Purpose of Visual Field Examination

Detection of Visual Field Defects:

• Identifies scotomas (blind spots) and peripheral vision loss.
• Differentiates between types of defects (e.g., arcuate, bitemporal, homonymous).

Monitoring Progression of Diseases:

• Glaucoma.
• Optic neuritis.
• Retinal diseases like retinitis pigmentosa.

Evaluation of Neurological Conditions:

• Brain tumors.
• Stroke.
• Pituitary adenomas.

Screening:

• Used in routine ophthalmologic exams or preoperative assessments.

Types of Visual Field Tests

Confrontation Visual Field Test:

• A quick, manual screening test.
• The patient focuses on the examiner’s nose while peripheral vision is tested using hand movements or finger counting.

Amsler Grid Test:

• Evaluates the central visual field.
• Patients identify distortions or missing areas in a grid pattern, often used in macular disease evaluation.

Automated Perimetry:

• Provides precise, quantitative analysis.
• Examples: Humphrey Field Analyzer (HFA), Octopus Perimeter.
• Patient presses a button upon detecting light stimuli at various locations.

Goldmann Perimetry:

• Manual, kinetic test mapping the visual field with moving light targets of varying intensities and sizes.
• Ideal for assessing peripheral vision loss or complex visual field defects.

Frequency Doubling Technology (FDT) Perimetry:

• Detects early glaucomatous damage by presenting flickering striped patterns.

Octopus Kinetic Perimetry:

• Combines static and kinetic testing for more detailed mapping.

Parameters Assessed in Visual Field Testing

Field Extent:

• Normal visual field:
  • 60° nasally.
  • 100° temporally.
  • 60° above and 75° below the horizontal meridian.

Defects:

• Scotomas:
  • Central: Near fixation.
  • Paracentral: Near central vision.
  • Arcuate: Follows the nerve fiber layer.
• Hemianopia:
  • Bitemporal: Chiasmal lesions.
  • Homonymous: Post-chiasmal lesions.
• Quadrantanopia: Loss in a specific quadrant.