OCTOPUS PERIMETRY

GLAUCOMA PROGRESSION ANALYSIS

Dr. Rohit Khatri
Chair : Dr. Neetha S.

OCTOPUS PERIMETRY

The Octopus perimetry system focuses

on getting efficient field examinations
by shortening testing time thereby
reducing errors caused by patient
fatigue.
It achieves this by using different
strategies:
1) staging & phasing
2) dynamic strategy
3) tendency oriented perimetry(TOP)

STAGING

The examination is run in a sequence of

diagnostically relevant stages.
In each stage a predefined subset of test
locations is tested.
Priority can be allocated to those test
locations which are more critical in relation to
glaucoma & these locations are tested first.
Thus, the essential part of the field exam is
completed initially when the patient is more
alert.

PHASING
After concluding a number of stages in
the 1st phase, the 2nd phase offers
possibility to extend the examination in
different directions:
1) repeat phase 1, to know SF.
2) go to peripheral test points.
3) quantify relative defects.
4) stop.

ADVANTAGES OF STAGING
& PHASING

Adapting test time to patients

situation.
Shortening test time with minimal info
loss.
Prioritizing to diagnostically relevant
areas.
Extending the test in directions as
required in individual cases.

DYNAMIC TESTING
STRATEGY

With increase in the defect depth, the

step sizes increase progressively from
2 to 10 dB. The threshold is crossed
only once.
The procedure allows retesting at all
locations.
It reduces testing time by 40-50 % in
fields with severe depression.

TENDENCY ORIENTED
PERIMETRY

TOP algorithm takes into account that

threshold values(differential light sensitivity)
of neighboring areas are interrelated.
It reduces testing time by 80% to about 2
minutes.
It assesses the threshold in the location
where stimulus is presented, & also
threshold of adjacent points by interpolation.
Especially useful in depressed fields, children
& elderly.

TOP strategy

GAZE TRACKING

Instead of using the blindspot locator

with fixation monitor as a method of
assessing fixation losses, the Octopus
has a gaze tracking system.
It works by locating the light reflex in
the pupillary area & looking for any
changes in gaze to assess fixation
losses.

STANDARD TEST
CONDITIONS
OCTOPUS 101
Background illuminance 4 asb
Size Goldmann I-V
Maximum luminance 1000 asb
OCTOPUS 300
Background illuminance 31.4 asb
Size Goldmann III,V
Maximum luminance 4800 asb

SEVEN-IN-ONE PRINTOUT

Patient data
Examination data
Value table (raw data)
Grey scale
Comparison table
Corrected comparison table
Probability plots
Visual field indices
Bebie curve ( defect curve )

SEVEN IN ONE

VALUE TABLE

Gives the actual sensitivities of

individual points in the field in decibels.
The other tables are derived by
comparing these values with normative
data.

GREYSCALE

Standard greyscale : value table values

are divided into 10 zones & each is
given a color code. Darker areas signify
lower sensitivity.
Comparison greyscale : shades are
given based on comparison table
values. A normal field result will be
white on this scale.

COMPARISON TABLE

Plots the difference between the value

table & age matched normal
population.

BEBIE CURVE (CUMULATIVE

DEFECT)

It shows all the sensitivity values

arranged in descending order as a line
graph.
They are useful in clearly & quickly
assessing the characteristics & depth of
the defect.
They cannot distinguish between
glaucomatous and nonglaucomatous
causes of localized or diffuse visual field
loss.

The most important highlight of the

Bebie curve is the zone of age
corrected normality at the top.
It represents 90 % confidence interval
of the normal population which are
represented by two lines (4 dB).
The diffuse loss ( deviation ) is
represented below the curve in dB.

If the Bebie curve is evenly depressed

below the 95th percentile, depression
of the visual field is generalized.
If only the right side of the curve is
depressed, visual field loss is localized.
If the whole curve is depressed but in
an uneven fashion, both localized and
diffuse loss is present.

BEBIE CURVE

CORRECTED COMPARISON
TABLE

An estimate of the diffuse loss is

derived from the Bebie curve, termed
deviation.
This deviation is removed from the
Comparison table to arrive at the
Corrected Comparison table.

PROBABILITY & CORRECTED

PROBABILITY PLOTS

These are derived from the comparison

& corrected comparison tables
respectively by assigning P values to
each point.

