Confrontation visual field testing

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Confrontation visual field testing
PurposeFor rapid detection of large-scale visual field problems

Confrontation visual field testing is a test used in ophthalmology for rapid and gross detection of large-scale visual field problems. It is done by asking the patient to look directly at the examiner's eye or nose and compare the patient's visual field with the examiner's field. It can be used to test the binocular visual field (with both eyes open) and or the visual field of each eye separately (with one eye closed).

Contents

Indications

Confrontation visual field testing is an important part of a routine ophthalmological or neurological examination. It can be used for rapid and gross assessment of large-scale visual field problems due to ophthalmological or neurological diseases, such as homonymous and heteronymous hemianopias, quadranopsia, altitudinal visual loss, central/centrocecal scotoma etc. [1] [2] Test using a red target can detect red-desaturation, a sign of early optic nerve disease. [3]

Procedure

Confrontation visual field testing does not need a clinical setting to perform. It can be done in any well-illuminated room. Since the visual fields of both eyes overlap in the nasal area, each eye is tested separately. [4] [5] Patient is asked to sit in front of the examiner, at a distance between 66 and 100 cm, maintaining the eye level same as examiner's. [1] Patient is asked to remove his/her spectacles before starting the test. For testing the right eye field, the patient is asked to close his left eye, and look straight at the examiner's left eye (preferably) or nose. [1] Examiner should also close his/her right eye. [1] [6] Move a finger or bead-on-a-stick inwards from an area outside the usual 180º visual field, and ask the patient when they first see the targets. [1] [7] Alternatively, the patient may be asked to count the number of fingers the examiner shows or identify wiggling fingers. [6] For an accurate assessment of the patient's visual field, it is essential that the distance of all test objects from the patient is the same as the distance from the examiner. [6] The Examiner should compare the point at which the patient sees the target with his own visual field. [1] Repeat the procedure for all eight meridians. [1]

Record the type of target used and whether there are any significant abnormalities in the patient's visual field. Colored targets such as red are more sensitive than a white test target. [5] The test reliability may improve when techniques like finger counting, finger wiggling, identifying a target etc. are combined. [8] [9]

Confrontation testing can be done with both eyes open also. It is done for testing the binocular visual field. [3]

Advantages and disadvantages

The Confrontation visual field testing is a simple, easy, quick and inexpensive clinical technique that can be used for gross assessment of large-scale visual field problems, such as homonymous and heteronymous hemianopias, quadranopsia etc. [1] But testing is less useful for detecting arcuate scotoma, bitemporal hemianopsia, and visual field loss associated with parasellar tumors, glaucoma, and compressive optic neuropathies. [2] The test reliability may improve when techniques like finger counting, finger wiggling, identifying a target etc. are combined. [8] [9] To compare a patient's visual field with their own visual field, the examiner should have a full field of vision without any defects. [3]

Related Research Articles

<span class="mw-page-title-main">Scotoma</span> Medical condition

A scotoma is an area of partial alteration in the field of vision consisting of a partially diminished or entirely degenerated visual acuity that is surrounded by a field of normal – or relatively well-preserved – vision.

The visual field is "that portion of space in which objects are visible at the same moment during steady fixation of the gaze in one direction"; in ophthalmology and neurology the emphasis is mostly on the structure inside the visual field and it is then considered “the field of functional capacity obtained and recorded by means of perimetry”.

<span class="mw-page-title-main">Diplopia</span> Double vision

Diplopia is the simultaneous perception of two images of a single object that may be displaced horizontally or vertically in relation to each other. Also called double vision, it is a loss of visual focus under regular conditions, and is often voluntary. However, when occurring involuntarily, it results from impaired function of the extraocular muscles, where both eyes are still functional, but they cannot turn to target the desired object. Problems with these muscles may be due to mechanical problems, disorders of the neuromuscular junction, disorders of the cranial nerves that innervate the muscles, and occasionally disorders involving the supranuclear oculomotor pathways or ingestion of toxins.

<span class="mw-page-title-main">Eye examination</span> Series of tests assessing vision and pertaining to the eyes

An eye examination is a series of tests performed to assess vision and ability to focus on and discern objects. It also includes other tests and examinations pertaining to the eyes. Eye examinations are primarily performed by an optometrist, ophthalmologist, or an orthoptist. Health care professionals often recommend that all people should have periodic and thorough eye examinations as part of routine primary care, especially since many eye diseases are asymptomatic.

<span class="mw-page-title-main">Amsler grid</span> Tool to detect defects in central vision

The Amsler grid, used since 1945, is a grid of horizontal and vertical lines used to monitor a person's central visual field. The grid was developed by Marc Amsler, a Swiss ophthalmologist. It is a diagnostic tool that aids in the detection of visual disturbances caused by changes in the retina, particularly the macula, as well as the optic nerve and the visual pathway to the brain. Amsler grid usually help detecting defects in central 20 degrees of the visual field.

