Confrontation visual field testing is a test used in

ophthalmology Ophthalmology (, ) is the branch of medicine that deals with the diagnosis, treatment, and surgery of eye diseases and disorders. An ophthalmologist is a physician who undergoes subspecialty training in medical and surgical eye care. Following a ...

for rapid and gross detection of large-scale

visual field The visual field is "that portion of space in which objects are visible at the same moment during steady fixation of the gaze in one direction"; in ophthalmology and neurology the emphasis is mostly on the structure inside the visual field and it i ...

problems. It is done by asking the patient to look directly at the examiner's eye or nose and compare the patient's visual field with the examiner's field. It can be used to test the binocular visual field (with both eyes open) and or the visual field of each eye separately (with one eye closed).

Indications

Confrontation visual field testing is an important part of a routine ophthalmological or neurological examination. It can be used for rapid and gross assessment of large-scale

problems due to ophthalmological or neurological diseases, such as

homonymous In linguistics, homonyms are words which are either; ''homographs''—words that mean different things, but have the same spelling (regardless of pronunciation), or ''homophones''—words that mean different things, but have the same pronunciatio ...

and heteronymous hemianopias, quadranopsia, altitudinal visual loss, central/centrocecal

scotoma A scotoma is an area of partial alteration in the field of vision consisting of a partially diminished or entirely degenerated visual acuity that is surrounded by a field of normal – or relatively well-preserved – vision. Every normal mamm ...

etc. Test using a red target can detect red-desaturation, a sign of early

optic nerve In neuroanatomy, the optic nerve, also known as the second cranial nerve, cranial nerve II, or simply CN II, is a paired cranial nerve that transmits visual system, visual information from the retina to the brain. In humans, the optic nerve i ...

disease.

Procedure

Confrontation visual field testing does not need a clinical setting to perform. It can be done in any well-illuminated room. Since the visual fields of both eyes overlap in the nasal area, each eye is tested separately. Patient is asked to sit in front of the examiner, at a distance between 66 and 100 cm, maintaining the eye level same as examiner's. Patient is asked to remove his/her spectacles before starting the test. For testing the right eye field, the patient is asked to close his left eye, and look straight at the examiner's left eye (preferably) or nose. Examiner should also close his/her right eye. Move a finger or bead-on-a-stick inwards from an area outside the usual 180º visual field, and ask the patient when they first see the targets. Alternatively, the patient may be asked to count the number of fingers the examiner shows or identify wiggling fingers. For an accurate assessment of the patient's visual field, it is essential that the distance of all test objects from the patient is the same as the distance from the examiner. The Examiner should compare the point at which the patient sees the target with his own visual field. Repeat the procedure for all eight meridians. Record the type of target used and whether there are any significant abnormalities in the patient's visual field. Colored targets such as red are more sensitive than a white test target. The test reliability may improve when techniques like finger counting, finger wiggling, identifying a target etc. are combined. Confrontation testing can be done with both eyes open also. It is done for testing the binocular visual field.

Advantages and disadvantages

The Confrontation visual field testing is a simple, easy, quick and inexpensive clinical technique that can be used for gross assessment of large-scale visual field problems, such as homonymous and heteronymous hemianopias, quadranopsia etc. But testing is less useful for detecting arcuate scotoma, bitemporal hemianopsia, and visual field loss associated with parasellar tumors,

glaucoma Glaucoma is a group of eye diseases that can lead to damage of the optic nerve. The optic nerve transmits visual information from the eye to the brain. Glaucoma may cause vision loss if left untreated. It has been called the "silent thief of ...

, and compressive optic neuropathies. The test reliability may improve when techniques like finger counting, finger wiggling, identifying a target etc. are combined. To compare a patient's visual field with their own visual field, the examiner should have a full field of vision without any defects.

References

{{reflist Diagnostic ophthalmology Optometry