visual field digest 7th edition book digital · 2018-05-17 · 20 25 probabilities corrected...
TRANSCRIPT
255
CHAPTER 13CLINICAL CASES
INTRODUCTION
The previous chapters of this book have systematically presented various aspects of visual field testing and
is now put into a clinical context. In this chapter, 23 clin-
-mic disorder and retinal disease. The selected cases are model cases. They present typical defect patterns of the disease rather than unusual cases and are reliable, free of artifacts and can be fully trusted.
relevant clinical information. Background information on the patient’s history as well as other diagnostic results such as visual acuity, IOP, fundus images, OCT scans and MRIs which are relevant for clinical decision making, are shown. In all examples, visual acuity is expressed in dec-imal units for uniformity, but the Octopus allows users to select different units when performing the test. In each
are presented and summarized.
An overview of all available cases is presented on the next page.
256 Chapter 13 | Clinical cases
GLAUCOMA – SINGLE FIELD
1. Very early stage glaucoma (normal tension glaucoma)2. Early stage glaucoma (normal tension glaucoma)3. Early stage glaucoma (primary open-angle glaucoma)4. Early stage glaucoma (with cataract)5. Early stage glaucoma (normal tension glaucoma)6. Early stage glaucoma (primary open-angle glaucoma)7. Moderate glaucoma (normal tension glaucoma)8. Moderate glaucoma (primary open-angle glaucoma)9. Late stage glaucoma (normal tension glaucoma)
GLAUCOMA – TREND
10. Early to moderate glaucoma (normal tension glaucoma)11. Early to moderate glaucoma (primary open-angle glaucoma)12. Early to moderate glaucoma (primary open-angle glaucoma)13. Early to moderate glaucoma (normal tension glaucoma)14. Early to moderate glaucoma (primary open-angle glaucoma)15. End-stage glaucoma (exfolitative glaucoma)
NEUROLOGICAL DISEASES
16. Cerebral infarction (bilateral)17. Leber hereditary optic neuropathy (bilateral)18. Bilateral optic neuritis (multiple sclerosis)19. Tuberculum sellae meningioma (bilateral)
RETINAL DISEASES
20. Age-related macular degeneration21. Branch central retinal artery occlusion22. Macular hole23. Branch central retinal vein occlusion
257
OCTOPUS 101
Demo Jane, 1947/01/01 (57yrs)Right eye (OD) / 2004/11/18 / 12:01:27Seven-in-One
Classification:Comment:
:]gHmm[ POI:]mm[ lipuPRefraction S/C/A: -3.25// VA: 1.0Catch trials: 0/26 (0%) +, 1/26 (4%) - RF: 1.9Parameters: 4 / 1000 asb III 100 ms Duration: 16:41Programs: 32 Standard White/White / Normal Questions / repetitions: 520 / 0 30°
MS [dB]: 28.0MD [< 2.0 dB]: -1.5sLV [< 2.5 dB]: 1.8CsLV [dB]: 1.5SF [dB]: 1.6
95%..100%83%...94%71%...82%59%...70%47%...58%35%...46%23%...34%11%...22% 0%...10%
Grayscale (CO)
-1.9-1.6
3.1-1.1-
Values
2929
29 30
33
26
29
26
30
31
27
28
22
28
26
30
26
28
28
31
28 28
28 28 28 29
29
28
28 31 31 30
29 28
25 23
30 29
6292
21 30 32 27
26 26 31 29
9282
27 27
28 27
28 27 27 29
30 30 31 29
8262
9282
29 29 29 31
27 28 29 28
27.927.4
8.829.72
Comparisons
++
+ +
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+ +
+ + + +
+
+
+ + + +
+ +
+ +
+ +
++
+ + + +
+ + + +
++
+ +
+ +
+ + + +
+ + + +
++
++
+ + + +
+ + + +
Corrected comparisons
++
+ +
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+ +
+ + + +
+
+
+ + + +
+ +
+ +
+ +
++
5 + + +
+ 5 + +
++
+ +
+ +
+ + + +
+ + + +
++
++
+ + + +
+ + + +
Defect curve
Diffuse defect [dB]: -1.1
471
5%
95%
-5
0
5
10
15
20
25
Probabilities Corrected probabilities
p > 5p < 5p < 2p < 1p < 0,5
OCTOPUS®
Rank
Def
ect (
dB)
All testlocationsat p > 5%
Defect Curvein normal
range
Glaucoma | Single field
• 57-year-old female, no family history • Patient reported decreased visual acuity in both eyes and discomfort in left eye
• 15 mmHg/ 1.2 - 5.25 (sph)
• C/D = 0.9 • Rim thinning at 6 to 11 o'clock position • Optic disc hemorrhage and narrow slit-like RNFL defect at 11 o'clock position • Temporal alpha zone and beta zone peripapillary chorioretinal atrophy (PPA)
• hemorrhage, and RNFL loss
PATIENT
IOP/VA corr
FUNDUS
VERY EARLY STAGE GLAUCOMA (NORMAL TENSION GLAUCOMA)1
258
Rank
Def
ect (
dB)
OCTOPUS 101
Demo Jane, 1942/01/01 (53yrs)Left eye (OS) / 1996/06/21 / 14:24:40Seven-in-One
Classification:Comment: NTG
Pupil [mm]: 5.3 IOP [mmHg]: 12Refraction S/C/A: // VA: 1.2Catch trials: 0/24 (0%) +, 1/24 (4%) - RF: 2.0Parameters: 4 / 1000 asb III 100 ms Duration: 16:49Programs: G Standard White/White / Normal Questions / repetitions: 481 / 1 30°
MS [dB]: 25.9MD [< 2.0 dB]: 1.6sLV [< 2.5 dB]: 4.2CsLV [dB]: 3.9SF [dB]: 1.7
95%..100%83%...94%71%...82%59%...70%47%...58%35%...46%23%...34%11%...22% 0%...10%
Grayscale (CO)
6.90.7
9.0-3.0-
Values
2425
30 30
16
27
17
33
27
28
26
26
28
30
30
27
32 23
3334
21 24
2828
24
31
28
29
10
25
23
27
3432 17
3230
4242
2727
1282
2728
27 23
3231
8172
3125
14
23
23 21
2727
20.026.2
6.825.82
Comparisons
5+
+ +
14
+
10
+
+
+
+
+
+
+
+
+
+ 9++
+ +
++
5
+
+
+
15
+
+
+
++ 13
++
+ +
++
++
++
+ 6
++
+ 9
++
11
+
+ +
++
Corrected comparisons
5+
+ +
14
+
10
+
+
+
+
+
+
+
+
+
+ 9++
+ +
++
5
+
+
+
15
+
+
+
++ 13
++
+ +
++
++
++
+ 6
++
+ 9
++
10
+
+ +
++
Defect curve
Probabilities Corrected probabilities
p > 5p < 5p < 2p < 1p < 0,5
