Kinetic perimetry

18 March 2022 Prof Sanjay Shrivastava 1
Power point copy of talk
presented at 32nd M.P. State
Ophthalmic Conference held
from 17th to 19th October 2008
at Ujjain

Kinetic Perimetry
Dr Sanjay Shrivastava
Professor of Ophthalmology
Regional Institute of Ophthalmology
Gandhi Medical College, Bhopal
drs.rio@hotmail.com
www.eyeeducation.org

Visual Field
• The Normal visual field is depicted as
Traquair’s “Island of vision surrounded by
a sea of blindness”
• The three dimensional concept can be
reduced to quantitative values by plotting
lines (isopters) at various levels around
the island or by measuring the height
(sensitivity) at different points within the
island of vision.

Visual Field
• The normal visual field and glaucomatous
changes in visual field are the same as
when Bjerrum discovered the arcuate
scotoma using back of his consulting room
door as a background for testing visual
field nearly 110 years ago.
• Advances in the technology of visual field
testing are changing our perception of
normal and abnormal visual fields.

Influence of Glaucoma on Visual
Function
o Understanding about natural history of
progressive visual field loss is
continuously increasing with newer
instruments and technologies which has
increased the sensitivity of test
o The visual field defects that are caused by
loss of retinal nerve fiber bundles are the
most common and familiar change, the
central vision is typically one of the last
region to be lost

Influence of Glaucoma on Visual Function
o Studies have shown that mild central and
diffuse reduction in the visual field can
occur even in early stage of glaucoma

Visual Field defects in
Glaucoma
o Concentric contraction
o Enlargement of blind spot
o Angioscotoma
o Nerve fiber bundle defects:
a. Scatter (fluctuation/localized minor
disturbances): they are variable threshold
responses to repeated testing in the same area.
Scatter is studied with differential light threshold.
It is considered early warning sign of glaucoma

Visual Field defects in
Glaucoma
b. Arcuate defect
c. Nasal step
d. Vertical step
e. Temporal sector defect

Other Conditions Affecting
Visual Field
• Neurological Disorders
• Retinal Diseases including pigmentary
dystrophies and vascular diseases

Advanced Glaucomatous Field Defects
o Complete double arcuate scotoma with
extension to peripheral limits in all areas
except temporally
o This results in a central island and a
temporal island of vision in advanced
glaucoma

Other Measures of Visual
Impairment in Glaucoma

Other Measures
1. Colour vision
2. Contrast sensitivity
i. Spatial contrast sensitivity decreases :
impairment correlates with the central
field and optic nerve head damage
ii. Temporal contrast sensitivity
(Flickering visual stimulus) glaucoma
patients have reduced function

Techniques of Visual Field Analysis

Perimetry
• Determination of outer boundary of the visual
field is one aspect of testing the visual field, but
it is of limited value. More important is the fact
that every point within the boundary has certain
characteristics of visual function.
• Acuity away from the fovea can be measured for
the purpose of visual field testing. In perimetry
functional ability in terms of the weakest spot of
light (visual stimulus) that can be seen at
different location in the visual field is quantified

Techniques of Field Charting
• In visual field charting both the peripheral
limits of a visual field and the relative
visual acuity of areas within those areas
are recorded
• Visual fields can be charted by using
kinetic and/or static techniques with
instruments that are operated either
manually or computer assisted (automatic)

Kinetic Perimetry
• Involves moving of the test object from
non-seeing to seeing area and point at
which it is first seen in relation to fixation
point. This procedure documents the
boundaries of the visual field for:
a. absolute limits
b. areas of relative differences in visual
acuity with in the field

Kinetic Perimeter
• The best known of the kinetic perimeters is
referred to as the Goldmann-type
projection perimeter. This type perimeter is
named after Dr. Hans Goldmann, a
European ophthalmologist who did much
of the original design and testing on the
hemispherical bowl concept.

