Ohp2 Mt3 - Goldman Perimetry

Front 1

In what year was the Goldmann bowl perimeter w/ standardized testing parameters used for peripheral field testing?

Back 1

1942

Front 2

What year was the Tubingen perimeter (static threshold perimetry) introduced and used by many glaucoma centers?

Back 2

1965

Front 3

In what year was the Armaly technique to rapidly screen for early glaucomatous VF loss using combined static suprathreshold spot checking and kinetic isopter plotting used?

Back 3

1972

Front 4

Which type of perimetry standardized the testing process? Which one standardized the testing parameters and instrumentation?

Back 4

Automated = standardized process. Goldmann = instrumentation/parameters

Front 5

List a major advancement in perimetry

Back 5

1. Perimetry not using a white stimulus on a white background. -Developed because glaucoma structural damage way before VF loss on standard perimetry. Ex. FDT and SWAP

Front 6

List a few factors that cause inconsistency/fluctuation in VF tests

Back 6

-Fatigue. -Attention. -Excessive blinking. -Cooperation/Fixation. -Correction of RE. -State of retinal adaptation. -Level of accommo. -Perception of normal response. . All these have not been standardized although VER or ERG try to minimize them

Front 7

List some test process factors that cause 'scatter' in VF tests

Back 7

- Noise. - Random vs. Non-random presentation. -Type of stimulus: Static vs. Kinetic. -Interval between stimuli: Static. -Speed of movement of stimuli: Kinetic. . These are mostly standardized by automated perimetry

Front 8

List some Test condition factors that cause 'scatter' in VF tests

Back 8

Stimulus:. -Size. -Color. -Brightness. -Shape: Sphere vs. flat vs. oval. -Production: projected vs. LED. -Background brightness. . All standardized by Goldmann and Automated

Front 9

List some major advantages of Goldmann Perimetry

Back 9

1. Multiple testing strategies. 2. Screening, diagnostic or quantification. 3. Good for large, deep, steep bordered VF defects. 4. Good for peripheral field eval. 5. Isopter lines (kinetic) are relatively easy to interpret

Front 10

List some disadvantages of Goldmann

Back 10

1. Requires well trained perimetrist - major disadvantage. 2. Perimetrist affects test - variability. 3. Difficult to obtain repeatable testing process = difficult to compare serial VF tests. 4. Cannot perform extensive static threshold. 5. Kinetic: poor for Detection of scotomas. - Kinetic good for plotting size/shape but not depth of scotoma

Front 11

List a few indications for Goldmann

Back 11

1. Peripheral VF loss - detection and quantification. a. RD. b. Retinoschisis. c. RP. 2. Quantification in order to follow over time. -especially good for large, deep, steep defects. a. Retinoshisis. b. RD. 3. Detection of neurological VF loss. a. Chiasmal compressive mass (Chamblin step). 4. Extensive, dense central field loss - only when deep, large. a. Advanced glaucoma. b. AION-dense VF loss. c. Dense chiasmal or post chiasmal VF loss. 5. Patients who cannot perform automated

Front 12

So what is Goldmann GOOD for then?

Back 12

Peripherial VF loss and deep, dense, steep bordered field losses

Front 13

List some indications when Goldmann would not be preferred

Back 13

1. Suprathreshold screening. 2. Detection of scotomas. 3. Detection or quantification of relative defects. 4. Determination of Depth of a defect. 5. Detection of small central scotoma

Front 14

How many apostilbs is the Goldmann bowl illuminated?

Back 14

31.5 = photopic level of adaptation. -Calibrated on each patient. -Dark room

Front 15

If a patient is dilated and is going to perform Goldmann - what Rx is needed?

Back 15

30cm distance = +3.00 add for a dilated patient (any age) or a presbyope. -This is added to DISTANCE RX

Front 16

What do the following determine:. Roman numerals: V-0. Arabic Numberals: 4-1. Letters: e-a

Back 16

1. Roman: Size (V= largest). 2. Arabic: Brightness (4= Brightest). -Large (.5 LU) steps. 3. Letter: Brightness (e= Brightest). -Small (.1 LU) steps

Front 17

What is the largest stimulus available on Goldmann?

Back 17

V4e

Front 18

What happens to the area when you change the stimulus size from V to IV

Back 18

It is reduced by 1/4. This is because the diameter of the stimulus is cut in 1/2.

Front 19

What is the most commonly used stimulus size?. Which size is the largest and most resistant to blur (such as wrong trial lens or cataract)?