Diffuse defect [dB]: -1.1
471
5%
95%
-5
0
5
10
15
20
25
OCTOPUS®
Cluster ofabnormal locations
with p < 0.5 %
Chapter 13 | Clinical cases
• Mild superior nasal step and mild superior paracentral scotoma•
• 53-year-old female, no family history• Optic nerve cupping observed during unrelated emergency eye surgery
• 12 mmHg/ 1.2 + 0.25 (sph)
• C/D = 0.8• Rim thinning and RNFL loss at 5 to 6 o'clock position
PATIENT
IOP/VA corr
FUNDUS
2 EARLY STAGE GLAUCOMA (NORMAL TENSION GLAUCOMA)
259
Demo Jane, 1958/01/01 (56yrs)Right eye (OD) / 2015/01/09 / 01:31:08Four-in-One
Comment:
NV: T31 V1.0Pupil [mm]: 3.0 IOP [mmHg]:Refraction S/C/A: VA [m]:Catch trials: 0/4 (0%) +, 0/4 (0%) - RF: 0.0Parameters: 31.4 / 4000 asb III 100 ms Duration: 02:18Programs: G Standard White/White / TOP Questions / repetitions: 72 / 0 MS [dB]: 26.4
MD [< 2.0 dB]: 0.9sLV [< 2.5 dB]: 4.5
30°
Grayscale (CO)
MD [dB]2.52.2
-1.0 -0.5
Cluster analysis [dB]
+
+
3.1
5.47.4
++
++
+
Defect curve Polar analysis
10 20 30[dB]
S
IT N
OCTOPUS®
Diffuse defect [dB]: 2.3
591
5%
95%
-5
0
5
10
15
20
25
Rank
Def
ect (
dB)
Structural damagesuggested at 7 to 8
o'clock position
Nasal step,superior arcuate
and superiorparacentral defect
Local defect(glaucoma)
GC thinninginferortemporally
RNFL lossinferortemporally
Glaucoma | Single field
• Nasal step, superior arcuate and superior paracentral defect apparent in Cluster Analysis
position) and inferotemporal structural loss (fundus photo, RNFL & GC thickness map)
• 56-year-old female, her brother has POAG• Patient visited clinic to rule out glaucoma because of her family history
• 24 mmHg /1.0 - 3.25 (sph)
• Inferior RNFL defects
• RNFL and ganglion cell loss inferotemporally at 7 to 8 o’clock position
PATIENT
IOP/VA corr
FUNDUS
OCT
3 EARLY STAGE GLAUCOMA (PRIMARY OPEN-ANGLE GLAUCOMA)
260
Demo John, 1944/01/01 (71yrs)Left eye (OS) / 2015/04/29 / 14:57:18Four-in-One
Comment:
NV: T31 V1.0Pupil [mm]: 3.7 IOP [mmHg]:Refraction S/C/A: VA [m]:Catch trials: 2/4 (50%) +, 0/4 (0%) - RF: 25.0Parameters: 31.4 / 4000 asb III 100 ms Duration: 02:25Programs: G Standard White/White / TOP Questions / repetitions: 74 / 0 MS [dB]: 23.0
MD [< 2.0 dB]: 3.3sLV [< 2.5 dB]: 3.4
30°
Grayscale (CO)
MD [dB]6.44.2
0.1 2.5
Corrected cluster analysis [dB]
+
+
2.2
7.4+
++
++
+
+
+
2.2
7.4+
++
++
+
Defect curve Polar analysis
102030[dB]
S
IN T
OCTOPUS®
Diffuse defect [dB]: 2.3
591
5%
95%
-5
0
5
10
15
20
25
EyeSuite™ Static perimetry, V3.5.0OCTOPUS 300
Rank
Def
ect (
dB)
Nasal step (local defect)
Diffuse defect(cataract)
Structuraldamage
suggested at5 to 6 o'clock
positionLocal defect(glaucoma)
Hazy due tocataract
Chapter 13 | Clinical cases
• 71-year-old male, no family history• Patient reported defective vision in both eyes over the last 6 months and glare at night while crossing roads
• 24 mmHg/ 0.7 + 1.75 (sph), - 1.25 (cyl) x 80°
• Fundus image hazy due to cataract
• RNFL loss and ganglion cell loss at 5 to 6 o’clock position
• Both diffuse defect (due to cataract) and local defect (due to glaucoma) in Defect Curve• Corrected Cluster Analysis (removing diffuse defect) shows superior nasal step
position) and inferotemporal structural loss (fundus photo, RNFL & GC thickness map)
PATIENT
IOP/VA corr
FUNDUS
OCT
EARLY STAGE GLAUCOMA (WITH CATARACT)4
261
Rank
Def
ect (
dB)
Defect curve
OCTOPUS 101
Demo Jane, 1944/01/01 (58yrs)Left eye (OS) / 2003/03/14 / 16:43:49Seven-in-One
Classification:Comment: Gla
Pupil [mm]: 5.0 IOP [mmHg]: 13Refraction S/C/A: +0.5/-0.75/80 VA: 1.2Catch trials: 3/23 (13%) +, 0/23 (0%) - RF: 6.5Parameters: 4 / 1000 asb III 100 ms Duration: 15:23Programs: G Standard White/White / Normal Questions / repetitions: 459 / 0 30°
MS [dB]: 25.0MD [< 2.0 dB]: 2.2sLV [< 2.5 dB]: 5.8CsLV [dB]: 5.5SF [dB]: 2.8
95%..100%83%...94%71%...82%59%...70%47%...58%35%...46%23%...34%11%...22% 0%...10%
Grayscale (CO)
3.46.9
5.0-7.0-
Values
28
29 29
32
30
29
15
27
26
36
29
28
21
27
27
27 24
3331
22 23
2728
21
30
24
29
18
26
21
26
3221 31
3131
4212
2426
3252
2627
23
3032
4232
2827
23
23
20 21
2626
23.219.8
0.826.82
Comparisons
+
+ ++
+
+
15
+
+
+
+
+
8
+
+
+ 7++
+ +
++
7
+
+
+
7
+
+
+
+8 +
++
+ +
++
++
++
5
++
+ +
++
+
+
+ +
++
Corrected comparisons
+
+ ++
+
+
14
+
+
+
+
+
8
+
+
+ 7++
+ +
++
7
+
+
+
6
+
+
+
+8 +
++
+ +
++
++
++
5
++
+ +
++
+
+
+ +
++
Probabilities Corrected probabilities
p > 5p < 5p < 2p < 1p < 0,5
OCTOPUS®
Diffuse defect [dB]: -1.1
471
5%
95%
-5
0
5
10
15
20
25
Absolute defect(sensitivity threshold 0 dB)
Glaucoma | Single field
• 58-year-old female, father had glaucoma• Optic nerve cupping detected during routine medical visit
• 16 mmHg/ 1.2 - 1.0 (sph), - 0.75 (cyl) x 80°
• C/D = 0.9• Rim thinning and wide RNFL loss at 5 to 6 o'clock position
• Dense paracentral scotoma•
PATIENT
IOP/VA corr
FUNDUS
EARLY STAGE GLAUCOMA (NORMAL TENSION GLAUCOMA)5
262
Rank
Def
ect (
dB)
OCTOPUS 101
Demo John, 1951/01/01 (55yrs)Left eye (OS) / 2007/05/11 / 10:02:54Seven-in-One
Classification:Comment:
Pupil [mm]: 6.7 IOP [mmHg]:Refraction S/C/A: -2.75/-1.0/180 VA: 1.0Catch trials: 0/22 (0%) +, 0/23 (0%) - RF: 0.0Parameters: 4 / 1000 asb III 100 ms Duration: 13:43Programs: G Standard White/White / Normal Questions / repetitions: 447 / 0 30°
