1. Visual field examinations Week 6 Interpreting of visual fields

2. Interpreting the data  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?

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

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

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

7. interpretation 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 ?

8. Interpretation of Visual Fields 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.

9. Interpretation of visual fields Pseudotumor causing papilledema Bitemporal hemianopia

10. Interpreting visual fields Left eyeRight eye

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

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

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. Interpreting glaucomatous field defects Generalized depression Arcuate scotoma

17. Interpreting glaucomatous field defects Nasal stepTemporal wedge

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

19. Interpreting glaucomatous field defects End stage glaucoma

20. Interpreting retinal field defects Macular holeRetinal detachment

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

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

23. Interpreting retinal field defects Diabetic retinopathyRetinal detachment

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

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

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

27. Interpreting Chiasmal defects bitemporal hemianopia Chiasmal defect, from a pituitary tumor

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

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

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

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

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

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