Ординатура / Офтальмология / Английские материалы / Visual Fields Examination and Interpretation_Walsh_2011

Visual Fields

Ophthalmology Monographs

A series published by Oxford University Press in cooperation with the American Academy of Ophthalmology

Series Editor: Richard K. Parrish, II, MD, Bascom Palmer Eye Institute

American Academy of Ophthalmology Clinical Education Secretariat:

Louis B. Cantor, MD, Indiana University School of Medicine

Gregory L. Skuta, MD, Dean A. McGee Eye Institute

1.Retinal Detachment: Principles and Practices, third edition Daniel A. Brinton, MD, and Charles P. Wilkinson, MD

2.Electrophysiologic Testing in Disorders of the Retina, Optic Nerve, and Visual Pathway, second edition

Gerald Allen Fishman, MD, David G. Birch, MD, Graham E. Holder, MD, and Mitchell G. Brigell, MD

3.Visual Fields: Examination and Interpretation, third edition Edited by Thomas J. Walsh, MD

4.Glaucoma Surgery: Principles and Techniques, second edition Edited by Robert N. Weinreb, MD and Richard P. Mills, MD

5.Fluorescein and Indocyanine Green Angiography: Technique and Interpretation, second edition Joseph W. Berkow, MD, Robert W. Flower, David H. Orth, MD, and James S. Kelley, MD

6.Neuroimaging in Ophthalmology, second edition

Michael C. Johnson, M.D., F.R.C.S.C, Bruno A. Policeni, M.D., Andrew G. Lee, M.D., and Wendy R. K. Smoker, M.D., F.A.C.R.

[First edition published as Magnetic Resonance Imaging and Computed Tomography: Clinical Neuro-Orbital Anatomy by Jonathan D. Wirtschafter, MD, Eric L. Berman, MD, and Carolyn S. McDonald, MD]

7.Cataract Surgery and Intraocular Lenses: A 21st-Century Perspective, second edition Edited by Jerry G. Ford, MD, and Carol L. Karp, MD

8.Surgery of the Eyelid, Orbit, and Lacrimal System

Edited by William B. Stewart, MD

9.Surgical Anatomy of the Ocular Adnexa: A Clinical Approach

David R. Jordan, MD, and Richard R. Anderson, MD

10.Optic Nerve Disorders, second edition

Edited by Lanning B. Kline, MD, and Rod Foroozan, MD

11.Laser Photocoagulation of the Retina and Choroid [with slide set] James C. Folk, MD, and José S. Pulido, MD

12.Low Vision Rehabilitation: Caring for the Whole Person

Edited by Donald C. Fletcher, MD

13.Glaucoma Medical Therapy: Principles and Management, second edition Edited by Peter A. Netland, MD, PhD

14.Diabetes and Ocular Disease: Past, Present, and Future Therapies, second edition

Edited by Ingrid U. Scott, MD, MPH, Harry W. Flynn, Jr., MD, and William E. Smiddy, MD

15.HIV/AIDS and the Eye: A Global Perspective

Emmett T. Cunningham, Jr., MD, and Rubens Belfort, Jr.

16.Corneal Dystrophies and Degenerations: A Molecular Genetics Approach [with CD] Edited by Ming X. Wang, MD, PhD

17.Strabismus Surgery: Basic and Advanced Techniques

Edited by David A. Plager, MD; written by Edward G. Buckley, MD, David A. Plager, MD, Michael X. Repka, MD, and M. Edward Wilson, MD; contributions by Marshall M. Parks, MD and Gunter K. von Noorden, MD

www.oup.com/us/aao/plager/strabismus

18.A Compendium of Inherited Disorders and the Eye

Elias I. Traboulsi, MD www.oup.com/us/aao/traboulsi/genetic

Legal Notice

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any, mentioned in this monograph.

Some material on recent developments may include information on drug or device applications that are not considered community standard, that reflect indications not included in approved FDA labeling, or that are approved for use only in restricted research settings. This information is provided as education only so physicians may be aware of alternative methods of the practice of medicine, and should not be considered endorsement, promotion, or in any way encouragement to use such applications. The FDA has stated that it is the responsibility of the physician to determine the FDA status of each drug or device he or she wishes to use in clinical practice, and to use these products with appropriate patient consent and in compliance with applicable law.

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in any material by any author, whether such claims are asserted by a physician or any other person.

DISCLOSURE STATEMENT

Unless otherwise noted below, each author states that he or she has no significant financial interest or other relationship with the manufacturer of any commercial product discussed in the chapters that he or she contributed to this publication or with the manufacturer of any competing commercial product.

Preface

The ophthalmologist has many instruments available for examining different parts of the visual system. The slit lamp examines the anterior chamber of the eye. The direct and indirect ophthalmoscopes afford a detailed

inspection of the central and peripheral retina. The art of examining the visual fields is probably the only ophthalmic technique that allows investigation of each and every part of the visual system. The defects that are found must then be interpreted as being in one particular area of the area of the visual system or as being the result of other conditions, such as opacities of the lens or of the media, which point to an organic abnormality in the visual system. It is my experience that although many examinations may be delegated to the ophthalmic technician, it is the ophthalmologist who is experienced in diagnosing ocular disease and therefore the person who should select the visual field technique and program that best serve the patient.

