Glaucoma y Perimetria SPG 20130425-4

7/21/2019 Glaucoma y Perimetria SPG 20130425-4

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Glaucoma y PerimetríaComputarizada



José Alejandro Santos Espinoza

Medico Cirujano Oftalmólogo



Glaucoma y Perimetría Computarizada




• Here comes your text. – It can be bullet points or description.










Siempre Evaluar todo el Campo Visual




Siempre Evaluar todo el Campo Visual


















Nunca



Division del examen y Orden de Prelación

1

8

7

654

3

2




• Oscilación de un escotomaparacentral a largo plazo




• Oscilación de un escotomaparacentral a largo plazo






















• Escotomas Blancos























Algoritmos en Humphrey Field Analizer







• Error de aprendizaje.




• Error de aprendizaje.



Criterios Diagnósticos del Glaucoma Perimétrico











Swedish Interactive Threshold Algorithm (SITA)




Swedish Interactive Threshold Algorithm (SITA)

The SITA strategy uses more efficientmathematical methods for estimation of

threshold values based on normative data,patient age, and patient responses during the

test




SITA-Standard

reduced the test duration by ?50% compared to the Full Thresholdstrategy. Importantly, this reduction in the test duration is not done bysacrificing quality; SITA matches and even surpasses the accuracy ofthe Full Threshold strategy.[10-16] To further decrease the test duration

by 30-50%, SITA-Fast strategy was designed. However, test-retestreliability for this strategy is worse compared to SITA-Standard.[12-14] Currently, the most common clinically used strategy of SAP is the

SITA-Standard.




Total Deviation (TD) andPattern 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 theperiphery have a wider range. Therefore, TD plots are center-weighted such that an abnormal central point is assignedmore significance than a peripheral point. These are presented as a dB plot (top left plot on The Single Field Analysis) andas 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 fielddefects and ignore generalized changes (Key Feature 4). [7]

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




Global indices:

MD - an average deviation of the patient's visual field from theage-matched controls.

PSD - the degree of irregularity in the field.

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

CPSD - a PSD corrected for STF




MD vs. PSD

CV

actual

CV del

grupo

etario

corregid

o

con la

sensibili

dad

umbralDesviación TotalPatrón estándar

de desviación

CVdel

grupo

etario

MD PSD



Criterio para anormalidad minima:

1. Tres o mas puntos que no sean del borde en lalocalizacion esperada con sensibilidades en p < 5% yun punto con sensibilidad en p < 1%, o

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

3. GHT indicando un campo anormal





• Excesiva cantidad de falsos positivos






Caso Clinico

• Paciente de sexo femenino, edad 70 años.

• Tonometría: O.D. 13 mmHg., O.S. 11 mmHg.

• Fondo de ojo: hemorragia papilar a 2 h en ojo derecho• Excavación: O.D. 0.6 Dp O.S. 0.4 Dp

• Gonioscopía: ángulo abierto IIIº ambos ojos

Gl P i í C i d




• Paciente de sexo femenino, edad 70 años.

• Tonometría: O.D. 13 mmHg., O.S. 11mmHg.

• Fondo de ojo: hemorragia papilar a 2h enojo derecho

• Excavación: O.D. 0.6 Dp O.S. 0.4 Dp

• Gonioscopía: ángulo abierto IIIº ambos ojos

Gl P i t í C t i d




Gl P i t í C t i d




Gl P i t í C t i d




Gl P i t í C t i d




• Asociaciónde Clusters

Gl P i t í C t i d




Progresion del Gla coma



Progresion del Glaucoma

• El software usa triangulos – abiertos

– Semisombreados y

– Sombreados





Possible Likely





• Si tres o mas puntos han cambiado en la misma

localización en dos test consecutivos, elprograma reportara “possible progression,” el

cual lleva al oftalmólogo a realizar otro test. Silos hallazgos son confirmados en el tercer test,entonces el programa reportara “likelyprogression”

Análisis de la Progresión del Glaucoma - Criterios



Análisis de la Progresión del Glaucoma Criterios

• Criterios de Análisis deProgresión del Glaucoma





• El Oftalmólogo debe considerar varias limitaciones cuando usael análisis de progresión de Glaucoma.

• Al menos se requiere 5 campos visuales para el diagnostico deprogresión.

• La selección inicial de los campos visuales de base esautomática, pero puede ser necesario revisar la selección ycambiarla si es necesario.




Conclusiones

La evaluación del Campo Visual es solo unamodalidad disponible en el manejo de lospacientes con glaucoma.

Cuando tomamos decisiones acerca del

diagnostico o tratamiento, otros parámetrostales como la PIO, análisis del Nervio Óptico,la edad del paciente y otros factores de riesgo

deben también ser considerados.




Dr. José Alejandro Santos Espinoza

Muchas Gracias





Table of contents



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Organizational Chart



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CEO

VP IT VP Admin Secretary

Manager Development

Manager QA

Manager Admin

Manager HR

Test Lead 1Team Members List

Test Lead 2Team Members List

Dev Lead 1Team Members List

Dev Lead 2Team Members List

Admin Officer 1 Admin Officer 2

Support 1Support 2Support 3

HR Executive 1HR Executive 2

HR Support 1HR Support 2

Accounts&Finance Staff

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Quarterly Sale



Quarterly Sale

13%

17%

57%

13%

1st Qtr

2nd Qtr

3rd Qtr

4th Qtr

Employee Detail



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



Area Wise Growth

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1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

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Important Points



Important Points

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Project Iterations



j

Planning Execution Testing Deployment

Product Line Transitions



Finished Product

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Input

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Compass



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Yearly Sales



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Sale in Million $

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Formula



65%

20%15%

Growing Wealth



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and cons of plan A

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RawSale

Finished

Good

Training



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comeshere

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Name of Product A

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Name of Product C

Time Line



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4th QuarterMilestone

1st QuarterMilestone

2nd QuarterMilestone

Joint Ventures



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SWOT Analysis



Opportunities

OThreats

T

StrengthsS

WeaknessesW

Main Points



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Timeline



2007 2008 2009 2010 2011

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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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Obstacles



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Glaucoma y Perimetria SPG 20130425-4