Visual field test

Last updated
Visual field test
Fotothek df n-10 0000776.jpg
Taking visual field test using a Goldmann perimeter
ICD-9-CM 95.05
MeSH D010499
MedlinePlus 003879
LOINC 28629-4

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.

Contents

The exam may be performed by a technician in one of several ways. The test may be performed by a technician directly, with the assistance of a machine, or completely by an automated machine. Machine-based tests aid diagnostics by allowing a detailed printout of the patient's visual field.

Other names for this test may include perimetry, Tangent screen exam, Automated perimetry exam, Goldmann visual field exam, or brand names such as Henson 9000 Perimeter, Humphrey Field Analyzer, Octopus Perimeter, Oculus Easyfield perimeter, etc.[ citation needed ]

Examination methods

Techniques used to perform this test include the confrontation visual field examination (Donders' test). The examiner will ask the patient to cover one eye and stare at the examiner. Ideally, when the patient covers their right eye, the examiner covers their left eye and vice versa. The examiner will then move his hand out of the patient's visual field and then bring it back in. Commonly the examiner will use a slowly wagging finger or a hat pin for this. The patient signals the examiner when his hand comes back into view. This is frequently done by an examiner as a simple and preliminary test.

Perimetry

Perimetry or campimetry is one way to systematically test the visual field. [1] [ failed verification ] It is the systematic measurement of differential light sensitivity in the visual field by the detection of the presence of test targets on a defined background. Perimetry more carefully maps and quantifies the visual field, especially at the extreme periphery of the visual field. The name comes from the method of testing the perimeter of the visual field.

Automated perimeters are used widely, and applications include: diagnosing disease, job selection, visual competence assessment, school or community screenings, military selection, and disability classifications. [2]

Types

Goldmann Perimeter Goldmann Perimeter.png
Goldmann Perimeter
Tangent screen
The simplest form of perimetry uses a white tangent screen. [3] Vision is tested by presenting different sized pins attached to a black wand, which may be moved, against a black background. [3] This test stimulus (pins) may be white or colored. [3]
Goldmann perimeter
The Goldmann perimeter is a hollow white spherical bowl positioned a set distance in front of the patient. [3] An examiner presents a test light of variable size and intensity. The light may move towards the center from the perimeter (kinetic perimetry), or it may remain in one location (static perimetry). The Goldmann method is able to test the entire range of peripheral vision and has been used for years to follow vision changes in glaucoma patients. [3] However, now automated perimetry is more commonly used.
Automated perimetry
Automated perimetry uses a mobile stimulus moved by a perimetry machine. The patient indicates whether he sees the light by pushing a button. The use of a white background and lights of incremental brightness is called "white-on-white" perimetry. This type of perimetry is the most commonly used in clinical practice, and in research trials where loss of visual field must be measured. [4] However, the sensitivity of white-on-white perimetry is low, and the variability is relatively high; as many as 25–50 percent of the photoreceptor cells may be lost before changes in visual field acuity are detected. [4] This method is commonly used for early detection of blind spots. The patient sits in front of an (artificial) small concave dome in a small machine with a target in the center. The chin rests on the machine and the eye that is not being tested is covered. A button is given to the patient to be used during the exam. The patient is set in front of the dome and asked to focus on the target at the center. A computer then shines lights on the inside dome and the patient clicks the button whenever a light is seen. The computer then automatically maps and calculates the patient's visual field. [5] [6]
Microperimetry
Microperimetry assesses the macular function in a similar way to perimetry. However, fundus imaging is performed at the same time. This allows for fundus tracking to ensure accurate stimulus placement. Thus, microperimetry provides enhances the retest reliability, enables precise structure-function correlation, and allows for examination of patients with unstable fixation. [7]

Methods of stimulus presentation

Static perimetry

Static perimetry tests different locations throughout the field one at a time. [3] First, a dim light is presented at a particular location. If the patient does not see the light, it is made gradually brighter until it is seen. [3] The minimum brightness required for the detection of a light stimulus is called the "threshold" sensitivity level of that location. [3] This procedure is then repeated at several other locations, until the entire visual field is tested. [3]

Threshold static perimetry is generally done using automated equipment. It is used for rapid screening and follow-up of diseases involving deficits such as scotomas, loss of peripheral vision and more subtle vision loss. Perimetry testing is important in the screening, diagnosing, and monitoring of various eye, retinal, optic nerve and brain disorders.

Kinetic perimetry

Kinetic perimetry uses a mobile stimulus moved by an examiner (perimetrist) such as in Goldmann kinetic perimetry. [8] First, a single test light of constant size and brightness is used. The test light is moved towards the center of vision from the periphery until it is first detected by the patient. This is repeated by approaching the center of vision from different directions. Repeating this enough will establish a boundary of vision for that target. The procedure is repeated using different test lights that are larger or brighter than the original test light.

