visual field-blindness

G R O U P 1 7 P R E S E N T AT I O N
 OBJECTIVES

To appreciate what the visual field is and it’s

importance in clinical practice.

To explore and understand the different types

of blindness related to the visual field.
Functional anatomy of the eye
 Visual field

It is defined as the total area in which objects

can be seen in the peripheral vision while
focusing on a central point without moving
your eyes or head.
According to Traquair, the visual field is
described as “island of vision, surrounded by
a sea of blindness.”
 Visual field divisions

 Visual field of the human eye has an angle of 160° in horizontal meridian and
135° in vertical meridian.
 Visual filed is divided into four parts:
1. Temporal field
2. Nasal field
3. Upper field
4. Lower field
 The temporal and nasal visual fields are separated by the fixation point, the
meeting point of visual axis with the object, where the temporal visual field
extends 100º but the nasal part extends only up to 60º.
 The visual field is also divided into an upper and lower field by a horizontal
line passing through the fixation point.
 Extent of the upper field is about 60 º, as it is restricted by upper eyelid and the orbital margin.
 The lower field extends about 75º, restricted by cheek.
 Thus, the visual field is restrict in all the sides, except in the temporal part.
 Binocular and Monocular Vision

 Binocular vision: is the vision in which both eyes

are used together, so that a portion of the external
world is seen by the eyes together.
 In humans, eyeballs are placed in front of the head leading
to the visual field of both eyes to overlap,
 Because of this. A portion of the external world is seen by
the eyes.
 Monocular vision: is the vision in which each eye is
used separately.
 Animals like dogs have there eyeballs on the sides of the
head so the visual fields of both eyes overlap to a small
extent.
 This allows them to see different portions of the external by
each eye.
 Visual field and retina
Light rays from
different halves of
each visual field do
not fall on the same
halves of the retina.
Temporal field light
rays fall on nasal part
of retina of that eye.
Nasal field light rays
fall on the temporal
part of the retina of
that same eye.
 Course of the Visual Pathway
Visual pathway
consists of 6
components:
1. Optic nerve
2. Optic chiasma
3. Optic tract
4. Lateral geniculate
body
5. Optic radiation
6. Visual cortex.
 IMPORTANCE.

• Navigation & movement- helps detect

obstacles and maintain spatial awareness when
walking, driving, playing sport or performing day
to day activities.
• Peripheral vision- this is the ability to see
things outside your direct line of sight which
allows you to react quickly to objects or
movements ensuring safety.
• Early detection of health issues- changes in
visual field can signal medical conditions like
glaucoma, stroke or brain injuries which makes it
an essential diagnostic tool.
 Blindness

Blindness can be defined as the complete or

significant loss of vision.
It encompasses a spectrum of visual impairments,
ranging from partial vision loss to total absence of
light perception.
Blindness can be due to damage to the eye, retina, or
damage to the visual pathway at different levels.
other common causes of blindness may include:
 retinitis pigmentosa
 Glaucoma
 macula degeneration
 diabetic retinopathy
 brain tumors and stroke.
 Types of blindness

Anopia: loss of vision in one visual field.

 Two types:
 Right Anopia
 Left Anopia.
Causes:
 Visual pathway lesions
 Retinal detachment
 Retinal artery occlusion
 Types of blindness

Hemianopia (Half Field Vision Loss) – Loss of

vision in one-half of the visual field.
Classified as:
 Homonymous hemianopia
 Heteronymous hemianopia
Causes include:
 Visual pathway lesions.

 Stroke
 Brain injuries or tumors (pituitary gland)
Types of blindness
 Types of blindness

Tunnel vision (loss of peripheral vision)- a

person can only see objects right in front of
them and not the sides or the side vision is
significantly reduced.
 Can occur in:
 Glaucoma
 Retinitis pigmentosa- a genetic disorder that causes
progressive tunnel vision.
 Brain injury and stroke.
Types of blindness
 Types of blindness

 Loss of central vision – the central part of the visual field is impaired, making
it hard to read, recognize faces, or focus on fine detail.
 This can be caused by:
 Macular degeneration – a condition affecting the macula, the part of the

retina responsible for central vision

 Diabetic retinopathy- high blood sugar levels damage blood vessels in the

retina.
 Types of blindness

 Scotomas (blind spots) – these are either small or large areas

of vision loss within the visual field. Causes:
 Optic nerve damage from conditions like multiple sclerosis

or glaucoma.
 Retinal diseases that cause localized damage
 Types of blindness

Legal Blindness (Visual Field Criteria) – A

person may be legally blind if their visual
field is restricted to 20 degrees or less in the
better eye, even if their central vision is
functional.
 This is often associated with:
 Advanced glaucoma
 Retinitis pigmentosa.
 Other types of blindness

