Glaucoma y Perimetra

Computarizada
Jos Alejandro Santos Espinoza
Medico Cirujano Oftalmlogo
Glaucoma y Perimetra Computarizada

Glaucoma y Perimetra Computarizada
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Glaucoma y Perimetra Computarizada
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Glaucoma y Perimetra Computarizada
Siempre Evaluar todo el Campo Visual
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Siempre Evaluar todo el Campo Visual
Glaucoma y Perimetra Computarizada
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Glaucoma y Perimetra Computarizada
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Glaucoma y Perimetra Computarizada
Nunca
Division del examen y Orden de Prelacin
1
8
7
6 5 4
3
2
Glaucoma y Perimetra Computarizada
Oscilacin de un escotoma
paracentral a largo plazo
Glaucoma y Perimetra Computarizada
Oscilacin de un escotoma
paracentral a largo plazo
Glaucoma y Perimetra Computarizada

Glaucoma y Perimetra Computarizada

Glaucoma y Perimetra Computarizada

Glaucoma y Perimetra Computarizada

Glaucoma y Perimetra Computarizada
Glaucoma y Perimetra Computarizada
Glaucoma y Perimetra Computarizada
Escotomas Blancos
Glaucoma y Perimetra Computarizada
Escotomas Blancos
Glaucoma y Perimetra Computarizada
Escotomas Blancos
Glaucoma y Perimetra Computarizada
Escotomas Blancos
Glaucoma y Perimetra Computarizada

Escotomas Blancos
Glaucoma y Perimetra Computarizada

Escotomas Blancos
Algoritmos en Humphrey Field Analizer
Glaucoma y Perimetra Computarizada
Glaucoma y Perimetra Computarizada
Error de aprendizaje.
Glaucoma y Perimetra Computarizada
Error de aprendizaje.
Criterios Diagnsticos del Glaucoma Perimtrico


Criterios Diagnsticos del Glaucoma Perimtrico
Criterios Diagnsticos del Glaucoma Perimtrico


Swedish Interactive Threshold Algorithm (SITA)
Glaucoma y Perimetra Computarizada
Swedish Interactive Threshold Algorithm (SITA)
The SITA strategy uses more efficient
mathematical methods for estimation of
threshold values based on normative data,
patient age, and patient responses during the
test
Glaucoma y Perimetra Computarizada
SITA-Standard
reduced the test duration by ?50% compared to the Full Threshold
strategy. Importantly, this reduction in the test duration is not done by
sacrificing quality; SITA matches and even surpasses the accuracy of
the Full Threshold strategy.
[10-16]
To further decrease the test duration
by 30-50%, SITA-Fast strategy was designed. However, test-retest
reliability for this strategy is worse compared to SITA-Standard.
[12-14]

Currently, the most common clinically used strategy of SAP is the
SITA-Standard.
Glaucoma y Perimetra Computarizada
Total Deviation (TD) and
Pattern Deviation (PD)
Total Deviation (TD) plots are calculated as a difference between the patient's threshold values and those of the age-
matched normals. Points on a visual field close to fixation have a narrow range of normal values, while those on the
periphery have a wider range. Therefore, TD plots are center-weighted such that an abnormal central point is assigned
more significance than a peripheral point. These are presented as a dB plot (top left plot on The Single Field Analysis) and
as a probability plot (bottom left plot on The Single Field Analysis) (Fig. 196.2).

Pattern Deviation (PD) dB and probability plots are located to the right of the TD plots on The Single Field Analysis printout
(Fig. 196.2). PD is calculated by adjusting the overall sensitivity (TD values) of the visual field by the seventh-most sensitive
non-edge point, to differentiate focal defects from generalized changes. Therefore, PD plots highlight focal visual field
defects and ignore generalized changes (Key Feature 4).
[7]

PD plots highlight focal visual field defects and ignore generalized changes.




Glaucoma y Perimetra Computarizada
Global indices:
MD - an average deviation of the patient's visual field from the
age-matched controls.

PSD - the degree of irregularity in the field.

STF - the consistency of patient responses during a test, on
retesting the same ten points.