MS [dB]: 24.2MD [< 2.0 dB]: 3.3sLV [< 2.5 dB]: 8.7CsLV [dB]: 8.6SF [dB]: 1.5
95%..100%83%...94%71%...82%59%...70%47%...58%35%...46%23%...34%11%...22% 0%...10%
Grayscale (CO)
15.11.2
4.1-0.2-
Values
921
31 30
31
31
29
32
31
30
31
17
27
10
18
533 32
3133
25 23
3030
3
30
28
30
4
29
27
29
3430 3
3131
9162
2431
692
2729
23 3
3031
612
2830
15
28
24 23
2930
11.725.6
0.921.03
Comparisons
207
+ ++
+
++
+
+
+
10
+20
10
22+ +
++
+ +
++
26
+
+
+
21
+
+
+
++ 27
++
+ 5
++
91+
++
6 26
++
6 21
++
9
+
+ +
++
Corrected comparisons
218
+ ++
+
++
+
+
+
10
+21
10
22+ +
++
+ +
++
26
+
+
+
22
+
+
+
++ 28
++
+ 6
++
02+
++
7 26
++
7 22
++
10
+
+ +
++
Defect curve
Probabilities Corrected probabilities
p > 5p < 5p < 2p < 1p < 0,5
OCTOPUS®
Diffuse defect [dB]: -1.1
471
5%
95%
-5
0
5
10
15
20
25
Very reliable test
Local defect
Chapter 13 | Clinical cases
•
• 55-year-old male, no family history• Patient reported decreased visual acuity and blurred vision
• 23 mmHg/ 1.2 - 4.25 (sph), - 1.0 (cyl) x 180°
• C/D = 0.8• Small disc• Rim thinning at 5 to 6 o'clock position
PATIENT
IOP/VA corr
FUNDUS
6 EARLY STAGE GLAUCOMA (PRIMARY OPEN-ANGLE GLAUCOMA)
263
Rank
Def
ect (
dB)
Demo Jane, 1947/01/01 (57yrs)Left eye (OS) / 2004/11/18 / 12:25:31Seven-in-One
Classification:Comment:
Pupil [mm]: 5.8 IOP [mmHg]:Refraction S/C/A: -3.25// VA: 1.0Catch trials: 0/32 (0%) +, 2/33 (6%) - RF: 3.0Parameters: 4 / 1000 asb III 100 ms Duration: 21:13Programs: 32 Standard White/White / Normal Questions / repetitions: 642 / 0 30°
MS [dB]: 18.4MD [< 2.0 dB]: 8.2sLV [< 2.5 dB]: 10.9CsLV [dB]: 11.0SF [dB]: 2.2
95%..100%83%...94%71%...82%59%...70%47%...58%35%...46%23%...34%11%...22% 0%...10%
Grayscale (CO)
14.11.9
5.416.1
Values
616
11
24
27
28
32
23
13
2
29
31
28
28
27
32
1
17
26
2227
11222527
4
141827
2729
2017
2025
328
412428
262728
27
328
2627
15232529
227
928
28
172429
26222926
11.724.1
3.219.52
Comparisons
2211
18
+
+
+
+
+
13
22
+
+
+
+
+
+
24
10
+
++
135++
24
1110+
++
+6
6+
23+
21295+
+++
+
24+
++
9+++
26+
18+
+
126+
+5++
Corrected comparisons
2211
17
+
+
+
+
+
12
22
+
+
+
+
+
+
23
9
+
++
135++
24
1010+
++
+5
6+
22+
2028++
+++
+
24+
++
8+++
26+
17+
+
115+
++++
Defect curve
Probabilities Corrected probabilities
p > 5p < 5p < 2p < 1p < 0,5
OCTOPUS 101OCTOPUS®
Diffuse defect [dB]: -1.1
471
5%
95%
-5
0
5
10
15
20
25
Large sLV showssevere local defect
Glaucoma | Single field
• 57-year-old female, no family history• Patient reported decreased visual acuity in both eyes and discomfort in left eye
• 16 mmHg/ 1.0 - 5.5 (sph)
• C/D = 0.95• Rim thinning at 12 to 6 o'clock position• Vein angulation and bayoneting at 12 and 6 o'clock position
•
PATIENT
IOP/VA corr
FUNDUS
MODERATE GLAUCOMA (NORMAL TENSION GLAUCOMA)7
264
Rank
Def
ect (
dB)
Demo Jane, 1954/01/01 (52yrs)Right eye (OD) / 2007/02/06 / 09:27:13Seven-in-One
Classification:Comment:
:]gHmm[ POI:]mm[ lipuP 13Refraction S/C/A: -3.0/-0.25/180 VA: 1.2Catch trials: 0/22 (0%) +, 5/23 (22%) - RF: 11.1Parameters: 4 / 1000 asb III 100 ms Duration: 14:18Programs: G Standard White/White / Normal Questions / repetitions: 448 / 4 30°
MS [dB]: 17.2MD [< 2.0 dB]: 10.4sLV [< 2.5 dB]: 10.4CsLV [dB]: 10.3SF [dB]: 2.1
95%..100%83%...94%71%...82%59%...70%47%...58%35%...46%23%...34%11%...22% 0%...10%
Grayscale (CO)
8.723.9
8.09.7
Values
15
21 31
29
26
25
29
25
14
21
24
12
337
29 33
911
26 27
16
28
297
15
27
27306
28 31
21
6222
23
629
1211
24 27
241
8281
11
5
25 24
18.43.1
5.720.02
Comparisons
13
8 ++
+
++
+
14
6
+
16
+24+ +
1615
+ +
13
+
+19
10
+
6+24
+ +
5
+ +
+
+81
1718
6 +
+27
11 +
13
19
+ +
Corrected comparisons
10
5 ++
+
++
+
11
+
+
13
+21+ +
1312
+ +
11
+
+16
7
+
++21
+ +
+
+ +
+
+51
1415
+ +
+24
8 +
10
16
+ +
Defect curve
Probabilities Corrected probabilities
p > 5p < 5p < 2p < 1p < 0,5
OCTOPUS 101OCTOPUS®
Diffuse defect [dB]: -1.1
471
5%
95%
-5
0
5
10
15
20
25
Absolute defects(sensitivity threshold 0 dB)
Chapter 13 | Clinical cases
•
• 52-year-old female, no family history• Patient diagnosed with glaucoma during medical check-up
• 20 mmHg/ 1.2 - 4.0 (sph), - 0.25 (cyl) x 180°
• C/D = 0.9• Rim thinning at 6 to 8 o'clock position and notching at 11 o’clock position• Large RNFL loss at 6 to 8 o'clock position and small RNFL loss at 11 o’clock position• Angulation of lower vein and undermining due to optic disc cupping• Temporal alpha zone and beta zone peripapillary chorioretinal atrophy (PPA)
PATIENT
IOP/VA corr
FUNDUS
8 MODERATE GLAUCOMA (PRIMARY OPEN-ANGLE GLAUCOMA)
265
Rank
Def
ect (
dB)
Demo John, 1954/01/01 (52yrs)Right eye (OD) / 2006/11/24 / 16:24:03Seven-in-One
Classification:Comment:
:]gHmm[ POI:]mm[ lipuP 16Refraction S/C/A: +2.75/-0.5/80 VA: 1.0Catch trials: 0/22 (0%) +, 11/22 (50%) - RF: 25.0Parameters: 4 / 1000 asb III 100 ms Duration: 13:53Programs: G Standard White/White / Normal Questions / repetitions: 438 / 0 30°
MS [dB]: 8.6MD [< 2.0 dB]: 19.0sLV [< 2.5 dB]: 10.1CsLV [dB]: 10.0SF [dB]: 2.4
95%..100%83%...94%71%...82%59%...70%47%...58%35%...46%23%...34%11%...22% 0%...10%
Grayscale (CO)
14.026.2
3.319.22
Values
1
1
26
21
27
21
28
283
29 25
69
5 14
24
20
15
17
3029
28
7
411
18
20
5
15
42
12 13
13.00.8
0.510.5
Comparisons
28
295
6
+5
+
+29+ 7
1917
22 14
+
8
10
10
+++
19
25 14
9
7
23
13
2022
14 14
Corrected comparisons
