| Identifier |
confrontation_visual_fields_lee_novel |
| Title |
Confrontation Visual Fields |
| Creator |
Andrew G. Lee, MD; Chelsea Livingston |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (CL) Class of 2022, Baylor College of Medicine, Houston, Texas |
| Subject |
Visual Fields; Peripheral Field Test |
| Description |
Summary: • Confrontation Visual Fields o Use your own visual field as the control - cover your eye that's the comparative eye to the patient's o Test central field > Test each eye separately > Use an Amsler grid at the bedside or use your own face o Test peripheral field (4 quadrants) > Kinetic testing • Moving from non-seeing field into the seeing field • Have the patient tell you when they can see your finger > Static testing • Hold up fingers and as the patient how many fingers they see o Test vertical meridian > Used to detect homonymous or bitemporal hemianopsia > Enhance the testing by using a colored test object (red is most sensitive) > Ask if the object is equally red across the vertical meridian. |
| Transcript |
So today we're going to talk about something that's underutilized which is confrontation visual fields. Note it's confrontation not confrontational. Confrontational is like this. Confrontation means you're using your own field as the control. You're going to cover your eye that's the comparative eye to the patient's, so you're serving as your own control. And so you'd like to have the patient and the tester be at the same level, and we're going to cover one eye to mirror the field defect. And we're going to test three things in this visual field. We're going to test their center vision, and you can do that with an Amsler grid at the bedside. Just the little grid that they can show whether there's a field defect on it. Test each eye separately, and that's a good test of the central vision. You can also use your own face to be the central vision. Do you see all parts of my face or any parts missing? And then we want to do a kinetic and a static testing of the peripheral field. Kinetic just means you're moving from non-seeing field into the seeing field. And so you're just going to say, "tell me when you see my finger." And the static field testing is just how many fingers you see (2, 1, 1, 2, 3). And so if we can get a good assessment in the four quadrants of the visual field in each eye, as well as the central field, and then we want to pay particular attention to putting the stimuli across the vertical meridian. So we'd like to test across the vertical meridian because that's really what we're trying to determine in a confrontation visual field at the bedside because you're really not going to be able to detect the subtle glaucomatous arcuate field defect or a blind spot enlargement. Really what we're trying to detect here is homonymous hemianopsia (yes or no), bitemporal hemianopsia (yes or no). We can enhance the testing across the vertical meridian by using a colored test object. Usually red is more sensitive. So that's the red top of the dilating drop tube. And we're going to put that red thing across the vertical meridian. Is the red top equally red across this vertical meridian? On the right side or the left side across this vertical meridian is it equally red? And you can push that red object across the vertical meridian. Tell me when it becomes less red (red, red, red, red, not red, red, red, red, red, not red, red, red, red, red, not red). If you can generate that vertical step that's going to be very helpful because then you can say okay we're dealing with a homonymous hemianopsia which is going to be on the opposite side in the retrochiasmal pathway. Or am I dealing with a bitemporal hemianopsia which is at the chiasm. So at the bedside we have very limited ability to test the visual field. If you're going to use confrontation testing with your fingers test the central field, the peripheral field, kinetic, and statically. Test across that vertical meridian. Use a red test object. And try and define whether we're dealing with a homonymous or bitemporal hemianopsia. And I think that's about all you're going to be able to get out of a confrontation field at the bedside. |
| Date |
2021-04 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6519vr1 |
| Setname |
ehsl_novel_lee |
| ID |
1680595 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6519vr1 |
