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7/21/2019 Glaucoma y Perimetria SPG 20130425-4
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Glaucoma y PerimetríaComputarizada
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José Alejandro Santos Espinoza
Medico Cirujano Oftalmólogo
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Glaucoma y Perimetría Computarizada
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Glaucoma y Perimetría Computarizada
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Glaucoma y Perimetría Computarizada
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Glaucoma y Perimetría Computarizada
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Siempre Evaluar todo el Campo Visual
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Siempre Evaluar todo el Campo Visual
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Glaucoma y Perimetría Computarizada
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Glaucoma y Perimetría Computarizada
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Glaucoma y Perimetría Computarizada
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Glaucoma y Perimetría Computarizada
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Nunca
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Division del examen y Orden de Prelación
1
8
7
654
3
2
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Glaucoma y Perimetría Computarizada
• Oscilación de un escotomaparacentral a largo plazo
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Glaucoma y Perimetría Computarizada
• Oscilación de un escotomaparacentral a largo plazo
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Glaucoma y Perimetría Computarizada
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Glaucoma y Perimetría Computarizada
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Glaucoma y Perimetría Computarizada
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Glaucoma y Perimetría Computarizada
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Glaucoma y Perimetría Computarizada
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Glaucoma y Perimetría Computarizada
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Glaucoma y Perimetría Computarizada
• Escotomas Blancos
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Glaucoma y Perimetría Computarizada
• Escotomas Blancos
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Glaucoma y Perimetría Computarizada
• Escotomas Blancos
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Glaucoma y Perimetría Computarizada
• Escotomas Blancos
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Glaucoma y Perimetría Computarizada
• Escotomas Blancos
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Glaucoma y Perimetría Computarizada
• Escotomas Blancos
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Algoritmos en Humphrey Field Analizer
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Glaucoma y Perimetría Computarizada
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Glaucoma y Perimetría Computarizada
• Error de aprendizaje.
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Glaucoma y Perimetría Computarizada
• Error de aprendizaje.
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Criterios Diagnósticos del Glaucoma Perimétrico
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Criterios Diagnósticos del Glaucoma Perimétrico
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Criterios Diagnósticos del Glaucoma Perimétrico
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Swedish Interactive Threshold Algorithm (SITA)
Glaucoma y Perimetría Computarizada
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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
Glaucoma y Perimetría Computarizada
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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.
Glaucoma y Perimetría Computarizada
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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.
Glaucoma y Perimetría Computarizada
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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
Glaucoma y Perimetría Computarizada
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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
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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
Glaucoma y Perimetría Computarizada
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Glaucoma y Perimetría Computarizada
• Excesiva cantidad de falsos positivos
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Glaucoma y Perimetría Computarizada
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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
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Glaucoma y Perimetría Computarizada
• 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
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Glaucoma y Perimetría Computarizada
Gl P i t í C t i d
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Glaucoma y Perimetría Computarizada
Gl P i t í C t i d
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Glaucoma y Perimetría Computarizada
Gl P i t í C t i d
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Glaucoma y Perimetría Computarizada
• Asociaciónde Clusters
Gl P i t í C t i d
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Glaucoma y Perimetría Computarizada
Progresion del Gla coma
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Progresion del Glaucoma
• El software usa triangulos – abiertos
– Semisombreados y
– Sombreados
Progresion del Glaucoma
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Progresion del Glaucoma
Possible Likely
Progresion del Glaucoma
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Progresion del Glaucoma
• 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
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Análisis de la Progresión del Glaucoma Criterios
• Criterios de Análisis deProgresión del Glaucoma
Progresion del Glaucoma
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Progresion 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.
Glaucoma y Perimetría Computarizada
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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.
