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Perimetry you can trust.
Haag-StreitThe technology leader in perimetry.
Your reliable partner.
Octopus & Goldmann Kinetic
Perimetry Perimetry
Matthias MonhartProduct Manager
20092009
Perimetry you can trust.
Matthias J. MonhartEngineer FH (BSc)
in Electronics, Measurement and Control Product Specialist in Perimetry
HAAG-STREIT AG
The instructor has a financial interest in the subject
Octopus & Goldmann
Kinetic Perimetry
Perimetry you can trust.
• Kinetic Perimetry Principle
Examination
Results
Agenda
Perimetry you can trust.
Onset End stage
Functional Test:B/Y-SWAP, FDT, Flicker
Structural Test:Stereo Fundus-PhotographyImaging (HRT, OCT, GDX)
Standard W/W PerimetryLow Vision
StrategyKinetic perimetry
HFA 10-2
Methods
Progression of the disease
Role of Perimetry
Application fields
Perimetry you can trust.
Sensitivity distribution in the eye:
Sensitivity drops steeply towards the periphery
In the macula, there is a sensitivity peak.
Hill-of-vision
Anatomy of the eye
Perimetry you can trust.
Static perimetry is ideal for measuring the rather flat shape of the central 30° field and is more sensitive than the kinetic method to detect early visual field loss.
StaticStimulus
KineticVector
90° 30° 0° 30° 90°
Sen
sitiv
ity
Kinetic perimetry is ideal for the periphery and deep local defects.
Static or Kinetic Perimetry
Application fields
Cross section through the hill-of-vision
Perimetry you can trust.
Multiple responses connect to one isopterline(Line of equivalent sensitivity)
Isopters
Kinetic Perimetry
Perimetry you can trust.
OSOS ODOD
Stimulus size III and the maximum Intensity (4e) in an average normal subject yield these eccentricities.
Theoretic eccentricity
Kinetic Perimetry
Perimetry you can trust.
Practical eccentricity
Kinetic Perimetry
Perimetry you can trust.
Prof. Hans Goldmann invented the
Haag-Streit Goldmann Perimeter and
set the standard for kinetic perimetry
since 1945.
Instruments: Goldmann
Kinetic Perimetry
Perimetry you can trust.
“Drawing” the test
Goldmann Perimetry
Perimetry you can trust.
“Drawing” in Windows
Octopus 101 GKP
Perimetry you can trust.
“Drawing” in Windows
Octopus 900 Goldmann
Perimetry you can trust.
1. Prepare the form
Goldmann Examination
Perimetry you can trust.
Stimulus size 0..V, @ Octopus I..V
Stimulus-Intensity 4,3,2,1 in 5dB stepsStimulus-Intensity a,b,c,d,e in 1dB steps
Maximum 4e = 0dB = 1000asb
Minimum 1a = 19dB = 13asb
2. Stimulus intensity
Goldmann Examination
Perimetry you can trust.
Blind spot location:
X = +15° for OD, -15° for OSY = -1° for OS and OD
Recommendations
I Blind spot, scotoma
III Periphery
V End stage / remaining vision
Comparison of stimulus size III with the sensitivity map of the blind spot(approx. 5° Horizontal, 6° Vertical)
3. Stimulus size
Goldmann Examination
Perimetry you can trust.
Identification of Patients: Identification of Patients:
Examination date:Examination date:
Pupil diameterPupil diameter
Small pupils influence the isopter sizeSmall pupils influence the isopter size
OS: left eyeOS: left eyeOD: right eyeOD: right eye
Use near correction for Use near correction for isopters and testing within 30°isopters and testing within 30°
4. Patient information
Goldmann Examination
Perimetry you can trust.
„Drawing“ of the examination on the Goldmann form
5. “Drawing” the exam
Goldmann Examination
Perimetry you can trust.
