Home Customer Care Customer Care for Ophthalmology & Optometry Quick Help for HFA Devices Humphrey Field Analyzer (HFA) Quick Help We’ve compiled quick help solutions to common problems that might address your current issue quickly and easily. Humphrey Field Analyzer was evaluated using the gaze fixation line Humphrey Field Analyzer II-i Series, User Manual. PDF Documents For more than 30 years, the Humphrey® Field Analyzer (HFA™) has been the accepted The HFA3 replaces the old manual process with a patented Liquid Trial Lens™, which. Training on the Humphrey Field Analyzer II-i series. The service manual is designed to support Level 1 of a two-level service strategy. Level 1 (on-site) field service employs modular replacement of printed circuit boards and other assemblies that are most effectively repaired at a central repair facility. This is the service strategy used in U.S. CARL ZEISS Humphrey 740i Field Analyzer / HFA II-i. The Humphrey Field Analyzer II 'i' Series including the Zeiss 750i, 745i, 740i, and the 720i, all contain a hard drive, and Magneto.
- Humphrey Field Analyzer Ii-i Series User Manual Windows
- Humphrey Field Analyzer 3 Manual
- Humphrey Visual Field Analyzer
- Humphrey Visual Field Analyzer Manual
Humphrey field analyser (HFA), is a tool for measuring the human visual field, it is used by optometrists, orthoptists and ophthalmologists, particularly for detecting monocular visual field.[1]
The results of the Analyser identify the type of vision defect. Therefore, it provides information regarding the location of any disease processes or lesion(s) throughout the visual pathway. This guides and contributes to the diagnosis of the condition affecting the patient's vision. These results are stored and used for monitoring the progression of vision loss and the patient's condition.[2]
- 2Method of assessment
- 3Interpreting results
- 3.2Plots
- 4Advantages and Disadvantages
Medical uses[edit]
The Analyser can be used for screening, monitoring and assisting in the diagnosis of certain conditions. There are numerous testing protocols to select, based on the purpose. The first number denotes the extent of the field measured on the temporal side, from the centre of fixation, in degrees. The '-2' represents the pattern of the points tested.[3] They include:
- 10-2: Measures 10 degrees temporally and nasally and tests 68 points. Used for macula, retinal and neuro-ophthalmic conditions and advanced glaucoma[4]
- 24-2: Measures 24 degrees temporally and 30 degrees nasally and tests 54 points. Used for neuro-ophthalmic conditions and general screening[5] as well as early detection of glaucoma[6][7]
- 30-2: Measures 30 degrees temporally and nasally and tests 76 points. Used for general screening, early glaucoma and neurological conditions[6]
The above tests can be performed in either SITA-Standard or SITA-Fast. SITA-Fast is a quicker method of testing. It produces similar results compared to SITA-Standard, however repeatability is questionable and it is slightly less sensitive[8][9]
There are additional tests for more specific purposes such as the following:
- Esterman – Used to test the functionality of a patient's vision to ensure they are safe to drive, as requested by VicRoads, Australia[10][11]
- SITA SWAP: Short Wavelength Automated Perimetry (SWAP) is used for detection of early glaucomatous loss[5]
Method of assessment[edit]
The Analyser test takes approximately 5–8 minutes, excluding patient set up. There are multiple steps which need to be done before commencement of the test to ensure reliable results are attained.
The test type and eye are firstly selected and the patient's details are entered, including their refractive error. The Analyser will provide a lens strength and type (either spherical and/or cylindrical), if required for the test. In these instances, wire-rimmed trial lenses are generally used, with the cylindrical lens placed closest to the patient so the axis is easily read. The clinician can alter the fixation targets as per necessary (see Fixation Targets for advice).[12]
Before putting the patient onto the machine, the requirements of the test itself are clearly explained. The patient is instructed to maintain fixation on the central target and is given a buzzer to only press when they see a light stimulus. It is not possible to see every light and some lights appear brighter/duller and slower/faster than others. The eye not being tested is patched and the room lights are dimmed prior to commencement of the test.[12]
The patient is positioned appropriately and comfortably against the forehead rest and chin rest. Minor adjustments to the head position are made to centre the pupil on the display screen to allow eye monitoring throughout the test. The lens holder should be as close to the patient's eye as possible to avoid artefacts (see Disadvantages for possible artefacts).
