Summary
Highlights
Begin by asking the patient simple questions like 'Is any bit of my face missing?' or present two hands to detect obvious gross defects. For more detailed assessment, the patient covers one eye, and the examiner covers the opposite eye. The patient looks directly at the examiner's open eye while fingers are presented in each of the four quadrants (imagining a cross through the pupil). The patient reports the number of fingers seen, ensuring fingers are presented within each quadrant and not across meridians.
This video demonstrates a visual field examination by confrontation, a common method for identifying visual field defects in ophthalmology. Before starting, introduce yourself, wash hands, explain the procedure to the patient, and ensure they remove their glasses to avoid artificial defects. Conduct the assessment in a well-lit environment with neutral backgrounds.
Correct positioning of both the examiner and the patient is crucial for accurate comparison of visual fields. The examiner's and patient's eyes should be at a similar level, and they should be close enough (knees almost touching) to present targets midway between them.
The next stage confirms initial findings or identifies more subtle defects. Using a white pin or target, bring it from the periphery to the center along a diagonal line aimed towards the patient's pupil. The patient reports when they first see the target. If a pin is unavailable, a wiggling finger can be used. Ensure the target is displayed midway between the patient and examiner.
The final stage involves assessing the blind spot, typically using a red pin because the central visual field is more sensitive to red light. With one eye covered, the patient looks at the examiner's open eye. The red pin is moved temporally from the center (as the blind spot is 15° temporal to fixation). The patient reports when the pin disappears and reappears. An enlarged blind spot can indicate conditions like optic neuritis or optic nerve head swelling.
A complete demonstration of the visual field examination is shown, covering all stages from initial gross defect assessment, using fingers and a white pin to assess quadrants, and finally checking the blind spot with a red pin. Patients are instructed to cover one eye, look at the examiner's open eye, and report what they see or when the target appears/disappears.