1. PERFORMING RELIABLE VISUAL FIELDS
Heart of America Congress
Presented by
Jill Luebbert, CPOT, ABOC

2. What are “Visual Fields”
A test?
A view of the plains of Nebraska?
“the area or extent of physical space visible to the eye in a given position

3. How much can we see? Monocular visual fields usually measure
60 degrees superior
75 degrees inferior
105 degrees temporal
60 degrees nasal

4. Making a map
a.k.a. Performing Visual Fields

5. Meridians and Quadrants
Horizontal meridian
Vertical meridian
Quadrants
Circles of eccentricity

6. Two methods of presenting Visual Fields
Kinetic
Static

7. Kinetic
Target in motion moved from non-seeing to seeing

8. Static
Stationary target
Threshold or suprathreshold

9. Terminology
What are they talking about?

10. Terms used Perimetry Scotoma Blind Spot (natural) Isopter Decibel
Visual field testing with eye located at the center of a curved instrument
Campimetry
Visual field testing eye located a specified distance from a flat surface
Scotoma
Vision entirely absent
Blind Spot (natural)
Approximately 15 degrees temporal to fixation (Optic Nerve)
Isopter
Boundary mapped for a particular stimulus size and intensity
Iso = equal opter = sight
Decibel
Relative unit, 1/10 log unit

11. Threshold Suprathreshold False negative False positive
Every test point is evaluated by bracketing or staircase method
Suprathreshold
Target value assumed to be above threshold value for all points
False negative
Patient does not respond when a maximally bring stimulus is present at a point previously found to be normal
False positive
Patient responds when no stimulus was present

12. Pattern Standard Deviation
Grayscale
To be used for patient education – Represents tested points, which have been assigned value
Mean Deviation
Difference in decibels between “normal” and patient’s hill of vision
Pattern Standard Deviation
The measurement of the degree which the shape of patient’s measured “hill” of vision departs from normal
Short Term Fluctuation
A measurement of the degree of variation of threshold during the test

13. Types of Visual Fields Confrontation
Harrington Flocks (Burton) Screener
Tangent Screen

14. Arc Perimeter
Amsler Grid

15. Frequency Doubling Technology
FDT

16. Goldmann introduced in 1945

17. Auto Perimeters
Humphrey
(Carl Zeiss Meditec)
Octopus (Haag-Steit)

18. What is the “hill of vision”?

21. Why do we perform Visual Fields?
To monitor area of vision utilized
Monitor diseases
Glaucoma
Macular Degeneration
Stroke

22. The technician’s responsibility
To be comfortable and knowledgeable with the instrument used
To perform accurate and reliable visual fields
To perform repeatable visual fields
To accurately gather diagnostic data
To keep the patient as comfortable and relaxed as possible
This is not a speed test

23. Setting up and Preparing
Data entry can be completed before the patient sits down
Choose the correct test
Set variables

24. Setting up Choose the pre-determined test Variables Color Fluctuation
Blind Spot Size
Test Speed

25. Setting Up Enter Patient Information
Spell the name same format every time
All caps or upper and lower case
Last name first or first name fist
Middle initial with period or without period
Date of Birth
Vision Acuities
Lens Used
Pupil Size

26. Preparing the patient Introduce yourself
Acknowledge them by their name
Comfortable atmosphere
Explanation of what to expect
What to see or not to see
How long to expect
Breaks??

27. Ready to start Clean the instrument New chin cover sheet
Give them the controller
Occlude non-testing eye

28. Positioning Make this as comfortable as possible
Adjust the instrument height
Adjust the chin rest height
Chin and forehead firmly in place
Keep teeth clenched together
Adjust lens holder
Not too close or too far away

29. Ready??? Verify the patient is in position
Give them a short test run first
All OK??
Ready
Set
Start

30. Now what? MONITOR Monitor fixation Monitor attentiveness
DO NOT LEAVE THE PATIENT
Monitor fixation
Monitor attentiveness
Is the patient staying securely to forehead rest and in chin rest

31. Remember Restart if necessary Is the patient staying attentive
It is important to achieve reliable results
Is the patient staying attentive
Take breaks as you judge necessary
This is not a race

32. Finished Are you performing the same test on the other eye?
Take a short break between
Let the patient stretch their fingers, neck
Occlude next eye
Give the patient the control
Any questions???
Position

33. Keep a watchful eye
Monitor
Fixation
Patient attentiveness

34. Testing Complete Save results Return instrument control
Return testing lens
Return occluder
Print or send results to correct station
Note any observations
patient restless, etc
Escort patient to next station

35. “How did I do?” Do not share results
Let the patient know they provided lots of data for the doctor to review
The doctor will visit with them regarding the results

36. Congratulations on performing
Thorough
Accurate
Repeatable
Visual Fields

37. Enjoy Heart of America Experience
Jill J Luebbert, CPOT, ABOC
Luebbert Consulting & Training