WHAT is an octopus

The Octopus is another instrument used for visual field testing (your visual field is everything that you can see while fixating on a single point). It has the ability to run both screening visual field tests (which picks up current visual field defects) and threshold testing (which picks up even minute decreases in sensitivity that could potentially become visual field defects); however it is mostly used for screening visual fields.

How to Complete a screening Visual Field using the Octopus

Prepare the instrument

Turn on the instrument at the beginning of the day by flipping the switch on the lower right side of the instrument. Then, hit the oval button on the lower left side of the screen (this is done at the beginning of the day and then left on until close).
To begin measuring a patient's visual field, first search to determine if any previous measurements have been taken
Type the patient's last name into the search box on the left side of the screen. If their name comes up, click on it to select, then begin testing.
If their name does not come up, add them to the computer by clicking the New button in the center of the screen.
Type in patient's ID (account number in Eyecare); Last Name; First Name; DOB; Gender and click Save
Once the patient is either found or added, click on the icon to the left with the single small white circle inside a larger white circle.
Click the OD button at the top, left side of screen.

Prepare the patient

If the patient wears cls they can keep them in; if the patient wear glasses they should remove them.
Hand the patient the eye patch, having them cover their left eye first.
Hand them the patient response button.

Determining test lenses

The patient needs to be looking through distance correction while performing the Octopus. If they are wearing cls which correct them for distance, then test lenses are not required. If they wear glasses, which could interfere with fixation monitoring, they will remove their glasses, and test lenses are used to correct them for distance. These test lenses are stored in compartments on the right and left side of the instrument.
Test lenses come in sphere increments of 1 diopter (+1.00, +2.00, +3.00, etc). To select the appropriate lens for each eye, find the patient’s sphere measurement (the first of three potential numbers in a patient’s prescription) using either the autorefractor finding or the patient’s last glasses prescription, then round down to the nearest diopter. If the auto refractor read the patient’s right eye -3.50, -0.25 x 111 then you would take the sphere (-3.50) and round down and select the -3.00 trial lens. If their left eye read -0.75, -0.25 x 020, then you would take the sphere (-0.75), round down to 0, and no trial lens would be used.

Beginning testing

Ask the patient to rest their forehead against the blue headrest.
Align the patient, so that their pupil is centered within the green box. This is how fixation is monitored during the test; if the pupil is not in the center of the box, the instrument will register a loss of fixation and pause the test until fixation is restored. The easiest way to centered the patient’s pupil within the green box is to ask them to move their forehead in the direction you want their pupil to go. If their pupil is to the left of the green box, ask them to move their forhead to the right; if their pupil is above the green box, ask them to move their forehead down.
Explain the test to the patient as follows: Out of your right eye you should see some yellow lines; you want to stay focused in the center of those yellow lines throughout the whole test. Tiny lights are going to start popping up all around, and whenever you see those lights, anywhere at all, just press the button. Are you ready to begin?
Click the button at the bottom of the screen with the triangle (play button) to begin the test.
Once that eye is complete, have the patient transfer the eye patch to cover their right eye.
The instrument will automatically switch to test the left eye, press play to begin the test.
Once the test is complete, have the patient remove the eye patch and place the response button back in the holder in front of them.
View the patient's test results by selecting their name on the patient selection screen and expanding the test data for the correct date in the bottom right of the screen. If a patient clicked after a light it will appear in that portion of the field as a +, if they missed the light then it will appear a black box.
If no spots missed, then testing is complete
If any spots are missed that eye needs to be repeated; if same spots are missed again, the print the field and scan into the patient's EHR record.
Wipe down the eye patch, headrest, and patient response button with alcohol.

How to Record the Octopus in the chart

Octopus Results are recorded in Visual Fields (By Confrontation) boxes the middle of the Workup Tab. If the patient missed no spots for an eye, “Octopus Screening: Full and reliable” is recorded in the box for that eye.

If the patient missed spots for an eye, “See Attached” is recorded in the box for that eye and the test results are printed out, scanned, and imported into a testing tab entry.

To print, scan, and import a visual field from the octopus, begin by finding the Eyesuite program on the local desktop of the appropriate computer (this will be in room 1 in Westerville).

Once you open this program, you will see a menu that looks very similar to the menu on the Octopus. Search for the patient and then highlight their name once found. Then select the test from the correct date in the lower right corner; double click to open it. Then press the print icon in the upper left corner of the menu and the test will print to the default printer (“WV Upper Level” in Westerville). Once you have the printout, scan it into one of the scan folders (usually “WV EHR” in Westerville).

Next you will create an entry for the test in the testing table on the testing tab so that we can import the scanned image. Use the three dot ellipsis in the upper left corner of the testing table to create an entry.

This will open up a new window. In this window type “VF” under the test field and use the drop down to open up a list of visual field test options.

Select the “VF Octopus Screener Both Eyes” option.

This will populate the Testing and Department fields. Next type in B under Eye (standing for both eyes); the date the Visual Field was completed in the ordered, performed, and reviewed boxes in the lower left corner; the initials of the doctor who ordered and reviewed the visual field, and the initials of the OA who ran the visual field. .

To import the scanned image, right click on the large image box on the right side of the window and select “import”.

Find the file in the appropriate scan folder and double click it to import. Click save in the upper right corner.

This will add the Visual Field entry with imported image into the testing table.

Here is a video showing how to add an Octopus entry

Please complete the Checkpoint Quiz