The refinement of radiographic studies, such as computer tomography (CT) and magnetic resonance imaging (MRI), has permitted the identification of discrete lesions in the visual pathway. However, these technologies are not infallible, so that many times no lesion is visualized. It is the experienced physician who puts the clinical picture and field abnormality together in one anatomic location: The amount of information that can be seen in a current printout does not always give the answer, so we have to use other, new tests to provide the complete picture. It is the same physician, the ophthalmologist, who has mastered the different parametric techniques to obtain the most accurate information from any field examination.

The principal impetus behind the current revision of this monograph has been the widespread popularity of computerized perimetry in recent years. The discussion of the major changes in perimetry from the first edition of this book as a monograph,

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published in 1990, will continue in this edition. And we will not forget some of the other techniques that have been useful throughout the years and need to be learned by the well-founded perimetrist.

In previous editions, we have put the tangent screen illustrations next to the computerized illustrations. In this edition, we have put the tangent screen in the first chapter to show that it still can be a valuable technique when computerized fields cannot be used.

Chapter 1 “FIELD OF Vision”, reviews the type of defects that we find in doing visual fields. There is also a review of techniques that preceded automated perimetry and have uses even today in special situations. Chapter 2, “The Anatomic Basis and Differential Diagnosis of Field Defects”, reviews the neurologic significance of certain types of field defects and identifies the location of the defect along the long visual pathway.

Chapter 3, “Essentials of Automated Perimetry,” discusses several programs such as SITA Standard and SITA Fast as well as other programs useful for glaucoma. This is followed by Chapter 4, “Automated Perimetry in Glaucoma,” which demonstrates the usefulness of these new programs in diagnosing and in monitoring progression of the disease.

In Chapter 5, “Inherited or Congenital Optic Nerve Diseases,” and Chapter 6, “Acquired Optic Nerve Diseases,” the authors comment on the use of fluorescein, MRI, and OCT in making a diagnosis.

Chapter 7, “Visual Field Defects in Chorioretinal Disorders”, shows examples of the use of perimetry as an important adjunct in the management of Retinal disease in this era of OCT and photography.

Chapter 8, “Optic Chiasm Field Defects,” discusses the current thoughts regarding Wilbrand’s knee junction scotoma and the field defects associated with lesions of the optic chiasm.

In “Optic Tract and Lateral Geniculate Body Field Defects,” Chapter 9, radiation was looked at again in terms of the history of congruity. Some new material is also provided about the size of the calcarine cortex and how much of the area is seen in a 24-2 program. There are also new chapters on chorioretinal disease and another on the optic tract. Chapter 10,”Retrogeniculate Visual Field Defects”, is more important in this era of MRI and other radiologic modalities that allow us to identify the type of lesion and its extension. In this era of more sophisticated surgery, radiation and chemotherapy it contributes significantly to therapy and not just as a marker.Chapter 11,”Functional Visual Loss,” is one of the most important features of doing fields. Many people produce a false field or do it so poorly as to obscure the real diagnosis. It is important to note that people with functional fields get sick also and we must be able to perform different techniques in order to get the real answer and provide the correct information to their physician to order the correct test which may be radiologic or from the laboratory.

From the laboratory.

In the centennial year of 1996, celebrating the founding of the American Academy of Ophthalmology, the publication of the second edition of this book on visual fields had special significance. It was 50 years earlier that the first edition of what was then called a manual on this topic was published. My contributors and I are indebted to

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C. Wilbur Rucker, MD, the author of that manual, published in 1946, on which this monograph is based. Dr. Rucker emphasized the importance of doing visual field examinations as well as demonstrating some of the techniques for performing them successfully. Many others have contributed to earlier editions, such as the late Thomas Hedges, Jr., who is now followed by his son in this edition.

In recent editions of this monograph, we have been helped by perimetrists of this era like Joseph Caprioli and Mark Weitzman, who have given valuable help in the area of glaucoma, as well as Brian Younge: all have added their knowledge and perimetry skills so that their insights can be carried over to this edition. We have also been fortunate in our department at Yale University to have the experience of Bruce Shields and James Tsai, who have added the fruits of their own extensive experience to this complex subject.

Jonathan Horton, in the last edition as well as in this one, has contributed advice and illustrative explanations concerning both Wilbrand’s knee in the chiasm and the visual cortex and how it is transcribed into the Humphrey 30-2 and 24-2.

One of the sad features of compiling this third edition is the loss of Jonathan Wirtschafter, both as a skilled clinician and a dear friend. He was a giant in the field. His chapter in this volume brings together the field defects we see in the perimeter printout and shows us their clinical neuro-ophthalmologic application. His original chapter on blending neuroanatomy and perimetry brought increased clarity to the diagnosis of visual field disorders and remains a classic in perimetry. Those of us who have followed in his and Traquair’s tradition have endeavored to update and further contribute to the state of the art of perimetry.

The updates and techniques outlined in this third edition of the monograph will continue to be valuable to the ophthalmology resident as well as to the practicing ophthalmologist.

THOMAS WALSH, MD

New Haven, Connecticut