18
19+
+
++
+
+19+ +
107
13 5
+
+
+
+
+++
9
15 +
+
+
13
+
1112
+ +
Defect curve
Probabilities Corrected probabilities
p > 5p < 5p < 2p < 1p < 0,5
OCTOPUS 101OCTOPUS®
Diffuse defect [dB]: -1.1
471
5%
95%
-5
0
5
10
15
20
25
10 30 40 50 60 70 80 90
90105120 75 60
270255240 285 300
45135
315225
30150
330210
15165
345195
0180
Glaucoma | Single field
• 52-year-old male, no family history• Patient reported decreased visual acuity in both eyes
• 15 mmHg/ 1.2 + 1.25 (sph), - 0.5 (cyl) x 80°
• C/D = 1.0• Rim disappearance at 12 and 6 to 8 o’clock position• Narrowing of retinal artery
• Dense double arcuate defect with many locations showing absolute defects•••
PATIENT
IOP/VA corr
FUNDUS
LATE STAGE GLAUCOMA (NORMAL TENSION GLAUCOMA)9
266 Chapter 13 | Clinical cases
0
15
25
MD Mean defect
Slope: 0.8dB / Yr (p<0.5%)
0
15
sLV Loss variance
Slope: 0.7dB / Yr (p<0.5%)
0
25
DD Diffuse defect
Slope: 0.0dB / Yr
0
2007 2007
2007 200715
LD Local defect
Slope: 1.0dB / Yr (p<0.5%)
MD change0.8 dB/year
1998 2007
-0.0
1.92.4
1.1
0.0
1.9
0.1
-0.0-0.1
-0.2
102030[dB]
S
IN T
Structural progressionsuggested at 6 to 8
o'clock position
Cluster MD change1.1 – 2.4 dB/year
1998 2007
• 40-year-old male, no family history• Glaucoma was suspected after routine medical check-up
• 16 mmHg/1.2 - 2.5 (sph), - 1.5 (cyl) x 110°
• 1998 Rim thinning RNFL loss at 7 o’clock position• 2007 Rim thinning & RNFL loss at 6 to 8’clock position indicating progression
• Grayscale series shows expansion of superior nasal defect to a superior arcuate defect from 1998 to 2007• (Cluster MD change 1.1 to 2.4 dB/year)• Large (up to 30 dB) progression at 6 to 8 o’clock position in Polar Trend Analysis• Rim thinning and RNFL loss spreading from 7 o’clock position towards 6 and 8 o’clock position•
PATIENT
IOP/VA corr
FUNDUS
EARLY TO MODERATE GLAUCOMA (NORMAL TENSION GLAUCOMA)10
267Glaucoma | Trend
0
15
2001 200825
MD Mean defect
Slope: 0.4dB / Yr (p<0.5%)
0
2001 2008
2001 2008 2001 2008
15
sLV Loss variance
Slope: 0.8dB / Yr (p<0.5%)
0
25
DD Diffuse defect
Slope: -0.2dB / Yr
0
15
LD Local defect
Slope: 0.8dB / Yr (p<0.5%)
MD change0.4 dB/year
2001 2008
0.3
1.11.8
1.9
-0.2
2.1
-0.3
0.1-0.4
0.5
102030[dB]
S
IN T
Structural progressionsuggested at 6 to 8
o'clock position
2001 2008
Large progression at 6 to 8 o’clock position
• 68-year-old female, no family history
• 22 mmHg/1.5 + 0.75 (sph), - 0.25 (cyl) x 10°
• 2001 Mild, slit-like RNFL loss at 7 o’clock position. No rim thinning or notching.• 2008 RNFL loss & additional rim thinning with undermining at 6 to 8 o’clock position indicating progression; laser scar at 1 to 3 o’clock position due to treated BRVO, which developed in 2002 during follow up
• Grayscale series shows expansion of superior nasal defect to a superior arcuate defect from 2001 to 2008 and mild inferotemporal sensitivity loss due to BRVO • clusters (Cluster MD change 1.1 to 2.1 dB/year)• Large (up to 30 dB) progression at 6 to 8 o’clock position in Polar Trend Analysis• Rim thinning and RNFL loss spreading from 7 o’clock position towards 6 and 8 o'clock position•
PATIENT
IOP/VA corr
FUNDUS
11 EARLY TO MODERATE GLAUCOMA (PRIMARY OPEN-ANGLE GLAUCOMA)
268 Chapter 13 | Clinical cases
0
15
2002 2008
2002 2008
2002 2008
2002 2008
25
MD Mean defect
Slope: 0.5dB / Yr (p<0.5%)
0
15
sLV Loss variance
Slope: 0.1dB / Yr
0
25
DD Diffuse defect
Slope: 0.2dB / Yr
0
15
LD Local defect
Slope: 0.5dB / Yr (p<0.5%)
2002 2008
102030[dB]
S
IN T
0.2
0.61.1
0.1
0.1
2.5
0.2
-0.40.0
0.0
Structural progressionsuggested at
5 o'clock position
Floor effect(near absolute sensitivity loss)
2002 2008
Large progression at 5 o’clock position
• 53-year-old male, no family history
• 25 mmHg/1.2 - 0.75 (sph), - 1.0 (cyl) x 90°
• 2002 Rim thinning at 1 to 2 o’clock position. Rim notching at 5 o’clock position. RNFL loss at same positions. Optic disc hemorrhage at 6 o’clock position.• 2008 Rim thinning from 1 to 6 o’clock position
• Grayscale series shows expansion of inferior arcuate defect to superior nasal side from 2002 to 2008 • clusters (Cluster MD change up to 2.5 dB/year)• Large (~28 dB) progression at 5 o’clock position in Polar Trend Analysis• Rim thinning and RNFL loss spreading from 1 to 2 o'clock position towards 6 o'clock position•
PATIENT
IOP/VA corr
FUNDUS
EARLY TO MODERATE GLAUCOMA (PRIMARY OPEN-ANGLE GLAUCOMA)12
269Glaucoma | Trend
0
15
2001 2002 2003 200425
MD Mean defect
Slope: 1.2dB / Yr (p<0.5%)
0
2001 2002 2003 200415
sLV Loss variance
Slope: 0.8dB / Yr (p<0.5%)
0
2001 2002 2003 200425
DD Diffuse defect
Slope: 0.5dB / Yr
0
2001 2002 2003 200415
LD Local defect
Slope: 1.0dB / Yr (p<0.5%)
2001 2004
102030[dB]
S
IN T
0.8
0.81.1
5.4
3.3
0.8
0.4
0.60.6
0.5
Very fast progressionin central visual
field clustersLarge progression suggestedat inferior temporal optic disc
2001 2004
• 51-year-old male, no family history
• 15 mmHg/1.0 - 6.0 (sph), - 1.25 (cyl) x 160°
• 2001 position. Temporal alpha zone and beta zone peripapillary chorioretinal atrophy (PPA).• 2004 Challenging to identify changes because of small disc and severe myopia