Only coarse calibration of stimulus and background intensities
Quality influenced by experience
Limited Repeatability
Different standards in every clinic
Limitations
Goldmann Perimetry
Perimetry you can trust.
The pantograph is replaced by the mouseThe pantograph is replaced by the mouse
assisted kinetic perimetry
From manual to computer
Perimetry you can trust.
The template „travels“ to the screen The template „travels“ to the screen
Octopus shows age matched norms for orientationOctopus shows age matched norms for orientation
assisted kinetic perimetry
From manual to computer
Perimetry you can trust.
Near correction for points (isopters) < 30°Near correction for points (isopters) < 30°same principle as in static perimetry same principle as in static perimetry
Goldmann und Goldmann und Octopus 900 Octopus 900 (30cm)(30cm)
30-40J30-40J +1.0+1.040-45J40-45J +1.5+1.545-50J45-50J +2.0+2.050-55J50-55J +2.5+2.555-60J55-60J +3.0+3.0>60J>60J +3.25+3.25
Octopus 101 GKP Octopus 101 GKP (42.5cm)(42.5cm)
40-44J40-44J +1.0+1.045-49J45-49J +1.25+1.2550-54J50-54J +1.75+1.75>55>55 +2.0+2.0
assisted kinetic perimetry
From manual to computer
Perimetry you can trust.
Stimulus size and -intensityStimulus size and -intensity
GoldmannGoldmann Octopus 101Octopus 101 Octopus 900Octopus 900
assisted kinetic perimetry
From manual to computer
Perimetry you can trust.
Constant velocities result in better reproducible test results
Recommendation <30°: 2°/Sec. >30°: 5°/Sec.
Preset of constant velocitiesPreset of constant velocities
assisted kinetic perimetry
From manual to computer
Perimetry you can trust.
Automatic and accurate calibration
Good quality exams based on constant velocities / stimulus movements
Automatic repetition of examination allows for follow up
General standards can more easily be applied and exchanged
Advantages
Octopus Goldmann Kinetic
Perimetry you can trust.
Test vectors for general examination
Guided vectors for special conditions, like the nasal step, where still a
constant velocity shall be maintained
Vectors define the path a stimulus movesVectors define the path a stimulus movesVector types
Octopus Goldmann Kinetic
Perimetry you can trust.
The RT (Reaction Time) vector must be visible right from the
start. The delay in response to an RT vector can be
compensated in regular responses.
stimulus visiblestimulus visible
response button pushedresponse button pushed
corrected responsecorrected response
Reaction time compensation
Octopus Goldmann Kinetic
Perimetry you can trust.
Only in Octopus 101:Only in Octopus 101:A perpendicular line A perpendicular line at the beginning of at the beginning of the vector indicates the vector indicates an early response. an early response. This means, it might This means, it might have been seen from have been seen from the start – or – the the start – or – the patient did produce a patient did produce a false positive false positive response.response.
Only in Octopus 101:Only in Octopus 101:A perpendicular line A perpendicular line at the beginning of at the beginning of the vector indicates the vector indicates an early response. an early response. This means, it might This means, it might have been seen from have been seen from the start – or – the the start – or – the patient did produce a patient did produce a false positive false positive response.response.
Possible early responses
Octopus Goldmann Kinetic
Perimetry you can trust.
Fluctuation:Fluctuation:Response fluctuation Response fluctuation exists in kinetic exists in kinetic perimetry just the perimetry just the same as in static same as in static perimetry. Repeating perimetry. Repeating vectors lead to vectors lead to responses that vary to responses that vary to a certain extent.a certain extent.
Fluctuation:Fluctuation:Response fluctuation Response fluctuation exists in kinetic exists in kinetic perimetry just the perimetry just the same as in static same as in static perimetry. Repeating perimetry. Repeating vectors lead to vectors lead to responses that vary to responses that vary to a certain extent.a certain extent.
Fluctuation
Octopus Goldmann Kinetic
Perimetry you can trust.
