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Ростовский Государственный Медицинский Университет

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Visual Fields Examination and Interpretation_Walsh_2011

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Contents

Contributors			xvii
A History of Perimetry			xix
Chapter 1. Overview of Perimetry			3
Thomas J. Walsh, MD
1-1	Overview of Perimetry		3
	1-1-1	Peripheral Fields	5
	1-1-2	Central Fields	6
	1-1-3	Physiologic Blind Spot	7
	1-1-4	Recording the Fields	7
1-2	Structure of the Visual Pathway		12
1-3	Interpretation of Defects in the Fields		16
1-4	Techniques of Field Testing		21
	1-4-1	Confrontation Technique	21
	1-4-2	Central Field Technique	24
	1-4-3	Chamlin Step Technique	31
	1-4-4	Peripheral Field Technique	34
	1-4-5	Amsler Grid	36
	1-4-6	Color Testing	36

xii	Contents
Chapter 2. Anatomic Basis and Differential Diagnosis of
	Field Defects			41
	Jonathan D. Wirtschafter, MD, and Thomas J. Walsh, MD
	2-1 Categories of Field Defects			41
	2-2 Overview of the Visual Pathway			43
		2-2-1	Occipital Lobe	46
	2-3 Monocular Field Defects			48
		2-3-1	Localized Defects	48
			2-3-1-1 Wedge-Shaped Temporal Field Defect	48
			2-3-1-2 Arcuate and Paracentral Field Defects	52
			2-3-1-3 Central Scotoma or Depression	54
			2-3-1-4 Enlarged Physiologic Blind Spot	56
			2-3-1-5 Centrocecal Scotoma or Depression	57
			2-3-1-6 Equatorial Annular Scotoma or Depression	58
			2-3-1-7 Altitudinal Hemianopia	59
		2-3-2	Generalized Defects	59
			2-3-2-1 Generalized Depression or Peripheral Contraction	59
	2-4	Binocular Field Defects		60
		2-4-1 Homonymous Hemianopias		60
			2-4-1-1 Complete: Macular Splitting	60
			2-4-1-2 Incomplete Congruous: Horizontal Sectoranopia	62
			2-4-1-3 Incomplete Congruous: Paramidline-Sparing Vertical	63
			Hemianopia	63
			2-4-1-4 Incomplete: Macular Sparing	64
			2-4-1-5 Incomplete: Two Scotomas	64
			2-4-1-6 Incomplete Incongruous	65
			2-4-1-7 Incomplete: Unilateral Sparing of Temporal Crescent	66
			2-4-1-8 Incomplete: Unilateral Defect of Temporal Crescent	67
		2-4-2	Bitemporal Hemianopias	67
			2-4-2-1 Complete	67
			2-4-2-2 With Central Depression, Scotomatous	69
		2-4-3	Binasal Field Defects	70
			2-4-3-1 Complete	70
			2-4-3-2 Incomplete	71
		2-4-4 Altitudinal Field Defects		72
			2-4-4-1 Noncongruous Binocular and Monocular	72
			2-4-4-2 Congruous	73
		2-4-5 Quadrantanopias		75
			2-4-5-1 Superior Homonymous, Incomplete	75
			2-4-5-2 Inferior Homonymous, Complete	76
		2-4-6	Bilateral Central Field Defects	77
			2-4-6-1 Scotoma or Depression	77
		2-4-7	Bilateral Peripheral Field Defects	78
			2-4-7-1 Generalized Depression or Peripheral Contraction	78
		2-4-8	Bilateral Checkerboard Scotomas	79
		2-4-9	Bilateral Homonymous Hemianopias	80
	2-5	Junctional Field Defects		80
		2-5-1	Complete Monocular Plus Incomplete Contralateral Ocular	80
		2-5-2 Homonymous Hemianopia Plus		81
		2-5-3	Bitemporal Hemianopia Plus	83