• clusters (Cluster MD change 3.3 and 5.4 dB/year)• Challenging to asses structural changes, but large (up to 30 dB) progression at 5 o’clock position in Polar Trend Analysis corresponding with RNFL loss in fundus image suggests glaucomatous progression•
PATIENT
IOP/VA corr
FUNDUS
13 EARLY TO MODERATE GLAUCOMA (NORMAL TENSION GLAUCOMA)
270 Chapter 13 | Clinical cases
0
15
201325
MD Mean defect
Slope: 1.0dB / Yr (p<0.5%)
0
201325
DD Diffuse defect
Slope: 0.2dB / Yr
0
15
sLV Loss variance
Slope: 0.4dB / Yr (p<0.5%)
0
2013
2013
15
LD Local defect
Slope: 1.1dB / Yr (p<0.5%)
MD change1.0 dB/year
Significantlocal
progression
No diffuseprogression
2008 2013
102030[dB]
S
IN T
0.4
2.52.6
1.7
0.7
-0.5
0.2
-0.00.0
-0.1
Fast superiorparacentralprogression
2008 2013
• 74-year-old female• Patient showed advanced disc damage at presentation Suboptimal IOP control under topical medication, but patient refused surgery
• 16 – 22 mmHg (28 mmHg pre-treatment)/1.0
• 2008 Pathologically low peripapillary RNFLT in inferotemporal sectors • 2013
• 2008 Advanced disc damage (C/D=0.95)
• Grayscale series shows progression of superior arcuate and both superior and inferior paracentral defects from 2008 to 2013• progression in superior arcuate and superior and inferior paracentral clusters (Cluster MD change up to 2.6 dB/year)• Up to 30 dB progression at infero- and superotemporal test locations in Polar Trend Analysis spatially related to further RNFLT loss between 2008 and 2013•
PATIENT
IOP/VA uncorr
OCT
FUNDUS
EARLY TO MODERATE GLAUCOMA (PRIMARY OPEN-ANGLE GLAUCOMA)14
271Glaucoma | Trend
0
15
201335
MD Mean defect
Slope: 0,1dB / Yr
0
201315
sLV Loss variance
Slope: -0,2dB / Yr (p<10%)
0
201325
DD Diffuse defect
Slope: -0,0dB / Yr
0
201315
LD Local defect
Slope: 0,0dB / Yr
Floor effect(DD > 20 dB, no progression)
Floor effect(MD > 20 dB, no progression)
2008 2013
-0.0
0.0-0.0
1.4
2.5
-0.0
-0.9
0.0-0.0
-0.0
102030[dB]
S
IN T
Fast superiorand inferiorparacentralprogression
2008 2013
• 79-year-old female
further medication during follow up
• 08 – 14 mmHg (43mmHg pre-treatment)/1.0 + 1.0 (sph)
• 2008 Severe peripapillary RNFLT loss• 2013 No change in the average peripapillary RNFLT
• 2008 C/D=0.99
• measurement range)•• 12 to 25 dB progression at 8 to 10 o’clock position (papillomacular bundle) in Polar Trend Analysis not
• Polar and Cluster Trend Analysis indicate late-stage glaucomatous progression
PATIENT
IOP/VA corr
OCT
FUNDUS
15 END-STAGE GLAUCOMA (EXFOLITATIVE GLAUCOMA)
272
Rank
Def
ect (
dB)
Demo John, 1933/01/01 (65yrs)Left eye (OS) / 1999/07/12 / 11:36:23Seven-in-One
Classification:Comment:
Pupil [mm]: 6.4 IOP [mmHg]: 14Refraction S/C/A: +0.75/-1.5/90 VA: 0.4Catch trials: 0/20 (0%) +, 4/21 (19%) - RF: 9.7Parameters: 4 / 1000 asb III 100 ms Duration: 15:54Programs: G Standard White/White / Normal Questions / repetitions: 409 / 2 30°
MS [dB]: 18.3MD [< 2.0 dB]: 8.4sLV [< 2.5 dB]: 12.4CsLV [dB]: 12.5SF [dB]: 1.5
95%..100%83%...94%71%...82%59%...70%47%...58%35%...46%23%...34%11%...22% 0%...10%
Grayscale (CO)
25.7-0.1
9.70.1-
Values
24
31 27
28
26
27
31
29
29
21
30
1
29 1
224
26
2830
18
27
30
24
27
2330
130
27
2828
25
2627
28 5
3029
26
2727
1
24
24
2629
0.426.3
0.914.82
Comparisons
+
+ +
+
+
+
+
+
+9
+
26
+ 30297
+
++
11
+
+
+
+
9+
28+
+
++
+
++
+ 23
++
+
++
23
+
+
++
Corrected comparisons
+
+ +
+
+
+
+
+
+9
+
26
+ 30297
+
++
10
+
+
+
+
9+
28+
+
++
+
++
+ 23
++
+
++
23
+
+
++
Defect curve
Probabilities Corrected probabilities
p > 5p < 5p < 2p < 1p < 0,5
OCTOPUS 101OCTOPUS®
Diffuse defect [dB]: -1.1
471
5%
95%
-5
0
5
10
15
20
25
Sensitivity lossat fixation
Vertical dropcharacteristic forquadrantanopia
Chapter 13 | Clinical cases
• 65-year-old male, no family history• Patient experienced occipital headache and optic agnosia of name, letters, etc.• Diagnosed with cerebral infarction in left temporal lobe• Previous central serous chorioretinopathy in left eye
PATIENT
CEREBRAL INFARCTION (BILATERAL)16
273
Demo John, 1933/01/01 (65yrs)Right eye (OD) / 1999/07/12 / 11:00:42Seven-in-One
Classification:Comment:
Pupil [mm]: 6.0 IOP [mmHg]: 14Refraction S/C/A: +0.5/-2.0/90 VA: 1.0Catch trials: 0/21 (0%) +, 6/22 (27%) - RF: 13.9Parameters: 4 / 1000 asb III 100 ms Duration: 16:01Programs: G Standard White/White / Normal Questions / repetitions: 424 / 0 30°
MS [dB]: 19.9MD [< 2.0 dB]: 6.8sLV [< 2.5 dB]: 11.3CsLV [dB]: 11.3SF [dB]: 2.0
95%..100%83%...94%71%...82%59%...70%47%...58%35%...46%23%...34%11%...22% 0%...10%
Grayscale (CO)
24.1-0.1
1.64.1-
Values
28
30 24
26
29
29
28
24
27
21
28
13
1
3
130
31 20
24
28 25
27
29 18
27
28
25
2928
29
23
8282
25
4292
2528
30 27
27
5282
26
27
25
28 25
2.026.3
4.123.82
Comparisons
+
+ 5+
+
+
+
+
+
9
+
13
26
22
30++ 11
+
+ +
+
+ 9
+
+
+
+++
+
+ +
+
++
++
+ +
+
+ +
+
+
+
+ +
Corrected comparisons
+
+ 5+
+
+
+
+
+
9
+
13
25
22
29++ 11
+
+ +
+
+ 9
+
+
+
+++
+
+ +
+
++
++
+ +
+
+ +
+
+
+
+ +
Defect curve
Probabilities Corrected probabilities
p > 5p < 5p < 2p < 1p < 0,5
OCTOPUS 101OCTOPUS®
Diffuse defect [dB]: -1.1
471
5%
95%
-5
0
5
10
15
20
25
Rank
Def
ect (
dB)
Neuro | Single field
• OD 19 mmHg/ 1.0 + 0.5 (sph), – 2.0 (cyl) x 100°; OS 20 mmHg/ 0.4 – 1.5 (cyl) x 90°
• No abnormality
IOP/VA corr
FUNDUS
infarction in left temporal lobe• decrease in visual acuity (0.4)
274
Demo John, 1973/01/01 (31yrs)Left eye (OS) / 2004/10/21 / 12:51:41Seven-in-One
