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Smartfield

The Modern Device for Standard Automated Perimetry

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Take the smart approach to visual field testing!

As the latest entry in the pioneering compact perimeter design line of OCULUS, the Smartfield is purposefully optimized for monitoring functional impairment in glaucoma. Taken together, its shortened examination time, more intuitive analysis of findings and the increased patient comfort provide a comprehensive and modern clinical solution for visual field testing.

Measurements of the Smartfield are carried out using an ultra-high-luminance LCD screen. This screen also serves to generate a standard background illumination level for static perimetry and present test stimuli against this background. Using a single source for the background and the test stimulus ensures a more reliable calibration of the device during examinations.

Advantages

  • Fast: Short examination times even for threshold tests
  • Comprehensive: Advanced test strategies, unique evaluation tools
  • Interconnected: Native Ethernet access
  • Robust: Extended lifetime due to the absence of moving parts
  • Light: Small footprint and reduced weight for increased transportability
  • Compact: No dark room required thanks to the closed design
  • Portable: Practical carrying handle
  • Ergonomical: Height-adjustable measuring head
OCULUS Smartfield

Functions

Ergonomic Design

The OCULUS Smartfield stands out with a very small footprint, which is smaller still than that of the Easyfield®. Its closed design and light-protected viewer permit examinations in rooms with normal lighting conditions. Its low weight and the practical carrying handle make the Smartfield perimeter convenient for portable use.

The height-adjustable double chin rest and measuring head allow for better positioning of the patient and improved comfort. The absence of moving parts guarantees a long product lifetime.
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Easy Operation

The Smartfield perimeter is designed for operation via an external computer (notebook or PC) connected to the common office data network. This ensures network availability of examination data. The translucent lateral eye shields render the use of an eye patch during the examination unnecessary, thus saving valuable time in preparation for the test.

Increased Diagnostic Reliability

Powerful test strategies such as SPARK and other assessment tools contribute to the great diagnostic utility of the Smartfield perimeter. The enhanced Glaucoma Staging System (GSS 2) of Dr. Brusini and the Glaucoma Staging Program (GSP) offer extended support in single field analysis.

Structure-function relationships are predicted by the new PATH evaluation module. The Threshold Noiseless Trend (TNT) module performs efficient progression analysis. Examination quality is ensured by a patented fixation control algorithm, a high resolution video camera for eye monitoring and the various built-in catch trials.
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Examination Programs

The Smartfield is equipped with a set of predefined programs for the most frequently needed examination routines of the central visual field or the macular area. A default program for the periphery is also included. The program list can be easily extended according to specific requirements by combining the available test patterns and test strategies.

OCULUS Test Strategies

The Smartfield features the innovative SPARK test strategy for faster and more stable threshold measurements in glaucoma patients. Rounding off the testing capabilities of the Smartfield is the complete set of traditional OCULUS test methods, including threshold and suprathreshold strategies.

The classical 4-2 dB staircase strategy (Threshold) uses two reversals in the patient’s answer to deliver a threshold value in each tested point. The OCULUS Fast Threshold strategy is a clever improvement over the classical procedure which reduces examination time by using variable steps and taking advantage of already measured locations. Suprathreshold strategies like the 2-zone or 3-zone strategy offer a quick overview of the visual field.
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OCULUS Test Patterns

The grid corresponding to the SPARK examination strategy (30×24) is the preferred pattern in the Smartfield. However, other commonly used patterns such as 24-2 or 10-2 are readily available. Custom patterns for the central visual field can be easily created. The modular structure of the test programs allows for all patterns to be examined using any available standard strategy.

Results Printout

Measurement results of the Smartfield perimeter are commonly summarized in a standard printout. For suprathreshold tests a qualitative overview is printed, whereas for threshold examinations all clinically relevant data are shown in various representations. Besides the standard printout the Smartfield software features various assessment displays.

Comprehensive Perimetry

Examining the periphery: Beyond the central visual field

While static perimetry is usually performed within the central visual field (up to 30° eccentricity), if the aim is to gain an overall impression of the entire visual field, there are also many compelling reasons for examining the periphery. Despite its compactness, the Smartfield perimeter has the capacity to test the visual field up to 60° horizontally and 50° vertically. To overcome the limitations of the projection screen, an ingenious shift of the fixation target is performed, extending the testing capabilities of the device. This procedure allows testing of patterns extending over the periphery. Nevertheless, threshold strategies are not recommended for peripheral examinations.

