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Visual field

The visual field is the spatial array of visual stimuli that can be perceived by an individual while maintaining steady fixation on a central point, encompassing both central and peripheral vision.^[1] In a normal human eye, the monocular visual field extends approximately 100 degrees temporally (laterally), 60 degrees nasally (medially), 60 degrees superiorly (upward), and 70 degrees inferiorly (downward), forming an irregular oval shape limited by the orbital margins, eyelids, and physiological blind spot near the optic disc.^[2] Binocular vision combines these fields to provide a wider panoramic view, typically spanning about 200 degrees horizontally and 130 degrees vertically.^[3] The visual field arises from the retinal photoreceptors' mapping onto the external environment, with light rays projecting inverted images that are processed along the visual pathway—from the retina through the optic nerve, optic chiasm (where nasal fibers cross), optic tract, lateral geniculate nucleus, optic radiations, to the primary visual cortex in the occipital lobe.^[1] Sensitivity varies across the field, with highest acuity in the central 30 degrees (macular vision) mediated by the fovea and papillomacular bundle, decreasing toward the periphery where motion detection predominates.^[4] The physiological blind spot, corresponding to the optic disc, is located approximately 15 degrees temporally from fixation and 1.5 degrees below the horizontal meridian, measuring about 5.5 degrees horizontally by 7.5 degrees vertically, remaining imperceptible due to binocular overlap and brain filling-in.^[1]^[2] Clinically, the visual field is assessed through perimetry to identify defects such as scotomas (isolated blind spots), arcuate defects, or hemianopias (half-field loss), which localize lesions in the visual pathway and aid diagnosis of conditions including glaucoma (progressive peripheral constriction), stroke (homonymous hemianopia), multiple sclerosis, or orbital tumors.^[5] Common testing methods include confrontation visual field exams for screening, kinetic perimetry (e.g., Goldmann) using moving targets, and automated static perimetry (e.g., Humphrey visual field analyzer) that measures light sensitivity at discrete points, enabling early detection and monitoring of progression in eye and neurological disorders.^[6] Abnormalities in the visual field can significantly impact daily activities like driving or navigation, underscoring its role in comprehensive visual health evaluation.^[4]

Anatomy and Physiology

Definition and Scope

The visual field refers to the total spatial extent in which objects can be seen at the periphery while the eyes remain fixated on a central point.^[1] This encompasses the entire region visible without shifting gaze, forming the basis of an individual's field of vision during steady observation.^[6] The scope of the visual field distinguishes between its perceptual aspect—what is actively detected and processed—and its anatomical boundaries, which are constrained by physical structures such as the eyelids, nose, and orbital rim.^[7] Perceptually, it integrates central vision, primarily served by the macula for detailed, high-acuity tasks, with peripheral vision, which extends outward for broader environmental monitoring.^[8] This field is quantified in angular degrees relative to the fixation point, providing a standardized measure of its horizontal and vertical expanse.^[4] Early descriptions of the visual field's extent trace back to the 11th-century polymath Alhazen (Ibn al-Haytham), who analyzed it point by point in his Book of Optics, laying foundational principles for understanding visual perception.^[9] The visual field plays a critical role in spatial awareness by enabling the integration of environmental cues, facilitating navigation through dynamic surroundings, and supporting the rapid detection of potential hazards such as approaching obstacles or sudden movements.^[10]

