visual field examinations
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Visual Field Examinations. Week 7 Review. Visual field examinations review. Perimetry - the science of measuring the peripheral vision in order to determine the visual field. (The art of determining boundaries of the visual field.) - PowerPoint PPT PresentationTRANSCRIPT
Week 7 Review
Perimetry- the science of measuring the peripheral vision in order to determine the visual field. (The art of determining boundaries of the visual field.)
Visual field- the portion of visual space which is visible to an individual at any given moment.
Isopter-Boundaries of VF areas of equal or greater sensitivity. Isopters are used in Goldmann perimetry. Each isopter is labeled with the size and intensity of the stimulus.
Threshold-A stimulus intensity which has a 50% probability of being seen. This test compares what has the probability of being seen with the possible inaccuracy of the test. Computerized perimetry only.
Asb- intensity value of a stimulus. Used in static perimetry. Smaller asb= greater retinal sensitivity.
dB- intensity value of a stimulus. Larger dB= greater retinal sensitivity.
scotoma
Scotoma Visual loss, either
blindness (absolute) or decreased sensitivity (relative).
Island of visionAn analogy for visual field testing.
Physiological blind spotNormal visual field boundaries
95-100 degrees=temporal 75 degrees= inferior 60 degree= nasal 60 degrees=superior
Computerized VF tests
30-2 and 24-2 threshold- white lights, varying in intensity. Tests 30 or 24 degrees off the macula in all meridians on dilated patient.
Macula- white lights, varying in intensity. Tests 5 degrees off the macula in all meridians on dilated patient.
Plaquinil- red lights, varying in intensity. Tests 5 degrees of the macula in all meridians on dilated patient. Used for the drug “Plaquinil” which can damage cone photoreceptors.(RA)
Bleph- White lights, fixed intensity testing the superior region of the visual field on an undilated patient. There is a lower fixation light.
False positive-no light shown, patient responded. (“trigger happy”.)
False negative-no response to a previously seen target.
30-2 threshold VF Central 10/macular VF
Computerized VF tests
Screening tests Minimal information done on a computerized VF. Takes much less time to perform. C= central region P= peripheral region FF= full field The number after the letter indicates how many
targets will be shown to the patient. The targets are fixed intensity. It does not print out in grey scale- screening
tests will show a circle for seen targets and a black square for unseen targets.
Confrontation visual field Amsler grid
Goldmann manual VF
Technician moves target, changes target intensity and size, watches fixation, plots chart, investigates a depression or scotoma.
Goldmann VF testing can be done with static or kinetic targets.
Isopters are used and are color coded or labeled to indicate intensity of target.
Types of scotomas
Hemianopia- Binocular- Monocular- Homonymous- Congruent- Incongruent- Bi nasal- Bi temporal- Altitudinal- Central cecal- Nasal step-( bjerrum) Temporal wedge-
Types of scotomas
4 visual pathway zones
Monocular retinal zone Nerve fiber/ optic nerve zone Binocular chiasmal zone Post chiasmal zone
4 majors visual pathway zones
Monocular retinal zone This zone includes the retinal layer, sub retinal layer,
rod and cone dystrophy or damage, retinitis pigmentosa, and macular pathology.
Characteristics All defects will be monocular. Most pathology will be visible with a scope. Lesions temporal to fovea present nasal of VF.
(inverted field image) Lesions can cross meridians. Central scotomas will cause abnormal VA and color
vision will be compromised.
4 major visual pathway zones
Nerve fiber/optic nerve zone This zones includes glaucoma, papilledema, and
nerve fiber bundle defects. Characteristics All defects will be monocular. Both eyes can have the same disease causing
congruent or incongruent scotomas. Most defects will be visible with a scope. Defects will points to the disc since nerve fibers are
traveling towards this point. Glaucomatous scotomas will respect the horizontal
meridian.
4 major visual pathway zones
Binocular chiasmal zone This zone includes pathology or damage to the
pituitary gland. Charateristics Defects will be bilateral, most commonly bi temporal
but bi nasal defects can also occur. NOT visible with a scope, a CT-scan or MRI will be
ordered. Defects here are not an eye problem, this problem is
in the brain and effects both eyes because the nasal axons or nerve fibers have crossed to the opposite side at the chiasm.
Defects will respects the vertical meridian and be hemianopic.
4 major visual pathway zones
Post chiasm zone This zone includes the optic tract, lateral geniculate
body, optic radiations and the occipital cortex. Characteristics Most defects will respect the vertical meridian. Defects will be homonymous and hemianopic. This is NOT an eye problem, this is a brain problem
and a CT-scan or MRI will be ordered. Nerve fibers from the nasal VF of one eye and
temporal fibers of the other eye will be effected on one side of the brain giving the defect a classification of left or right even though is effects both eyes. The left or right relates to the side of the brain effected.
4 major visual pathway zones
Good luck on the test and have a great summer! See you in September.