Search for scotoma with static points Search for scotoma with static points Stimulus I4e, 0°/Sec. (static), Example blind spot Stimulus I4e, 0°/Sec. (static), Example blind spot
1. search horizontal extent 1. search horizontal extent 2. search vertical extent 2. search vertical extent
Examination procedure
Octopus Goldmann Kinetic
Perimetry you can trust.
Define the size and shape with kinetic vectors Define the size and shape with kinetic vectors Stimulus I4e, 2°/Sec., example blind spotStimulus I4e, 2°/Sec., example blind spot
Draw vectors from inside of a scotoma to outside Draw vectors from inside of a scotoma to outside Vectors are placed starting in non-seeing area and ending in seeing area, ideally Vectors are placed starting in non-seeing area and ending in seeing area, ideally perpendicular to the border of the scotoma or visual field border perpendicular to the border of the scotoma or visual field border
Examination procedure
Octopus Goldmann Kinetic
Perimetry you can trust.
Reaction time testing and compensation Reaction time testing and compensation Stimulus I4e, 2°/Sec., example around the blind spot:Stimulus I4e, 2°/Sec., example around the blind spot:
RT-Vectors have to be visible all the time, they thus must start RT-Vectors have to be visible all the time, they thus must start in areas of preserved vision.in areas of preserved vision.Responses on the right side include reaction time compensation.Responses on the right side include reaction time compensation.
Examination procedure
Octopus Goldmann Kinetic
Perimetry you can trust.
The operation of the Goldmann pantograph can The operation of the Goldmann pantograph can be reproduced by moving the mouse. be reproduced by moving the mouse. Stimulus I4e, „free“, example of manual spiraling at the blind spot:Stimulus I4e, „free“, example of manual spiraling at the blind spot:
Drawing spirals is one method of searching remaining visionDrawing spirals is one method of searching remaining vision
0-1°/sec black
2-3°/sec blue
4-7°/sec green
≥ 8°/sec red
Manual operation
Octopus Goldmann Kinetic
Perimetry you can trust.
Setting anchor vectors to judge the quadrantsSetting anchor vectors to judge the quadrants
Vectors towards the center (Meridians) on 45,135,225Vectors towards the center (Meridians) on 45,135,225and 315° from outside to inside the normal range.and 315° from outside to inside the normal range.
Stimulus III4e (oder III3e), 5°/Sec., example quadrantanopiaStimulus III4e (oder III3e), 5°/Sec., example quadrantanopia
Examination procedure
Octopus Goldmann Kinetic
Perimetry you can trust.
Outlining a quadrantanopia Outlining a quadrantanopia
Best accuracy is given when vectors cross the Best accuracy is given when vectors cross the scotoma borders perpendicularly scotoma borders perpendicularly
Examination procedure
Octopus Goldmann Kinetic
Perimetry you can trust.
The nasal stepThe nasal step
Especially in glaucoma, a sensitivity difference slightly Especially in glaucoma, a sensitivity difference slightly above and below the nasal midline appears:above and below the nasal midline appears:The guided vectors can be used in this situation.The guided vectors can be used in this situation.
Examination procedure
Octopus Goldmann Kinetic
Perimetry you can trust.
Suggested procedure:Suggested procedure:
1)1) Blind spot with I4e, 2°/Sec.Blind spot with I4e, 2°/Sec.2)2) Test reaction timeTest reaction time3)3) Outer periphery with III4e Outer periphery with III4e
(sometimes III3e) 5°/Sec.(sometimes III3e) 5°/Sec.4)4) Additional isopters, eg. Additional isopters, eg.
I3e, 5°/Sec.I3e, 5°/Sec.5)5) I2e, 3 oder 5°/Sek.I2e, 3 oder 5°/Sek.