Neural Pathways and Processing

The visual field begins with the retina, a multilayered neural tissue lining the back of the eye, where photoreceptors—rods and cones—convert light into electrical signals. Rods, which are more sensitive to low light levels, predominate in the peripheral retina and contribute to the broad extent of the visual field, while cones, responsible for color vision and high acuity, are concentrated in the central fovea, enabling detailed perception in the central field.^[11] These photoreceptors synapse with bipolar and horizontal cells, which in turn connect to retinal ganglion cells (RGCs), the output neurons of the retina whose axons form the optic nerve.^[11] RGCs possess receptive fields that map specific regions of the visual field, organized in a topographic manner to provide a point-to-point representation of the external world. Each receptive field typically features a center-surround structure, where stimulation in the center elicits a strong response (either excitatory or inhibitory) and the surrounding annulus produces the opposite effect, enhancing contrast detection across the field.^[11] The mosaic of RGC receptive fields covers the entire visual field without gaps, with higher density in the central region corresponding to foveal input, thus establishing the foundational neural encoding of spatial visual information.^[11] The optic nerve carries RGC axons from the retina, exiting the eye at the optic disc and converging at the optic chiasm, where nasal fibers from each eye cross to the contralateral side while temporal fibers remain ipsilateral.^[12] This partial decussation results in hemifield representation, such that the right visual hemifield from both eyes projects to the left optic tract and vice versa, preserving a unified binocular field in the brain.^[12] From the optic chiasm, the primary retinogeniculate pathway directs most fibers (about 90%) to the lateral geniculate nucleus (LGN) of the thalamus, where they synapse in layered structures that maintain retinotopic organization.^[12] LGN neurons then relay signals via the optic radiations to the primary visual cortex (V1, or striate cortex) in the occipital lobe, establishing a detailed point-to-point map of the visual field.^[13] A smaller extrageniculate pathway branches to the superior colliculus in the midbrain, which processes transient visual stimuli, including peripheral motion detection for reflexive orienting behaviors.^[12] In the cortex, visual processing proceeds hierarchically from V1, where simple cells detect basic features like edges and orientations within receptive fields that mirror the visual field's topography, to higher areas such as V2 for contour integration, V3 for form, V4 for color, and V5 (MT) for motion direction.^[13] This progression builds from local feature detection in V1 to global scene perception in extrastriate regions, with parallel dorsal ("where/how") and ventral ("what") streams facilitating spatial and object-based analysis.^[13] A key feature of this cortical organization is magnification, where the foveal representation occupies a disproportionately large area in V1 compared to the periphery, reflecting the higher density of cones and RGCs in the central retina and enabling finer resolution for central vision.^[13] This cortical magnification factor decreases with eccentricity, ensuring that neural resources align with behavioral demands for detailed foveal processing.^[14] Binocular integration occurs primarily in the visual cortex, where neurons in V1 and beyond receive convergent input from corresponding points in both eyes' retinas, allowing fusion of slightly disparate images to compute depth via stereopsis.^[13] This process, refined in extrastriate areas, supports a single, coherent perception of the binocular visual field with three-dimensional structure.^[15]

Normal Characteristics

Monocular and Binocular Limits

The monocular visual field, when viewing with one eye, forms an asymmetric oval shape, extending approximately 60° nasally, 90–100° temporally, 60° superiorly, and 70–75° inferiorly from the fixation point.^[16]^[17] This results in a total horizontal span of roughly 160–170°, reflecting the broader temporal reach due to the eye's lateral positioning in the orbit.^[17] The field resembles an "island of vision," with a central hill of high acuity at the fovea tapering to lower sensitivity at the edges, bounded by physiological blind spots like the optic disc.^[1] In binocular viewing, the fields from both eyes overlap substantially, creating a combined horizontal extent of 180–200° and a vertical extent of about 130°.^[3] The central binocular overlap, essential for depth perception via stereopsis, covers approximately 120° horizontally.^[17] These limits are shaped by orbital anatomy—such as the nose occluding the nasal field and the brow or cheeks limiting superior and inferior views—the physical extent of the retina, and soft tissue obstructions like eyelids.^[17] Clinically, these extents inform standards for activities requiring wide peripheral awareness, such as driving; for instance, the European Union mandates a minimum binocular horizontal visual field of 120° for group 1 driving licenses (cars and motorcycles).^[18]