Kinetic Perimeter
• Available Goldmann-type perimeters are
manually operated. The operator selects the
target (stimulus), size and intensity, moves
the target within the bowl, monitors patient
fixation and records responses on the chart.
In some cases, automatic recording is
provided which provides for automatic
marking of the field of vision chart each time
the patient presses the response button.

Kinetic Perimetry
o Boundaries or contour lines are called isopters.
The size of isopter depends on the stimulus
value of the test object
o Kinetic targets: a stimulus velocity of 4 degree
per second appears to be optimal for all targets
in the central and peripheral visual field
o Background illumination for manual perimetric
techniques has traditionally been mesopic to
stimulate both rods and cones. Field luminances
used ranges from photopic to mesopic, 4 – 31.5
apostilbs

Static Techniques
• Static technique involves the presentation of stationary
test objects using suprathreshold or threshold
presentation
• Suprathreshold static presentation is an “off & on”
technique in which an object just above the anticipated
threshold for the field is presented for 0.5 to 1 second
and the point at which the patient fails to recognize the
target are noted. Spot checking is done for areas of
relative or absolute blindness usually in 30 degree
central visual field

Static Techniques
• Threshold static (Profile) perimetry measures the
relative intensity thresholds for the visual acuity
of individual retinal points within the field of
vision. Light intensity is increased gradually and
the level at which patient is able to recognize
target is recorded or by decreasing light from
suprathreshold value to lowest stimulus value
seen
• Point can be tested in one meridian in radiating
manner or circular manner

Static Techniques
• The more common technique with
automated perimetry is to test retinal
points distributed in a portion of the visual
field and record the visual thresholds as
symbols or numerical values
• Threshold static perimetry has been
shown to be more sensitive than kinetic
perimetry in detecting glaucomatous field
loss

Manual Perimetry
o Although automated perimeters are being
used with increasing frequency, the older
manual perimeters still provide valuable
information, especially when the test is
performed by a skilled observer

Screening Techniques
• Selective perimetry or the Armaly-Drance
technique: in this method Goldmann type
perimeter with suprathreshold static
perimetry is used to test central area field
and both suprathreshold static and kinetic
perimetry to examine the peripheral field
with emphasis on the nasal and temporal
periphery

Automated Perimetry
• The first era of perimetry – mid 19th
century, the work of von Graefe provided
Tangent Screens and Arc perimeters.
• They were lacking standardization
• In middle 20th century Goldmann perimeter
brought standardization
• The problem of subjectivity of both patient
and perimetrist remained

Automated Perimetry
o The problem of subjectivity of perimetrist was
eliminated by automation which began in the
1970s
o Automated perimetry improved the uniformity
and reproducibility of visual fields
o Utilization of computers has provided new
capabilities that were not possible with manual
perimetry, including random presentation of
targets, estimation of patient reliability and
statistical evaluation of data at different levels

Automated Perimetry
o Automated perimetry is more accurate and
informative (but it is neither fast nor cheap)

Factors Influencing Field
o In perimetry the following factors influence
the visibility of white target:
1. Size/ diameter/ area of the spot
2. luminous intensity of the spot
3. Background illumination

Influence of moving spot
o As the stimulus moves across the retina, a
temporospatial summation occurs that makes
kinetic stimuli more visible than the static ones.
This phenomenon is more striking in disease
conditions in which large intense objects are not
seen until they move (Riddoch phenomenon).
Statokinetic dissociation (Riddoch phenomenon)
seen in hemianoptic field defect

Neurological types of field defects
1. Prechiasmal defects
2. Chiasmal defects
3. Postchiasmal defects

Points in favour of Kinetic
• Glaucoma rarely affects mean deviation
appreciably without first producing a
localized defect
• It is rare for a neurologic field defect to
affect only the area outside 30 degrees

Points in favour of kinetic
• Automated static perimetry particularly,
threshold perimetry is different experience
for patient from kinetic perimetry.
Automated static test is longer, and target
is stationary and everything appears
dimmer to the patients. Therefore patient
finds automated perimetry more difficult
and stressful compared to kinetic
perimetry

