Clinical Neuro-Optometry (LECTURE) - Module 3

M3 While Task

Before our lecture starts, please watch this video to give an overview of our subject matter. The link is
https://www.youtube.com/watch?v=ETIp8kZPoBw

M3 Lesson 1 Anatomy of the Visual Pathway

All animals possess some mechanism by which they are able to perceive their surroundings. However, sight is a highly specialized
method used by most animals to navigate through their surroundings. The eyes act as the initial point of contact through which
photons pass to access the visual pathway. The visual pathway refers to the anatomical structures responsible for the conversion
of light energy into electrical action potentials that can be interpreted by the brain. It begins at the retina and terminates at the
primary visual cortex (with several intercortical tracts).

Anatomy of the Visual Pathway

 Clinical Neuro-Optometry (LECTURE) - Module 3

Key Points in Visual Pathway

Components

M3 Lesson 2 The Visual Field Defect

Visual field defect, a blind spot (scotoma) or blind area within the normal field of one or both eyes. In most cases the blind
spots or areas are persistent, but in some instances they may be temporary and shifting, as in the scotomata of migraine
headache. The visual fields of the right and left eye overlap significantly, and visual field defects may not be evident without
specific testing of each eye separately. Causes of visual field defects are numerous and include glaucoma, vascular
disease, tumours, retinal disease, hereditary disease, optic neuritis and other inflammatory processes, nutritional
deficiencies, toxins, and drugs.
Certain patterns of visual field loss help to establish a possible underlying cause. For instance, generalized constriction of
the visual field can be due to glaucoma, retinitis pigmentosa, hysteria, or chronic high intracranial pressure. Increases in
intracranial pressure can also cause enlargement of the natural blind spot due to abnormal swelling of the optic disks in both
eyes, a condition called papilledema.
When defects occur in the visual field of only one eye, the cause can be localized to the eye or to anterior visual pathways
(before the two optic nerves meet at the optic chiasm). In contrast, defects that involve the visual fields of both eyes often
 Clinical Neuro-Optometry (LECTURE) - Module 3
(but not always, as in the case of glaucoma) reflect disease processes at the optic chiasm or farther back in the brain. The
specific condition where visual field defects are present in corresponding halves of the right and left eye fields is called
homonymous hemianopia, whereas defects involving the outer or inner halves of both visual fields are called bitemporal or
binasal hemianopia, respectively.
The extent and the location of the blind areas in the visual fields may provide further clues concerning the location of the
lesion responsible. Bitemporal hemianopia suggests, for example, a lesion in the optic chiasm, the point at which the optic
nerves from the two eyes meet and exchange some of the nerve fibres from each retina. A tumour of the pituitary may press
upon the chiasm and have this effect. Precise demonstration of visual field defects can be accomplished via perimetry, in
which the affected individual fixates his gaze straight ahead and indicates whether he can see special test lights projected
onto an illuminated domed screen.

Common Visual Field Defects

 Clinical Neuro-Optometry (LECTURE) - Module 3

Visual Field Defects and Its Lesion

Location
 Clinical Neuro-Optometry (LECTURE) - Module 3

M3 Lesson 3 Visual Field Tests/Procedure

What is visual field testing?
As you focus on the words in this article, how much can you see out of the corners of your eyes? Can you tell what's
happening in your surroundings?
Your visual field is how wide of an area your eye can see when you focus on a central point. Visual field testing is one
way your ophthalmologist: https://www.aao.org/eye-health/tips-prevention/what-is-ophthalmologist
measures how much vision you have in either eye, and how much vision loss may have occurred over time.

Visual field testing can detect blind spots

A visual field test can determine if you have blind spots (called scotoma) in your vision and where they are. A scotoma’s size
and shape can show how eye disease or a brain disorder is affecting your vision. For example, if you have glaucoma.
https://www.aao.org/eye-health/diseases/what-is-glaucoma ,this test helps to show any possible side (peripheral) vision loss
from this disease.

Ophthalmologists also use visual field tests to assess how vision may be limited by eyelid
https://www.aao.org/eye-health/anatomy/eyelid-4 . problems such as ptosis https://www.aao.org/eye-health/diseases/what-
is-ptosis and droopy eyelids.

Six types of visual field tests

1. Confrontation visual field test
A common way for your doctor to screen for any problems in your visual field is with a confrontation visual field test. You
will be asked to look directly at an object in front of you, (such as the doctor’s nose) while one of your eyes is covered. Your
doctor may hold up different numbers of fingers in areas of your peripheral (side) vision field and ask how many you see as
you look at the target in front of you.

2. Automated static perimetry test

To check for a suspected eye problem or monitor the progress of an eye disease, your ophthalmologist will rely on more
specific tests to measure how you see objects in your field of vision. The automated static perimetry test is used for this
purpose. It helps create a more detailed map of where you can and can’t see.
To do this test, you will look into the center of a bowl-shaped instrument called a perimeter. The eye not being tested will be
covered with a patch. The testing eye will have your lens prescription placed in front of it to make sure you are seeing as
well as possible.
 Clinical Neuro-Optometry (LECTURE) - Module 3
You will be asked to keep looking at a center target throughout the test. Small, dim lights will begin to appear in different
places throughout the bowl, and you will press a button whenever you see a light. The machine tracks which lights you did
not see.
You may blink normally during the test. You may also pause the test if you feel you need to take a break for a moment.
Because you are looking straight ahead during the test, your doctor can tell which lights you see outside of your central area
of vision. Since glaucoma affects peripheral vision, this test helps show if there is vision loss outside of your central visual
field.
This is called a "static" test because the lights do not move across the screen, but blink at each location with differing
amounts of brightness. This allows the machine to find the dimmest light you can see at each location in your peripheral
vision.
The machine will show some lights that are too dim for you to see. This is done deliberately to find what is called the “visual
threshold” of each location, meaning the brightness that you have trouble seeing half the time. You may be concerned
because you can’t see every light. Rest assured that this is how the test is supposed to work.

3. Kinetic visual field test

In some cases, you may have a test called kinetic visual field testing. While it is similar to the perimetry testing process
described above, the kinetic test uses moving light targets instead of blinking lights.

4. Frequency doubling perimetry

Another way your ophthalmologist can assess loss of vision is using something called frequency doubling perimetry. It
uses an optical illusion to check for damage to vision. Vertical bars (usually black and white) appear on the perimeter
screen. These bars will flicker at varying rates. If you are not able to see the vertical bars at certain times during the test, it
could show vision loss in certain parts of your visual field.