Physiological Variations

The visual field extent exhibits natural physiological variations influenced by factors such as age, ethnicity, refractive status, environmental adaptations, and inherent anatomical asymmetries. These differences arise from structural and functional changes in the ocular and neural systems, affecting the overall scope of peripheral vision without indicating pathology. Age-related changes lead to a progressive constriction of the visual field, primarily due to a decline in retinal ganglion cells and reduced neural efficiency in the aging retina. In healthy individuals, the peripheral visual field shrinks by approximately 1-3 degrees per decade after age 45, with more pronounced loss after age 65, potentially resulting in a 10-20 degree reduction by age 70. This constriction is attributed to a 25% loss of retinal ganglion cells near the fovea and nasal retina, alongside decreased oxygen tension and altered retinal metabolism.^[19]^[20]^[21] Ethnic variations, such as those between East-Asian and Caucasian populations, show subtle differences in far peripheral field performance, with East-Asians demonstrating marginally reduced temporal field extent (up to 5 degrees narrower at 60-80 degrees eccentricity), attributed to facial contour and orbital anatomy influencing eyelid and brow interference.^[22] Refractive errors also induce slight alterations in effective visual field extent through optical defocus, affecting peripheral detection thresholds. Uncorrected refractive errors can elevate thresholds due to blur, particularly in the periphery.^[23]^[24] Environmental adaptations, such as targeted visual training, can yield potential enhancements in visual field utilization among athletes and pilots. Sports vision training programs improve peripheral awareness and reaction times, with studies showing up to 20% better performance in dynamic field tasks after 4-8 weeks, as seen in professional baseball players and futsal athletes through enhanced sensorimotor integration. Similarly, pilots benefit from analogous training, reporting improved peripheral detection during high-speed maneuvers, though quantitative field expansion remains modest (1-3 degrees effective increase via better utilization).^[25]^[26] A natural slight nasal-temporal asymmetry exists in the normal visual field, stemming from retinal and orbital anatomy. The temporal hemifield extends farther (approximately 90-100 degrees) than the nasal (60 degrees), with nasal retina showing 2-4 times greater contrast sensitivity in peripheral regions, reflecting denser ganglion cell distribution and crossed vs. uncrossed projections.^[27]^[28]

Clinical Assessment

Traditional Perimetry Techniques

Traditional perimetry techniques encompass manual and semi-automated methods that have been foundational in clinical ophthalmology for mapping the visual field since the early 20th century. These approaches primarily assess the extent and sensitivity of the visual field by presenting stimuli to the patient and recording responses, allowing detection of defects that deviate from normal monocular limits of approximately 60° nasally, 100° temporally, 60° superiorly, and 70° inferiorly.^[2]^[4] Confrontation testing is a simple, non-instrumental bedside method used to screen for gross visual field defects. In this technique, the examiner sits facing the patient at a distance of about 2 feet, and the patient is instructed to fixate on the examiner's nose or eye while one eye is covered; the examiner then presents fingers or a wiggling motion in each of the four quadrants of the visual field, asking the patient to report when they detect it. This qualitative assessment is quick, requiring no specialized equipment, and is effective for identifying large hemianopic or quadrant defects, though it has lower sensitivity for subtle losses compared to quantitative methods.^[6]^[29]^[30] Goldmann perimetry represents a classic manual kinetic approach, utilizing a hemispheric dome perimeter to project moving stimuli of varying sizes and brightness levels toward the patient's fixation point. The technician manually moves the target from the non-seeing periphery into the visual field until the patient signals detection, plotting multiple isopters—curves connecting points of equal sensitivity—to delineate sensitivity gradients and identify scotomas. This method excels in defining the overall shape and extent of the visual field, particularly for peripheral defects, and remains a gold standard for kinetic testing due to its ability to adapt stimulus parameters in real-time.^[2]^[31] The Humphrey Field Analyzer (HFA) is a widely adopted device for static automated perimetry, where stationary light stimuli of controlled intensity are presented at predefined grid points within a bowl-shaped perimeter, and the patient responds via button press to measure differential light sensitivity thresholds. Common testing patterns include the 24-2 (54 points covering the central 24° with 6° spacing) and 30-2 (76 points extending to 30°), which focus on areas vulnerable to glaucomatous damage while excluding the far periphery. Reliability is monitored through indices such as fixation losses (assessed by stimuli in the blind spot, with rates >20-33% indicating poor gaze stability) and false positives (responses to no stimulus, suggesting over-alertness), ensuring test validity for longitudinal monitoring.^[4]^[32] Frequency-doubling technology (FDT) perimetry employs a specialized stimulus consisting of low-spatial-frequency gratings that flicker at high temporal rates (e.g., 25 Hz), creating a perceptual illusion of doubled frequency that preferentially stimulates magnocellular retinal ganglion cells sensitive to early glaucomatous damage. Devices like the Humphrey Matrix present these alternating-contrast targets in patterns such as 24-2 or N-30, with threshold algorithms determining contrast sensitivity; studies show it detects early field loss with 85-95% sensitivity and 80-100% specificity, often identifying defects up to 4 years before standard automated perimetry in glaucoma suspects.^[33]^[34] These traditional techniques offer key advantages in clinical practice, including high reliability through standardized protocols that minimize inter-operator variability and enable reproducible results across diverse settings. Their widespread adoption facilitates comparison with normative databases and supports consistent diagnostics for conditions like glaucoma, enhancing patient management without requiring cutting-edge infrastructure.^[32]^[35]