Please refer to the Octopus 101 Please refer to the Octopus 101 GKP manual or Octopus 900 SOPGKP manual or Octopus 900 SOP(Standard Operating Procedure)(Standard Operating Procedure)
Conclusion Conclusion
Examination procedure
Octopus Goldmann Kinetic
Perimetry you can trust.
Application example - 1
Reaction time compensation
Perimetry you can trust.
Blind spot size in 2 eyes, red isopter: not corrected
Application example - 2
Reaction time compensation
Perimetry you can trust.
Without compensation With RT compensation: 2300ms (!)
55 yrs, female, OD
Application example - 3
Reaction time compensation
Perimetry you can trust.
Testing the real visual field Testing the real visual field
Receiving reaction time as Receiving reaction time as additional information additional information
Better reproducibilityBetter reproducibility
Advantages
Reaction time compensation
Perimetry you can trust.
Automating testsUse an existing test or draw a generic oneUse an existing test or draw a generic one
When drawing a generic test, click „Pause“ firstWhen drawing a generic test, click „Pause“ first
Octopus Goldmann Kinetic
Perimetry you can trust.
Automating testsSaving an existing test as standard testSaving an existing test as standard test
Octopus Goldmann Kinetic
Perimetry you can trust.
Automating testsSelecting a test from the librarySelecting a test from the library
Octopus Goldmann Kinetic
Perimetry you can trust.
Automating testsRunning the test automaticallyRunning the test automatically
Octopus Goldmann Kinetic
Perimetry you can trust.
Standardization of tests within Standardization of tests within the clinic the clinic
Combination of intial standard testCombination of intial standard test and when needed individual and when needed individual continutation of the test continutation of the test
Simple to administer and delegateSimple to administer and delegate
Advantages
Automated testing
Perimetry you can trust.
Follow up button
Automated testing
Perimetry you can trust.
The previous test performed onThe previous test performed on a patient is automatically repeated, a patient is automatically repeated, no matter whether it was based on no matter whether it was based on a standard test or was individual a standard test or was individual Allows for progression analysis Allows for progression analysis Improves reliability Improves reliability
Simple to performSimple to perform
Follow up button
Automated testing
Perimetry you can trust.
DescriptionGoldmann like templateAge matched normsReaction time
compensation Individual test libraryFollow up button Implementation of
„Complete examination“ and „Randomized sequence“ functions
Kinetic examination produces EMR response file
Features
Octopus Goldmann Kinetic
Perimetry you can trust.
DescriptionTurn on/off vectorsZoom function „What you see is what
you get“ print function
Display and printout
Octopus Goldmann Kinetic
Perimetry you can trust.
Ausdrucksfunktionen
Kinetic printout
Perimetry you can trust.
Advanced visual field defects of any kind
Patients that require an interactive examination and cannot perform a purely automated test (when used in semi-automated or manual testing mode)
Neuro-Ophthalmic conditions
Peripheral visual field quantification and follow up for studying the medical safety of drugs
Application
Kinetic Perimetry
Perimetry you can trust.
Static & kinetic perimetry
Application
Perimetry you can trust.
Static & kinetic perimetry
Application
Example for the
remainin local
drop of sensitivity
years after a
Berlin edema
Perimetry you can trust.
Glaucoma
OS
Aulhorn III, S.M., f, 1944
Perimetry you can trust.
Glaucoma
OS
Aulhorn IV, S.L., f, 1933
Perimetry you can trust.
Hemianopsia
Perimetry you can trust.
Double Vision
Diplopia
Octopus & Goldmann kinetic perimetry can be used with different response criteria
In this case, the patient shall respond whenever seeing two targets instead of one
Perimetry you can trust.
Training software downloadable free of charge on www.haag-streit.com
10 cases, partly with patient history
Full functionality
Learn, teach, repeat
Kinetic Training
Perimetry you can trust.
Haag-StreitThe technology leader in perimetry.
Your reliable partner.
Octopus & Goldmann Kinetic
Perimetry
Matthias Monhart
Thank youThank you