Kinetic Perimetry
• In kinetic perimetry the test consists of
sequence in which the light comes on,
gets brighter then he conveys its
recognition by pressing button, then light
goes off, then again the stimulus comes in
similar manner.
• Whereas in automated static perimetry the
light goes on and stays only for 0.2 second
and it goes off irrespective of whether
patient see it or not and respond to it

Why is Goldmann Kinetic
Perimetry so important
o Kinetic perimetry is optimal for the more
steeply descending periphery and is much
faster than the static method in this region. It
is ideal for advanced defects or patients
having problems understanding static testing.
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.

Kinetic Perimetry
o Many patients hate perimetry, as it
demanding task that requires
attentiveness and an effort to give the
“correct answer” , the test is as stressful
as school examination. The patient must
realize that the field examination is a
subject medical test of their visual function
and it is not to test their intellectual, artistic
or physical abilities

Disadvantages of kinetic perimetry
include:
• the lack of automation provided by most
instruments,
• lack of computerized, normative, age-
related comparison of results,
• the need for an experienced tester,
• the potential for missing subtle scotomas,
• and the length of time required to perform
the tests

Shortcomings of traditional
Goldmann kinetic perimetry
o Regular training of examiner is reflected in
the quality of the result
o Regular manual calibration of the
instrument required
o Quality guidelines recommended
(Standard set of parameters, Verification
of the blind spot, Surveillance of the eye)

Automated Kinetic Perimeters
• Tasks that can be performed with present
generation of automated perimeters
1. Evaluation of central and peripheral
visual fields
2. Evaluation of blind spot
3. Correcting for reaction time
4. Examination of peripheral isopter
5. Superimposition of static field

Automated Kinetic Perimeters
6. Superimposition of visual field and
fundus image
7. Underlay fundus image
8. Underlay previous fields
9. Create an automated examination
10. Run an automatic examination

Negative aspect of static
testing
• About 30% of all highly pathological
patients cannot be tested with static
perimetry. Part of the problem is that the
reliability of the test is not guaranteed
because of the variability of the answers
the patients will give.

Disclosure
• Author does not have any financial or
trade interest in any of the companies
instruments of which are mentioned
presentation

Advantages of OCTOPUS
computer assisted Goldmann
kinetic perimetry
o 1:1 Goldmann Functionality
o Patented Reaction time compensation
o Resolution down to 0.1° enabling to accurately test the
blind spot
o Calculation of isopter and scotoma areas
o Automatic retest of once established kinetic field
o Superposition of static field
o True full field perimeter
o Produces comparable results
o Quick transition from traditional Goldmann

Studies in favour of Kinetic
Perimetry

The use of semi-automated kinetic
perimetry (SKP) to monitor
advanced glaucomatous visual field
loss
Graefe's Archive for Clinical and Experimental
Ophthalmology
Volume 246, Number 9 / September, 2008
Pages 1331-1339
J. Nevalainen, J. Paetzold, E. Krapp, R. Vonthein,
C. A. Johnson and U. Schiefer

Purpose and Conclusions
o Purpose (i) To compare visual field (VF) results obtained with semi-
automated kinetic perimetry (SKP) and automated static perimetry
(ASP) in patients with advanced glaucomatous VF loss, (ii) to
evaluate test-retest reliability of SKP and ASP and (iii) to assess
patients’ preference for SKP and ASP.
o Conclusions The comparability between SKP and ASP
is satisfactory and within the range of the test-retest
reliability of ASP. SKP shows slightly better test-retest
reliability than ASP. The majority of patients with
advanced glaucomatous visual field loss prefer SKP
instead of ASP. SKP is a valuable alternative to ASP in
monitoring advanced glaucomatous visual field loss.