Advanced Measurement Methods

Advanced measurement methods for visual fields extend beyond traditional perimetry by incorporating imaging, selective stimuli, computational analysis, and portable technologies to enhance sensitivity, precision, and accessibility in detecting subtle defects. These techniques address limitations in standard automated perimetry, such as variability and late detection of early damage, by correlating structural changes with functional outcomes or enabling remote testing.^[36] Optical coherence tomography (OCT) provides high-resolution imaging of retinal structures, allowing correlation between structural metrics like retinal nerve fiber layer (RNFL) thickness and functional visual field performance. By mapping RNFL thickness, OCT detects early glaucomatous changes that precede visible field defects in standard tests, offering objective quantification of axonal loss. Longitudinal studies have shown that OCT-measured RNFL thinning predicts future visual field progression with high accuracy, improving diagnostic timelines.^[37]^[38] Short-wavelength automated perimetry (SWAP), also known as blue-on-yellow perimetry, targets the blue-yellow color vision pathway using a short-wavelength blue stimulus on a yellow background to isolate short-wavelength-sensitive cones. This method reveals early retinal ganglion cell damage in glaucoma up to 3-5 years before standard white-on-white perimetry, making it valuable for pre-perimetric detection. SWAP's higher sensitivity stems from its focus on preferentially vulnerable parvocellular pathways, though it requires longer test times and patient adaptation to the chromatic stimuli.^[39]00692-7/fulltext) Artificial intelligence (AI) and machine learning models automate the analysis of perimetry data, predicting visual field defects by identifying patterns in large datasets that human interpreters might overlook. Since the 2020s, deep learning frameworks trained on multimodal data, including serial perimetry and OCT scans, have achieved superior accuracy in forecasting glaucoma progression, with some models outperforming traditional trend analyses. These systems enhance defect classification and progression risk assessment, facilitating personalized monitoring in clinical settings.^[40] Virtual reality (VR) perimetry employs head-mounted devices to simulate naturalistic testing environments, projecting stimuli onto a wide field while tracking eye movements for fixation control. This approach yields results comparable to or better than conventional perimetry in terms of mean deviation and reliability indices, with improved patient compliance due to reduced need for chin rests and enhanced engagement. VR systems support unsupervised home-based testing, broadening access for frequent monitoring in chronic conditions like glaucoma.^[36]^[41] Microperimetry integrates fundus imaging with real-time tracking to assess macular sensitivity, presenting stimuli precisely on targeted retinal loci while compensating for eye movements via infrared fundus cameras. This technique maps scotomas directly to anatomical features, providing topographic correlation between retinal structure and function in central vision disorders. Unlike conventional perimetry, microperimetry's fundus-driven stimulation minimizes fixation losses and enables detailed evaluation of fixation stability and preferred retinal loci.^[42]^[43] Recent developments post-2023 have integrated wearable technologies, such as portable VR headsets and smartphone-linked devices, for home-based visual field monitoring, enabling frequent, unsupervised assessments with data transmission to clinicians. These wearables incorporate AI for real-time quality checks and progression alerts, demonstrating high test-retest reliability and patient retention in long-term glaucoma studies. Such advancements promote decentralized care, reducing clinic visits while maintaining diagnostic fidelity.00175-1/fulltext)^[44]