It is important for the patient to blink normally, relax and maintain concentration throughout the test. This will increase the reliability of results.[12]
Because “manual” has connotations of dense, boring text, some manufacturers or technical writers prefer the label “guide” for what would traditionally be called a “manual.”You will learn: Basic Setup & MaintenanceConnection Setup Errors & MessagesCamcorder displays an error code with the letter C: or E: followed by a number Movies & VideoTransfer Video To Your ComputerHow to transfer videos to a Macintosh computerThe AVCHD video is choppy or does not playback smoothly on a computer.AVCHD video is not recognized or cannot be transferred to a Macintosh computer. Sony handycam hdr-hc 21 user manual software. Parts & AccessoriesWatch Out for Counterfeit Products NFCCan I use the NFC function of the camera to connect with the Mobile Wallet app on a smartphone? That’s why we recommend the pdf version, viewable on your computer or mobile device at much larger font sizes.
How it works[edit]
The Analyser projects a series of white light stimuli of varying intensities (brightness), throughout a uniformly illuminated bowl. The patient uses a handheld button that they press to indicate when they see a light. This assesses the retina's ability to detect a stimulus at specific points within the visual field. This is called retinal sensitivity and is recorded in 'decibels' (dB).[1]
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The Analyser currently utilises the Swedish Interactive Thresholding Algorithm (SITA); a formula which allows the fastest and most accurate visual field assessment to date. Results are then compared against an age-matched database which highlights unusual and suspicious vision loss, potentially caused by pathology.[8]
Fixation targets[edit]
There are different targets a patient can fixate on during the test. They are chosen on the basis of the patient's conditions.[12]
- Central target: Yellow light in the bowl's centre
- Small diamond: For patients who cannot see the central target such as those with macular degeneration. The patient looks into the centre of the four lights
- Large diamond: For patients who cannot see the above two[12]
Interpreting results[edit]
Reliability indices[edit]
Issues of reliability are critical in result interpretation. These include, but not limited to, the patient losing concentration, closing their eyes or pressing the buzzer too frequently. Monitoring fixation is made visible via the display screen and gaze tracker, located at the bottom of the printout. The degree of reliability is determined by the reliability indices located on the printout (Fig. 4). These are assessed first and allow the examiner to determine if the end results are reliable. These indices include:
- Fixation Losses: Recorded when a patient responds to a stimulus that is projected on to area of their blind spot. Fixation losses exceeding 20%, are denoted with an 'XX' next to the score, and deems results unreliable[12]
- False Positives: Recorded when a patient responds when there is no stimulus present. This patient is often referred to as 'buzzer happy'. False positives exceeding 15% are denoted with an 'XX' and results are considered unreliable. This may indicate that the patient is anxious and concerned about missing targets[12]
- False Negatives:Recorded when a patient does not respond to brighter stimuli where a duller stimulus has already been seen. High false negative scores indicate that the patient is fatigued, inattentive, a malingerer or has genuine significant visual field loss.[12] Literature presents various percentages regarding reliability. However, majority of the literature defines that false negatives exceeding approximately 30% deem results unreliable.[13][14][15]
Plots[edit]
1: Reliability Indices
2: Numerical Display
3: Grey Scale
4: Total Deviation
5: Probability Display
6: Pattern Deviation
7: Global Indices
8: Glaucoma Hemifield Test
9: Visual Field Index
After reliability is determined, the remaining data is assessed.