Classification:Comment:
Pupil [mm]: 6.0 IOP [mmHg]:Refraction S/C/A: // VA:Catch trials: 0/29 (0%) +, 4/30 (13%) - RF: 6.7Parameters: 4 / 1000 asb III 100 ms Duration: 19:20Programs: 32 Standard White/White / Normal Questions / repetitions: 585 / 0 30°
MS [dB]: 14.2MD [< 2.0 dB]: 14.0sLV [< 2.5 dB]: 9.2CsLV [dB]: 9.2SF [dB]: 1.9
95%..100%83%...94%71%...82%59%...70%47%...58%35%...46%23%...34%11%...22% 0%...10%
Grayscale (CO)
18.78.5
5.028.7
Values
226
28
19
22
23
20
17
9
16
3
16
22
22
19
12
24
2015
14102218
10202021
1824
1221
1721
1512322
42222
27
521
2321
1371421
1132224
124
22
21125
15222419
8.819.3
0.84.12
Comparisons
28+
+
13
6
6
8
7
19
9
29
9
6
6
13
16
+
611
1219610
1710108
105
167
107
113176
2397
+
249
57
1219136
281785
275
7
29205
117510
Corrected comparisons
20+
+
5
+
+
+
+
11
+
21
+
+
+
5
9
+
++
+11++
9+++
++
8+
++
+23++
15++
+
16+
++
5125+
209++
19+
+
2113+
++++
Defect curve
Probabilities Corrected probabilities
p > 5p < 5p < 2p < 1p < 0,5
OCTOPUS 101OCTOPUS®
Diffuse defect [dB]: -1.1
471
5%
95%
-5
0
5
10
15
20
25
Rank
Def
ect (
dB)
10 30 40 50 60 70 80 90
90105120 75 60
270255240 285 300
45135
315225
30150
330210
15165
345195
0180
V4e
I4e
I3e
I3a
Chapter 13 | Clinical cases
• 31-year-old male, no family history• Patient reported decreased visual acuity in right eye • Patient diagnosed with central serous chorioretinopathy and retinal hemorrhage
• Patient diagnosed with Leber hereditary optic neuropathy based on maternal mitochondrial DNA test
PATIENT
LEBER HEREDITARY OPTIC NEUROPATHY (BILATERAL)17
275
Rank
Def
ect (
dB)
Demo John, 1973/01/01 (31yrs)Right eye (OD) / 2004/10/21 / 13:17:49Seven-in-One
Classification:Comment:
Pupil [mm]: 6.2 IOP [mmHg]:Refraction S/C/A: // VA:Catch trials: 0/29 (0%) +, 3/29 (10%) - RF: 5.1Parameters: 4 / 1000 asb III 100 ms Duration: 18:29Programs: 32 Standard White/White / Normal Questions / repetitions: 572 / 0 30°
MS [dB]: 20.0MD [< 2.0 dB]: 8.2sLV [< 2.5 dB]: 7.6CsLV [dB]: 7.5SF [dB]: 1.8
95%..100%83%...94%71%...82%59%...70%47%...58%35%...46%23%...34%11%...22% 0%...10%
Grayscale (CO)
12.64.7
2.016.5
Values
2426
23 24
22
22
25
24
23
24
21
20
19
19
20
4
7
23
23
24
24 24
22 26 22 21
25
25
23 23 21 25
25 23
18 20
24 23
142
22 22 15
23 24 19
8132
24 23
25 25
22 23 25 18
24 23 22
23
122
22 20 22 24
21 23 22 24
15.222.7
1.919.22
Comparisons
5+
8 6
11
+
+
+
+
+
+
12
6
9
8
28
25
5
6
+
+ +
+ + 6 7
5
6
+ 7 9 +
+ 6
7 5
+ 5
72+
+ 10 13
+ 7 10
115
5 7
+ +
+ + + 9
5 7 8
5
826
7 11 9 6
5 6 7 5
Corrected comparisons
++
+ +
6
+
+
+
+
+
+
7
+
+
+
22
20
+
+
+
+ +
+ + + +
+
+
+ + + +
+ +
+ +
+ +
22+
+ + 8
+ + 5
6+
+ +
+ +
+ + + +
+ + +
+
32+
+ 5 + +
+ + + +
Defect curve
Probabilities Corrected probabilities
p > 5p < 5p < 2p < 1p < 0,5
OCTOPUS 101OCTOPUS®
Diffuse defect [dB]: -1.1
471
5%
95%
-5
0
5
10
15
20
25
10 30 40 50 60 70 80 90
90105120 75 60
270255240 285 300
45135
315225
30150
330210
15165
345195
0180
V4e
I4e
I3e
I3c
I2e
Neuro | Single field
• OD OS 10 mmHg/ 30 cm, hand motion
• Pale optic discs in both eyes
• OD 32 Hz; OS 42 Hz
• Dense sensitivity loss in center of both eyes
IOP/VA corr
FUNDUS
CENTRAL CFF
276
Rank
Def
ect (
dB)
Demo Jane, 1975/01/01 (25yrs)Left eye (OS) / 2001/11/30 / 14:19:18Seven-in-One
Classification:Comment:
Pupil [mm]: 6.3 IOP [mmHg]: 11Refraction S/C/A: +0.25/-0.5/80 VA: 1.0Catch trials: 0/31 (0%) +, 1/32 (3%) - RF: 1.5Parameters: 4 / 1000 asb III 100 ms Duration: 20:51Programs: 32 Standard White/White / Normal Questions / repetitions: 627 / 2 30°
MS [dB]: 22.0MD [< 2.0 dB]: 6.6sLV [< 2.5 dB]: 4.4CsLV [dB]: 3.9SF [dB]: 2.6
95%..100%83%...94%71%...82%59%...70%47%...58%35%...46%23%...34%11%...22% 0%...10%
Grayscale (CO)
4.16.7
1.48.11
Values
2523
14 26
19
25
23
29
22
24
26
26
28
22
24
22
9
22
18
20
2621
23252518
25
28
24271815
2618
1613
2422
2322
22272420
22271224
2420
2624
2418
24222316
25282323
2520
2426
25261314
25252021
23.821.4
8.428.71
Comparisons
67
17 5
6
+
+
+
+
+
+
7
5
5
5
5
24
7
12
9
+6
+++10
5
+
++1214
+11
912
+7
56
5578
65205
59
+7
+10
+5+11
++86
+9
5+
551917
++108
Corrected comparisons
++
12 +
+
+
+
+
+
+
+
+
+
+
+
+
18
+
7
+
++
+++5
+
+
++79
+6
+7
++
++
++++
++15+
++
++
+5
+++6
++++
++
++
++1411
++5+
Defect curve
Probabilities Corrected probabilities
p > 5p < 5p < 2p < 1p < 0,5
OCTOPUS 101OCTOPUS®
Diffuse defect [dB]: -1.1
471
5%
95%
-5
0
5
10
15
20
25
10 30 40 50 60 70 80 90
90105120 75 60
270255240 285 300
45135
315225
30150
330210
15165
345195
0180
V4e
I4e
I3e
I3b
I2e
I2b
I1e
Chapter 13 | Clinical cases
• 25-year-old female, no family historyPATIENT
BILATERAL OPTIC NEURITIS (MULTIPLE SCLEROSIS)18
277
Rank
Def
ect (
dB)
Demo Jane, 1975/01/01 (25yrs)Right eye (OD) / 2001/11/30 / 14:45:35Seven-in-One
Classification:Comment:
:]gHmm[ POI:]mm[ lipuP 13Refraction S/C/A: +0.25/-1.0/85 VA: 0.7Catch trials: 0/28 (0%) +, 2/29 (7%) - RF: 3.5Parameters: 4 / 1000 asb III 100 ms Duration: 19:38Programs: 32 Standard White/White / Normal Questions / repetitions: 568 / 4 30°
MS [dB]: 24.7MD [< 2.0 dB]: 3.9sLV [< 2.5 dB]: 4.7CsLV [dB]: 4.5SF [dB]: 1.9
95%..100%83%...94%71%...82%59%...70%47%...58%35%...46%23%...34%11%...22% 0%...10%
Grayscale (CO)
2.02.1
3.86.3
Values
3028
27 20
25
25
26
28
26
27
26
29
19
26
27
26
26
28