Visual Field Defects

Classification and Patterns

Visual field defects are broadly classified into absolute and relative scotomas based on the degree of visual loss in affected areas. An absolute scotoma represents a complete loss of vision, where no stimulus, regardless of size or intensity, is detected within the defective region, akin to a true blind spot.^[1] In contrast, a relative scotoma involves partial sensitivity reduction, allowing perception of larger or brighter stimuli but not dimmer or smaller ones, indicating preserved but impaired neural function.^[1] Common patterns of visual field defects include several characteristic shapes that reflect underlying anatomical disruptions. A central scotoma affects the central 5 to 10 degrees of vision, often involving macular regions and leading to impaired fine detail perception. Arcuate scotomas appear as bow-shaped defects that follow the arcuate pattern of retinal nerve fibers, typically arching from the blind spot without crossing the horizontal meridian. Hemianopia involves the loss of an entire half of the visual field, either temporal (outer halves) or nasal (inner halves), respecting the vertical meridian. Quadrantanopia is a more localized variant, confined to one quadrant of the field, such as superior or inferior. Altitudinal defects manifest as the loss of the upper or lower half of the visual field, sharply delineated along the horizontal meridian.^[1]^[45]^[46] Defects are further distinguished as monocular or binocular, aiding in preliminary lesion localization. Monocular defects occur in a single eye, often resulting from unilateral ocular or pre-chiasmal issues, and appear isolated on perimetry of that eye alone. Binocular defects, by contrast, involve both eyes with congruent patterns, typically indicating post-chiasmal neurological involvement where corresponding field regions are symmetrically affected.^[1]^[47] In chronic conditions, visual field defects often exhibit progressive enlargement over time, with scotomas deepening in density or expanding in size, potentially leading to the development of new defects adjacent to existing ones. This gradual worsening underscores the importance of serial perimetry to monitor evolution.^[1]^[48] The diagnostic utility of these patterns lies in their ability to localize lesions through anatomical correlations, such as arcuate and altitudinal defects respecting the horizontal meridian, which suggests pre-chiasmal involvement, while hemianopic patterns respecting the vertical meridian point to chiasmal or post-chiasmal sites. Brief reference to perimetry techniques reveals these patterns via threshold sensitivity mapping, facilitating targeted clinical evaluation.^[1]^[49]

Ocular Causes

Ocular causes of visual field defects primarily involve pathologies of the retina and optic nerve, leading to pre-chiasmal disruptions that often result in asymmetric or localized losses rather than homonymous patterns. These defects arise from damage to photoreceptors, retinal ganglion cells, or the optic nerve head, manifesting as scotomas or peripheral constrictions that can progress if untreated. Common examples include degenerative, inflammatory, and vascular conditions affecting the eye's anterior visual pathway. Glaucoma, a leading cause of irreversible visual field loss, is characterized by progressive damage to retinal ganglion cells and their axons, resulting in specific patterns such as arcuate scotomas that follow the arcuate nerve fiber bundles and nasal steps due to differential involvement along the horizontal meridian. These defects typically begin paracentrally and expand, reflecting the preferential loss of ganglion cells in the superonasal and inferotemporal regions. Early detection through perimetry is crucial, as untreated progression can lead to tunnel vision from extensive peripheral field constriction. Age-related macular degeneration (AMD) predominantly affects central vision, producing central or paracentral scotomas due to photoreceptor and retinal pigment epithelium degeneration in the macula. In the dry form, geographic atrophy causes gradual expansion of these scotomas, while the wet form involves choroidal neovascularization leading to more rapid hemorrhagic or exudative damage and potentially larger central defects. Both forms impair fine visual tasks, with scotoma size correlating to the extent of macular involvement. Retinal detachments, often rhegmatogenous, produce sectoral visual field losses corresponding to the detached area, appearing as curtain-like shadows advancing from the periphery toward the center if the macula is involved. Extensive detachments can result in total monocular field loss, though surgical intervention may preserve or restore function depending on the duration and macular status prior to repair. Prompt diagnosis is essential to minimize permanent photoreceptor damage and associated field defects. Optic neuritis, an inflammatory demyelinating condition of the optic nerve, commonly presents with acute central or cecocentral scotomas due to conduction block in papillomacular bundle fibers. These defects often resolve partially or fully with time, as axonal remyelination occurs, though residual mild central sensitivity loss may persist in some cases; high-dose corticosteroids accelerate recovery but do not alter long-term outcomes. The pattern reflects the nerve's selective vulnerability during inflammation. Diabetic retinopathy contributes to visual field defects through retinal vascular complications, where intraretinal hemorrhages and ischemia create peripheral islands of vision loss or scattered scotomas, particularly in proliferative stages with neovascularization. These localized losses can coalesce into broader peripheral constriction if vitreous hemorrhage or tractional detachment ensues, exacerbating field impairment beyond central macular edema effects. Rare genetic conditions like Leber's hereditary optic neuropathy (LHON) cause bilateral sequential central scotomas from mitochondrial dysfunction affecting retinal ganglion cells, leading to rapid vision loss in young adults with minimal recovery potential. The defects are typically cecocentral, expanding to involve the entire central field, and are pathognomonic for this maternally inherited disorder.

