Confrontation visual field testing: detecting gross visual field defects

Monocular visual field defects generally localize at or anterior to the optic chiasm, while homonymous hemianopias localize to the retrochiasmal visual pathway. Highly incongruous visual field defects may be difficult to identify on 24-2 Humphrey visual field testing, and this case demonstrates the value of optical coherence tomography (OCT) ganglion cell-inner plexiform layer (GCIPL) in rapidly localizing the lesion. A 54-year-old woman was found on routine examination to have an isolated superonasal quadrant visual field defect respecting the vertical meridian in the left eye only on Humphrey 24-2 SITA-Fast testing. She had a remote history of significant head trauma. Visual acuity, anterior segment, and fundus examination were normal. OCT revealed a bow-tie atrophy of the retinal nerve fiber layer in the right eye (OD), and binocular homonymous hemi-macular atrophy of OCT GCIPL, confirming the localization was the left retrochiasmal visual pathway. A repeat Humphrey 30-2 SITA-Fast visual field demonstrated that the visual field defect was also present in the OD in a highly incongruous manner. Magnetic resonance imaging of the brain with contrast showed mild atrophy of the left optic tract. This case demonstrates that highly incongruous visual field defects may be difficult to identify on Humphrey 24-2 SITA-Fast visual fields, and OCT GCIPL serves as a rapid way to localize the lesion. More detailed visual field testing including 30-2 programs should be considered in these cases.

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Peripapillary Retinal Thickness Maps in the Evaluation of Glaucoma Patients: A Novel Concept

ISRN Ophthalmology ◽

10.5402/2011/146813 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Kayoung Yi ◽

Mircea Mujat ◽

Wei Sun ◽

B. Hyle Park ◽

Johannes F. de Boer ◽

...

Keyword(s):

Visual Field ◽

Retinal Thickness ◽

Field Testing ◽

Fundus Photography ◽

Visual Field Defects ◽

Visual Field Testing ◽

Fiber Layer ◽

Rnfl Thickness ◽

Novel Concept ◽

Field Defects

Purpose. To show how peripapillary spectral domain optical coherence tomography (SDOCT) retinal thickness (RT) maps can complement retinal nerve fiber layer (RNFL) thickness maps in the evaluation of glaucoma patients. Methods. After a complete eye exam with standard fundus photography and visual field testing, normal and glaucomatous eyes were imaged with an experimental SDOCT system. From SDOCT images, RNFL thickness and RT maps were constructed and then correlated with disc photography and visual field testing. Results. Two normal eyes of 2 patients and 5 eyes of 4 glaucoma patients were imaged. Although both RNFL and RT maps correlated well with visual field defects, glaucomatous arcuate defects were sometimes more easily identified in the RT maps. Conclusions. To our knowledge, this is the first paper to show that peripapillary SDOCT RT maps may provide important supplemental information to RNFL thickness maps in the evaluation of glaucoma patients.

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Retrogeniculate Visual Field Defects

Visual Fields ◽

10.1093/oso/9780195389685.003.0015 ◽

2010 ◽

Author(s):

Thomas R. Hedges III

Keyword(s):

Visual Field ◽

Vision Loss ◽

Visual Fields ◽

Field Testing ◽

Visual Field Defects ◽

Automated Perimetry ◽

Loss Of Vision ◽

Data Points ◽

Field Defects ◽

Macular Sparing

Automated perimetry has changed visual field testing considerably in recent years. What was considered an art has become an exercise in interpreting a set of data points obtained mechanically. Automated perimetry saves ophthalmologists time, which ideally should allow for more visual fields to be obtained on patients with unexplained vision loss. However, one must still keep in mind that automated perimetry still depends on the subjective responses from the patient. More important, automated perimetry has made interpretation of visual field defects, especially those due to occipital lesions, more difficult. For example, macular sparing may not be reflected, especially with programs limited to the central 24° or 30°. A 10° field may be required to show macular sparing. Also, sparing or involvement of the temporal crescent will not be shown with 24° or 30° visual fields. The limitation of most programs may lead to the appearance of incongruity when in fact the field is indeed congruous. Sometimes, a small homonymous hemianopic scotoma will be detected when one eye is tested but will be completely missed when the other eye is tested, giving the false impression that the visual loss is monocular. This is especially problematic if the patient also falsely interprets his or her homonymous loss of vision as monocular. Such individuals may complain of loss of vision in one eye when in fact it is one half of their visual field that is defective. The strategy of automated testing on either side the vertical and horizontal meridians may lead to the false impression that field defects respect the vertical or horizontal meridian when they do not. Automated perimetry should make it possible to test more patients with unexplained vision loss, but all automated visual fields must be interpreted with caution and, when necessary, substantiated with some other method, such as the tangent screen, which remains the most powerful method of detecting the size, shape, and density of visual field defects. Because most ophthalmologists no longer use tangent screen testing, at least an Amlser grid should be used to qualify the nature of a paracentral visual field defect.