		Contents	xiii
Chapter 3. Essentials of Automated Perimetry			85
George Shafranov, MD
3-1	Introduction		85
3-2 Historical Overview			85
3-3	Principles of Field Testing		86
	3-3-1	Kinetic Perimetry	88
	3-3-2	Static Perimetry	90
		3-3-2-1 Suprathreshold Techniques	90
		3-3-2-2 Threshold Techniques	92
	3-3-3	Frequency-of-Seeing Curves and Fluctuations	92
3-4 Test Selection and Algorithms			94
	3-4-1	Swedish Interactive Threshold Algorithm (SITA)	94
	3-4-2	Foveal Threshold	95
	3-4-3	Initial Values	95
	3-4-4	Fixation Monitoring	96
	3-4-5	Threshold Testing	99
3-5	Single Test Printout		99
	3-5-1	Test Selection (and General Information)	99
	3-5-2	Reliability Indices	99
	3-5-3	Numeric Results and Grayscale Results (Raw Data)	101
	3-5-4	Total Deviation	101
	3-5-5	Pattern Deviation	101
	3-5-6	Glaucoma Hemiﬁeld Test	102
	3-5-7	Global Indices	105
3-6 Custom Tests			105
	3-6-1	Grid Size	108
	3-6-4 FASTPAC		108
	3-6-5	Programs 30-1 and 24-1	109
	3-6-6	Program 10-2 and Macula Test	109
	3-6-7	Peripheral 60 and 60-4 Program	110
	3-6-8	Nasal Step Program	110
	3-6-9	Stimulus Size Option	111
3-7 Follow-up Printout			111
	3-7-1	Overview Printout	111
	3-7-2	Change Analysis Printout	111
	3-7-3	Glaucoma Progression Analysis Printout	114
	3-7-4	GPA-Guided Progression Analysis	114
3-8 Visual Function Speciﬁc Perimetric Technologies			114
	3-8-1	Short-Wavelength Automated Perimetry (SWAP)	117
	3-8-2	Frequency Doubling Perimetry	117
	3-8-3	High-Pass Resolution Perimetry	117
	3-8-4	Tendency-Oriented Perimetry	118
3-9	Learning Effect and Artifacts		118
	3-9-1	Miosis and Mydriasis	118
	3-9-2	Media Opacities	119
	3-9-3	Eyelid and Nose Effects	119
	3-9-4	Refractive Errors	119
	3-9-5	Corrective Lens/Frame Artifacts	120
3-10 Role of the Visual Field Technician			121

xiv	Contents
Chapter 4. Automated Perimetry in Glaucoma			127
	Hylton R. Mayer, MD, Marc L. Weitzman, MD, and
	Joseph Caprioli, MD
	4-1 Introduction		127
	4-2 Glaucomatous Field Loss		127
	4-3 Automated Perimetry Options		129
	4-4 Evaluation of a Single Test		132
	4-4-1	Patient Reliability	132
		4-4-1-1 Test Duration	133
		4-4-1-2 Fixation Losses	133
		4-4-1-3 False-Positive Responses	133
		4-4-1-4 False-Negative Responses	136
		4-4-1-5 Short-Term Fluctuation	136
		4-4-1-6 Stimuli Number	136
	4-4-2	Criteria for Abnormality	140
	4-4-3	Staging of Field Loss	143
	4-4-4	Test Selection	144
	4-4-5	Follow-up of Advanced Field Loss	144
	4-5 Evaluation of a Series of Tests		144
	4-5-1	Baseline Establishment	146
	4-5-2	Nature of Progression	149
	4-5-3 Artifacts		149
	4-5-4	Long-Term Fluctuation	154
	4-5-5	Criteria for Progression	155
	4-5-6	Glaucoma Progression Analysis	157
	4-5-7	Trend Analysis	159
	4-5-8	Follow-up of Central Abnormalities	159
	4-6 Future of Automated Perimetry		161
	4-6-1	Altered Stimuli	161
		4-6-1-1 Short-Wavelength Automated Perimetry	161
		4-6-1-2 Frequency-Doubling Technology	165
		4-6-1-3 Flicker Perimetry	165
		4-6-1-4 Ring Perimetry	167
		4-6-1-5 Motion Automated Perimetry	168
		4-6-1-6 Pattern-Discrimination Perimetry	168
		4-6-1-7 Color Perimetry	168
	4-6-2	Altered Strategies	169
	4-6-3	Interpretive Aids	171
Chapter 5. Inherited or Congenital Optic Nerve Diseases			177
	Peter A. Quiros, MD, Carlos Filipe Chicani, MD, PhD,
	and Alfredo A. Sadun, MD, PhD
	5-1 Introduction		177
	5-2 Congenital Optic Disc Anomalies		177
	5-2-1	Aplasias and Dysplasias	177
	5-2-2	Optic Nerve Colobomas and Pits	179
	5-2-3	Anomalous Disc Elevations: Pseudopapilledema With or Without
		Hyaline Bodies (Drusen)	181
	5-2-4	Tilted Disc and Crescents	181

		Contents	xv
5-3 Heredodegenerative Optic Atrophies			182
	5-3-1	Leber’s Hereditary Optic Neuropathy	183
	5-3-2	Dominant Optic Atrophy	185
	5-3-3	Recessive Optic Atrophy	189
Chapter 6. Acquired Optic Nerve Diseases			193
Carlos Filipe Chicani, MD, PhD, Peter A. Quiros, MD,
and Alfredo A. Sadun, MD, PhD
6-1	Introduction		193
6-2	Optic Neuritis		194
6-3 Ischemic Optic Neuropathy			196
	6-3-1	Nonarteritic Ischemic Optic Neuropathy	196
	6-3-2	Arteritic Ischemic Optic Neuropathy	196
6-4 Metabolic Optic Neuropathies			198
6-5 Compressive Optic Neuropathy			198
6-6 Papilledema			200
Chapter 7. Visual Field Defects in Chorioretinal Disorders			207
Ron A. Adelman, MD, MPH, FACS, and Patricia Pahk, MD
7-1	Introduction		207
7-2 Macular Diseases			207
7-3 Vascular Diseases			209
7-4 Congenital and Genetic Diseases			211
7-5 Inﬂammatory/Infectious Diseases			217
7-6	Toxicity		226
7-7 Peripheral Retina			226
Chapter 8. Optic Chiasm Field Defects			233
Christine E. Lin, and Jeffrey G. Odel, MD
8-1 History and Overview			233
8-2 Anatomy of the Chiasm			234
	8-2-1 Gross Anatomy		234
	8-2-2 Nerve Fiber Anatomy		236
8-3	Tests for Field Defects		240
8-4 Chiasmal Visual Field Defects			241
8-5 Chiasmal Region Lesions			247
	8-5-1	Common Lesions Affecting the Optic Chiasm	247
	8-5-2	Pituitary Tumors	247
	8-5-3 Meningiomas		248
		8-5-3-1 Suprasellar Meningiomas	248
		8-5-3-2 Suprachiasmatic Meningiomas	249
		8-5-3-3 Parasellar Meningiomas	249
	8-5-4 Craniopharyngiomas		249
	8-5-5 Aneurysms		249
	8-5-6	Dilatation of Third Ventricle	250
	8-5-7	Miscellaneous Lesions	250
8-6 Pseudo Temporal and Bitemporal Hemianopia			250