Comparison between semiautomated kinetic
perimetry and conventional goldmann manual
kinetic perimetry in advanced visual field loss
NOWOMIEJSKA Katarzyna (1 2) ; VONTHEIN Reinhard (3)
; PAETZOLD Iens (1) ; ZAGORSKI Zbigniew (2) ;
KARDON Randy (4) ; SCHIEFER Ulrich (1) ;
Ophthalmology ISSN 0161-6420 CODEN OPHTDG
Source / Source
2005, vol. 112, no8, pp. 1343-1354 [12 page(s)
(article)] (29 ref.)

• Purpose: To compare quantitatively visual field (VF) results obtained
using a new standardized semiautomated kinetic perimetry (SKP)
with those obtained by conventional Goldmann manual kinetic
perimetry (MKP) in patients with advanced VF loss.
• Conclusions: Their results indicated that SKP
isopter shape and size were very comparable to
those obtained on the same eyes with MKP.
Semiautomated kinetic perimetry may represent
a more standardized method of kinetic perimetry,
which still takes advantage of perimetrist-patient
interaction to diagnose and monitor advanced
VF loss in clinical practice.

Kinetic perimetry
Author: SHIKISHIMA KEIGO
(Fac. Medicine, Jikei Univ. School of Medicine, JPN)
Ophthalmology
VOL.48; NO.10; PAGE.1433-1438 (2006)

Conclusions
• The test result with GP were more reliable than one with
the automated perimeter in cases of old people and of
poor visual acuity. Also, it was superior in pattern
recognition of the visual field, detection of psychogenic
visual field abnormality, grasp of a peripheral part of
visual field and evaluation of visual abnormality
depending on whether the visual field is in line with
meridian or not.
• In addition, the points to be kept in mind in interpretation
of abnormal visual fields including Riddoch
phenomenon, factors which affect abnormal perimetry
and psychogenic visual field abnormality are described.

A Comparison of Semiautomated
Versus Manual Goldmann Kinetic
Perimetry in Patients With Visually
Significant Glaucoma.
Original Studies
Journal of Glaucoma. 17(2):111-117, March 2008.
Ramirez, Adriana M. MD *; Chaya, Craig J.
MD +; Gordon, Lynn K. MD, PhD * ++;
Giaconi, JoAnn A. MD * ++

o Purpose: To determine if semiautomated kinetic
perimetry (SKP) is reproducible and comparable
to Goldmann manual kinetic perimetry (GVF).
o Conclusions: SKP and GVF testing produced
similar visual field results in glaucoma patients,
and SKP testing seems to be reliable and
reproducible in this population. However,
overlapping isopters, typically associated with
nonorganic vision loss, and jagged isopters were
sometimes observed in SKP visual fields.
Further study of SKP is needed to explore these
findings.

I have tested for you. Automated
kinetic perimetry
Publication Type: Comparative Study; English Abstract;
Journal Article
Journal: Journal français d'ophtalmologie (J Fr Ophtalmol).
Reference: 2006-May; vol 29 Spec No 2 (issue ) : pp 36-9
PMID: 17072220 (status: MEDLINE) (last retrieval
date: 12/12/2007)

Conclusions
• Authors compared the kinetic perimetry of the
Humphrey Field Anayzer and the Haag Streit
Octopus 101 and assessed their use in relation
to Goldmann perimetry. The Humphrey kinetic
perimetry comes close to Goldmann perimetry
and the Octopus shows clear advantages,
notably in terms of ergonomics and its more
sophisticated software. The Goldmann requires
a high level of skill; examination time with the
Humphrey and the Octopus is at least double the
time required by a skilled Goldmann operator.

Conclusions … Contd
• The examiner can to a certain degree be
passive during the static visual field
examination, but is entirely active during the
kinematic visual field examination.
Therefore, contrary to static perimetry, the
examination can only be performed by a
physician. The future of automated
kinematic perimetry depends on
simplification of the software.