23
23
27 26
26 26 23 27
28
27
24 26 7 23
29 20
16 24
25 26
6262
25 30 27 28
27 30 26 29
7272
25 15
24 21
22 24 23 27
27 29 29 29
7272
9282
27 15 18 15
25 26 19 20
26.225.8
3.123.52
Comparisons
++
+ 11
+
+
+
5
+
+
+
+
14
+
+
+
7
+
7
6
+ +
+ + 6 +
+
+
+ 5 23 6
+ 9
9 +
+ +
++
+ + + +
+ + 6 +
++
+ 16
+ 7
+ + + +
+ + + +
++
++
+ 16 14 16
+ + 11 9
Corrected comparisons
++
+ 9
+
+
+
+
+
+
+
+
12
+
+
+
+
+
5
+
+ +
+ + + +
+
+
+ + 21 +
+ 7
7 +
+ +
++
+ + + +
+ + + +
++
+ 13
+ 5
+ + + +
+ + + +
++
++
+ 14 12 13
+ + 9 7
Defect curve
Probabilities Corrected probabilities
p > 5p < 5p < 2p < 1p < 0,5
OCTOPUS 101OCTOPUS®
Diffuse defect [dB]: -1.1
471
5%
95%
-5
0
5
10
15
20
25
10 30 40 50 60 70 80 90
90105120 75 60
270255240 285 300
45135
315225
30150
330210
15165
345195
0180
V4e
I4e
I3e
I3b
I2e
I2b
I1e
I1a
Intact peripheralvisual field
Neuro | Single field
• OD 13 mmHg/ 0.7 + 0.25 (sph), – 1.0 (cyl) x 85° OS 11mmHg/ 1.0 + 0.25 (sph), – 0.5 (cyl) x 80°
• No abnormality
• OD 34 Hz; OS 44 Hz
•
• Sensitivity loss on lower temporal side of vertical meridian in both eyes (i.e., mild bitemporal hemianopia)
chiasm
IOP/VA corr
FUNDUS
CFF
MRI
278
Rank
Def
ect (
dB)
Demo John, 1941/01/01 (64yrs)Left eye (OS) / 2005/10/12 / 12:52:19Seven-in-One
Classification:Comment:
Pupil [mm]: 5.7 IOP [mmHg]: 15Refraction S/C/A: +1.0/-1.0/100 VA: 1.0Catch trials: 0/21 (0%) +, 7/21 (33%) - RF: 16.6Parameters: 4 / 1000 asb III 100 ms Duration: 16:34Programs: 32 Standard White/White / Normal Questions / repetitions: 415 / 0 30°
MS [dB]: 13.0MD [< 2.0 dB]: 13.1sLV [< 2.5 dB]: 12.4CsLV [dB]: 12.4SF [dB]: 1.4
95%..100%83%...94%71%...82%59%...70%47%...58%35%...46%23%...34%11%...22% 0%...10%
Grayscale (CO)
1.624.7
9.05.62
Values
25
27
30
25
24
23
18
24
22
30
2
23
21222
27
29
25271
24
18
24
23
2530
2627
25
25
22
1924151
2527
28
27
2728
21269
23.70.9
4.526.0
Comparisons
+
+
+
+
+
+
+
+
+
+
24
+
+524
+
+
++27
+
5
+
+
++
++
+
+
+
++1024
++
+
+
++
++18
Corrected comparisons
+
+
+
+
+
+
+
+
+
+
22
+
++22
+
+
++25
+
+
+
+
++
++
+
+
+
++721
++
+
+
++
++16
Defect curve
Probabilities Corrected probabilities
p > 5p < 5p < 2p < 1p < 0,5
OCTOPUS 101OCTOPUS®
Diffuse defect [dB]: -1.1
471
5%
95%
-5
0
5
10
15
20
25
Absolute defectstopping at
vertical midline
10 30 40 50 60 70 80 90
90105120 75 60
270255240 285 300
45135
315225
30150
330210
15165
345195
0180
V4e
I4e
I3e
I2e
I1e
Chapter 13 | Clinical cases
• 64-year-old male, no family historyPATIENT
TUBERCULUM SELLAE MENINGIOMA (BILATERAL)19
279
Rank
Def
ect (
dB)
Demo John, 1941/01/01 (64yrs)Right eye (OD) / 2005/10/12 / 13:14:55Seven-in-One
Classification:Comment:
Pupil [mm]: 6.0 IOP [mmHg]: 13Refraction S/C/A: +0.5// VA: 0.15Catch trials: 0/18 (0%) +, 8/19 (42%) - RF: 21.6Parameters: 4 / 1000 asb III 100 ms Duration: 15:20Programs: 32 Standard White/White / Normal Questions / repetitions: 363 / 0 30°
MS [dB]: 4.3MD [< 2.0 dB]: 21.8sLV [< 2.5 dB]: 7.8CsLV [dB]: 7.7SF [dB]: 2.1
95%..100%83%...94%71%...82%59%...70%47%...58%35%...46%23%...34%11%...22% 0%...10%
Grayscale (CO)
25.625.3
1.728.9
Values
24
24
20
15
4
2
23
18 19
13
16 26
19
18
7
14
18 22
8 12
0.00.1
0.06.61
Comparisons
5
7
+
11
20
28
6
7 9
13
9 +
7
9
19
12
9 7
16 15
Corrected comparisons
+
+
+
+
+
9
+
+ +
+
+ +
+
+
+
+
+ +
+ +
Probabilities Corrected probabilities
p > 5p < 5p < 2p < 1p < 0,5
OCTOPUS 101OCTOPUS®
Diffuse defect [dB]: -1.1
471
5%
95%
-5
0
5
10
15
20
25
10 30 40 50 60 70 80 90
90105120 75 60
270255240 285 300
45135
315225
30150
330210
15165
345195
0180
V4e
I4e
I3e
I2e
I1e
Neuro | Single field
• OD 12 mmHg/0.15 – 2.0 (sph) OS 13 mmHg/1.2 – 1.5 (sph), – 1.0 (cyl) x 100°
• Pale optic disc with slight cupping• Slight bending of blood vessels
• OD 25 Hz; OS 40 Hz
• Meningioma in tuberculum sellae
• Complete sensitivity loss (heterononymous hemianopia) temporally of vertical meridian
IOP/VA corr
FUNDUS
CFF
MRI
280
Rank
Def
ect (
dB)
Demo John, 1942/01/01 (64yrs)Left eye (OS) / 2006/09/28 / 14:38:48Seven-in-One
Classification:Comment:
Pupil [mm]: 6.1 IOP [mmHg]: 19Refraction S/C/A: -1.0// VA: 0.3Catch trials: 0/38 (0%) +, 2/38 (5%) - RF: 2.6Parameters: 4 / 1000 asb III 100 ms Duration: 23:03Programs: M Standard White/White / Normal Questions / repetitions: 759 / 0 12°
MS [dB]: 16.4MD [< 2.0 dB]: 13.6sLV [< 2.5 dB]: 10.1CsLV [dB]: 10.2SF [dB]: 3.1
95%..100%83%...94%71%...82%59%...70%47%...58%35%...46%23%...34%11%...22% 0%...10%
Greyscale (CO)
15.213.8
0.217.21
Values
411
6 11
212
962118711
119
109
1159
4209
1313
278
149410467 7 6118
31213111816
11
2829
27172330
3023
1625
2624
3022
29252427
3027
29252828
11172525
31262725
28282727
14.615.8
3.814.71
Comparisons
2719
25 20
2919
232510132421
2122
2022
202723
281122
1918
282323
17232720272525 25 263013
281919201315
20
++
+126+
+6
145
56
+7
+56+
++
++++
1912++
+++5
++++
Corrected comparisons
2215
20 15
2415
1820592017
1618
1618
152219
24718
1413
231918
13182316222120 21 22268
24151516910
16
++
+8++
++
9+
++
++
++++
++
++++
158++
++++
++++
Defect curve
Probabilities Corrected probabilities
p > 5p < 5p < 2p < 1p < 0,5
OCTOPUS 101OCTOPUS®
Diffuse defect [dB]: -1.1
471
5%
95%
-5
0
5
10
15
20
25
M-pattern
Chapter 13 | Clinical cases
• 64-year-old male, no family history• Patient reported decreased visual acuity in left eye