VISUAL FIELD INDICES

MEAN SENSITIVITY:
It is the average of all differential light sensitivity
values on the raw data.
It is not corrected for age or diffuse loss.
MEAN DEFECT:

It is the average of all the values of the

comparison table.
It represents the age corrected mean sensitivity.
The trend of MD over time is a good indicator of
progression.

LOSS VARIANCE:
It is the square value of the standard deviation of
the local defects in the comparison table.
It is a very sensitive index to pick up early
localized damage.

SQUARE ROOT OF LV:

It is a more sensitive index for following up
fields to detect change in local defects over
time.
It is more smooth on the trend analysis graph.

SHORT TERM FLUCTUATION:

These are values obtained after
retesting certain points in the field.
Normal range is 1.5 2.5 dB
CORRECTED LOSS VARIANCE:
It is derived by removing the short
term fluctuations from the loss
variance.

RELIABILITY FACTOR

It indicates the patients co-operation.

It is calculated as- the sum of the false
positive & false negative answers
divided by the total number of catch
trial questions.
It should not be higher than 15%

Octopus v/s HFA

MACULAR PROGRAM

Developed for assessing & following up

central & paracentral fields.
M2 program has 45 test locations
which test the central 4 degree. This
gives a resolution of 0.7 degree with
Goldmann size III.
The outer 36 test locations are
between 4-9 degree from centre.

16 points in 5 degree Macular

Macular program in
Advanced Glaucoma

FOLLOW UP FIELDS
Humphrey field analyzer has STATPAC to
print follow up fields in these formats:
1) Overview printout
2) Change analysis printout
3) Glaucoma progression analysis

OVERVIEW PRINTOUT

It involves chronological arrangement

of field printouts & assessing for any
change over time.
It has all the data of a single field
except visual acuity & refractive
correction.
It requires experience to detect
sequential change in fields, & no
statistical analysis is involved.

The most important aspect to assess

progression is mean deviation index.
Accepted increase in MD index per year
is 0.08 dB.
Concentrate on probability plots to
know the progression in terms of
extent.
Exact loss of sensitivity can be known
from the raw data only.

CHANGE ANALYSIS
PRINTOUT
It has 3 components:
1) A box plot with its relation to the dB
scale.
2) Summary of the global indices.
3) Linear regression analysis of the
mean deviation.

1) Box plot :
gives info regarding the depth of the
field defect. Each box plot represents
the TDNP of each single field printout.
2) Global indices summary :
MD index & PSD index are displayed in
graphic format.
Uniform progression increase MD

Irregular generalized progression

increase MD, increase PSD.
3) Linear regression analysis of Mean
Deviation helps to know a temporal
change in MD index.

BOX PLOT

The box plot is constructed by placing the TDNP

values in decreasing order of sensitivity & dividing
them into 3 zones.
To know the type of field defect, the position of the
box plot in relation to the dB scale as well as its
shape is important.
Localized field defect lengthening of tail, no
change in position of box.
Uniform generalized field defect box is lower in
position.
Irregular generalized field defect box is lower in
position as well as lengthened.

BOX PLOT

LOCALIZED FIELD DEFECT

UNIFORM GENERALIZED
FIELD DEFECT

IRREGULAR GENERALIZED
FIELD DEFECT

GLAUCOMA PROGRESSION
ANALYSIS

The main drawback with overview printouts

or change analysis is that comparisons are
made between raw data (TDNP) of baseline &
follow up.
In this case we do not know whether the
change is due to actual disease progression
or long term fluctuation, learning effects /
media opacities.
In GPA, comparisons are made between
baseline pattern deviation numerical plots &
those on follow up.

BASELINE PRINTOUT

GPA baseline printout is a combination

of:
1) Overview printout of 1st two tests.
2) Linear regression analysis of mean
deviation of change analysis printout.

BASELINE

STEPS IN ANALYSIS
1) Establishing the baseline data:
PDNP of the 1st two printouts is used.
2) Establishing the deviation from baseline:
Follow up PDNP is compared to baseline &
deviation plots constructed.
3) Establishing progression analysis plot:
Each deviation from baseline is compared to
inter-test variability of stable glaucoma
patient & points which have progressed
significantly are indicated.

SYMBOLS ON GPA

progression at 95% significance

level.
progression significant in 2
consecutive exams.
progression significant in 3
consecutive exams.

PROGRESSION

Three
in one exam indicates
possible progression.
Three
in one exam indicates likely
progression.

POSSIBLE PROGRESSION

LIKELY PROGRESSION