6 min read
Interpreting visual fields
Patterns of loss and how they localize along the visual pathway.
Learning objectives
- Read a Humphrey field printout confidently.
- Map field defects to their anatomical location.
- Separate glaucomatous from neurological patterns.
1. Reliability
Check fixation losses and false positives/negatives before interpreting anything.
2. Respect the vertical and horizontal
Defects respecting the vertical midline are chiasmal/retrochiasmal; those respecting the horizontal are typically glaucomatous or vascular.
3. Congruity
Homonymous defects that are more congruous localize more posteriorly in the visual pathway.
4. Correlate
Match the field to the disc and OCT — the three should tell one story.
Pearls
- A bitemporal defect points to the chiasm; image the sella.
- An arcuate defect with a nasal step is the classic glaucomatous pattern.