Controlling a Goldmann kinetic test Automated kinetic test and automatic isopter drawing

1. To start an automated test, click the "Play" button.

"Complete examination" will not stop between different isopters. Turning this option off allows you to reinstruct the patient, remove or insert a refractive lens and then continue. "Randomized sequence" will show the vectors within the same isopter in random order, while turning the feature off will run the vectors in their programmed order. 2. It is recommended that even during an automated examination the patient is supervised and motivated. 3. Once the examination is finished, select the button Draw new isopter 4. Click on a response icon, move towards the response you want to connect and double click between the response icons: This will automatically connect the isopter.

5. Click the "Save" button to leave the examination window.

Elements and parameters in Goldmann Kinetic Perimetry GKP Vector types

In the option "Automated Goldmann Kinetic" you find the 3 vector types Test vector: The vector type most commonly used RT (Reaction time) Vector: A vector type used a few times during the test to calculate the patients average response time. Guided vector: A vector only used in special situations - eg to examine a nasal step - and by experienced users. All these vectors run in a repeatable fashion with the "angular veloctiy" in /sec predefined with this slide bar:

To present vectors (stimulus paths) you click on the start point, drag the mouse to the end point and release the mouse button. Right after releasing the mouse buttons, they are presented to the patient.

In the option "Manual Goldmann Kinetic" you find the vector type "Free". This is the direct replacement of the pantograph function in the Original Haag-Streit Goldmann perimeter. If you click and drag the mouse, the stimulus in the perimeter will follow your mouse path. To facilitate constant velocities, the "angular velocity" (movement speed) is color coded.

0-1/Sec black 2-3/sec blue 4-7/sec green 8/sec red Regular responses are marked with an open icon, "No" responses have a filled arrow head.

Depending on the selected Goldmann parameters, the symbols may vary (circles, triangles, squares).

How to create automated tests

You can either decide to save the vectors of a finished test in your test library or create a new test just by drawing vectors. If you want to create a test without actually examining a person, first click on the "Pause" icon

This will pause a test and prevent displaying stimuli while drawing vectors. Draw all vectors that shall be tested. Click on the button "Automatic tests", then click the "Edit" button. The following window is shown:

Save the test in the position of your choice, Name the test, then click "Change" to rename a test button Delete old tests you want to remove from the librar. Click "Close" once you saved / renamed the test.

The steps of a kinetic examination

A kinetic examination is an interactive process between the examiner and the patient. Most clinics have their own predefined and taught proceeding. The one we present here is our recommendation drawn as a conclusion from the many different proceedings we learnt from experienced manual Goldmann users. It includes the steps: a) Confirm central fixation by establishing the blind spot b) Establish the outer visual field borders c) Complete the examination with additional isopters d) Evaluate the result

Blind spot testing, calculating isopter areas and rounding isopter connections

1. Click on the magnifying glass to activate the zoom function. 2. Click 3 times on the template of the blind spot 3. Choose the vector type "test vector" 4. Select the angular velocity to be 2/second 5. Choose Stimulus size I (0,1 diameter)

A note on stimulus sizes: Size I / 1 is preferred for the blind spot, scotoma and the central visual field Size III / 3 is preferred for the peripheral vision Size V / 5 is preferred in end stage testing 7. Choose the stimulus intensity to be 4e (0dB, maximum intenstity for kinetic, corresponding to 1000asb)

1..4 are 5dB steps (eg 3e = 5dB) a..e are 1dB steps (eg 3a = 9dB) 8. Click on the "Draw new vector" icon 9. Always drag vectors from non-seeing to seeing areas. eg from inside the blind spot to well outside the blind spot: 10. Use the eraser icon to delete and repeat vectors with very early responses. 11. From the supposed center based on the patient responses draw additional vectors to establish the size and shape of the blind spot

12. Switch to the vector type "RT-vector". You will now establish the patient's reaction time (the delay in his/her responses). 13. Draw 3 RT-vectors (double arrow head vectors) in areas that are considered seeing areas.

14. The distance between the start of the vector and the response corresponds with the reaction time. This delay time is calculated in milliseconds and can be used to correct the responses on regular vectors (patented feature). To correct for reaction time click on the RT icon 16. To connect an isopter manually, start by selecting the "Draw new isopter" button , then click consecutively on all responses you want to connect and last to the one you started with again.

17. With a right click you terminate the isopter connection 18. For all additional functions, right click on the isopter line; a context menu appears

19. Spline switches to rounded isopters, measure will calculate the isopter area in degree square.

20. Turning on and off reaction time compensation calculations.

will show you the influence on all responses and

Testing peripheral vision

1. Choose the vector type "test vector" 2. Select the angular velocity to be 5/second 3. Choose Stimulus size III (0,43 diameter) 4. Choose the intensity 4e (0dB, maximum) 5. If a refractive lens has been used for blind spot testing, move the lens holder to its parking position now, using the lensholder down button. 6. Click on the start point from where the stimulus shall run towards the center 7. A single click will draw a vector that runs to the center. Click and drag will run from the location where you clicked to the location where you released the mouse button.

8. Run 8-12 vectors from the periphery and omit the vertical and horizontal midline. 9. Run another 8-12 vectors with the parameters stimulus size I, Intensity 3e.

10. Kinetic vectors should always enter seeing area perpendicular to the local visual field border. This provides the most accurate delimitation of islands of vision and of scotoma.

11. If you draw vectors in advance but then need to reinstruct or reposition the patient, you can pause and continue the vector sequence with these two buttons:

12. Normal value rings with 1 standard deviation (dark grey) and 2 standard deviations (light grey) are displayed to facilitate selecting reasonable start and endpoint locations for the vectors. To turn on and off the normal value template, click 13. Start the vectors according to the responses and to the normal value rings usually slightly outside the normal value rings. This will reduce the examination duration and thus support the attentiveness of the patient. 14. If there are too many vectors on the screen to keep the overview, click the button vectors with the actually chosen parameters are then hidden. : All but the

Guideline for a general kinetic examination

To conclude, a complete kinetic examination usually consists of: a) Blind spot testing with I4e, 2/sec b) 1st isopter (ring) with III4e, 5/sec c) 2nd isopter with I3e, 5/sec d) optional 3rd isopter with I2e, 5/sec Choose the stimulus size and intensity to the patient's visual field defects.

Example for the on-screen representation of two kinetic visual fields.

Evaluating and printing results

Visual Field test selection
For viewing results and trend analysis, go to the Patients section.