2 Visual field examinations review Perimetry- the science of measuring the peripheral vision in order to determine the visual field. (The art of determining boundaries of the visual field.)Visual field- the portion of visual space which is visible to an individual at any given moment.Isopter-Boundaries of VF areas of equal or greater sensitivity. Isopters are used in Goldmann perimetry. Each isopter is labeled with the size and intensity of the stimulus.
3 Visual field reviewThreshold-A stimulus intensity which has a 50% probability of being seen. This test compares what has the probability of being seen with the possible inaccuracy of the test. Computerized perimetry only.Asb- intensity value of a stimulus. Used in static perimetry. Smaller asb= greater retinal sensitivity.dB- intensity value of a stimulus. Larger dB= greater retinal sensitivity.
4 Visual field examinations review ScotomaVisual loss, either blindness (absolute) or decreased sensitivity (relative).scotoma
5 Visual field examinations review Island of visionAn analogy for visual field testing.
6 Visual field examinations review degrees=temporal75 degrees= inferior60 degree= nasal60 degrees=superiorPhysiological blind spotNormal visual field boundaries
7 Visual field examinations review 30-2 and 24-2 threshold- white lights, varying in intensity. Tests 30 or 24 degrees off the macula in all meridians on dilated patient. Macula- white lights, varying in intensity. Tests 5 degrees off the macula in all meridians on dilated patient. Plaquinil- red lights, varying in intensity. Tests 5 degrees of the macula in all meridians on dilated patient. Used for the drug “Plaquinil” which can damage cone photoreceptors.(RA) Bleph- White lights, fixed intensity testing the superior region of the visual field on an undilated patient. There is a lower fixation light. False positive-no light shown, patient responded. (“trigger happy”.) False negative-no response to a previously seen target.Visual field examinations reviewComputerized VF tests
8 Computerized visual field testing 30-2 threshold VFCentral 10/macular VF
9 Visual field examinations review Screening testsMinimal information done on a computerized VF.Takes much less time to perform.C= central regionP= peripheral regionFF= full fieldThe number after the letter indicates how many targets will be shown to the patient.The targets are fixed intensity.It does not print out in grey scale- screening tests will show a circle for seen targets and a black square for unseen targets.Visual field examinations reviewComputerized VF tests
10 Visual field examinations review Confrontation visual fieldAmsler grid
11 Visual field examinations review Technician moves target, changes target intensity and size, watches fixation, plots chart, investigates a depression or scotoma. Goldmann VF testing can be done with static or kinetic targets. Isopters are used and are color coded or labeled to indicate intensity of target.Goldmann manual VF
12 Visual field examinations review Hemianopia-Binocular-Monocular-Homonymous-Congruent-Incongruent-Bi nasal-Bi temporal-Altitudinal-Central cecal-Nasal step-( bjerrum)Temporal wedge-Visual field examinations reviewTypes of scotomas
13 Visual field examinations review Types of scotomas
14 Visual field examinations review Monocular retinal zoneNerve fiber/ optic nerve zoneBinocular chiasmal zonePost chiasmal zoneVisual field examinations review4 visual pathway zones
15 Visual field examinations review Monocular retinal zoneThis zone includes the retinal layer, sub retinal layer, rod and cone dystrophy or damage, retinitis pigmentosa, and macular pathology.CharacteristicsAll defects will be monocular.Most pathology will be visible with a scope.Lesions temporal to fovea present nasal of VF. (inverted field image)Lesions can cross meridians.Central scotomas will cause abnormal VA and color vision will be compromised.Visual field examinations review4 majors visual pathway zones
16 Visual field examinations review Nerve fiber/optic nerve zoneThis zones includes glaucoma, papilledema, and nerve fiber bundle defects.CharacteristicsAll defects will be monocular.Both eyes can have the same disease causing congruent or incongruent scotomas.Most defects will be visible with a scope.Defects will points to the disc since nerve fibers are traveling towards this point.Glaucomatous scotomas will respect the horizontal meridian.Visual field examinations review4 major visual pathway zones
17 Visual field examinations review Binocular chiasmal zoneThis zone includes pathology or damage to the pituitary gland.CharateristicsDefects will be bilateral, most commonly bi temporal but bi nasal defects can also occur.NOT visible with a scope, a CT-scan or MRI will be ordered.Defects here are not an eye problem, this problem is in the brain and effects both eyes because the nasal axons or nerve fibers have crossed to the opposite side at the chiasm.Defects will respects the vertical meridian and be hemianopic.Visual field examinations review4 major visual pathway zones
18 Visual field examinations review Post chiasm zoneThis zone includes the optic tract, lateral geniculate body, optic radiations and the occipital cortex.CharacteristicsMost defects will respect the vertical meridian.Defects will be homonymous and hemianopic.This is NOT an eye problem, this is a brain problem and a CT-scan or MRI will be ordered.Nerve fibers from the nasal VF of one eye and temporal fibers of the other eye will be effected on one side of the brain giving the defect a classification of left or right even though is effects both eyes. The left or right relates to the side of the brain effected.Visual field examinations review4 major visual pathway zones
19 Visual field examinations review 4 major visual pathway zones