Visual Field Testing
Fixation Losses
- This is when light is shone in the person’s blind spot, but they happen to see it
- Reason: patient shifted their eyes
- For the results to be reliable, there must be no “X” present next to it
False Positive
- Patient presses the button when no stimulus is present
- Reason: Patient may be anxious or eager
- Corrected by providing a simple statement that many stimuli may not be seen even with
normal vision
- Cannot exceed 30%
False Negative
- Patient fails to see a significantly brighter stimulus at a location where it was seen before
- Difficult to correct
- Reason: fatigue/ attention lapses
- Cannot exceed 30%
Numerical Sensitivity Plot
The higher number means that there is higher sensitivity since the person can see a dimmer
stimuli, and the smaller number or more negative numbers means that less sensitivity or
sensitivity loss within the field. The middle should be higher numbers due to the macula being
sensitive.
Grayscale Map
This shows the location of the blind spot and will show any scotomas. If the blind spot is on the
right side, then it is the right eye and if it is on the left then it is the left eye.
Total Deviation Map
Compare the patient’s visual field with someone of the same age.
These little boxes will show what % of the population had the same value. 0.5% is something to
look more into if the patient has it based on their map layout seen below
Pattern Deviation Map
This considers the entire visual field. Example: a cataract will dim the entire field. It also
highlights hidden defects. A case in point is a person with cataract and glaucoma since in the
visual field test the cataract will make the entire visual field look dim and reduce the results,
making it look abnormal. However, it hides other defects suchh as glaucoma. The pattern
deviation map will pick up the hidden defect which in this case will be the glaucoma.
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Mean Deviation (MD)
- Measure of the average sensitivity since it monitors the overall change in the visual field
- The values can go between -6 and 18
Pattern Standard Deviation (PSD)
- Measure of non-uniformity of the shape of the hill of vision
- More than +/- 2, patient will be a glaucoma suspect
Short-term Fluctuation (SF)
- Measure of the intra-test variance.
Corrected pattern standard deviation (CPSD)
- PSD corrected for SF
Basic Defects
Constriction
This is due to a defect at the retina or optic nerve. Another reason is that the patient can have
small pupils.
Ring Scotoma
This is due to retina degeneration
Central Scotoma
This is a defect located at the macula or optic nerve
Cecocentral Scotoma
This is a defect located at the papillomacular bundle or nearby retina in the region between the
macula and optic nerve head.
Arcuate Scotoma
This is a defect within the arcuate retina ganglion cell nerve fiber bundles or retinal vasculature
Temporal Wedge
This is a defect within the nasal retina radial fibers entering the optic nerve
Blind Spot Enlargement
This is a defect in the Optic Nerve
Altitudinal Scotoma
This is a defect in the temporal retina
Multiple Scattered defects
This is due to a defect at the retina
Hemifields respecting the horizontal meridian
This is a defect in the retina ganglion cell nerve fiber bundles or less commonly retinal
vasculature
Hemifields respecting the vertical meridian
This is a defect located at the optic chiasm or posterior visual pathways
Bitemporal Hemianopia
The defect is located at the optic chiasm
Congruous homonymous hemianopia
This defect is located closer to the posterior visual cortex
Incongruous homonymous hemianopia
This defect is located nearer to the optic chiasm but more posterior than the incongruous
homonymous hemianopia
Pie in the sky defect
The left eye shows the pie in the sky defect but the overall defect for both eyes will be right
homonymous superior quadrantopia. The defect is located in the temporal lobe.
Pie on the floor defect
The above in the pie in the sky defect but the overall type of vision loss is known as right
homonymous inferior quadrantopia. The lesion is located in the parietal lobe.
“Punched out” defects/Macular Sparing hemianopia
The defect is located at the occipital lobe
Unilateral temporal hemianopia
This defect is located at the front of the chiasm
Unilateral nasal hemianopia
This is seen in the diagram B and the defect is located at the optic tract
Homonymous paracentral Scotoma
This defect is located at the posterior visual cortex
Hourglass homonymous hemianopia
This defect is due to the occlusion of the anterior choroid artery
Silhouette hourglass homonymous hemianopia
This due to the occlusion of the posterior choroid artery
Other defects:
A- Nasal step and paracentral scotoma
C-Inferior nasal step
D- Anular paracentral scotoma