Glaucoma y Perimetría Computarizada
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Dr. José Alejandro Santos Espinoza
Muchas Gracias
Glaucoma y Perimetría Computarizada
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Glaucoma y Perimetría Computarizada
Table of contents
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Organizational Chart
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Organizational Chart
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
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Quarterly Sale
13%
17%
57%
13%
1st Qtr
2nd Qtr
3rd Qtr
4th Qtr
Employee Detail
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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
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Area Wise Growth
0
20
40
60
80
100
120
140
160
180
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
North
West
East
Important Points
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Important Points
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Project Iterations
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j
Planning Execution Testing Deployment
Product Line Transitions
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Finished Product
1 2 3 4
Process Diagram
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g
Process
Input
Output
Basic Process Flow Diagram
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g
Input
Output
Process
Compass
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p
East
North
West
South
Yearly Sales
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y
Quarters
Sale in Million $
1 2 3 4
100
150
200
250
300
170 M
155 M
230 M
250 M
Formula
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65%
20%15%
Growing Wealth
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Comparison Chart
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Plan
In this section pros
and cons of plan A
will be described.
This can be a brief
description or bullet
points.
Good Luck
Plan B
In this section pros
and cons of plan B
will be described.
This can be a brief
description or bullet
points.
Good Luck
Business Chain
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RawSale
Finished
Good
Training
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Trainingdetail
comeshere
Product List
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Name of Product A
Name of Product B
Name of Product C
Time Line
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3rd QuarterMilestone
4th QuarterMilestone
1st QuarterMilestone
2nd QuarterMilestone
Joint Ventures
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Detail of joint venturescan be provided here.
SWOT Analysis
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Opportunities
OThreats
T
StrengthsS
WeaknessesW
Main Points
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Timeline
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2007 2008 2009 2010 2011
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This is sampletext, pleasereplace it withyour originalfacts and figures.Thanks
This is sampletext, pleasereplace it withyour originalfacts and figures.Thanks
This is sample
text, pleasereplace it withyour originalfacts and figures.Thanks
This is sample
text, pleasereplace it withyour originalfacts and figures.Thanks
Sample Timeline
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2000
2010
2020
2030This is sample text, pleasereplace it with your originalfacts and figures. Thanks
This is sample text, pleasereplace it with your originalfacts and figures. Thanks
This is sample text, please replace it withyour original facts and figures. Thanks
This is sample text, please replace it with
your original facts and figures. Thanks
Sample Timeline
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2000
2010
2020
2030
Good News
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Economic Growth Circular Flow Model
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Goods and Services
Factors and Production
Consumer Expenditures
Wages Rent Dividends
Path Diagram
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Yourtext
Yourtext
Yourtext
Yourtext
Yourtext
Circles & Segments
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Y o u r t e x t h e
r e
Y o u r t e x t h e r
e
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Your text here
Circles & Segments
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Y o u r t e x t h
e r e
Y o u r t e x t h e
r e
Your text here
Your text here
YourTexthere
Circles & Segments
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Y o u r t e x t
h e r e
Y o u r t e x t h e
r e
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Your text here
Yourtext
Yourtext
Yourtext
Circles & Segments
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YourTexthere
Water Fall Model
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Your text here
Your text here
Your text here
Your text here
Your text here
Water Fall Model
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Your text here
Your text here
Your text here
Your text here
Your text here
Water Fall Model
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Your texthere
Your texthere
Your texthere
Your texthere
Your text
here
Water Fall Model
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Your Detail Comes Here.
Your text here
Your text here
Your text here
Your text here
Flowchart
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Your
Document
YourProcess
Closed
DB1
YourDecision
YourDecision
YourProcess
YourProcess
YourProcess
YourProcess
Annual Profit in million dollars
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2004 2005 2006 2007 2008 2009 2010 2011
$378 $580 $523 $590
$421 $492 $600 $610
Ideas
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Your text here. Your text here.
Your text here.
Your text here.
Obstacles
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Your ObstaclesDetail Comes Here
Your ObstaclesDetail Comes Here
Your ObstaclesDetail Comes Here
Checklist
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