Overview

Visual Field Testing is a diagnostic procedure used to assess the peripheral and central visual field. This examination is essential for diagnosing and monitoring glaucoma, optic neuropathies, and other visual pathway disorders.

Visual field testing is crucial for diagnosing and monitoring glaucoma, the leading cause of irreversible blindness worldwide. It also helps identify optic neuropathies, brain lesions, and other conditions affecting the visual pathway.

Learn more in our comprehensive RxDx Ophthalmology Course

Indications

✓
Glaucoma Screening

Routine screening for visual field defects

✓
Glaucoma Monitoring

Regular field testing in glaucoma patients

✓
Optic Neuropathy

Evaluation of optic nerve disorders

✓
Neurological Disorders

Assessment of brain lesions affecting vision

✓
Retinal Disorders

Evaluation of retinal diseases

Contraindications

Absolute Contraindications

✗ Patient refusal
✗ Severe cognitive impairment
✗ Inability to cooperate

Relative Contraindications

✗ Severe fatigue
✗ Recent eye surgery
✗ Poor fixation ability

📋 Equipment Checklist

Check off items as you gather them:

Pre-procedure Preparation

Preparation includes explaining the procedure to patient, selecting appropriate testing strategy, ensuring proper patient positioning, calibrating equipment, and preparing for potential complications. All team members should understand their roles.

Step-by-Step Procedure

Step 1: Patient Preparation

Explain procedure to patient. Position patient at perimeter. Ensure proper head positioning. Check patient comfort.

⚠️ Common Mistakes to Avoid:

  • Inadequate explanation
  • Poor positioning
  • Insufficient comfort

💡 Pro Tip:

Explain that the test requires concentration and cooperation.

Step 2: Equipment Calibration

Calibrate perimeter. Check fixation monitoring. Test response button. Ensure proper function.

⚠️ Common Mistakes to Avoid:

  • Skipping calibration
  • Poor monitoring
  • Equipment malfunction

💡 Pro Tip:

Always calibrate equipment before testing.

Step 3: Test Strategy Selection

Select appropriate test strategy. Choose stimulus size and intensity. Set test duration.

⚠️ Common Mistakes to Avoid:

  • Wrong strategy
  • Inappropriate parameters
  • Poor selection

💡 Pro Tip:

Use standard strategies for consistency and comparison.

Step 4: Patient Instruction

Explain test procedure. Demonstrate response button. Emphasize fixation importance.

⚠️ Common Mistakes to Avoid:

  • Poor instructions
  • Inadequate demonstration
  • Missing emphasis

💡 Pro Tip:

Clear instructions improve test reliability.

Step 5: Test Execution

Monitor patient fixation. Observe response patterns. Note any difficulties.

⚠️ Common Mistakes to Avoid:

  • Poor monitoring
  • Missing observations
  • Inadequate attention

💡 Pro Tip:

Monitor fixation and response reliability throughout test.

Step 6: Result Analysis

Analyze test results. Check reliability indices. Compare with previous tests.

⚠️ Common Mistakes to Avoid:

  • Poor analysis
  • Missing reliability check
  • Incomplete comparison

💡 Pro Tip:

Always check reliability indices before interpreting results.

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Post-procedure Care

Post-procedure care involves analyzing test results, comparing with previous examinations, monitoring for complications, and determining if additional testing is needed. Regular visual field testing is essential for glaucoma patients.

Complications & Management

Complication Incidence Signs Management Prevention
Patient fatigue Common Decreased responses, poor fixation Break, encouragement, repeat if needed Adequate breaks, encouragement
Poor reliability 10-20% High false positive/negative rates Repeat test, better instruction Clear instructions, patient preparation
Equipment malfunction Rare Inconsistent results, errors Equipment check, repeat test Regular maintenance, calibration
Patient anxiety 10-15% Poor cooperation, anxiety Reassurance, gentle approach Good communication, explanation

Clinical Pearls

💡

Explain that the test requires concentration and cooperation.

🎯

Always calibrate equipment before testing.

⚡

Use standard strategies for consistency and comparison.

🔍

Clear instructions improve test reliability.

📊

Monitor fixation and response reliability throughout test.

🎨

Always check reliability indices before interpreting results.

⚠️

Arcuate scotomas are characteristic of glaucoma - look for them.