Numerical Display[edit]
The numerical display represents raw values of patient's retinal sensitivity at specific retinal points in dB. Higher numbers equate to higher retinal sensitivities. Sensitivity is greatest in the central field and decreases towards the periphery. Normal values are approximately 30 dB while recorded values of <0 dB equate to no sensitivity measured.[16]
Grey Scale[edit]
The grey scale is a graphical representation of the numerical display, allowing for easy interpretation of the field loss. Lower sensitivities are indicated by darker areas and higher sensitivities are represented with a lighter tone.[3] This scale is used to demonstrate vision changes to the patient but is not used for diagnostic purposes.
pattern Deviation[edit]
The numerical total demonstrates the difference between measured values and population age-norm values at specific retinal points.[3]
Humphrey Field Analyzer Ii-i Series User Manual Windows
- Negative values indicate lower than normal sensitivity
- Positive indicates higher
- 0 equals no change[3]
The statistical display (located below the numerical total) demonstrates the percentage of the normal population who measure below the patient's value at a specific retinal point. The probability display provides this percentage a key for interpreting the statistical display.[3] For example, the darkest square in the key represents that <0.5% of the population would also attain this result, indicating that the vision loss is extensive. The Total Deviation plots highlight diffuse vision loss (i.e. the total departure from the age-norm).[17]
total Deviation[edit]
The pattern deviation provides a numerical total and statistical display as the Total Deviation plot. However, it accounts for general reductions of vision caused by media opacities (e.g. cataract), uncorrected refractive error, reductions in sensitivity due to age and pupil miosis. This highlights focal loss only (i.e. vision loss suspected from only pathological processes).[16] Therefore, this is the main plot referred to when making a diagnosis. The Pattern Deviation plot is generally lighter than the Total Deviation because of the factors accounted for.
Global Indices[edit]
A: Central scotoma
B: Centrocaecal scotoma
C: Nasal Step
D: Superior Arcuate
E: Nasal Wedge defect
F: Superior Nasal quadrantanopia
G: Superior Altitudinal
H: Nasal hemianopia
I: Enlarged Blind Spot with Paracentral scotoma located 15 degrees superiorly
These provide a statistical summary of the field with one number. Although not used for initial diagnosis, they are essential for monitoring glaucoma progression.[3] They include:
- Mean Deviation (MD): Derived from the Total Deviation and represents the overall mean departure from the age-corrected norm.[18] A negative value indicates field loss, while a positive value indicates that the field is above average. A P value is provided if the global indices are abnormal. It provides a statistical representation of the population. For example, P <2% means that less than 2% of the population have vision loss worse than measured[19]
- Pattern Standard Deviation (PSD): Derived from the Pattern Deviation and thus highlights focal loss only. A high PSD, indicating irregular vision, is therefore a more useful indicator of glaucomatous progression, than the MD[3]
Glaucoma Hemifield Test (GHT)[edit]
Humphrey Field Analyzer 3 Manual
The Glaucoma Hemifield Test (GHT) provides assessment of the visual field where glaucomatous damage is often seen. It compares five corresponding and mirrored areas in the superior and inferior visual fields.[3][20] The result of either 'Outside Normal Limits' (significant difference in superior and inferior fields), 'Borderline' (suspicious differences) or 'Within Normal Limits' (no differences) is only considered when the patient has, or is a suspect for, glaucoma.[20] This is only available in 30-2 and 24-2 Analyser protocol.[3]
Visual Field Index (VFI)[edit]
The VFI reflects retinal ganglion cell loss and function, as a percentage, with central points weighted more.[21]
It is expressed as a percentage of visual function; with 100% being a perfect age-adjusted visual field and 0% represents a perimetrically blind field. The pattern deviation probability plot (or total deviation probability plot when MD is worse than -20 dB) is used to identify abnormal points and age corrected sensitivity at each point is calculated using total deviation numerical map. VFI is a reliable index on which glaucomatous visual field severity staging can be based.[22]
The shaded pattern of vision loss provided on the Pattern Deviation plot allows for diagnosis of the type of vision loss present. This contributes to other clinical findings in the diagnosis of certain conditions. The types of vision loss and associated conditions are not described in the extent of this article, however Figure 5 provides typical examples of visual field loss seen. Refer to #See also for more information.