CPSD - a PSD corrected for STF


Glaucoma y Perimetra Computarizada
MD vs. PSD
CV
actual
CV del
grupo
etario
corregid
o
con la
sensibili
dad
umbral
Desviacin Total
Patrn estndar
de desviacin
CV
del
grupo
etario
MD
PSD
Criterio para anormalidad minima:
1. Tres o mas puntos que no sean del borde en la
localizacion esperada con sensibilidades en p < 5% y
un punto con sensibilidad en p < 1%, o

2. PSD (o CPSD) en p < 5%, o

3. GHT indicando un campo anormal


Glaucoma y Perimetra Computarizada
Glaucoma y Perimetra Computarizada
Excesiva cantidad de falsos positivos
Glaucoma y Perimetra Computarizada

Caso Clinico
Paciente de sexo femenino, edad 70 aos.
Tonometra: O.D. 13 mmHg., O.S. 11 mmHg.
Fondo de ojo: hemorragia papilar a 2 h en ojo derecho
Excavacin: O.D. 0.6 Dp O.S. 0.4 Dp
Gonioscopa: ngulo abierto III ambos ojos

Glaucoma y Perimetra Computarizada
Paciente de sexo femenino, edad 70 aos.
Tonometra: O.D. 13 mmHg., O.S. 11
mmHg.
Fondo de ojo: hemorragia papilar a 2h en
ojo derecho
Excavacin: O.D. 0.6 Dp O.S. 0.4 Dp
Gonioscopa: ngulo abierto III ambos ojos

Glaucoma y Perimetra Computarizada
Glaucoma y Perimetra Computarizada

Glaucoma y Perimetra Computarizada

Glaucoma y Perimetra Computarizada
Asociacin
de Clusters
Glaucoma y Perimetra Computarizada

Progresion del Glaucoma
El software usa triangulos
abiertos


Semisombreados y


Sombreados
Progresion del Glaucoma
Possible Likely
Progresion del Glaucoma
Si tres o mas puntos han cambiado en la misma
localizacin en dos test consecutivos, el
programa reportara possible progression, el
cual lleva al oftalmlogo a realizar otro test. Si
los hallazgos son confirmados en el tercer test,
entonces el programa reportara likely
progression
Anlisis de la Progresin del Glaucoma - Criterios
Criterios de Anlisis de
Progresin del Glaucoma
Progresion del Glaucoma
El Oftalmlogo debe considerar varias limitaciones cuando usa
el anlisis de progresin de Glaucoma.
Al menos se requiere 5 campos visuales para el diagnostico de
progresin.
La seleccin inicial de los campos visuales de base es
automtica, pero puede ser necesario revisar la seleccin y
cambiarla si es necesario.
Conclusiones
La evaluacin del Campo Visual es solo una
modalidad disponible en el manejo de los
pacientes con glaucoma.
Cuando tomamos decisiones acerca del
diagnostico o tratamiento, otros parmetros
tales como la PIO, anlisis del Nervio ptico,
la edad del paciente y otros factores de riesgo
deben tambin ser considerados.


Glaucoma y Perimetra Computarizada
Dr. Jos Alejandro Santos Espinoza
Muchas Gracias
Glaucoma y Perimetra Computarizada

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Organizational Chart
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Area Wise Distribution
0
10
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60
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80
90
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
East
West
North
Quarterly Sale
13%
17%
57%
13%
1st Qtr
2nd Qtr
3rd Qtr
4th Qtr
Employee Detail
Employee No Name Gender Grade Department
70899 Triet Beo Male 4 Management
70909 David Smith Male 4 Marketing
70839 Susan Cyler Female 4 Dev
70800 Suzi Decosa Female 5 Management
70829 Abrahim Bukhatir Male 2 Dev
70394 Suresh Kumar Male 5 Dev
70291 Deborah Green Female 3 Testing
70844 Michael Bennot Male 1 Doc
70194 George Wood Male 2 Testing
Area Wise Growth
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Important Points
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Project Iterations
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Compass
East
North
West
South
Yearly Sales
Quarters
Sale in Million $
1 2 3 4
100
150
200
250
300
170 M
155 M
230 M
250 M
Formula
65%





20%





15%
Growing Wealth
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Joint Ventures
SWOT Analysis


Opportunities
O


Threats
T

Strengths
S
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Main Points
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Timeline
2007 2008 2009 2010 2011
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Economic Growth Circular Flow Model
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Annual Profit in million dollars
2004 2005 2006 2007 2008 2009 2010 2011
$378 $580 $523 $590
$421 $492 $600 $610
Ideas
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