Computerized kinetic perimetry
detects tubular visual fields in
patients with functional visual loss
American Journal of
Ophthalmology
Volume 137, Issue 5, May 2004,
Pages 933-935
Stacy L. Pineles BSE and Nicholas
J. Volpe MD

Conclusions
• This test used a computerized kinetic
examination to reduce the subjective
nature of tangent screen testing for tubular
visual fields and to provide a computerized
recording of visual fields. This method is a
novel and easy-to-use technique to
demonstrate functional visual loss.

GKP Goldmann
Kinetic Perimetry
Instruction Manual
HS# 1802025 © Haag-Streit AG (Rev 4, 01/2006)
Haag-Streit AG
Gartenstadtstrasse 10, 3098 Köniz/Bern,
Switzerland
Telefon: ++41 31 978 0111, Fax: ++41 31 978
0282, E-Mail: info@octopus.ch,
www.octopus.ch

Octopus 900® Full-Field
Goldman Perimeter
All-In-One Perimeter, Kinetic
Perimetry, Customized Tests —

Octopus 900® Full-Field Goldman
Perimeter
• Goldmann Kinetic
perimetry in manual,
semi-automatic and
automatic modes.
• 30° threshold test in
2.5 minutes
• Octopus "No Fixation
Loss" technology
provides actionable
data for doctors

OCULUS CenterField Perimeter
• Finally, a Compact 70º Static/Kinetic/Colour
Perimeter
The Centerfield automatically performs static
and kinetic perimetry in a 36º visual field.
Expands to 70º with a fixation shift. Offers white
/white and blue /yellow colour perimetry.
Screening. Supra, fast, and normal threshold
measurements. Popular 30-2, 24-2, and 10-2
grids.
That's Incredibly Precise
Designed to the Goldmann standard

COMPARISON OF AUTOMATED
KINETIC AND STATIC VISUAL
FIELDS IN NEURO-
OPHTHALMOLOGY PATIENTS
Perimetry Update 1988/89, pp. 3-8
Proceedings of the VIIIth International Perimetric Society
Meeting
edited by A Heijl
Kugler & Ghedini
Publications, Amsterdam, Berkeley, Milan

Conclusions
• Eighty-three patients with various neuro-ophthalmic
diseases were submitted to a standard automated
protocol including kinetic and static perimetry
The results of this study indicated that the ideal
evaluation of neuro-ophthalmology patients
should include complete kinetic and static fields.
Both examinations present significant
advantages, namely, the static examination
assesses more precisely the volume of large
paracentral scotomas and the kinetic
examination is more sensitive and reliable for
the detection of relative scotomas at
eccentricities of over 15 degrees.

Humphrey® HFAII-i Field Analyzer.
Precision and less time.
Exactly as Goldmann specified
The HFA II-i Field Analyzer meets
all requirements for state-of-theart
static and kinetic perimetry.

Goldmann Kinetic Perimeter

Difficult Cases for Kinetic Perimetry
• Cases of early qualitative changes

Difficult Cases for Static Perimetry
• Advanced field changes found in cases of
glaucoma
• Hemianoptic visual field changes seen in
cases of neurological disorders

Superposition of VF and fundus
image
• Superimposition of visual field on colored
fundus photograph is possible for better
interpretation
A

SUPERIMPOTION OF STATIC FIELDS
• Superimposition of static visual field is
possible on kinetic visual field for better
interpretation

Summary
• Static and Kinetic perimetry, both record visual
fields and have their place in evaluation of cases
of Glaucoma, neurological and retinal disorders.
• There are some cases where static perimetry
may be difficult, like cases of advanced
glaucomatous field defects, neurological
diseases and retinal vascular diseases.
• The major disadvantage of kinetic perimeters i.e.
lack of standardization has been rectified with
automated kinetic perimeters

Thank you

Kinetic perimetry

Recomendados

Recomendados

Mais conteúdo relacionado

Mais procurados

Mais procurados (20)

Destaque

Destaque (20)

Semelhante a Kinetic perimetry

Semelhante a Kinetic perimetry (20)

Mais de Hossein Mirzaie

Mais de Hossein Mirzaie (20)

Último

Último (20)

Kinetic perimetry