Advantages and Disadvantages[edit]
Advantages[edit]
- Provides a comprehensive visual field assessment and ensures reliable results[12]
- Compares patient's data to age-matched populations[12]
- Distinguishes focal from diffuse vision loss[12]
- Figure 6 - Artefacts (right eye)Can be used for patients who are wheelchair users, hearing impaired, have postural and fixation problems and/or very low visual acuity[12]
A: Aphakia
B: Rim artefact
C: Chin slip
D: Lens position
E: Corneal opacity
F: Keratoconus
G: Ptosis
H: Pupil Miosis - 1mm
I: Pupil Miosis - 3mm - Provides a baseline measurement
- Simple for the examiner to perform and interpret
Disadvantages[edit]
- Requires a higher level of patient understanding and concentration compared to other visual field tests[9]
- Time-consuming
- Learning effect: new patients improve as more tests are performed due to understanding of the test conditions. Consider the third test as the baseline result[23]
- Potential for artefacts (i.e. uncharacteristic vision loss) (fig. 6). Below is a list of possible artefacts and a representation of how they may appear. These can however, be managed with correct patient setup.
- Uncorrected refractive error and aphakia cause significant decrease in visual field sensitivity[3]
- Rim of trial frame can simulate glaucomatous loss[24]
- Media opacities and keratoconus cause decreased sensitivity[3]
- Ptosis cause superior visual field loss[3]
- Miosis cause decreased peripheral sensitivity[3]
See also[edit]
References[edit]
- ^ abLanders, John; Sharma, Alok; Goldberg, Ivan; Graham, Stuart L (February 2010). 'A comparison of visual field sensitivities between the Medmont automated perimeter and the Humphrey field analyzer'. Clinical & Experimental Ophthalmology. doi:10.1111/j.1442-9071.2010.02246.x. PMID20447123.
- ^Kedar, Sachin; Ghate, Deepta; Corbett, JamesJ (2011). 'Visual fields in neuro-ophthalmology'. Indian Journal of Ophthalmology. 59 (2): 103–109. doi:10.4103/0301-4738.77013. PMC3116538. PMID21350279.
- ^ abcdefghijklmKanski, J. J.; Bowling, B. (2011). Clinical Ophthalmology. Edinburgh: Elsevier Saunders.
- ^Asaoka, Ryo; Vavvas, Demetrios (20 June 2014). 'Mapping Glaucoma Patients' 30-2 and 10-2 Visual Fields Reveals Clusters of Test Points Damaged in the 10-2 Grid That Are Not Sampled in the Sparse 30-2 Grid'. PLoS ONE. 9 (6): e98525. doi:10.1371/journal.pone.0098525. PMC4064971. PMID24950300.
- ^ abKhoury, Johnny, M.; Donahue, Sean, P.; Lavin, Patric, J.; Tsai, James (1999). 'Comparison of 24-2 and 30-2 Perimetry in Glaucomatous and Nonglaucomatous Optic Neuropathies'. Journal of Neuro-Ophthalmology. 19 (2): 100–108. doi:10.1097/00041327-199906000-00004.
- ^ abNouri-Mahdavi, Kouros (December 2014). 'Selecting visual field tests and assessing visual field deterioration in glaucoma'. Canadian Journal of Ophthalmology. 49 (6): 497–505. doi:10.1016/j.jcjo.2014.10.002.
- ^Huang, Charles Q.; Carolan, James; Redline, Daniel; Taravati, Parisa; Woodward, Kimberly R.; Johnson, Chris A.; Wall, Michael; Keltner, John L. (1 March 2008). 'Humphrey Matrix Perimetry in Optic Nerve and Chiasmal Disorders: Comparison with Humphrey SITA Standard 24-2'. Investigative Ophthalmology & Visual Science. 49 (3): 917–23. doi:10.1167/iovs.07-0241. PMID18326712.
