Visual field defects

The

Normal visual field is defined as

Island of vision surrounded by a sea of
blindness
The three dimensional concept can be
reduced to quantitative values by
plotting lines (isopters) at various levels
around the island or by measuring the
height (sensitivity) at different points
within the island of vision.

 60nasally.

50superiorly
70inferiorly .
90 temporally

The normal extent of field of

vision

Central field loss occurs with:

Optic neuropathy
Macular degeneration
Macular hole
Cone dystrophies
A number of rare conditions like

disease, Stargardt's disease and

achromatopsia.

Bests

common causes of VF defect

Peripheral

field loss occurs with:

Retinitis pigmentosa
Chorioretinitis
Glaucoma
Retinal detachment
Leber's optic atrophy

Screening tests
confrontational visual field testing
Amsler grid (assesses the central 10

the

visual field ) .
Quantitative measurements using manual
or automated perimetry.

Assessing for visual field defects

can be via

Visual

acuity tests the eye's greatest

power of resolution .
visual field testing measures the
peripheral sensitivity.

Visual

field defect - a portion of visual

field missing. This may be:
central (e.g. optic disc or nerve problem)
peripheral (along the visual pathways
from the optic chiasm back).

Terms

Scotoma

- this is a type of visual field

defect. It is a defect surrounded by normal
visual field.
Relative scotoma - an area where objects
of low luminance cannot be seen but
larger or brighter ones can.
Absolute scotoma - nothing can be seen at
all within that area.

Hemianopia

- binocular visual defect in

each eye's hemifield.
Bitemporal hemianopia - the two halves
lost are on the outside of each eye's
peripheral vision, effectively creating a
central visual tunnel.
Homonymous hemianopia - the two
halves lost are on the corresponding area
of visual field in both eyes, i.e. either the
left or the right half of the visual field.

 Altitudinal

hemianopia - refers to the

dividing line between loss and sight being
horizontal rather than vertical, with visual
loss either above or below the line.
Quadrantanopia - is an incomplete
hemianopia referring to a quarter of the
schematic 'pie' of visual field loss.
Sectoral defect - is also an incomplete
hemianopia

 the most commonly used assessment

An 'on/off' light signal is presented

throughout the patient's potential visual

field and the patient clicks every time they
see the signal.
can assess various amounts of the visual
field (10 to full field).
sensitive tests but are difficult to perform
Humphries' (and to a lesser extent,
Henson's) machines are most commonly
Static
used. perimetry

This

presents a moving stimulus from a

non-seeing area to a seeing area.
The most commonly used kinetic test is
Goldmann perimetry.
It is repeated at various points around the
clock and a mark is made as soon as the
point is seen. These points are then joined
by a line (an isoptre).

Kinetic perimetry

Goldmann perimeter

These

will produce a field deficit in the

ipsilateral eye.
Field defects from damage to the optic
nerve tend to be central, asymmetrical
and unilateral.
Lesions just before the chiasm can also
produce a small defect in the upper
temporal field of the other eye

Lesions before the chiasm

These

classically produce a bitemporal

hemianopia.
If they spread up from below, for
example, pituitary tumours, the defect is
worse in the upper field.
If the tumour spreads down from above ,
e.g. craniopharyngioma, the lesion is
worse in the lower quadrants.

Lesions at the chiasm

These produce homonymous field defects.

A lesion in the right optic tract produces

left visual field defect.

Lesions in the main optic radiation cause
complete homonymous hemianopia
without macular sparing.
Lesions in the temporal radiation cause
congruous upper quadrantic homonymous
hemianopia commonly with macular
sparing.

Lesions after the chiasm

Lesions

in the parietal radiation (rare)

cause inferior quadrantic homonymous
hemianopia without macular sparing.
Lesions in the anterior visual cortex
(common) produce a contralateral
homonymous hemianopia with macular
sparing .
Lesions in the macular cortex produce
congruous homonymous macular defect
Lesions of the intermediate visual cortex
produce a homonymous arc scotoma, with
sparing of both macula and periphery.

If

both occipital lobes are injured then the

patient is in a state of cortical blindness.
some patients deny their blindness and
attempt to behave as if they have vision.
This state of denial of cortical blindness is
called Anton's syndrome.

Occipital lobe lesions