OCULUS Smartfield - Printout of a suprathreshold examination
OCULUS Smartfield - Printout of a threshold examination

Threshold measurements

The most complete information about the visual field can be obtained by determining sensitivity threshold values in all locations of a test pattern using strategies for threshold measurements. The OCULUS Smartfield perimeter offers various threshold measurement procedures:

  • Full Threshold: The classical 4-2 dB staircase strategy using two reversals in the patient’s answer to deliver a threshold value.
  • Fast Threshold: Bracketing strategy using variable steps and taking advantage of already measured locations.
  • SPARK*: Fast and averaged threshold strategy based on statistical correlations between threshold values measured in different location.

*) SPARK is not an acronym, the name of the strategy was inspired by the appearance of the stimuli during perimetr

Focus on Glaucoma

Measurement – Assessment – Progression

Speed, precision and reliability: the SPARK threshold strategy
Defect assessment: Glaucoma Staging System (GSS 2)
Beyond field indices: Glaucoma Staging Program (GSP)
Efficient progression analysis: Threshold Noiseless Trend (TNT)
Predicting Anatomy from Thresholds (PATH)
The SPARK1) strategy is based on statistical relationships between threshold values found for different locations in the glaucomatous visual field. These relationships have been derived from more than 90000 perimetric examinations, providing high statistical significance and allowing for fast and very precise threshold measurements in the central visual field. The four-phase structure of SPARK makes it a versatile tool for clinical practice:

  • SPARK Precision is the full-fledged version of SPARK. Comprehensive visual field examinations of glaucoma patients can be performed in just 3 minutes per eye. Averaging the results over all four phases ensures a high degree of reliability and reproducibility for improved progression analysis.
  • SPARK Quick is the perfect strategy for follow-up and screening examinations. The procedure only takes 90 seconds per eye.
  • SPARK Training is ideal for patient training. This 40-second measurement can also be used for screening.
  • The SPARK strategy is fine-tuned for use in clinical examinations of glaucoma patients.

The enhanced Glaucoma Staging System2) classifies visual field results using the values of the mean defect (MD) and the pattern standard deviation (PSD or CPSD). The examination result is represented in the diagram by a point whose position is determined by the values of the perimetric indices. The diagram displays the severity of the detected visual field defects (Stage 0 – Stage 5) as well as their type (localized, generalized or mixed).
This novel evaluation module performs a thorough assessment of individual visual field findings using machine learning for pattern recognition. Besides its unique contribution to early glaucoma diagnosis, GSP3) can substantiate the clinical evaluation of test results.

GSP assigns each test result to a visual field class using an algorithm optimized to match evaluation by a glaucoma expert. In addition, the database of GSP includes correlations with the whole clinical picture (including structural changes). This information enables GSP to evaluate the degree of risk for the presence of different glaucoma stages on the basis of visual field findings.

Intuitive green-yellow-red colour coding helps in fast and reliable interpretation of the findings. The striking novelty of GSP consists in its capability to identify both glaucoma suspect patients and patients with possible pre-perimetric glaucoma using nothing but measured threshold values.

The TNT4) software module objectively evaluates changes over time in visual field results. Combined with the fast SPARK strategy, it increases considerably the sensitivity for detecting progression in early glaucoma.

  • TNT displays a concise report of the progression analysis with a summary of the most relevant parameters (MD slope, p-values, etc.).
  • TNT can distinguish between cases of diffuse or focal progression based on the value of the “Focality Index” (FI).
  • TNT uses multiple statistical criteria in establishing progression.
  • TNT presents age-related predictions on the visual field.

It is generally accepted that in glaucoma there is a close connection between the visual function and the anatomical structure of the retina or the optic nerve head. Based on the high reproducibility of visual field measurements using SPARK, the novel PATH5) evaluation module provides a prediction for morphological parameters such as retinal nerve fibre layer (RNFL) thickness or the area of the neuroretinal rim.