Back 19

I. V

Front 20

What percentage of the brightest stimulus is Arabic number 2?

Back 20

10% of the brightest = 4. -Or it is 1 log unit = 10 db

Front 21

How many Log Units does a change from e --> c represent?

Back 21

2/10 LU. - Each setting represents successive 1/10 attenuation (dimmer)

Front 22

Stimulus intensity is dependent upon the maximally brightest stimulus being ___?

Back 22

1000 apostilbs. -Must be calibrated to ensure that the brightest stimulus 4e is 1000 before EACH test

Front 23

Are LU and decibels Absolute or Relative units based upon the maximally brightest stimulus?

Back 23

Relative

Front 24

What is ESV?

Back 24

The relative detectability of a stimulus (larger/brighter stimuli easier to detect). -It's how easy is it to detect. . On Goldmann: Add stimulus size to the stimulus brightness. -Ex. V4e = ESV of 9 (5+4)

Front 25

How many standard Goldmann stimuli are there? 'standard' b/c each has a different equivalent stimulus value (ESV) and all other possible combinations of stimulus size and brightness are roughly equivalent stimuli to these

Back 25

There are 9. - V4e, IV4e, III4e, I4e, I3e, I2e, I1e, 01e

Front 26

A change in stimulus brightness of 1/2 LU is perceived as roughly equivalent to a stimulus size change of what?

Back 26

4 times the area (or 2 times the diameter). Ex: 13e is roughly equivalent to II2e

Front 27

T of F? Brightest stimulus available of Automated perimetry is the lowest decibel value

Back 27

True

Front 28

What is the Brightness and Goldmann equivalent to 20 Decibels on the HFA?

Back 28

20 db = 100 apositle = I4e. -20db = 2 LU = 10^2 = 100. -2 LU = a change of ~ 16 the area

Front 29

Which brightness value has a higher sensitivity, 0 db or 40 db?

Back 29

40 db because as decibels increase - brightness decreases so this stimulus is dimmer than 0 db (brightness possible)

Front 30

T of F? Stimulus size and brightness are varied during Automated perimetry

Back 30

False. Size is not varied, only brightness

Front 31

How do you calibrate the Goldmann Perimeter?

Back 31

1. Set stimulus V4e to read 1000 asb (absolute calibration). 2. Set stimulus V1e to equal 31.5 asb (relative calibration). 3. Match background to stimulus to make the background 31.5 asb

Front 32

What stimulus should you use to plot the blindspot?

Back 32

I4e - rate of movement = 2 deg/sec. -Plot 8 directions from center of BS. -Static suprathreshold - 15 deg temporal to fixation. -Move from non-seeing to seeing and as soon as patient responds turn off stimulus

Front 33

List some common causes of no BS

Back 33

1. Neither eye occluded. 2. Occluded wrong eye. 3. Poor fixation. 4. Nasal location

Front 34

What is the sequence of Isopter plotting?

Back 34

1. BS . 2. Peripheral > 50 deg. 3. Intermediate 30-50 deg. 4. Central < 30 deg. -use trial lens for central if needed. -Static suprathreshold search for scotomas

Front 35

T of F? Correction is needed to plot the peripheral isopter

Back 35

False

Front 36

Describe plotting Peripheral isopter > 50 deg

Back 36

1. V4e tests absolute field limits. -normal: Sup (70), Inf (90), Temp (110), Nasal (70). 2. Rate of movement = 3-5 deg/sec. 3. Non-seeing to seeing

Front 37

Which region is usually affected 1st in someone with RP?

Back 37

30-50 deg Isopter = Mid peripheral retina. -I4e and/or I3e isopters

Front 38

What stimulus do you use to plot the Central 30 deg?

Back 38

I2e or I1e if I2e is too large

Front 39

When plotting a scotoma, what does it mean if the isopter lines are widely spaced apart?

Back 39

Sloping borders = not steep

Front 40

What is considered the threshold on depth determination of a scotoma?

Back 40

The last seen stimulus

Front 41

Is Goldmann recommended for a general screening?

Back 41

No

Front 42

Is Automated VF testing recommended for peripheral retina disease?

Back 42

No - BIO best technique. -Goldmann good for followup and quantification

Front 43

What stimulus is used to plot the midperiphery of an RP patient

Back 43

I3e (I4e or I2e) stimulus and plot several successive peripheral and mid-peripheral isopters