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A Practical Approach To The Analysis of Visual Field Defects

This document provides an overview of visual field testing and analysis. It begins by defining key terms like visual field and perimetry. It then discusses the different types of perimetry tests and reliable indices. The main part of the document outlines a step-by-step approach to analyzing Humphrey visual field tests, including examining patient details, reliability indices, main displays, and global and hemifield analyses. It also reviews common field defect patterns associated with conditions like glaucoma, optic nerve disorders, and intracranial lesions. The document emphasizes using visual field testing alongside clinical evaluation for diagnosing and monitoring ophthalmic diseases.

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247 views43 pages

A Practical Approach To The Analysis of Visual Field Defects

This document provides an overview of visual field testing and analysis. It begins by defining key terms like visual field and perimetry. It then discusses the different types of perimetry tests and reliable indices. The main part of the document outlines a step-by-step approach to analyzing Humphrey visual field tests, including examining patient details, reliability indices, main displays, and global and hemifield analyses. It also reviews common field defect patterns associated with conditions like glaucoma, optic nerve disorders, and intracranial lesions. The document emphasizes using visual field testing alongside clinical evaluation for diagnosing and monitoring ophthalmic diseases.

Uploaded by

stolfish
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Dr Darren Stoler Registrar Division of Ophthalmology Department of Neurosciences University of the Witwatersrand

A Practical Approach to May 2010 the Analysis of Visual Field Defects

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Definitions
Visual Field (n) : That portion of the external environment of the observer wherein the steadily fixating eye can detect visual stimulus. Perimetry (n) : Method of assessment of the visual field.

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Normal field boundaries

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Presentation Plan

Types of Perimetry

1 2 3
Approach to Humphrey Defect Patterns

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Types of Perimetry

Types of Perimetry

Stat vsKineti c ic Goldmann Isopters

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Types of Perimetry

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Types of Perimetry

Threshold vs Suprathreshold Humphrey Field Analyser SITA (Swedish Interactive Thresholding Algorithm) SWAP (Short Wavelength Automated Perimetry) FDT (Frequency Doubling Contrast Test)

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Types of Perimetry

Oculus Centrefield

v s
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Approach to Analysis of a Humphrey Visual Field

Click icon to add media

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Where to Start?

Approach to Analysis
Target Visual Na of & Acuity Degree Pupil Field Ag Type/Colour Refraction Diameter Field Type me e

1 Patient & Test Details

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Approach to Analysis

False Fixation Negative Losses Positive

2 Reliability Indices
Test Foveal Duration Threshold
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White Scotoma The False Positive

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Clover Leaf The False Negative

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Approach to Analysis

3 Main Displays

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Approach to Analysis

Aged Matched Norms

4 Total Deviation

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Corrects for Generalised Insensitivity

Approach to Analysis

5 Pattern Deviation

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Approach to Mean PATTERN Standard Short term Corrected Pattern Standard Analysis

Average of all all Total Deviation Average of Pattern How ValuesConsistent is the Deviation values Patient? PSD corrected Compares points with eachother, Indication of overall Same spot measured twice at for SF not norms depression 10 points Removes generalised depression Can be misleading More sensitive and specific than MD

Deviation Deviation deviation fluctuation

6 Global Indices

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Approach to Analysis

7 Hemifield Analysis

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Describing a Scotoma Positi on Merid Sha ia Mono/Binoc pe Depular Inferonasal Nasal Step Increasing Horizontal Less than Monocu Uniform th
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Quadrant Sensitivity Meridian Arcuate 0 dB lar

Patterns of Field Loss

Optic Nerve & Bundle Glaucoma Retinopathies Intracerebral


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Optic Nerve & Bundle Defects

Disc Enlarged Blind itself


Spot Central Scotoma Paracentral
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7 x 5.5, 15 temporal to fixation

Centrocaecal

Nerve fibre

Scotoma

Optic Nerve & Bundle Defects


2. Fibre Loss Temporal Field Loss Fibre Loss centrocaecal central, paracentral, Organisation
scotomata
1.

Nerve fibre 3. Papillomacular Nasal bundle Retinotopic

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Proxi Cent Dist Extens Nas

Bjerru Seid Arcua Altitudi Nasal Temporal

Glaucomatous Which Diseases? Defects


ALL disc and NFL damage: papillitis Papilloedema Hereditary nutritional/toxic Ischaemic disc drusen disc colobomas

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Diagnosis AND progression Screening: 1% Prevalence, 5% False Positives Clinical Suspicion: 33% Prevalence, 5% False Positives Inferior and Superior Altitudinal defects merge: Ring Scotoma, sparing fixation, temporal rim

Glaucomatous Defects

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Glaucomatous Defects Anderson and Patella:


1.

Arcuate cluster of three or more non-edge points with threshold sensitivities below the lowest 5% of the general population normative values. One of these points must fall within 0.5% of general population normative values. PSD/CPSD should fall within the lower 5% of age-matched normative values. Hemifield analysis must be abnormal.
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2.

2.

Glaucomatous Defects

FDT & SWAP

EARLIER DETECTION
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Monitoring Progression Repeated Follow up field


comparisons:

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Monitoring New software such as GPA does the Progression


work for you!

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Retinal Defects
Correspond to area of damage.

Lesions can mimic neurological and glaucomatous field loss. PERIPHERAL RETINAL DISEASE Retinitis Pigmentosa, Panretinal photocoagulatio Ring n, Vitamin A Scotoma deficiency

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Intracranial Defects Optic Inferior Chiasm = ==Chiasm = Crossed Inferior & Superior Bitemporal Posterior Chiasm defects =Scotoma Macular Anterior Chiasm=Bilateral Mid Chiasm Junctional Monocular Chiasm Superotemporal Hemianopia (Willebrands Knee)
Quadrantinopia Bitemporal Hemianopia Hemianopia Prechiasmal

As a rule: Vertical meridian Respected Within 15 degrees


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Post Chiasmal Lesions

Homonymous defects Spared visual acuity Congruity = incongruous posterior

OPTIC TRACT ruleS: Syndrome

homonymous

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Contralateral bow tie atrophy &

Can be congruous, incongruous,

OR unique

Lateral Geniculate Lesions


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Posterolateral choroidal artery Anterior choroidal artery lesions = lesions = homonymous horizontal homonymous sector-sparingwedge
sectorinopia over horizontal meridian hemianopia

Optic Radiation Lesions

Temporal Lobe

Hemianopias that are denser superiorly

Superior incongruous homonymous Quadrantinopias

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pie-in-the sky

Optic Radiation Lesions

Parietal Lobe

Hemianopias that are denser pie-in-the reduced optokinetic inferiorlyin the direction of nystagmus reflex
gaze towards the lesion

Inferior incongruous homonymous Quadrantinopias

spasticity of conjugate gaze in the direction opposite the 4/1/12 lesion on attempting to produce a Bells reflex

floor

Occipital Cortex Lesions


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Congruent homonymous hemianopias. Large lesion - a double homonymous hemianopia Sparing fixation OR Isolated fixation scotoma (posterior lesion) Temporal crescent OR temporal crescent scotoma (anterior lesion) Homonymous crossed quadrantinopia

False Defects Aphakic Rim Effect

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False Defects Cataract

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False Defects - Miosis

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Approach to interpreting a patient presenting with a field Conclusion defect


Role to play in diagnosis & Varietyfollow up of ophthalmic disease Subjective test prone to error Of value only when used in conjunction with clinical picture

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Thank You.

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