before you detect any field defect and its possibilities, you have to know the interpretation of its sections.

1. Humphery perimetry
interpretation (part 1)
Samhaa Mohammed Abd Elmoneim
(FRCS Glasgow, Egyptian Fellowship, MSc.)
Zagazig Ophthalmic Hospital
(2021)

2. Objectives
Division the printout of Humphrey visual field into
sections
Interpretation and commenting on each section
Listing the indications of Humphery visual field

3. SMIL from point of
fixation
60° superiorly,
60° medially,
70° inferiorly,
100° laterally

4. • At 10-15° nasal (temporal in printout)
to fixation ON head … (Normal
Absolute scotoma)

6. Peak at fixation then ↓ suddenly 10° around fixation then ↑ then↓
gradually at periphery (3D dimensional hill)

7. Rule in visual field
‫ومقلوب‬ ‫معكوس‬
,
‫عن‬ ‫ويمثل‬
‫العيان‬ ‫شكوى‬
Reversed and inverted
and representing the
complaint

8. Perimetry
• Confrontation, Amsler chart:
clinical tests
• Manual (Tangent screen), or
Automated (Humphery)
• Static (Humphery), or
Kinetic (Octopus, Tangent screen)

10. Humphery perimetry,
How to interpret and comment on?
1.
Type of test, pattern, algorihm
(eg. humphery, SITA, 24-2),
Name, date, age.

12. Correct
D/N VA
Stimulus IV
if VA < 6/60

13. Humphery perimetry
• Test algorithms
-Threshold
-Suprathrshold …. For screening
-SITA (Sweddish Interactive Threshold Algorithm) …. less
time without losing accuracy
-FDT (Frequency Doubling Technique) …. Test magnocellular
for early glaucoma
-SWAP (Short Wavelength Automated Perimetry) … blue
yellow for early glaucoma
• Test patterns
- (24-2), (30-1), (30-2), (10-2)…. 1st number for tested area
around fixation, 2nd number for test at both sides of
meridian

14. If blind spot is with
your right hand , visual
field is of the right eye
and the reverse
2.
Which eye
Blind spot is temporal

15. 3.
Reliability indices < 25%
• Fixation loss (stimulus in blind spot)
• False positive (trigger happy, response> sounds)
• False negative (-ve with brighter stimulus)
• Gaze tracking GT
Clover leaf pattern (false
negative)

16. GT

18. 4.
Global indices
• Mean Deviation MD (average deviation
at each point from age corrected normal)
generalized depression
Minus value is bad
1. -2 to -6 … mild
2. -6 to -12 … moderate
3. > -12 … severe
4.
Global indices
• Pattern standard deviation PSD =TD
(standard deviation at each point from age
corrected normal)

19. 4.
Global indices
• Corrected Pattern standard Deviation
PSD = PD (corrected by short term
fluctuation)
4.
• Glaucoma hemifield test (GHT)
• (superior and inferior 5 clusters of points)
4.
• Glaucoma visual field index (VFI)
(overall VF function .. 100%)

23. 5.
Sensitivity values
Grey scale
• Dark tones … (low sensitivity)
• Blind spot … (temporal just inf. To
horizontal axis)
5.
Sensitivity values
Numerical scale
• Sensitivity to threshold at each point
in db
• Threshold is rechecked in unexpected
values or routinely (presented in
brackets ( )

25. 5.
Sensitivity values
Total Deviation TD
• Deviation of sensitivity at each
point from normal (corrected with
normal age values).
• Negative (lower sensitivity than normal),
positive (higher than normal) corrected
with normal age values.
• Generalized defect.

27. 5.
Sensitivity values
Pattern Deviation PD
• Total deviation values adjusted for
any generalized decreased
sensitivity.
→
Localized defect.

29. 5.
Sensitivity values
Probability value blots
• Probability values (percentage of abnormal
values present in normal persons) in TD, PD
• The lower p value, the more probability to be
abnormal.
• <5% to < 0.5%

33. When do you ask for visual field?
(indications)
• (diagnosed/ suspect) glaucoma patient clinically to
confirm Dx
• Diagnosed glaucoma patient for follow up
• Field defect (by complaint/ confrontation) of gradual
progressive onset without definite correlated ocular cause
• For diagnosis and follow up of neurological cause (eg:
intracranial lesion)
• Any field defect of acute onset with obvious typical retinal or optic
nerve cause (RAO, RVO, AION) for documentation !

34. References
• https://eyewiki.aao.org/Standard_Automated_Perimetry
• https://eyerounds.org/tutorials/VF-testing/
• https://glaucomatoday.com/articles/2007-nov-
dec/GT1107_10-php
• https://www.eophtha.com/posts/ten-pearls-in-interpreting-
humphrey-visual-field
• https://www.aao.org/young-ophthalmologists/yo-
info/article/demystifying-the-visual-field

35. Thank you