Visual Fields

Definition
Island of vision in sea of blindness.
The peak of the island represents the
point of highest acuity, the fovea
while the bottom less pit
represents the blind spot, the optic
disc.
 Normal Monocular &
Binocular Field
Monocular:
Nasal side - 50 to 60
Superior side - 60 to 70
Inferior side - 70 to 80
Temporal side- 100to110
Binocular:
Vertical field - 110
Horizontal field - 200
 Visual Field Testing
1.Stimuli: Testing the island of vision at
various levels requires targets that vary in
(a) Size(b) Intensity(c) Colour
2. Field Test Methods:
Kinetic; Mapping the contours of the
island at different levels, resulting
in one Isopter for each level
tested.
Static; Vertical contours of the
island along a selected meridian.
 Clinical testing methods
Central fields - Below 30
Peripheral fields Above 30 to 360
Central Fields:
Confrontation method
Amslers grid
Bjerrums screen
Peripheral Fields:
Listen perimeter
Goldmann perimeter
 Defects
Retina
Glaucoma
Neuro
 Retina
Field defect
Central Scotoma:
* Central serious Retinopathy
* Macula Degeneration
* Macular Oedema ( any macular
disease)
*Centro-cecal scotoma
* Toxic Amblyopia
* Stargadits
Central Scotoma & Centro-cecal
 Field Defect

Contraction & Tubler field

* Retinitis pigmentosa
* High myopia
* CRAO with Sparing of
cilioretinal artery
Contraction
 Field Defect
Altitudinal defect:
* AION
Depression:
* Retinal Detachment
Ring Scotoma:
* High myopia
* Aphakic spectacle correction
* Retinitis pigmentosa
* Pan retinal photocoagulation
Altitudinal defect
Ring Scotoma
Glaucoma Fields
 Glaucoma
Field defect
Isopter contraction:
Peripheral Isopter
contraction may be significantly
smaller prior to any filed loss.
Baring of the blind spot:
It is also considered to be an
early field defect in glaucoma.
 Field defect
Angio-scotomata:
Are long branching scotomata above
or below the blind spot which are
presumed to be resulted from shadow
created by large retinal vessels and are
felt to be an early change
Para central scotoma:
One or more isolated Para central
scotomata develop in the Bjerrum or
arcute area.
Para central scotoma
 Field defect
Seidels scotoma:
A sickle shape defect arises from the blind
spot and tapers to a point in a curved course with
concavity towards the fixation point.
Bjerrums or Arcute scotoma:
A relatively larger area of defect in the form of
arching scotoma, which eventually fills the entire
arcute area, from blind spot to the median raphe.
With further progression, a double arcuate (ring
or annular ) scotomata will develop.
Arcute Scotoma
 Field defect
Roennes nasal step:
The arcuate defects may not
proceed at the same rate in the upper and
lower portion of the eye. Consequently, a
step-like defect is frequently created
where the arcuate defects meet at the
median raphe. This is called Roennes
nasal step, and it is mostly superior nasal
step as, Superior field is involve
somewhat more frequently.
 Field defect
Contraction & Tubler field:
Generalized constriction of
the peripheral field along with double
arcuate scotoma- leads to Tubler
field of vision in which only central
vision remains clear.
 Anatomy of the Visual
Pathway
The Visual pathway
(i) The end-organ It is the neural epithelium
of the rods & cones
(ii) The first order neurone It is bipolar cell
with its axons in the inner layer of the retina.
(iii) The second order neurone It is ganglion
cell of the retina its axons passes in to the nerve
fibre layer and along the optic nerve to the LGB
(iv) The third order nerurone Originates in
the cells of LGB, then travels by way of the optic
radiations to the occipital cortex ( Visual centre)
The visual pathway thus consist of
Two Optic nerves
An Optic chiasma
Two Optic tracts
Two LGB
Two Optic radiation
Visual cortex on each side
 Optic nerve
It extents from the lamina crib Rosa up to
the optic chiasma
The total length of optic nerve- 3.5cm
to5.5cm
it can be divided into four parts:
(i) Intra ocular part - 1mm
(ii) Intra orbital part - 2 to 3cm
(iii) Intracanalicular part - 4 to10mm
(iv) Intracranial part - 1cm
 Diseases of the Optic nerve
Congenital & Hereditary
Traumatic
Tumour
Inflammatory
Toxic
Vascular Lesion
 Congenital
Mylinated nerve fiber defect
Coloboma
Hypoplasia
Drusen
Optic nerve pits
Tilted disc
 Field defects
Mylinated nerve fiber
*Blind spot enlargement
*Paracecal scotoma
*Ring scotoma
*Central scotoma
Coloboma
*Superior nasal depression
*Contraction
*Superior altitudinal hemianopia
 Field defect
Hypoplasia:
* Central Scotoma
* Binasal&Bitemporal hemianopia
* Bilateral inferior extension of blind
spot
Drusen:
* Blind spot enlargement
* Irregular nerve fiber bundle scotoma
 Field defect
Optic nerve pits:
* Blind spot enlargement with
or without macula involvement.
* Central scotoma
* Altitudinal hemianopia
* Upper temporal field defect
Tilted disc:
* Upper temporal defect which may be
mistaken for chiasmal compression.
 Hereditary
Field defect
Optic atrophy (Lepers)
* Contraction
* Tubler Field
Retinitis Pigmentosa
* Contraction
* Ring scotoma
* Tubler field
 Traumatic
Field defect
Traumatic optic neuropathy:
* Superior altitudinal defect
* Total Blind
 Tumour
Field defect
Glioma:
* Blind spot enlargement
* Contraction
* Tubler field
Meningioma:
* Junctional scotoma
* Central scotoma
* Upper temporal field defect
 Inflammatory
Field defect
Papillitis:
* Central scotoma
* Centro-cecal scotoma
* Para central scotoma
* Blind spot enlargement
Retro bulbar neuritis:
* Central scotoma
* Para central scotoma
* Sectoral scotoma
* Ring scotoma
Neuro retinitis:
* Central Scotoma
* Centro- cecal scotoma
 Toxic
Field defect
Mild Toxic :
* Central scotoma
* Centro- cecal scotoma (BE)
Severe Toxic :
* Peripheral contraction
* Total blind
 Vascular lesion
Field defect
Anterior Ischemic optic neuropathy:
* Altitudinal hemianopia
( mainly involving the inferior half)
 Lesion due to pressure
Papilloedema:
* Blind spot enlargement
* Peripheral contraction
* Total loss of visual field
 Chiasma
Field defect
Infra chiasmatic lesion:
* Bitemporal hemianopia
Supra chiasmatic lesion:
* Central hemianopic scotoma
* Bitemporal hemianopia
* Junctional scotoma
* One eye is more field defect and
other is less field defect (inferior
temporal)
Bitemporal hamianopia
 Field defect
Posterior side:
* Infra Temporal field defect
* Bilateral inferior quadrant
scotoma ( near fixation point)
* Bitemporal hemianopia
 Optic Tract
Field defect
Part I:
* Homonymus hemianopia
Part II:
* Incongruous hemianopia
RE Homonymous hemianopia
 LGB
Field defect
Congruous Homonymus lower
Quadrantropia
Congruous Homonymus upper
Quadrantropia
 Optic radiation
Field defect
Bie in the Sky ( superior homonymus
quadrantropia )
Bie in the floor ( Inferior homonymus
quadrantropia )
 Visual Cortex
Field defect
Congruous homonymus hemianopia
Congruous quadrantropia
Homonymus hemianopia with
macula sparring
Homonymus hemianopia with
macula splitting
Altitudinal hemianopia
Tubler field