- ^ abBengtsson, Boel; Olsson, Jonny; Heijl, Anders; Rootzén, Holger (27 May 2009). 'A new generation of algorithms for computerized threshold perimetry, SITA'. Acta Ophthalmologica Scandinavica. 75 (4): 368–375. doi:10.1111/j.1600-0420.1997.tb00392.x.
- ^ abSzatmáry, Gabriella (1 September 2002). 'Can Swedish Interactive Thresholding Algorithm Fast Perimetry Be Used as an Alternative to Goldmann Perimetry in Neuro-ophthalmic Practice?'. Archives of Ophthalmology. 120 (9): 1162. doi:10.1001/archopht.120.9.1162.
- ^'Vic Driving Vision Standards'. Optometry Australia. Optometry Australia. Archived from the original on 2016-04-18.
- ^'Visual impairment'. VicRoads. State Government of Victoria. 2015. Archived from the original on 2019-02-28.
- ^ abcdefghijklArtes, Paul H (2012). Humphrey Field Analyzer II-i series User Manual. Carl Zeiss Meditec.
- ^Bengtsson, B; Heijl, A (2000). 'False-negative responses in glaucoma perimetry: indicators of patient performance or test reliability?'. Investigative Ophthalmology and Visual Science. 41 (8): 2201–2204.
- ^McKendrick, Allison M.; Denniss, Jonathan; Turpin, Andrew (August 2014). 'Response times across the visual field: Empirical observations and application to threshold determination'. Vision Research. 101: 1–10. doi:10.1016/j.visres.2014.04.013. PMID24802595.
- ^Johnson, Chris A; Keltner, John L; Cello, Kimberly E; Edwards, Mary; Kass, Michael A; Gordon, Mae O; Budenz, Donald L; Gaasterland, Douglas E; Werner, Elliot (March 2002). 'Baseline visual field characteristics in the ocular hypertension treatment study'. Ophthalmology. 109 (3): 432–437. doi:10.1016/S0161-6420(01)00948-4.
- ^ abWyatt, Harry J.; Dul, Mitchell W.; Swanson, William H. (March 2007). 'Variability of visual field measurements is correlated with the gradient of visual sensitivity'. Vision Research. 47 (7): 925–936. doi:10.1016/j.visres.2006.12.012. PMC2094527. PMID17320924.
- ^Cubbidge, R (2012). 'Essentials of visual field assessment'. The Optician. 243 (6356): 14–16. ProQuest1027770159.
- ^Chen, Yi-Hao; Wu, Jian-Nan; Chen, Jiann-Torng; Lu, Da-Wen (2008). 'Comparison of the Humphrey Field Analyser and Humphrey Matrix Perimeter for the Evaluation of Glaucoma Patients'. Ophthalmologica. 222 (6): 400–407. doi:10.1159/000154203.
- ^Stamper, Robert L; Lieberman, Marc F; Drake, Michael V (2009). Becker-Shaffer's diagnosis and therapy of the glaucomas (8th ed.). [Edinburgh]: Mosby/Elsevier. ISBN978-0-323-02394-8.
- ^ abIshiyama, Y.; Murata, H.; Mayama, C.; Asaoka, R. (11 November 2014). 'An Objective Evaluation of Gaze Tracking in Humphrey Perimetry and the Relation With the Reproducibility of Visual Fields: A Pilot Study in Glaucoma'. Investigative Ophthalmology & Visual Science. 55 (12): 8149–8152. doi:10.1167/iovs.14-15541. PMID25389198.
- ^Horton, M. (2015). '10 tips for improving visual fields: perimetry may seem like second nature, but these recommendations can help you obtain better results by refining your understanding of the technology'. Review of Optometry. 152 (4): 62.
