested eye the hea
77. tivity thresholds are improving are displayed in green color if the evolution rate is statistically significant the value of the rate of evolution is displayed in dB per unit of time e if the evolution is not statistically significant the program displays a question mark The analysis is by default performed on the last 3 visual fields or 2 if only 2 results are available Tssrstr r a a i ee aa 2 3 16 08 04 02 02 Of 08 16 3 12 dE year DETERIORATION IMPROVEMENT from 18 08 1998 to 25 02 1399 The number of exams used for the analysis can be modified by pressing the right and left arrows of the keyboard after having selected the window with the map of evolution Exams can also be invalidated by deselecting them in the list of examinations The statistical validity criterion is based on the Student law with a confidence interval of 95 percent 40 94 Copyright 2014 Metrovision Exploitation results Analysis of neurological visual fields The analysis of neurological visual fields program e displays both eyes visual fields e compares the deficits of visual field quadrants e compares the deficits of right and left hemi fields compares the deficits of upper and lower hemi fields e compare the deficit of both eyes visual fields congruence CHAMP VISUEL OG CHAMP VISUEL OD 1 d x N x Y A N a 3 azla a 2
78. y adenomas assessment of modern means of neuro ophthalmological subjective investigation Neuro ophthalmology 1991 2 1 19 24 GROCHOWICKI M VIGHETTO A PISSAVIN C Pseudotumor cerebri Longitudinal study using contrast sensitivity and automated static perimetry Neuro Ophthalmology 1990 10 2 97 108 HUTCHING N HOSKING S L WILD J M FLANAGAN J G Long term fluctuation in short wavelength automated perimetry in glaucoma suspects and glaucoma patients Invest Ophthalmol Vis Sci 2011 42 10 2332 2337 50 12866 Norme internationale sur les Instruments ophtalmiques P rim tres 2009 SAMPLE WEINREB R N Color perimetry for assessment of primary open angle glaucoma Invest Ophthalmol Vis Sci 1990 31 9 1869 1875 SLOAN L L Area and luminance of test object as variables in examination of the visual field by projection perimetry Vision Research 1961 1 1 2 121 138 TROBE J D GLASER J S The visual fields manual A practical guide to testing and interpretation Triad Publishing Co 1983 ROVISION 93 94 Copyright 2014 Metrovision Visual field e VAN DER SCHOOT J REUS N J COLEN T P LEMIJ H G The ability of short wavelength perimetry to predict conversion to glaucoma Ophthalmology 2010 117 1 30 34 e VERNIER F CHARLIER J NGUYEN D Application of CRT technology to the clinical evaluation of visual functions Optical Engineering 1988 27 123 128 e VERRIEST G

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