Visual field examinations Week 6 Interpreting of visual

Visual field examinations Week 6 Interpreting of visual fields

v. Is it a legitimate defect? ( tech or patient error) v. Is the defect in one or both eyes? v. What part of the pathway is effected because of the defect shown? v. Does the VF make sense? (Compared to the patient complaints and Dx. ) v. 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 2 nd 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 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 20/200 VA 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? 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