Visual field examinations

1
Visual field examinations

• Week 6 Interpreting of visual fields

2
Interpreting the data

• Is it a legitimate defect? ( tech or patient
  error)
• Is the defect in one or both eyes?
• What part of the pathway is effected because of
  the defect shown?
• Does the VF make sense? (Compared to the patient
  complaints and Dx.)
• Is there another VF to compare with this VF?

3
Is this a legitimate defect?

• Technician error
• Wrong corrective lens
• Poor instruction to patient
• Forgot to patch patients eye
• Lens holder to far from eye
• Doing the wrong test
• Entering wrong birthday
• Dilating or not dilating pupil
• Is it a depression, scotoma, or neurologic defect?

4
Technician error

• Wrong correction lens

• Pupil was dilated 2nd time.

5
Technician error

• Lens holder to far away from eye.

• Wrong birth date

6
Technician error

• 30-2 vs central 10

• Poor patient instruction- false positives

7
interpretation

• Is there a defect in one eye or both eyes?
• If there is a defect in only one eye, it will be
  before the chiasm.
• It can be retinal, glaucomatous, or nerve
• If there is a defect in both eyes, is it
  congruent or incongruent?
• If both eyes, is it neurological (chiasm and
  beyond) or same problem in both eyes ?

8
Interpretation of Visual Fields

• What part of the pathway has caused this defect?
• Both eyes glaucoma hx? Trauma? Macular
  degeneration?
• Do the defects have horizontal or vertical
  respect?
• Retinal, macular, nerve and glaucoma are
  considered to be the same problem happening in
  both eyes.
• Defects that happen at or after the chiasm are
  effecting both eyes, but are a neurologic
  problem.

9
Interpretation of visual fields

• Pseudotumor causing papilledema

• Bitemporal hemianopia

10
Interpreting visual fields

• Left eye

• Right eye

11
Interpreting visual fields

• 4 VFs, you tell me!

• Both eyes effected, you tell me whats wrong!

12
Interpreting visual fields

• Right and left eyes both have a problem-

• What is wrong?

13
Depression, step or scotoma? Interpreting visual
fields
14
Interpretation of visual fields

• Does this VF make sense?
• If the patient came in for a 6 month repeat VF
  because of glaucoma, does this field match the
  Dx?

15
Interpretation of visual fields

• Are there other VFs stored in the computer to
  compare with the most recent VF?
• This is a printout of all the VFs this patient
  has taken. With this printout of ALL VFs taken,
  it is easy to see how the glaucomatous defects
  have progressed.
• If something is out of the ordinary from what you
  expect- this comparison is a great way to look at
  all the past VFs to figure out the problem.

16
Interpreting glaucomatous field defects

• Generalized depression

• Arcuate scotoma

17
Interpreting glaucomatous field defects

• Nasal step

• Temporal wedge

18
Interpreting glaucomatous field defects

• Nerve fiber bundle, nasal step

• Nerve fiber bundle, arcuate scotoma

19
Interpreting glaucomatous field defects

• End stage glaucoma

• End stage glaucoma

20
Interpreting retinal field defects

• Macular hole

• Retinal detachment

21
Interpreting retinal field defects

• Retinal scar due to ocular toxoplasmosis

• Choroidal rupture after a blunt trauma causing a
  scar.

22
Interpreting retinal field defects

• Nerve fiber bundle defects OU

• Followed after open heart surgery

23
Interpreting retinal field defects

• Diabetic retinopathy

• Retinal detachment

24
Interpreting optic nerve field defects

• Optic neuritis OU

• Usually associated with MS, effects both eyes
  suddenly when this happens.

25
Interpreting optic nerve field defects

• Optic atrophy VA 20/200

• Papilledema OU

26
Interpreting optic nerve field defects

• AION (anterior ischemic optic neuropathy)

• You guess now!!!

27
Interpreting Chiasmal defects

• bitemporal hemianopia

• Chiasmal defect, from a pituitary tumor

28
Interpreting Chiasmal field defects

• Bitemporal quadrant hemianopia

• Bitemporal hemianopias at different stages

29
Interpreting post chiasmal field defects

• Homonymous quadrant hemianopia

• Originating from a problem on the right or left
  side of the brain?

30
Interpreting post chiasmal field defects

• homonymous hemianopia, which side?

• Homonymous hemianopia, which side?

31
Interpreting visual field defects

• Now you try

• What are these defects?

32
Interpreting visual field defects

• Try again.

• What are these defects?

33
Interpreting visual field defects

• See
• Its not that hard after all!
• You did a great job!