Vision therapy (VT), or behavioral optometry, is an umbrella term for alternative medicine treatments using eye exercises, based around the pseudoscientific claim that vision problems are the true underlying cause of learning difficulties, particularly in children. Vision therapy has not been shown to be effective using scientific studies, except for helping with convergence insufficiency. Most claims—for example that the therapy can address neurological, educational, and spatial difficulties—lack supporting evidence. Neither the American Academy of Pediatrics nor the American Academy of Ophthalmology support the use of vision therapy.

<span class="mw-page-title-main">Visual field test</span> Eye examination that can detect dysfunction in central and peripheral vision

A visual field test is an eye examination that can detect dysfunction in central and peripheral vision which may be caused by various medical conditions such as glaucoma, stroke, pituitary disease, brain tumours or other neurological deficits. Visual field testing can be performed clinically by keeping the subject's gaze fixed while presenting objects at various places within their visual field. Simple manual equipment can be used such as in the tangent screen test or the Amsler grid. When dedicated machinery is used it is called a perimeter.

<span class="mw-page-title-main">Hemianopsia</span> Loss of vision in half the visual field

Hemianopsia, or hemianopia, is a loss of vision or blindness (anopsia) in half the visual field, usually on one side of the vertical midline. The most common causes of this damage are stroke, brain tumor, and trauma.

<span class="mw-page-title-main">Worth 4 dot test</span>

The Worth Four Light Test, also known as the Worth's four dot test or W4LT, is a clinical test mainly used for assessing a patient's degree of binocular vision and binocular single vision. Binocular vision involves an image being projected by each eye simultaneously into an area in space and being fused into a single image. The Worth Four Light Test is also used in detection of suppression of either the right or left eye. Suppression occurs during binocular vision when the brain does not process the information received from either of the eyes. This is a common adaptation to strabismus, amblyopia and aniseikonia.

Suppression of an eye is a subconscious adaptation by a person's brain to eliminate the symptoms of disorders of binocular vision such as strabismus, convergence insufficiency and aniseikonia. The brain can eliminate double vision by ignoring all or part of the image of one of the eyes. The area of a person's visual field that is suppressed is called the suppression scotoma. Suppression can lead to amblyopia.

<span class="mw-page-title-main">Homonymous hemianopsia</span> Visual field loss on the left or right side of the vertical midline

Hemianopsia, or hemianopia, is a visual field loss on the left or right side of the vertical midline. It can affect one eye but usually affects both eyes.

<span class="mw-page-title-main">Chiasmal syndrome</span> Set of signs and symptoms that are associated with lesions of the optic chiasm

Chiasmal syndrome is the set of signs and symptoms that are associated with lesions of the optic chiasm, manifesting as various impairments of the affected's visual field according to the location of the lesion along the optic nerve. Pituitary adenomas are the most common cause; however, chiasmal syndrome may be caused by cancer, or associated with other medical conditions such as multiple sclerosis and neurofibromatosis.

<span class="mw-page-title-main">Cranial nerve examination</span> Type of neurological examination

The cranial nerve exam is a type of neurological examination. It is used to identify problems with the cranial nerves by physical examination. It has nine components. Each test is designed to assess the status of one or more of the twelve cranial nerves (I-XII). These components correspond to testing the sense of smell (I), visual fields and acuity (II), eye movements and pupils, sensory function of face (V), strength of facial (VII) and shoulder girdle muscles (XI), hearing and balance, taste, pharyngeal movement and reflex, tongue movements (XII).

The National Institutes of Health Stroke Scale, or NIH Stroke Scale (NIHSS), is a tool used by healthcare providers to objectively quantify the impairment caused by a stroke and aid planning post-acute care disposition, though was intended to assess differences in interventions in clinical trials. The NIHSS was designed for the National Institute of Neurological Disorders and Stroke (NINDS) Recombinant Tissue Plasminogen Activator (rt-PA) for Acute Stroke Trial and was first published by neurologist Dr. Patrick Lyden and colleagues in 2001. Prior to the NIHSS, during the late 1980s, several stroke-deficit rating scales were in use.

The Peli Lens is a mobility aid for people with homonymous hemianopia. It is also known as “EP” or Expansion Prism concept and was developed by Dr. Eli Peli of Schepens Eye Research Institute in 1999. It expands the visual field by 20 degrees. He tested this concept on several patients in his private practice with great success using 40Δ Fresnel press-on prisms. Development of the lens and clinical trials were funded by NEI-NIH Grant EY014723 awarded to Chadwick Optical. The results of the multi-center clinical trials were published in 2008 reporting a 74% patient acceptance rate. Under this grant Chadwick Optical also designed and produced a cosmetically acceptable permanent version of this concept in a prescription lens.

