Confrontation visual field testing in routine ophthalmic practice – what is the relevance?

Abstract

Background: Visual field testing, aids in detecting, localizing and monitoring diseases of the visual pathway. Early detection may help to preserve the patient’s sight or life. In some situations, standard perimetry may not be possible.
Aim: To highlight the relevance of confrontation visual field testing (CVF) in routine ophthalmic practice.
Methodology: Three clinical cases are presented. A retrospective review of their medical records was done. Data on symptoms, clinical examination including CVF were obtained.
Perimetry and neuroimaging findings were obtained where possible.
Results: Two patients had symptoms of headache and visual blurring, galactorrhea and amenorrhea. A right homonymous hemianopia and bitemporal hemianopia respectively were detected on CVF. The 3rd patient complained of visual blurring and bumping into objects following an assault to the head. CVF detected homonymous hemianopia. Automated perimetry could not be done in 2 of the patients either because they had run out of funds or the machine was faulty or the patient was lost to follow-up. Cranial computed tomography revealed a suprasellar mass and an intracerebral hemorrhage in the parietal lobe respectively in 2 of the patients. CT scan was not available in one of the patients.
Conclusion: Confrontation visual field testing is relevant in routine ophthalmic practice. It is a quick and useful test for detecting gross visual field defects; and it may be the first pointer to a vision or life threatening disease. However, it is not a substitute to formal quantitative visual field testing.

Keywords: confrontation testing, automated perimetry, routine ophthalmic practice