In this way, kinetic perimetry is useful for mapping visual field sensitivity boundaries. It may be a good alternative for patients that have difficulty with automated perimetry, either due to difficulty maintaining constant gaze, or due to cognitive impairment. [9]

Stimulus settings and photoreceptor-specific perimetry

Photopic perimetry

The most commonly performed perimetry test uses white stimuli on a bright white background (photopic white-on-white testing). This tests isolated L- and M-cone function and is applied in the setting of glaucoma. [10]

Scotopic perimetry

Following 30 minutes of dark-adaptation, it is possible to selectively test rod function using short-wavelength (blue) stimuli on a dark background. [11] Today, it is also possible to perform this type of examination in eyes with unstable fixation using scotopic microperimetry. [7] [12] [13]

See also

Related Research Articles

<span class="mw-page-title-main">Glaucoma</span> Group of eye diseases

Glaucoma is a group of eye diseases that lead to damage of the optic nerve, which is important for transmitting visual information from the eye to the brain. This damage is often caused by increased pressure within the eye, known as intraocular pressure (IOP) and may cause vision loss if left untreated. The word glaucoma originated from the Greek word ΓλαύV̇ξ (glaukos), which means "to glow". Glaucoma has been called the "silent thief of sight" because the loss of vision usually occurs slowly over a long period of time. It is associated with old age, a family history of glaucoma, and certain medical conditions or medications.

<span class="mw-page-title-main">Optic nerve</span> Second cranial nerve, which connects the eyes to the brain

In neuroanatomy, the optic nerve, also known as the second cranial nerve, cranial nerve II, or simply CN II, is a paired cranial nerve that transmits visual information from the retina to the brain. In humans, the optic nerve is derived from optic stalks during the seventh week of development and is composed of retinal ganglion cell axons and glial cells; it extends from the optic disc to the optic chiasma and continues as the optic tract to the lateral geniculate nucleus, pretectal nuclei, and superior colliculus.

<span class="mw-page-title-main">Peripheral vision</span> Area of ones field of vision outside of the point of fixation

Peripheral vision, or indirect vision, is vision as it occurs outside the point of fixation, i.e. away from the center of gaze or, when viewed at large angles, in the "corner of one's eye". The vast majority of the area in the visual field is included in the notion of peripheral vision. "Far peripheral" vision refers to the area at the edges of the visual field, "mid-peripheral" vision refers to medium eccentricities, and "near-peripheral", sometimes referred to as "para-central" vision, exists adjacent to the center of gaze.

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 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">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">Slit lamp</span> Device for examining the eye

In ophthalmology and optometry, a slit lamp is an instrument consisting of a high-intensity light source that can be focused to shine a thin sheet of light into the eye. It is used in conjunction with a biomicroscope. The lamp facilitates an examination of the anterior segment and posterior segment of the human eye, which includes the eyelid, sclera, conjunctiva, iris, natural crystalline lens, and cornea. The binocular slit-lamp examination provides a stereoscopic magnified view of the eye structures in detail, enabling anatomical diagnoses to be made for a variety of eye conditions. A second, hand-held lens is used to examine the retina.

<span class="mw-page-title-main">Ophthalmoscopy</span> Part of an eye examination

Ophthalmoscopy, also called funduscopy, is a test that allows a health professional to see inside the fundus of the eye and other structures using an ophthalmoscope. It is done as part of an eye examination and may be done as part of a routine physical examination. It is crucial in determining the health of the retina, optic disc, and vitreous humor.

<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.

Meridian is used in perimetry and in specifying visual fields. According to IPS Perimetry Standards 1978 (2002): "Perimetry is the measurement of [an observer's] visual functions ... at topographically defined loci in the visual field. The visual field is that portion of the external environment of the observer [in which when he or she is] steadily fixating ...[he or she] can detect visual stimuli."

The red reflex refers to the reddish-orange reflection of light from the back of the eye, or fundus, observed when using an ophthalmoscope or retinoscope. The reflex relies on the transparency of optical media and reflects off the fundus back through media into the aperture of the ophthalmoscope. The red reflex is considered abnormal if there is any asymmetry between the eyes, dark spots, or white reflex (Leukocoria).

The Swedish interactive thresholding algorithm, usually referred to as SITA, is a method to test for visual field loss, usually in glaucoma testing or monitoring. It is combined with a visual field test such as standard automated perimetry (SAP) or short wavelength automated perimetry (SWAP) to determine visual fields in a more efficient manner.

<span class="mw-page-title-main">Fundus photography</span> Medical imaging of the eyes

Fundus photography involves photographing the rear of an eye, also known as the fundus. Specialized fundus cameras consisting of an intricate microscope attached to a flash enabled camera are used in fundus photography. The main structures that can be visualized on a fundus photo are the central and peripheral retina, optic disc and macula. Fundus photography can be performed with colored filters, or with specialized dyes including fluorescein and indocyanine green.

Jannik Petersen Bjerrum was a Danish ophthalmologist who was a native of Skærbæk, a town in the southernmost part of Jutland. In 1864 Skærbæk became part of Germany due to consequences of the Second Schleswig War.

