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Visual field examinations

Visual field examinations. Week 6 Interpreting of visual fields. Is it a legitimate defect? ( tech or patient error) Is the defect in one or both eyes? What part of the pathway is effected because of the defect shown? Does the VF make sense? (Compared to the patient complaints and Dx.)

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Visual field examinations

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  1. Visual field examinations Week 6 Interpreting of visual fields

  2. Is it a legitimate defect? ( tech or patient error) • Is the defect in one or both eyes? • What part of the pathway is effected because of the defect shown? • Does the VF make sense? (Compared to the patient complaints and Dx.) • Is there another VF to compare with this VF? Interpreting the data

  3. Is this a legitimate defect? Technician error Wrong corrective lens Poor instruction to patient Forgot to patch patient’s eye Lens holder to far from eye Doing the wrong test Entering wrong birthday Dilating or not dilating pupil Is it a depression, scotoma, or neurologic defect?

  4. Wrong correction lens Pupil was dilated 2nd time. Technician error

  5. Lens holder to far away from eye. Wrong birth date Technician error

  6. 30-2 vs central 10 Poor patient instruction- false positives Technician error

  7. Is there a defect in one eye or both eyes? • If there is a defect in only one eye, it will be before the chiasm. • It can be retinal, glaucomatous, or nerve • If there is a defect in both eyes, is it congruent or incongruent? • If both eyes, is it neurological (chiasm and beyond) or same problem in both eyes ? interpretation

  8. What part of the pathway has caused this defect? • Both eyes: glaucoma hx? Trauma? Macular degeneration? • Do the defects have horizontal or vertical respect? • Retinal, macular, nerve and glaucoma are considered to be the same problem happening in both eyes. • Defects that happen at or after the chiasm are effecting both eyes, but are a neurologic problem. Interpretation of Visual Fields

  9. Pseudotumor causing papilledema Bitemporalhemianopia Interpretation of visual fields

  10. Left eye Right eye Interpreting visual fields

  11. 4 VF’s, you tell me! Both eyes effected, you tell me what’s wrong! Interpreting visual fields

  12. Right and left eyes both have a problem- What is wrong? Interpreting visual fields

  13. Depression, step or scotoma? Interpreting visual fields

  14. Interpretation of visual fields Does this VF make sense? If the patient came in for a 6 month repeat VF because of glaucoma, does this field match the Dx?

  15. Interpretation of visual fields Are there other VF’s stored in the computer to compare with the most recent VF? This is a printout of all the VF’s this patient has taken. With this printout of ALL VF’s taken, it is easy to see how the glaucomatous defects have progressed. If something is out of the ordinary from what you expect- this comparison is a great way to look at all the past VF’s to figure out the problem.

  16. Generalized depression Arcuate scotoma Interpreting glaucomatous field defects

  17. Nasal step Temporal wedge Interpreting glaucomatous field defects

  18. Nerve fiber bundle, nasal step Nerve fiber bundle, arcuatescotoma Interpreting glaucomatous field defects

  19. End stage glaucoma End stage glaucoma Interpreting glaucomatous field defects

  20. Macular hole Retinal detachment Interpreting retinal field defects

  21. Retinal scar due to ocular toxoplasmosis Choroidal rupture after a blunt trauma causing a scar. Interpreting retinal field defects

  22. Nerve fiber bundle defects OU Followed after open heart surgery Interpreting retinal field defects

  23. Diabetic retinopathy Retinal detachment Interpreting retinal field defects

  24. Optic neuritis OU Usually associated with MS, effects both eyes suddenly when this happens. Interpreting optic nerve field defects

  25. Optic atrophy VA 20/200 Papilledema OU Interpreting optic nerve field defects

  26. AION (anterior ischemic optic neuropathy) You guess now!!! Interpreting optic nerve field defects

  27. bitemporalhemianopia Chiasmal defect, from a pituitary tumor Interpreting Chiasmal defects

  28. Bitemporal quadrant hemianopia Bitemporalhemianopias at different stages Interpreting Chiasmal field defects

  29. Homonymous quadrant hemianopia Originating from a problem on the right or left side of the brain? Interpreting post chiasmal field defects

  30. homonymous hemianopia, which side? Homonymous hemianopia, which side? Interpreting post chiasmal field defects

  31. Now you try… What are these defects? Interpreting visual field defects

  32. Try again…. What are these defects? Interpreting visual field defects

  33. See… • It’s not that hard after all! You did a great job! Interpreting visual field defects

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