xvi	Contents
Chapter 9.		Optic Tract and Lateral Geniculate Body Field Defects		253
		Thomas R. Hedges III, MD
		9-1 Optic Tract Field Defects		253
		9-2 Lateral Geniculate Body Field Defects		258
Chapter 10.		Retrogeniculate Visual Field Defects		263
		Thomas R. Hedges III, MD
		10-1 Testing for Reticulogeniculate Visual Field Defects		263
		10-2 Localization and Congruity of Optic Radiation and
		Calcarine Cortex Visual Field Defects		264
		10-3 Temporal Lobe Field Defects		267
		10-4 Parietal Lobe Field Defects		269
		10-5 Occipital Lobe Field Defects		272
		10-5-1	Types of Occipital Cortex Field Defects	273
		10-5-2	Field Defects Unique to the Occipital Cortex	282
		10-5-3	Color Field Defects in the Occipital Lobe	285
Chapter 11.		Functional Visual Loss.		293
		Thomas J. Walsh, MD
		11-1 Types of Patients		293
		11-2 Types of Field Loss		294
		11-3 Tests for Functional Field Loss		295
		Index		299

Contributors

	Ron A. Adelman, MD, MPH, FACS	Peter A. Quiros, MD
	Yale University	Doheny Eye Institute
	Joseph Caprioli, MD	Alfredo A. Sadun, MD, PhD
	Jules Stein UCLA School of Medicine	Doheny Eye Institute
	Carlos Filipe Chicani, MD, PhD	George Shafranov, MD
	Doheny Eye Institute	Yale University
	Thomas R. Hedges III, MD	Thomas J. Walsh, MD
	Tufts University Medical School	Yale University
	Christine E. Lin	Marc L. Weitzman, MD
	Columbia University	Assistant Clinical Professor
	Hylton R. Mayer, MD	Yale University School of Medicine
	Hylton R. Mayer, MD
	Yale University	Jonathan D. Wirtschafter, MD
	Jeffrey G. Odel, MD	University of Minnesota School of
	Jeffrey G. Odel, MD	Medicine
	Columbia University	Medicine
	Columbia University
	Patricia Pahk, MD
	Mount Sinai Medical Center

xvii

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A History of Perimetry

THOMAS J. WALSH, MD

The history of perimetry is the history of anatomy. In the early days of perimetry, in the late 1800s, the study of anatomy involved learning the muscles, vessels, and bony structures of the body. The brain was recognized as an organ, but the special functions of its different structures were generally

unknown. Before the availability of current methods to study the brain—including those based on histology, electron microscopy, and electrophysiology and magnetic resonance imaging, magnetic resonance angiography, computed tomography, computed tomography angiography, optical coherence tomography, and positron emission tomography—our predecessors used their observations of visual functions to devise a technique to examine those functions: this technique is called perimetry. Just as the ﬁeld of anatomy has been dynamic, so has the development of techniques in perimetry. With the advent of more sophisticated techniques, we have been able to diagnose diseases earlier and treat them more successfully. However, some of the older techniques can still be used when sophisticated techniques do not work, especially in neuro-ophthalmology.

Perimetric techniques are as variable as are the patients and the diseases that are treated. Although most of this monograph is directed at computerized perimetry, techniques such as confrontation and the tangent screen are also discussed. Just as the range of defects varies, so, too, must the range of different techniques mark the ability of an accomplished perimetrist. As newer techniques and newer computerized programs come online, updating the sophistication of perimetry, so, too, should the perimetrist continually hone his or her skills.

The contributors to this monograph are humbled by the giant steps in the development of perimetry made by the observations and ingenuity of those who have preceded us.

In this chapter, we present the contributions and persons who are important to the history of our understanding of perimetry. The Imaging and Perimetry Society (formerly the International Perimetric Society)1 has added to our knowledge of those who have gone before us, including a history of perimetry by Thompson

xix

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