Microperimetry, sometimes called fundus-controlled perimetry, is a type of visual field test which uses one of several technologies to create a "retinal sensitivity map" of the quantity of light perceived in specific parts of the retina in people who have lost the ability to fixate on an object or light source. The main difference with traditional perimetry instruments is that, microperimetry includes a system to image the retina and an eye tracker to compensate eye movements during visual field testing.

<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.

<span class="mw-page-title-main">Henry (Harry) Moss Traquair</span>

Henry (Harry) Moss Traquair, FRSE, PRCSE was a Scottish ophthalmic surgeon who made important contributions to the science of perimetry and the use of visual field testing in the diagnosis of disease. He was President of the Royal College of Surgeons of Edinburgh in 1939/40 and President of the Ophthalmological Society of the United Kingdom.

<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

Photostress recovery time (PSRT) is the time taken for visual acuity to return to normal levels after the retina has been bleached by a bright light source. Photostress recovery time measurement procedure is known as photostress test. Normal recovery time is about 15–30 seconds.

<span class="mw-page-title-main">Heidelberg Retinal Tomography</span>

The Heidelberg Retinal Tomography is a diagnostic procedure used in ophthalmology. The Heidelberg Retina Tomograph (HRT) is an ophthalmological confocal point scanning laser ophthalmoscope for examining the cornea and certain areas of the retina using different diagnostic modules. However, the most widely used area of application for HRT is the inspection of the optic nerve head (papilla) for early detection and follow-up of glaucoma. The procedure has established itself as an integral part of routine glaucoma diagnostics alongside the visual field examination (perimetry), the chamber angle examination (gonioscopy) and the measurement of intraocular pressure (tonometry). The HRT is the most widely used application of confocal scanning laser ophthalmoscopy.

Functional visual loss (FVL) also known as Functional vision loss or Nonorganic visual loss (NOVL) is a reduction in visual acuity or loss of visual field that has no physiological or organic basis. This disease can come under the spectrum of functional neurological disorder or somatic symptom disorder.

References

  1. "Visual Field". NIH, US National Library of Medicine. Medline Plus. Retrieved 28 November 2012.
  2. "1990 Perimetry Standards". First Codicil. Imaging and Perimetry Society. Retrieved 28 November 2012.
  3. 1 2 3 4 5 6 7 8 9 Cunningham, Emmett T.; Paul Riordan-Eva (2011). "Chapter 2: Ophthalmologic Evaluation - Specialized Ophthalmologic Examinations". Vaughan & Asbury's general ophthalmology (18th ed.). New York: McGraw-Hill Medical. ISBN   978-0071634205.
  4. 1 2 McKendrick, Allison M (March 2005). "Recent developments in perimetry: test stimuli and procedures". Clinical and Experimental Optometry. 88 (2): 73–80. doi: 10.1111/j.1444-0938.2005.tb06671.x . PMID   15807638.
  5. "Visual Field Testing". January 2, 2013.
  6. Siverstone, DE, Hirsch, J: Automated Visual Field Testing. Appelton-Century Croft. Norwalk, CT. 1986.
  7. 1 2 Pfau M, Jolly JK, Wu Z, Denniss J, Lad EM, Guymer RH, Fleckenstein M, Holz FG, Schmitz-Valckenberg S (May 2021). "Fundus-controlled perimetry (microperimetry): Application as outcome measure in clinical trials". Prog Retin Eye Res. 82: 100907. doi: 10.1016/j.preteyeres.2020.100907 . ISSN   1350-9462. PMID   33022378.
  8. "What is Perimetry?". Imaging and Perimetry Society. Retrieved 28 November 2012.
  9. Ing, Edsel. "Neuro-Ophthalmic Examination". Web MD, LLC. Medscape. Retrieved 29 November 2012.
  10. Simunovic MP, Moore AT, MacLaren RE (May 2016). "Selective Automated Perimetry Under Photopic, Mesopic, and Scotopic Conditions: Detection Mechanisms and Testing Strategies". Transl Vis Sci Technol. 5 (3): 10. doi:10.1167/tvst.5.3.10. PMC   4884057 . PMID   27247858.
  11. Jacobson SG, Voigt WJ, Parel JM, Apáthy PP, Nghiem-Phu L, Myers SW, Patella VM (December 1986). "Automated light- and dark-adapted perimetry for evaluating retinitis pigmentosa". Ophthalmology. 93 (12): 1604–11. doi:10.1016/s0161-6420(86)33522-x. PMID   3808619.
  12. Crossland MD, Luong VA, Rubin GS, Fitzke FW (February 2011). "Retinal specific measurement of dark-adapted visual function: validation of a modified microperimeter". BMC Ophthalmol. 11: 5. doi:10.1186/1471-2415-11-5. PMC   3042987 . PMID   21303544.
  13. Pfau M, Lindner M, Fleckenstein M, Finger RP, Rubin GS, Harmening WM, Morales MU, Holz FG, Schmitz-Valckenberg S (2017). "Test-Retest Reliability of Scotopic and Mesopic Fundus-Controlled Perimetry Using a Modified MAIA (Macular Integrity Assessment) in Normal Eyes" (PDF). Ophthalmologica. 237 (1): 42–54. doi:10.1159/000453079. PMID   27997924.