A review for medical students. This presentation includes a definition of the visual field, normal VF and defective VF.

1. VISUAL FIELD
EXAMINATION
AND
ABNORMALITIES
By: Qurat-ul-ain
Ophthalmic Medical
Technologist/ MBA Health &
Hospital management

2. PREAMB
LE
Visual field definition
Normal visual field
Visual field defects
Examining techniques
Tools

3. VISUAL FIELD (VF):
• The visual field refers to the total area in which objects can be seen in the
side (peripheral) vision while you focus your eyes on a central point.
• The function of the periphery of the retina is assessed by the measurement
of visual field.
• In the assessment of the peripheral retina, VF is measured, in which the
individuals detects targets that stimulate the retina at varying distance from
the fovea.
• This function may be measured accurately by one of the several instruments,
or it may be estimated by means of the confrontation test.

4. THE NORMAL VF:
• The field of vision is defined as the area that is perceived simultaneously by a
fixating eye.
• The normal extent of field of vision:
60 nasally
50 superiorly
70 inferiorly
90 temporally

5. VISUAL FIELD
DEFECTS

6. VF DEFECTS:
• Scotoma
• Hemianopia
• Homonymous hemianopia
• Homonymous scotoma
• Quadrantanopia
• Complete loss of vision
• Attitudinal hemianopia
• Sectoral defect
• A portion of visual field is
missing. This may be:
• Central (e.g. optic disc or
nerve problem)
• Peripheral (along the
visual pathway from the
optic chiasm)
TYPES OF VF DEFECTS:

7. SCOTOMA:
Definition:
This is a type of VF
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.

8. HEMIANOPIA:
Definition
Binocular vision defect
in each eye’s hemi field.
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 VF in both eyes,
i.e. either the left or the
right half of the VF.

9. LESIONS IN THE
VISUAL PATHWAY

10. TYPES OF LESION:
COMPLETE LOSS
OF VISION
Optic nerve lesion
QUADRANTOANOPIA
Right temporal lobe
lesion
HOMONYMOUS
HEMIANOPIA
Lesion in optic radiation
Homonymous
Scotoma
Lesion at the tip of
occipital lobe
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.
Quadrantoanopia:
Is an incomplete
hemianopia referring to a
quarter of the schematic
pie of visual field loss.

11. LESIONS W.R.T. LOCATION

12. • These will produce a field deficit in the
ipsilateral eye.
• Filed defects from damage to the optic
nerve tend to be central, asymmetrical
and unilateral.
• These classically produce a bitemporal
hemianopia.
Lesion before the
Chiasm
Lesions at the Chiasm

13. LESIONS AFTER 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.
• Lesions in the temporal radiation cause congruous upper quadrantic
homonymous hemianopia.
• Lesions in the parietal radiation (rare) cause inferior quadrantic homonymous
hemianopia.
• Lesions in the anterior visual cortex (common) produce a contralateral
homonymous hemianopia
• Lesions in the macular cortex produce congruous homonymous macular
defect
• Lesions of the intermediate visual cortex produce a homonymous arc
scotoma.

14. OCCIPITAL LOBE LESIONS
• 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.

15. EXAMINATION TECHNIQUES

16. EXAMINATION
TECHNIQUES
• Confrontation test
• Automated static perimetry test
• Kinetic visual field test
• Frequency doubling perimetry
• Electroretinography
• Amsler grid

17. RESOURCES
• The Wills Eye Manual, 7th edition, Wolters Kluwer
• https://www.aao.org/eye-health/tips-prevention/visual-field-testing
• https://www.brainkart.com/article/The-Visual-Pathway-of-the-Brain_19029/
• https://geekymedics.com/visual-pathway-and-visual-field-defects/

18. THANK YOU!