This article needs more reliable medical references for verification or relies too heavily on primary sources .(January 2022) |
Visual field test | |
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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.
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 the Humphrey Field Analyzer, Octopus Perimeter, Optopol perimeter, etc.[ citation needed ]
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 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]
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 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]
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]
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]
Glaucoma is a group of eye diseases that can lead to damage of the optic nerve. The optic nerve transmits visual information from the eye to the brain. Glaucoma may cause vision loss if left untreated. It has been called the "silent thief of sight" because the loss of vision usually occurs slowly over a long period of time. A major risk factor for glaucoma is increased pressure within the eye, known as intraocular pressure (IOP). It is associated with old age, a family history of glaucoma, and certain medical conditions or the use of some medications. The word glaucoma comes from the Ancient Greek word γλαυκός, meaning 'gleaming, blue-green, gray'.
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 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”.
An eye examination, commonly known as an eye test, is a series of tests performed to assess vision and ability to focus on and discern objects. It also includes other tests and examinations of 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. Typically, a healthy individual who otherwise has no concerns with their eyes receives an eye exam once in their 20s and twice in their 30s.
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.
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.
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.
Dilated fundus examination (DFE) is a diagnostic procedure that uses mydriatic eye drops to dilate or enlarge the pupil in order to obtain a better view of the fundus of the eye. Once the pupil is dilated, examiners use ophthalmoscopy to view the eye's interior, which makes it easier to assess the retina, optic nerve head, blood vessels, and other important features. DFE has been found to be a more effective method for evaluating eye health when compared to non-dilated examination, and is the best method of evaluating structures behind the iris. It is frequently performed by ophthalmologists and optometrists as part of an eye examination.
Optic neuropathy is damage to the optic nerve from any cause. The optic nerve is a bundle of millions of fibers in the retina that sends visual signals to the brain.
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 red reflex may be absent or poorly visible in people with dark eyes, and may even appear yellow in Asians or green/blue in Africans.
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.
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).
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.
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.
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.
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.
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.
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.
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 and or the visual field of each eye separately.