Cerebral diplopia or polyopia describes seeing two or more images arranged in ordered rows, columns, or diagonals after fixation on a stimulus. The polyopic images occur monocular bilaterally and binocularly, differentiating it from ocular diplopia or polyopia. The number of duplicated images can range from one to hundreds. Some patients report difficulty in distinguishing the replicated images from the real images, while others report that the false images differ in size, intensity, or color. Cerebral polyopia is sometimes confused with palinopsia, in which multiple images appear while watching an object. However, in cerebral polyopia, the duplicated images are of a stationary object which are perceived even after the object is removed from the visual field. Movement of the original object causes all of the duplicated images to move, or the polyopic images disappear during motion. In palinoptic polyopia, movement causes each polyopic image to leave an image in its wake, creating hundreds of persistent images (entomopia).

<span class="mw-page-title-main">Prism fusion range</span>

The prism fusion range (PFR) or fusional vergence amplitude is a clinical eye test performed by orthoptists, optometrists, and ophthalmologists to assess motor fusion, specifically the extent to which a patient can maintain binocular single vision (BSV) in the presence of increasing vergence demands. Motor fusion is largely accounted to amplitudes of fusional vergences and relative fusional vergences. Fusional vergence is the maximum vergence movement enabling BSV and the limit is at the point of diplopia. Relative fusional vergence is the maximum vergence movement enabling a patient to see a comfortable clear image and the limit is represented by the first point of blur. These motor fusion functions should fall within average values so that BSV can be comfortably achieved. Excessive stress on the vergence system or inability to converge or diverge adequately can lead to asthenopic symptoms, which generally result from decompensation of latent deviations (heterophoria) or loss of control of ocular misalignments. Motor anomalies can be managed in various ways, however, in order to commence treatment, motor fusion testing such as the PFR is required.

<span class="mw-page-title-main">Humphrey visual field analyser</span> Tool used by eye care professionals

Humphrey field analyser (HFA) is a tool for measuring the human visual field that is commonly used by optometrists, orthoptists and ophthalmologists, particularly for detecting monocular visual field.

The FourPrism Dioptre Reflex Test is an objective, non-dissociative test used to prove the alignment of both eyes by assessing motor fusion. Through the use of a 4 dioptre base out prism, diplopia is induced which is the driving force for the eyes to change fixation and therefore re-gain bifoveal fixation meaning, they overcome that amount of power.

<span class="mw-page-title-main">Visual pathway lesions</span> Overview about the lesions of visual pathways

The visual pathway consists of structures that carry visual information from the retina to the brain. Lesions in that pathway cause a variety of visual field defects. In the visual system of human eye, the visual information processed by retinal photoreceptor cells travel in the following way:
Retina→Optic nerve→Optic chiasma →Optic tract→Lateral geniculate body→Optic radiation→Primary visual cortex

References

  1. 1 2 3 4 5 6 7 8 Elliott, David B.; Flanagan, John (2007). "Assessment of Visual Function". Clinical Procedures in Primary Eye Care. pp. 29–81. doi:10.1016/B978-0-7506-8896-3.50007-9. ISBN   978-0-7506-8896-3.
  2. 1 2 Johnson, L. N.; Baloh, F. G. (October 1991). "The accuracy of confrontation visual field test in comparison with automated perimetry". Journal of the National Medical Association. 83 (10): 895–898. PMC   2571584 . PMID   1800764.
  3. 1 2 3 Broadway, David C; Kyari, Fatima (2019). "Examining visual fields". Community Eye Health. 32 (107): 58–59. PMC   7041825 . PMID   32123478.
  4. Allen, Richard C. "Confrontation Visual Fields". EyeRounds.
  5. 1 2 Visual Field Testing~technique at eMedicine
  6. 1 2 3 Pollock, Stephen C. "Confrontation Visual Fields A Concise Guide for Ophthalmologists in Training" (PDF).
  7. "Visual Field Test". American Academy of Ophthalmology. 10 March 2022.
  8. 1 2 Prasad, Sashank (24 August 2010). "How Accurate Is Confrontation Visual Field Testing?". NEJM Journal Watch. ProQuest   1284220446.
  9. 1 2 Kerr, N.M.; Chew, S.S.L.; Eady, E.K.; Gamble, G.D.; Danesh-Meyer, H.V. (13 April 2010). "Diagnostic accuracy of confrontation visual field tests". Neurology. 74 (15): 1184–1190. doi:10.1212/WNL.0b013e3181d90017. PMID   20385890.