Visual Field

Wilbrand's Knee

A debated anatomical structure where crossing inferonasal fibers travel anteriorly before entering the optic tract, potentially causing junctional scotomas in posterior optic nerve lesions.

• 60° Normal Visual Field Ranges

superiorly

70 to 75°

inferiorly VF range

60°

nasally Normal Visual Field Ranges

100 to 110°

temporally visual field range

15° temporally

Physiologic Blind Spot, The optic disc, which lacks photoreceptors, creating a blind spot _____ in each eye.

Visual Field Testing Techniques

All visual field tests require the subject to indicate whether a stimulus is seen, making them unreliable for uncooperative or very sick patients. Tests should be done monocularly to avoid masking defects.

Bedside Visual Field Testing

Quick and easy but less reliable. Methods include:

Face Test

Patient reports missing parts of the examiner's face.

Grid Test

Patient fixates on a central point and marks areas where grid lines disappear.

Finger Confrontation

Detects dense hemianopic or altitudinal defects.

Upper visual field

Visual Field Retina Relationship of inferior retina

Lower visual field

Visual Field Retina Relationship of superior retina

Nasal visual field

Visual Field Retina Relationship of temporal retina

Temporal visual field

Visual Field Retina Relationship of nasal retina

53% and 47%

Nasal fibers from the ipsilateral eye (___) cross in the chiasm and join uncrossed temporal fibers (___) from the contralateral eye to form the optic tract, synapsing in the lateral geniculate nucleus before reaching the occipital cortex (visual area 17).

Tangent Screen Testing

Rarely used, primarily for detecting nonorganic visual field constriction.

Tangent Screen Testing

Patient fixates on a central target while stimuli are moved from the periphery inward.

Tangent Screen Testing

An isopter is plotted based on patient responses. Distance variation can help differentiate organic vs. nonorganic constriction.

Goldmann Perimetry

Assesses the entire visual field, including far temporal periphery.

Goldmann Perimetry

Patient fixates on a central spot while white light stimuli are projected onto a hemispheric screen. Responses are recorded, and isopters are drawn.

Goldmann Perimetry

Quality depends on the examiner and does not detect subtle changes.

Automated Perimetry

More sensitive, quantitative, and reproducible but requires good patient cooperation.

Automated Perimetry

Preferred for optic nerve lesions, papilledema, chiasmal compression, and progressive visual disorders.

Humphrey Visual Field Printout Interpretation

Uses threshold testing to determine the dimmest stimulus a patient can detect.

fixation losses, false positives, and false negatives

Reliability metrics include

>33%

indicates an unreliable test

Total Deviation

Shows how much each point deviates from age adjusted norms (more negative = more abnormal).

Pattern Deviation

Highlights focal visual field loss patterns.

Decreased vision, left eye

Left optic nerve lesion

Junctional scotoma

Posterior left optic nerve lesion

Bitemporal hemianopia

Optic Chiasm lesion

Right homonymous hemianopia

Left optic tract lesion

Right homonymous sectoranopias

Left lateral geniculate nucleus lesion

Right homonymous superior hemianopic defect

Left temporal lobe lesion

Right homonymous inferior hemianopic defect

Left parietal lobe lesion

Right homonymous inferior quadrantanopia

Left occipital lobe (upper bank) lesion

Right homonymous superior quadrantanopia

Left occipital lobe (lower bank) lesion

Right homonymous macular sparing hemianopia

Left occipital lobe lesion

Right homonymous scotomas

Tip of the left occipital lobe lesion