- ^Kuzhuppilly N, Patil S, Dev S, Deo A. Reliability of Visual Field Index in Staging Glaucomatous Visual Field Damage. Journal of Clinical & Diagnostic Research. 2018 Jun 1;12(6): NC05-NC08
- ^Saigal, Rahul. 'Learning Effects and Artefacts in Automated Perimetry'(PDF). Association Of Optometry Ireland.
- ^Donahue, Sean. P. (1998). 'Lens Holder Artifact Simulating Glaucomatous Defect in Automated Perimetry'. JAMA Ophthalmology. 116 (12): 1681–1683. doi:10.1001/archopht.116.12.1681. PMID9869806.
Humphrey Visual Field Analyzer
Humphrey Visual Field Analyzer Manual
Fixation control
•Heijl/Krakau blind spot monitor
•Video eye monitor
•Gaze tracking
•Remote video eye monitor capability
Operator interface
•Touch Screen CRT with Keyboard Stimulus
•White-on-white
•Red- or blue-on-white
•Blue-on-yellow (SWAP) - Option
General testing features
•Stimulus sizes - Goldman I-V
•Foveal threshold testing
User-defined test storage
•YES
Software features
•Glaucoma Hemifield test (GHT)
•Glaucoma Progression Analysis (GPA)
•STATPAC 2-single field analysis
•Serial field overview
•Networking (i model only)
Printer
•Printrex thermal printer, table mounted
•Data storage, retrieval and analysis
•Hard drive - 40 GB
•Magneto-optical disk drive - Option
Threshold Visual Fields in as Little as 2 Minutes
• SITA sensitivity, reproducibility & accuracy has been shown in clinical testing when using the Zeiss 740i Perimeter
Diagnostic Precision
• STATPAC 2 - Single & Multiple Field Analysis is a standard feature on the Zeiss 740i Perimeter. STATPAC, the language of perimetry, compares results to proprietary age normative and glaucoma databases
Improved Reliability
• The Zeiss 740i Perimeter also offers patented fixation monitoring including, Krakau Blind Spot Monitoring, Video Eye Monitor, Gaze Tracking and Remote Video Eye Monitor capability
• Social Security Disability testing, Monocular, Binocular, and Custom Testing are standard features on the Zeiss Humphrey 740i, while Kinetic Testing is an option on the Zeiss 740i, providing the widest range of testing protocols on any perimeter
Early Glaucoma Detection
• The Zeiss 750i, 750, 745i, and 745 Perimeters all offer SITA-SWAP software, which reduces blue-yellow threshold test time to just 4-6 minutes, providing a clinically practical tool for early detection of glaucoma. The SITA-SWAP software is standard on the Zeiss 750i Perimeter, and the Zeiss 745i Perimeter, and available as an option on the Zeiss 750 Perimeter, and the Zeiss 745 Perimeter
Gold Standard
• Over 40,000 Zeiss Humphrey Perimeters worldwide including the Zeiss 750i, 745i, 740i, 720i, 750, 745, 740, 735, and the Zeiss 720 Perimeter Visual Field Analyzer
Operator Friendly & Patient Friendly
• The Zeiss 740i Perimeter offers a touch screen, featuring on-screen menus to simplify and expedite instrument operations. The Zeiss 740i Perimeter is also wheelchair accessible and an ergonomic design allows maximum comfort for all patient body types
Practice & Patient Friendly
• The Zeiss 750i, 745i, 740i, and the 720i Perimeters include networking software which automates Visual Field Analysis by connecting directly to your office information system
• Touch-screen and menu-driven interface simplifies operation
• The Zeiss 740i Perimeter offers agronomic design for maximum comfort, access and versatility
Complete Archiving System
• The Humphrey Field Analyzer II 'i' Series including the Zeiss 750i, 745i, 740i, and the 720i, all contain a hard drive, and Magneto-optical drive
Advanced Analysis
• Zeiss Humphrey GPA Glaucoma Progression Analysis software identifies clinically significant progression automatically
• Pattern Deviation Plots identify localized field loss typical of glaucoma, minimizing ocular media
effects such as cataracts