Estimating retinal nerve fibre layer thickness
Using the results of SPARK perimetry, RNFL thickness is determined in 25 points of the TSNIT (Temporal – Superior – Nasal – Inferior – Temporal) circle around the optic disc. The most relevant functional data are selected for each point. This procedure is objectively automated and does not rely on other findings such as on the correspondence between nerve fibre pathways and visual field areas.

Estimating the relative area of the neuroretinal rim
The ratio between the neuroretinal rim area and the total area of the optic disc is estimated as a linear combination of relevant threshold results. The result is compared to normative data and expressed as a percentage of the population average (normalized to 100%)

Device
SPARK-Strategie Glaucoma Staging System (GSS 2) nach Brusini - Darstellung der GSS2-Klassifizierung Glaucoma Staging Program (GSP) - GSP-Analyse eines präperimetrischen Befundes Threshold Noiseless Trend (TNT) - TNT-Hauptdarstellung Vorhersage der relativen Größe der Randsaumfläche mit PATH

Title

Description

1) M. González de la Rosa, J Glaucoma 2013
2) P. Brusini, S. Filacorda, J. Glaucoma (2006) 15: 40–46
3) D. Wroblewski et al, Graefes Arch Clin Exp Ophthalmol 2009
4) M. González de la Rosa and M. González-Hernandez, Br. J. Ophthalmol. 2011; V.T Diaz-Aleman et al., Br. J. Ophthalmol. 2009
5) M. Gonzalez de la Rosa, M. Gonzalez-Hernandez, S. Alayon, Eur J Ophthalmol 2015

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Technical Data

Static perimetry

Programs Pre-defined glaucoma, macula, screening and neurological tests
user-defined tests
Test patterns 30×24 (SPARK), 24-2, 10-2, customized patterns
Strategies Threshold strategies: SPARK Precision, SPARK Quick, OCULUS Fast Threshold, Full Threshold (4/2), Age-adapted suprathreshold screening (2-zone, 3-zone)
Examination speed Adaptive/fast/normal/slow/user-defined
Fixation control Through central threshold, Heijl-Krakau (using the blind spot), live video image
Result display Greyscale, dB values (absolute/relative), symbols, probabilities, 3D plot
Reports Enhanced Glaucoma Staging System (GSS 2), Glaucoma Staging Program (GSP), PATH function-structure analysis, Threshold Noiseless Trend (TNT) progression report

Specifications

Stimulus viewing distance Infinity
Max. eccentricity horizontal/vertical 30°/25° (60°/50° with fixation shift)
Stimulus size Goldmann III
Stimulus colour White
Stimulus duration 200 ms/user-defined
Threshold range/step 0.8 – 3 180 cd/m2 (2.5 – 10 000 asb), 0 – 36 dB/1 dB
Background luminance 10 cd/m2 (31.4 asb)
Patient positioning Height-adjustable measuring head, adjustable chin rest, double head rest
Software Device control, patient management, backup and print software (Windows®)
Built-in networking, easy EMR-integration, DICOM compatibility
Schnittstelle RJ45

Technical specifications

Dimensions (W x D x H) 332 x 418 to 477 x 402 mm (13.1 x 16.5 to 18.8 x 15.9 in)
Weight 7.6 kg (16.8 lbs)
Max. power consumption 30 W
Voltage 100 – 240 V AC
Frequency 50 – 60 Hz
Recommended computer specifications Intel® CoreTM i5, 500 GB HDD, 8 GB RAM, Intel® HD Graphics, Windows® 10

FAQ

There are four models in the OCULUS perimeter range. All four models can perform screening (supra-threshold) and threshold perimetry. Apart from being various sizes they differ as follows:

Model Easyfield® Smartfield Centerfield® Twinfield®
Maximum Eccentricity 30° 30°/25°
With fixation shift: 60°/50°		 36°
With fixation shift: 70°		 90°
Goldmann stimulus size III III III I, III & V
Static/Kinetic Static Static Static/Kinetic Static/Kinetic
Colour perimetry White-white White-white White-white
Blue-yellow		 White-white
Blue-yellow
Red-white
Stimulus presentation Light emitting diodes (LED) LCD display Back surface projection Back surface projection

All commercially available perimeters make use of the same basic testing principles. What makes one perimeter different to another is the way it performs fast thresholding test. Various fast threshold strategies are included in the OCULUS perimeters, one of which is the SPARK strategy – currently the fastest OCULUS strategy for glaucoma patients. It is the product of many years of research dedicated to obtaining reliable averaged results within the shortest possible time.