Neurological Causes

Neurological causes of visual field defects arise from lesions along the visual pathways from the optic nerve to the cerebral cortex, leading to characteristic patterns of binocular field loss that reflect the anatomy of the disrupted structures. These defects differ from ocular causes by producing congruent binocular impairments rather than unilateral monocular ones, and they often require neuroimaging for localization and diagnosis.^[50] Pre-chiasmal lesions, affecting the optic nerve or tract before the optic chiasm, typically result in unilateral visual field defects such as central scotomas or altitudinal hemianopias. For instance, optic neuritis, commonly associated with multiple sclerosis, can cause diffuse field loss, central or cecocentral scotomas, or arcuate defects in the affected eye. Ischemic optic neuropathy often produces an altitudinal defect, sparing the horizontal meridian and predominantly involving the inferior hemifield due to vascular supply patterns.^[51]^[51] Chiasmal lesions at the optic chiasm intersection produce bitemporal hemianopia, where the temporal fields of both eyes are lost due to compression of crossing nasal fibers. Pituitary adenomas are the most common etiology, accounting for the majority of chiasmal syndromes in adults, often presenting with superior bitemporal quadrantanopia initially as the tumor grows suprasellarly. Aneurysms, particularly of the anterior communicating artery, can also compress the chiasm, leading to similar bitemporal defects, though less frequently than tumors.^[52]^[53]^[52] Post-chiasmal lesions beyond the chiasm, involving the optic tract, lateral geniculate nucleus, optic radiations, or occipital lobe, cause homonymous hemianopia, affecting the same hemifield in both eyes. Occipital strokes, especially in the posterior cerebral artery territory, frequently result in contralateral homonymous hemianopia with macular sparing, where the central 5-10 degrees of vision is preserved due to dual blood supply from the middle and posterior cerebral arteries. Quadrantanopias occur with partial radiation involvement; temporal lobe lesions affecting Meyer's loop produce superior homonymous quadrantanopia, while parietal lobe damage leads to inferior quadrantanopia.^[50]^[54]^[50] Higher cortical visual defects stem from damage to specialized areas beyond the primary visual cortex, disrupting complex processing without complete field loss. Achromatopsia, or cerebral color blindness, results from bilateral lesions in area V4 of the ventral occipitotemporal cortex, impairing color perception while preserving form vision. Akinetopsia, a rare motion blindness, arises from damage to area MT/V5 in the dorsal stream, causing moving objects to appear static or discontinuous, as seen in cases of bilateral occipitotemporal infarcts.^[55]^[56]^[57] Migraine auras can produce transient neurological visual field defects, most notably scintillating scotomas, which manifest as shimmering, zigzag patterns expanding across the visual field over 5-30 minutes due to cortical spreading depression in the occipital cortex. These episodes are self-limited and resolve without permanent loss, distinguishing them from structural lesions.^[58]^[59] Rare disorders like Anton-Babinski syndrome involve anosognosia for cortical blindness or hemianopia following bilateral occipital damage, where patients deny their visual deficit and confabulate explanations for obstacles, often from strokes or trauma. This syndrome highlights the role of parietal-occipital integration in visual awareness.^[60]^[61]