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Morphology of the optic nerve head in glaucomatous eyes with visual field defects in superior or inferior hemifield

European Journal of Ophthalmology ◽

10.5301/ejo.5001033 ◽

2017 ◽

Vol 28 (2) ◽

pp. 175-181 ◽

Cited By ~ 1

Author(s):

Antonio Longo ◽

Teresio Avitabile ◽

Maurizio G. Uva ◽

Vincenza Bonfiglio ◽

Andrea Russo ◽

...

Keyword(s):

Optic Nerve ◽

Visual Field ◽

Optic Nerve Head ◽

Field Testing ◽

Visual Field Defects ◽

Fiber Layer ◽

Rnfl Thickness ◽

Pattern Deviation ◽

Control Study ◽

Field Defects

Purpose: To evaluate the morphology of optic nerve head (ONH) and border tissue (BT) of Elschnig in glaucomatous eyes with visual field defects in superior or inferior hemifield. Methods: In a case-control study, we included 25 patients with superior arcuate scotoma, 25 patients with inferior arcuate scotoma, and 25 healthy controls. They received visual field testing, measurement of peripapillary retinal nerve fiber layer (RNFL) thickness, and ONH examination in a radial pattern with spectral-domain optical coherence tomography. In each ONH scan, the length of Bruch membrane opening (BMO) and BT were measured. Pattern deviation of 6 areas of the visual field and RNFL thickness in corresponding sectors was calculated. Results: Mean BMO length did not differ between groups. Compared with controls, glaucomatous eyes with superior scotoma had a greater BT length in inferior sectors (p<0.001), and eyes with inferior scotoma had a greater BT length in superotemporal sectors (p = 0.006). In both groups, a significant correlation was found between BT length and pattern deviation and RNFL thickness of corresponding sectors of superior and inferior hemifields. Conclusions: In patients with arcuate scotoma in one hemifield, the length of the BT correlates with glaucomatous anatomical and functional damage.

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Visual Field Testing

Glaucoma ◽

10.1093/oso/9780199757084.003.0008 ◽

2012 ◽

Author(s):

Troy Close

Keyword(s):

Visual Acuity ◽

Visual Field ◽

Field Testing ◽

Spot Size ◽

Visual Field Defects ◽

Visual Field Testing ◽

Kinetic Perimetry ◽

Field Of Vision ◽

Finger Counting ◽

Definition Of

• Glaucoma results in progressive visual field deterioration, and detecting changes or recording stability in the visual field is important in the management of glaucoma. • Visual field testing is a highly subjective and operator-dependent test. • In patients with glaucoma, the visual field is tested in monocular fashion. •The boundaries of the visual field (in a well-lit environment with an easily visible target) are grossly 60 degrees superiorly, 75 degrees inferiorly, 100 degrees temporally, and 60 degrees nasally. • Basic concept in determination of visual field is “threshold” •Definition of “threshold”: weakest test stimulus that is just visible in a particular location (stimulus intensity at which the patient responds 50% of the time) •Types of visual field testing strategies •Confrontation •Spot testing •Kinetic spot testing •Static spot testing •An initial screening tool to look for large and dense visual field defects that may be present in very advanced glaucoma •Both hands should be used in the testing processed. The patient should occlude the untested eye with the palm of the hand. •If the visual acuity will allow the finger counting technique, all four quadrants may be tested at 3 to 4 feet from the patient at an approximate 45-degree angle holding up either one or two fingers, or a whole hand. • If the visual acuity is HM or LP, then test for light perception in the respective 4 quadrants. • It is important that the patient be able to tell you where the light is located in the field of vision, not simply the presence of light. • Factors that affect the visibility of the spot • Size Intensity • Background illumination Others: color, movement, duration of presentation, attentiveness of the patient, and refractive state of the eye • Kinetic • Usually Goldmann perimetry (though some of the automated machines such as the Octopus will perform kinetic perimetry) • The perimetrist may adjust the location, size, and intensity of the stimulus throughout the test. •Useful in the following cases: Those who need coaching and an altered pace of testing (e.g., elderly, wheelchair-bound, or limited concentration)

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