Furthermore all the perimeters include a unique glaucoma staging display called the Glaucoma Staging Program (GSP).

Lastly glaucoma progression is monitored by the Threshold Noiseless Trend (TNT) analysis method. The method can distinguish between diffuse or focal progression, and unlike methods based on event analysis, trend analyses make full use of the data pool of earlier examinations.

Yes, it may differ somewhat in appearance, but all the essential data known from other perimeters is available on the OCULUS perimeter printouts.

  • Full Threshold (4-2 dB Staircase) Strategy – the algorithm of this strategy can easily be implemented in any instrument and therefore it is available on most commercial perimeters. Results obtained with this strategy can be compared to results from any other perimeter using the same strategy.
  • OCULUS Fast Threshold Strategy – this strategy aims to reduce test time of the 4-2 dB Staircase strategy. The idea of the OCULUS Fast Threshold Strategy is to achieve a compensating gain in information by starting the measurement at each test point with a luminance value equal to the expected sensitivity value at that point. This expected value is calculated on the basis of measurement results already obtained at neighbouring test points.
  • CLIP (Continuous Light Increment Perimetry) Strategy – locations are tested individually by increasing the luminance of the stimulus continuously until the patient responds.
  • SPARK – the examination is performed in four phases. Each of these phases supplies a possible estimation of the functioning of the entire visual field, and the final result is obtained by averaging of the values obtained during each phase.

Yes. SPARK Precision is performed in four phases over a time period of three minutes. Each of the 66 points in the test pattern will be tested at least once during the three minutes.

Shorter examination time and better repeatability are the main benefits of SPARK. Testing time for this strategy will not exceed three minutes and this holds true even for patients with severely impaired visual field function. Compared to other known strategies, SPARK results have a much lower variability.

Various quick screening methods are available. Normally supra-threshold tests are used, however SPARK Quick has been designed specifically with screening in mind. The duration of the test is 1.5 minutes (90 seconds) on all patients and threshold values are generated after the examination.

Most perimeters only have Heijl-Krakau method to monitor patient fixation. This method uses the blind spot as reference. Glaucoma can cause absolute defects in the vicinity of the blind spot, which may increase as the disease progresses. Using the Heijl-Krakau method for these patients may be problematic. Central fixation control – only available in the OCULUS perimeters – uses the central luminance threshold as reference. This is a helpful method to control fixation for glaucoma patients.

All OCULUS perimeters allow for manual set-up of programs. When comparing current results from an OCULUS perimeter with previous results from other perimeters it is important to adapt the parameters of the current examination as closely as possible to those of the earlier examinations. This needs to be done in order to achieve the highest degree of comparability.

Examinations on the Easyfield®, Smartfield or Centerfield® can be performed in a normally lit room, provided the lighting is diffuse and there are no powerful light sources in the patient’s back. The Twinfield® requires a darkroom, as its perimetric hemisphere must be free of shadows.

GSP uses pattern recognition algorithms in order to assess the visual field results of the patient. For “Normal” and “Glaucomatous” visual fields a risk class can be determined by comparing the detected patterns to the visual field patterns stored in the database of the GSP. If the “Pre-perimetric” risk class dominates the bar chart, it means that the pattern of the measured visual field is similar predominantly to the patterns of patients with pre-perimetric glaucoma from the database. Pre-perimetric glaucoma is defined through glaucomatous changes to the optic nerve head and/or the retinal nerve fibre layer without detectable visual field losses. A “Pre-perimetric” result should be followed by a closer monitoring of the patient.

The software automatically chooses exams done with the same test pattern and the same strategy making comparison fast and easy to detect progression. Exams showing obvious learning effects are excluded by the software. The operator can also manually exclude exams if needed.

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