• 13 mmHg/ 0.2 – 1.75 (sph), – 0.75 (cyl) x 80°
• Exudative age-related macular degeneration in macula area
• M-pattern (10°) used for a high resolution of the macula
PATIENT
IOP/VA corr
FUNDUS
AGE-RELATED MACULAR DEGENERATION20
281
Demo Jane, 1956/01/01 (51yrs)Left eye (OS) / 2007/05/16 / 11:37:22Seven-in-One
Classification:Comment:
:]gHmm[ POI:]mm[ lipuPRefraction S/C/A: -2.5/-0.75/80 VA: 1.0Catch trials: 0/35 (0%) +, 3/36 (8%) - RF: 4.2Parameters: 4 / 1000 asb III 100 ms Duration: 21:19Programs: M Standard White/White / Normal Questions / repetitions: 703 / 0 12°
MS [dB]: 23.1MD [< 2.0 dB]: 7.7sLV [< 2.5 dB]: 10.3CsLV [dB]: 10.1SF [dB]: 4.0
95%..100%83%...94%71%...82%59%...70%47%...58%35%...46%23%...34%11%...22% 0%...10%
Greyscale (CO)
10.319.3
8.05.0
Values
131
33 32
333331
2933
31293332
30
916278
1
253029
422932815
283225 33 25292632313331
323332
611
2320212
2322
297
3027
3126
30323132
2929
18222319
202520
31313132
28293030
20.211.1
2.034.03
Comparisons
1830
+ +
+++
++
++++
+
2317524
30
7++
2729++2416
++8 + 8+5++++
+++
2218
6102818
77
+24
++
++
++++
++
117610
11510
++++
++++
Corrected comparisons
1729
+ +
+++
++
++++
+
2215+22
29
5++
2628++2315
++6 + 7++++++
+++
2116
592716
56
+22
++
++
++++
++
96+9
9+9
++++
++++
Defect curve
Probabilities Corrected probabilities
p > 5p < 5p < 2p < 1p < 0,5
OCTOPUS 101OCTOPUS®
Diffuse defect [dB]: -1.1
471
5%
95%
-5
0
5
10
15
20
25
Rank
Def
ect (
dB)
10 30 40 50 60 70 80 90
90105120 75 60
270255240 285 300
45135
315225
30150
330210
15165
345195
0180
V4e
I4e
I3e
I2e
I1e
Retina | Single field
• M-pattern (10°) used for a high resolution of the macula
retinal artery• Fixation is spared, corrected visual acuity of 1.0 is maintained• Kinetic perimetry shows absolute defect outside 10° nasally
• 51-year-old female, no family history
• 14 mmHg/ 1.0 – 4.0 (sph), + 0.75 (cyl) x 80°
• Ischemia-induced retinal edema in area of blood vessels caused by occlusion of the downward branch of the central retinal artery
PATIENT
IOP/VA corr
FUNDUS
21 BRANCH CENTRAL RETINAL ARTERY OCCLUSION
282
Rank
Def
ect (
dB)
Demo Jane, 1939/01/01 (67yrs)Right eye (OD) / 2006/07/31 / 13:23:40Seven-in-One
Classification:Comment:
:]gHmm[ POI:]mm[ lipuP 14Refraction S/C/A: +1.0/-2.5/80 VA: 0.2Catch trials: 1/30 (3%) +, 2/31 (6%) - RF: 4.9Parameters: 4 / 1000 asb III 100 ms Duration: 18:13Programs: M Standard White/White / Normal Questions / repetitions: 611 / 0 12°
MS [dB]: 25.5MD [< 2.0 dB]: 4.3sLV [< 2.5 dB]: 3.8CsLV [dB]: 3.6SF [dB]: 1.9
95%..100%83%...94%71%...82%59%...70%47%...58%35%...46%23%...34%11%...22% 0%...10%
Greyscale (CO)
4.34.0
6.46.3
Values
2728
25 27
2526
2627 17
18 2425
2325
2824 2127
25
2324
20 2226
2525 25
25 2420 2530 24 251623 18 28
26 2423 2626 27
28
22 25
27 27 27 26
7262
9292
8292
6282
28 30 29 28
28 25
22 28 27 27
29 270392
828230 30
28 28 27 26
25.125.6
3.524.62
Comparisons
++
5 +
55
5+ 15
14 76
85
+ 7 115
6
77
12 9 5
55 5
6 711 5+ 7 7169 13 +
5 7 9 55 +
+
5 +
+ + + +
++
++
++
++
+ + + +
+ +
6 + + +
+ +++
+++ +
+ + + +
Corrected comparisons
++
+ +
++
++ 13
12 5+
6+
+ 5 8+
+
55
9 6 +
++ +
+ 5 8 ++ 5 +146 11 +
+ 5 6 ++ +
+
+ +
+ + + +
++
++
++
++
+ + + +
+ +
+ + + +
+ +++
+++ +
+ + + +
Defect curve
Probabilities Corrected probabilities
p > 5p < 5p < 2p < 1p < 0,5
OCTOPUS 101OCTOPUS®
Diffuse defect [dB]: -1.1
471
5%
95%
-5
0
5
10
15
20
25
M-pattern
Signficantfoveal defectat p < 0.5%
Chapter 13 | Clinical cases
• 67-year-old female, no family history• Patient reported distorted vision in right eye
• 12 mmHg/ 0.2 – 1.5 (sph), – 2.5 (cyl) x 80°
•
• M-pattern (10°) used for a high resolution of the macula
PATIENT
IOP/VA corr
FUNDUS
MACULAR HOLE22
283
Rank
Def
ect (
dB)
Demo John, 1928/01/01 (76yrs)Left eye (OS) / 2004/03/24 / 15:44:51Seven-in-One
Classification:Comment:
Pupil [mm]: 7.2 IOP [mmHg]:Refraction S/C/A: +7.0/-2.0/170 VA: 0.2Catch trials: 1/24 (4%) +, 0/24 (0%) - RF: 2.0Parameters: 4 / 1000 asb III 100 ms Duration: 16:31Programs: G Standard White/White / Normal Questions / repetitions: 474 / 1 30°
MS [dB]: 19.1MD [< 2.0 dB]: 6.9sLV [< 2.5 dB]: 4.1CsLV [dB]: 4.0SF [dB]: 2.1
95%..100%83%...94%71%...82%59%...70%47%...58%35%...46%23%...34%11%...22% 0%...10%
Greyscale (CO)
8.78.7
8.41.5
Values
1814
24 23
24
22
10
11
14
21
24
21
20
19
14
1811 16
2422
12 18
2022
20
24
20
22
15
18
18
20
1724 25
2420
5181
2422
6132
2223
14 15
2323
2112
2422
17
22
16 16
2222
16.716.7
4.126.12
Comparisons
1013
+ 55
5
16
17
11
+
5
7
5
10
12
718 14
68
12 6
65
7
+
5
+
8
6
5
5
14+ +
58
6 8
++
8+
++
14 12
55
5 13
++
6
+
7 6
++
Corrected comparisons
+7
+ ++
+
11
12
6
+
+
+
+
+
7
+13 9
++
6 +
++
+
+
+
+
+
+
+
+
9+ +
++
+ +
++
++
++
8 7
++
+ 8
++
+
+
+ +
++
Defect curve
Probabilities Corrected probabilities
p > 5p < 5p < 2p < 1p < 0,5
OCTOPUS 101OCTOPUS®
Diffuse defect [dB]: -1.1
471
5%
95%
-5
0
5
10
15
20
25
Very reliable test
Diffuse &local defect
Retina | Single field
• 76-year-old male, no family history• Patient reported decreased visual acuity in left eye, blurred and double vision
• 10 mmHg/ 0.2 + 3.75 (sph), – 2.0 (cyl) x 170°
• Retinal hemorrhage and soft exudate along RNFL in lower retinal arcade
PATIENT
IOP/VA corr
FUNDUS
23 BRANCH CENTRAL RETINAL VEIN OCCLUSION