Total blindness
Congenital blindness
Color blindness
Nyctalopia ( Night blindness)
Acquired blindness.
Amblyopia (Lazy Eye)
 Diagnosis

Perimetry test ( Visual Field Testing) –

Identifies patterns of vision loss.
Fundoscopy and Optic Coherence
Tomography (OCT) – examines the retina and
optic nerve.
Ophthalmic examination.
MRI/CT Scan – Detects neurological causes.
Perimetry is an
important process
used to make a
chart of the field of
vision in each eye.
It is majorly used
to diagnose
blindness in
specific portions of
the retina.
 Management

Medical Treatment – Glaucoma medications,

corticosteroids for neuritis.
Surgical Options – Retinal detachment repair,
tumor removal.
Vision Rehabilitation – Assistive devices,
mobility training
Lifestyle modification for conditions like
glaucoma, diabetic retinopathy.
Gene therapy for retinitis pigmentosa.
 Case question

 CASE 1- A 60 year old man presents with gradual loss of

peripheral vision in both eyes.
QUESTION- What are the possible causes of his visual field
loss and what diagnostic tests would you recommend?

 CASE 2- A 45 year old woman reports sudden loss of vision in

one eye.
QUESTION- What conditions should be considered and what is
the appropriate management?
 Case 1
 Possible cause of his peripheral vision loss could be
glaucoma(Normal Tension Glaucoma). This is a condition that
develops when the optic nerve is damaged due to increased
intraocular pressure. Damage to the optic nerve disrupts
transmission of visual information from the eye to the brain.
Other potential causes could be:
1. Retinitis pigmentosa- these are a group of rare genetic disorders
that cause progressive degeneration of the retina, particularly the
rod photoreceptor cells responsible for peripheral and night vision.
2. Retrochiasmal damage- this is damage of the visual pathway
located behind the optic chiasm (optic tract, lateral geniculate
nucleus or occipital lobe)
3. Carotid artery disease- when the carotid artery which supplies
the brain and the eyes becomes narrowed or blocked due to
plaque. This reduced blood flow to the retina or optic nerve can
lead to ischemic damage causing visual field defects like peripheral
vision loss.
 Case 1

Diagnostic tests:
• Visual field testing
• Ophthalmic examination (to assess intraocular pressure
& optic nerve health)
• Gonioscopy- to assess the drainage in glaucoma
• Imaging (optical coherence tomography for detailed
retinal imaging and MRI of brain and orbits to rule out
retrochiasmal damage and pituitary tumors)
Treatment and management:
 Treat underlying cause-;
 Glaucoma: medication (eye drops),leaser therapy or surgery
to reduce intraocular pressure.
 Vision rehabilitation and assistive devices.
 Case 2

Possible causes(conditions):
1. Retinal Artery Occlusion - a blockage of the blood
vessel supplying the retina often caused by a blood
clot or cholesterol embolus. Causes sudden painless
vision loss with cherry-red spot on fundoscopic
exam.
2. Retinal detachment- when the retina separates
from its underlying supportive tissue which
disrupts its ability to process light and send signals
to the brain leading to vision impairment or loss.
3. Optic neuritis- this happens when the optic nerve
gets inflamed. Associated with multiple sclerosis,
may have pain with eye movement.
 Fundoscopy

Cherry-red spot on a fundoscopic

examination.
 Case 2

Management:
 History- assess onset and associated symptoms (pain
and other systemic conditions like diabetic
retinopathy).
 Examination- perform ocular exams like fundoscopy,
Fluorescein Angiography for vascular occlusions.
 Imaging- OCT, MRI of brain and orbits.
 Surgical options like pneumatic retinopexy.
 High dose IV corticosteroids may help in the
management.
 Group Members

Wonder M. Munalula - 2202000087

Saboi Nawa - 2201000461
Lombe Chansonsa - 1802008880
Rabecca Muteba - 2102000185
Teresa Ng’andu – 2302001119
Samuel Sambaulu - 2202000418
Priscilla K. Ng’andu - 2102000262