Transcript Visual field examinations

Visual field
examinations
Week 6
Interpreting of visual fields
 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?
Interpreting the data
Is this a legitimate
defect?
Technician error
•Wrong
corrective lens
•Poor instruction to patient
•Forgot to patch patient’s 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?
Wrong correction lens
Pupil was dilated 2nd
time.
Technician error
Lens holder to far
away from eye.
Wrong birth date
Technician error
30-2 vs central 10
Poor patient instructionfalse positives
Technician error
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 ?

interpretation




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.
Interpretation of Visual Fields
Pseudotumor causing
papilledema
Bitemporal hemianopia
Interpretation of visual fields
Left eye
Right eye
Interpreting visual fields
4 VF’s, you tell me!
Both eyes effected, you
tell me what’s wrong!
Interpreting visual fields
Right and left eyes
both have a problem-
What is wrong?
Interpreting visual fields
Depression, step or scotoma?
Interpreting visual fields
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?
Interpretation of
visual fields
Are there other VF’s stored in
the computer to compare with
the most recent VF?
This is a printout of all the
VF’s this patient has taken.
With this printout of ALL VF’s
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 VF’s to figure out the
problem.
Generalized depression
Arcuate scotoma
Interpreting glaucomatous field
defects
Nasal step
Temporal wedge
Interpreting glaucomatous field
defects
Nerve fiber bundle,
nasal step
Nerve fiber bundle,
arcuate scotoma
Interpreting glaucomatous field
defects
End stage glaucoma
End stage glaucoma
Interpreting glaucomatous field
defects
Macular hole
Retinal detachment
Interpreting retinal field defects
Retinal scar due to
ocular toxoplasmosis
Choroidal rupture after a
blunt trauma causing a
scar.
Interpreting retinal field defects
Nerve fiber bundle
defects OU
Followed after open
heart surgery
Interpreting retinal field defects
Diabetic retinopathy
Retinal detachment
Interpreting retinal field defects
Optic neuritis OU
Usually associated with MS,
effects both eyes suddenly
when this happens.
Interpreting optic nerve field
defects
Optic atrophy
VA 20/200
Papilledema OU
Interpreting optic nerve field
defects
AION (anterior ischemic
optic neuropathy)
You guess now!!!
Interpreting optic nerve field
defects
bitemporal hemianopia
Chiasmal defect, from
a pituitary tumor
Interpreting Chiasmal defects
Bitemporal quadrant
hemianopia
Bitemporal hemianopias
at different stages
Interpreting Chiasmal field defects
Homonymous quadrant
hemianopia
Originating from a
problem on the right or
left side of the brain?
Interpreting post chiasmal field
defects
homonymous hemianopia, Homonymous hemianopia,
which side?
which side?
Interpreting post chiasmal field
defects
Now you try…
What are these defects?
Interpreting visual field defects
Try again….
What are these defects?
Interpreting visual field defects
See…
 It’s not that hard after all!

You did a great job!
Interpreting visual field defects