Automated Perimetry Visual Field Interpretation Report

Automated Perimetry Visual Field Interpretation Report

(Hard stop: If patient identifiers [Patient Name, MRN, DOB] or Test Date are missing, do not finalize this report. Return for completion before signature.)

Patient Name: [Patient Name]
MRN: [MRN]
DOB: [DOB]
Age: [Age]
Test Date: [Test Date]
Ordering Clinician: [Ordering Clinician]
Interpreting Clinician: [Interpreting Clinician]
Practice/Location: [Practice/Location]

This is a standalone interpretation and report of automated perimetry.

(General guidance: Document only information explicitly available in device output and clinical documentation. Do not infer diagnoses or indications from problem lists. Label interpretive statements as interpretations rather than definitive findings.)

Indication

[Primary indication and specific clinical question being addressed, with pertinent modifiers if documented and relevant to interpretation] (If indication is not available from documentation, state: "Indication: Not specified in available documentation.")

Test Parameters

(Document acquisition parameters per eye. If an eye was not tested, state "Not tested" with reason if known. If parameters cannot be retrieved, state: "Parameters: Not available from device interface.")

OD: [Perimeter/platform]; [Test program/pattern]; [Testing strategy]; [Fixation monitoring method / Not specified]

OS: [Perimeter/platform]; [Test program/pattern]; [Testing strategy]; [Fixation monitoring method / Not specified]

Reliability

• OD:
  • Fixation losses: [numerator/denominator (%) / Not available]
  • False positives: [% / Not available]
  • False negatives: [% / Not available]
  • Overall reliability: [Reliable / Borderline (interpret with caution) / Unreliable (not interpretable)] (If Borderline or Unreliable, briefly state reason. If indices unavailable, provide clinical reliability judgment with rationale.)
• OS:
  • Fixation losses: [numerator/denominator (%) / Not available]
  • False positives: [% / Not available]
  • False negatives: [% / Not available]
  • Overall reliability: [Reliable / Borderline (interpret with caution) / Unreliable (not interpretable)] (If Borderline or Unreliable, briefly state reason. If indices unavailable, provide clinical reliability judgment with rationale.)

Visual Field Findings

(For each eye, document global indices followed by defect description. If urgent neurologic patterns are present, surface prominently here and in Impression.)

OD:
Global indices: MD [value]; PSD [value]; VFI [value / Not available]; GHT [result / Not available]
[Defect description including: presence/absence of defect; location; pattern type; depth/density; whether fixation is threatened; interpretive statement regarding likely etiology; suspected artifacts if applicable] (If normal: "No reproducible focal defect. Global indices within expected limits. No pattern suggesting glaucomatous or neurologic loss.")

OS:
Global indices: MD [value]; PSD [value]; VFI [value / Not available]; GHT [result / Not available]
[Defect description including: presence/absence of defect; location; pattern type; depth/density; whether fixation is threatened; interpretive statement regarding likely etiology; suspected artifacts if applicable] (If normal: "No reproducible focal defect. Global indices within expected limits. No pattern suggesting glaucomatous or neurologic loss.")

Comparison to Prior Fields

(If no valid prior comparison exists, state: "No prior comparable visual field available for comparison." Use only constrained terminology for change summary and state basis for determination.)

OD: [Comparator test date]; [Comparability: same program/strategy confirmed / not comparable]; Change: [Stable / Possible progression (requires confirmation) / Likely progression (repeatable change) / Improved / Indeterminate]; Basis: [device-based analysis / trend-based slope / pointwise-qualitative]; [Confounders if any]

OS: [Comparator test date]; [Comparability: same program/strategy confirmed / not comparable]; Change: [Stable / Possible progression (requires confirmation) / Likely progression (repeatable change) / Improved / Indeterminate]; Basis: [device-based analysis / trend-based slope / pointwise-qualitative]; [Confounders if any]

Impression

[Integrated clinical interpretation: overall assessment (normal vs abnormal), laterality and symmetry, stability vs progression, clinical significance including fixation threat and severity, interpretive statement regarding likely etiology. Use OD:/OS: sub-statements if asymmetric. Include confidence qualifiers when reliability or comparability is limited. Prominently note urgent neurologic patterns.]

Plan Impact

• [Prognostic implications]
• [Management recommendations]
• [Recommended interval for repeat testing]
• [Notification/escalation performed for urgent findings, if applicable]

(If interpreting clinician is not the treating clinician: "Results forwarded to treating clinician for correlation with clinical findings.")

Attachments

Raw perimetry printout stored in [EHR media tab / device archive] [identifier if available].

Authentication

Interpreting Clinician: [Name, credentials]
Electronic Signature: [e-signature]
Date/Time of Interpretation: [Date and time]

(Do not finalize report if signature is missing; route to signature workflow.)