automatedvisualfieldanalysis-privatefloridaresearch.docVIP

Automated Visual Field Analysis Joseph Sowka, OD, FAAO, Diplomate Visual Field Changes in Glaucoma Damage may be widespread or focal Relative scotomas Fluctuating scotomas Absolute scotomas Paracentral scotomas (5-15() Nasal steps Arcuate scotomas (Bjerrum’s scotomas) Altitudinal defects General depression and in sensitivity “diffuse loss” is actually very rare in glaucoma and more indicative of cataract, miosis, or other media/refractive issues. Clinical Pearl: The earliest visual field defect in glaucoma is increased short term fluctuation. The next is a shallow fluctuating scotoma. Clinical Pearl: The majority of automated threshold field tests performed today test only the central 240. This implies that you can miss up to 7% of initial glaucoma defects. However, careful examination of the disc, IOP, and other risk factors should elevate your suspicion and lead you to utilize more peripheral field tests and thus raise your sensitivity to nearly 100%. Clinical Pearl: You can do a field on a dilated or non-dilated patient, but you cannot do a field while the patient is dilating. Sensitivity: Up to 50% of the optic nerve fibers can be destroyed in a glaucoma patient who may demonstrate full fields It may take 4-6 years before ganglion cell damage will be detectable on conventional visual fields Threshold test strategies: Threshold testing strategies can be full threshold, SITA Standard (SS), or SITA Fast (SF) These are all names of threshold strategies designed to identify the retinal sensitivities at predetermined points in the visual field. 30-2 (30 degrees tested) 24-2 (24 degrees tested) 10-2 (10 degrees tested) Swedish Interactive Thresholding Algorithm (SITA) Threshold strategy which reduces threshold test time down to 3-5 minutes from original 15 – 18 minutes (Full Threshold algorithm) without sacrificing accuracy SITA standard threshold field is a good routine test for diagnosing and following glaucoma SITA Fast is a good screening test and