Visual fields in neuro-ophthalmology

Abstract

Visual field assessment is important in the evaluation of lesions involving the visual pathways and should be performed at baseline and periodically in the follow-up. Standard automated perimetry has been shown to be adequate in neuro-ophthalmic practise and is now the technique of choice for a majority of practitioners. Goldman kinetic visual fields are useful for patients with severe visual and neurologic deficits and patients with peripheral visual field defects. Visual fields are useful in monitoring progression or recurrence of disease and guide treatment for conditions such as idiopathic intracranial hypertension (IIH), optic neuropathy from multiple sclerosis, pituitary adenomas, and other sellar lesions. They are used as screening tools for toxic optic neuropathy from medications such as ethambutol and vigabatrin. Visual field defects can adversely affect activities of daily living such as personal hygiene, reading, and driving and should be taken into consideration when planning rehabilitation strategies. Visual field testing must be performed in all patients with lesions of the visual pathway.

Critical pathogenic events underlying progression of neurodegeneration in glaucoma

“…This progression is analogous to the pattern of visual field deficits in both human glaucoma and in non-human primate models (Harwerth et al, 2002). While it is tempting to consider this pattern etiologically-specific to glaucoma, other common optic neuropathies demonstrate sectorial deficits as well (Bernstein et al, 2007a; Bernstein et al, 2007b; Kedar et al, 2011), as does an animal model of streptozotocin-induced diabetes (Fernandez et al, 2011). The latter is especially interesting since the insult is systemic.…”

Visual field changes as an early indicator of glioblastoma multiforme progression: two cases of functional vision changes before MRI detection

“…While imaging has played and will continue to play a key role in the monitoring of GBM, the development of accurate tools to assess clinical status should be similarly emphasized. HVF testing may prove to be useful for monitoring clinical signs of progression, as up to 50% of patients with lesions in the optic pathway show visual field defects 13. The utility of HVF testing has already been recognized in the area of hydroxychloroquine toxicity screening, where roughly 10% of patients manifest visual field changes in a classic ring scotoma pattern before any evidence of photoreceptor damage on optical coherence tomography macula and fundus exam 14.…”

Hémianopsie bitemporale révélatrice d’une atteinte toxique sévère à l’éthambutol

“…La première hypothèse dans ce cas est celle d'une atteinte compressive de la région chiasmatique (adénome hypophysaire, méningiome, craniopharyngiome, anévrisme) [12]. En l'absence de processus comprimant le nerf optique, il est indispensable d'évoquer une atteinte inflammatoire ou toxique du chiasma optique [13].…”