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Smartfield

Compact visual field device

  • Ergonomic design
  • Flexible use regardless of lighting conditions
  • Short examination times
  • Highlights
  • Software
  • FAQ
  • Technical Data
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Smartfield

The OCULUS Smartfield is a compact visual field device purposefully optimized for monitoring functional impairment in glaucoma. Based on an ultra-high-luminance LCD screen it performs standard automated perimetry of the central visual field and beyond. Despite its small size, the Smartfield perimeter offers a comprehensive clinical solution in visual field testing for any glaucoma practice.

OCULUS Smartfield - Kompaktes LCD-Perimeter

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.

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.

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.

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.

Perimetry-Software

SPARK threshold strategy
Glaucoma Staging System (GSS 2) per Brusini
Glaucoma Staging Program (GSP)
Threshold Noiseless Trend (TNT) Progression Analysis
Predicting Anatomy from Thresholds (PATH)
The SPARK examination strategy was primarily developed for glaucoma patients and is available for all OCULUS perimeters. It is based on data from more than 90 000 perimetric findings and allows a very fast, yet very precise measurement of thresholds in the central visual field. The modular structure of the method makes it suitable for a variety of applications:

  • SPARK Precision (optional software) is the full version of SPARK. The complete visual field examination of glaucoma patients takes only 3 minutes per eye. The greater stability of the results allows for more sensitive progression analysis.
  • SPARK Quick is used for follow-up or screening examinations. The test takes just 90 seconds per eye.
  • SPARK Training is ideal for patient training. The 40 second measurement can also be used as a screening examination.

The enhanced Glaucoma Staging System (GSS 2) of Brusini classifies visual field defects based on the perimetric indices MD (Mean Deviation) and PSD (Pattern Standard Deviation). The representative point of the examination is placed in a chart according to the values of these indices. The chart displays defined areas for the different stages of disease (Stage 0 – Stage 5) and separates generalized, localized and mixed defects.
The Glaucoma Staging Program (GSP) is based on pattern recognition and is dedicated to early detection of glaucoma.

The GSP software places examination findings into visual field classes (normal, glaucomatous, artifactual and neuro) based solely on their appearance. In addition, risk classes (normal, suspect, pre-perimetric, early stage, moderate and severe) are also assigned to findings that are classified as normal or glaucomatous. The evaluation results are presented in intuitive green-yellow-red color coding.

The striking novelty of the GSP is its ability to detect subtle changes in the visual field associated with early stage glaucoma. Findings of suspect and pre-perimetric risk classes may contain reductions in the visual field that cannot be readily seen by the examiner. They usually remain undetected also by standard perimetric indices.

The Glaucoma Likelihood Index (GLI) summarizes the results of the GSP classification into a single parameter presenting a value between 0 (normal) and 5 (severe glaucoma).

The Glaucoma Staging Program (GSP) is available for OCULUS Twinfield® 2, Centerfield® 2 and Easyfield® perimeters. This upgrade is available for the existing units.

TNT provides a quantitative, statistical analysis of the visual field examinations conducted over time. For follow-up purposes the software uses all visual field results taken over the entire observation period and takes the patient's threshold values into account obtained on the 30-2, 30x24 or 24-2 patterns. TNT uses a specific filter to reduce the fluctuation range of the threshold values and to perform a consistent trend analysis. In conjunction with the fast SPARK strategy, the sensitivity of detecting progression in early stage glaucoma is greatly improved.

  • TNT creates a concise progression analysis report containing the most important parameters (MD increase, p-values, etc.).
  • TNT can differentiate between diffuse and focal progression based on the focality index (FI) value.
  • TNT applies multiple statistical criteria to establish possible progression.
  • TNT displays the prognosis of the expected visual field for a patient age-group selected by the examiner.

Functionality of a retinal location obviously depends on the underlying anatomical structure of the retina in that location. One characteristic feature of glaucoma is that there is a close connection between sensitivity levels of given retinal locations (as described by visual field measurements) and anatomical structures related to the optic nerve head. The merit of PATH is that it provides an estimate of the retinal nerve fibre layer (RNFL) thickness around the optic nerve head and the relative area of the neuroretinal rim based solely on the results of visual field measurements performed with the SPARK examination strategy. This novel approach of predicting structure from function is made possible by the high reproducibility of the SPARK visual field exams.

Predicting RNFL thickness

Working from the results of SPARK perimetry, RNFL thickness is predicted at 25 points of the TSNIT (Temporal – Superior – Nasal – Inferior – Temporal) circle around the optic nerve head. The value at each point is calculated from functional data selected for relevance. This selection is based on an objectively automated machine learning algorithm and does not rely on other findings such as on the correspondence between nerve fibre pathways and visual field areas.

Predicting the relative area of the neuroretinal rim

A linear combination of relevant threshold results is used in order to predict the ratio between the neuroretinal rim area and the total area of the optic disc. The result is compared to normative data and expressed as a percentage of the population average value (normalized to 100%).

Device
SPARK threshold strategy Glaucoma Staging System (GSS 2) per Brusini Glaucoma Staging Program (GSP) Threshold Noiseless Trend (TNT) Progression Analysis Predicting Anatomy from Thresholds (PATH)

Title

Description

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
Color 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.

No, the TSNIT curve displayed by the PATH evaluation of Smartfield is merely a prediction based on the results of the measured visual field.

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
Features

Stimulus viewing distance Infinity
Max. eccentricity horizontal/vertical 30°/25° (60°/50° with fixation shift)
Stimulus size Goldmann III
Stimulus color 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
Technical Data

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

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