Other Etiologies

Toxic and metabolic factors can induce visual field defects through optic neuropathy affecting the papillomacular bundle. Tobacco-alcohol amblyopia, also known as toxic-nutritional optic neuropathy, typically presents with bilateral central or cecocentral scotomas, often detected via static perimetry such as the Humphrey 10-2 program, alongside gradual vision loss and reduced color vision.^[62] Vitamin B12 deficiency similarly causes nutritional optic neuropathy, resulting in symmetric central or cecocentral scotomas due to axonal damage in the papillomacular bundle, with progression over months and potential improvement following supplementation.^[63] Traumatic injuries contribute to visual field defects through mechanical disruption or secondary effects. Orbital fractures, particularly of the floor, can lead to restrictive visual fields from entrapment of extraocular muscles or optic nerve compression, often accompanied by decreased macular function and abnormal visual evoked potentials.^[64] Traumatic brain injury frequently produces mixed visual field defects, including scattered points (56.4%), homonymous hemianopsia (14.5%), and quadrantanopia (10.9%), which correlate with injury severity and complicate rehabilitation.^[65] Vascular etiologies, such as nonarteritic anterior ischemic optic neuropathy (NA-AION), manifest as acute, painless visual field loss. Common patterns include relative inferior altitudinal defects (34.9%) and absolute inferior nasal defects (22.4%), with central scotomas in approximately 49% of cases, typically appearing within weeks of onset.^[66] Infectious causes like histoplasmosis choroiditis can produce focal chorioretinal lesions leading to visual field defects. In presumed ocular histoplasmosis syndrome, peripheral spots or scars may result in central and paracentral scotomas, with visual field deterioration disproportionate to acuity loss in early stages.^[67] Iatrogenic factors, including post-surgical complications, may cause transient or persistent visual field alterations. After cataract surgery with intraocular lens implantation, patients can experience peripheral visual field shifts exceeding 5 degrees or negative dysphotopsias resembling temporal scotomas, often due to edge effects of the implant.^[68]^[69] Congenital conditions such as albinism impact the effective visual field through associated nystagmus and retinal abnormalities. Individuals with albinism exhibit significant visual field deficits, with mean detection thresholds of -3.10 dB (worse than in idiopathic infantile nystagmus), particularly in the superior nasal quadrant, correlating with reduced visual acuity and not fully attributable to nystagmus alone.^[70]

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Evaluating New Perimetry Techniques - Visual Field Assessment ...
For a perimetry technique to assess disability effectively and accurately, its results must be valid, reliable, reproducible, and applicable for the specific ...
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Virtual reality headsets for perimetry testing: a systematic review - PMC
This review reveals a growing consensus that VR headset perimetry devices perform comparably to, or even better than, standard automated perimetry.
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Correlation of Retinal Nerve Fiber Layer Thickness and Visual ...
Jan 30, 2014 · Visual field testing is subjective and prone to inter-test variability, whereas OCT imaging of RNFL thickness measurements are objective.Missing: seminal | Show results with:seminal
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Optical Coherence Tomography Longitudinal Evaluation of Retinal ...
The purpose of this study is to longitudinally evaluate OCT circumpapillary RNFL measurements compared with standard clinical assessment and automated ...Missing: seminal | Show results with:seminal
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Short-wavelength automated perimetry - PubMed - NIH
SWAP is a powerful clinical tool able to detect visual field deficits 3 to 5 years before standard automated perimetry (white-on-white) in most glaucoma ...Missing: early sources
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Artificial intelligence-based model for the interpretation and ...
Jul 21, 2025 · Purpose: Standard automated perimetry has been the standard method for measuring visual field changes for several years.Missing: machine analysis data defect prediction 2020s
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Clinical Assessment of a Virtual Reality Perimeter Versus the ...
Oct 11, 2025 · The flexibility and efficiency of VR-based perimetry can improve patient comfort and compliance—for instance, by eliminating the need for chin ...
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Use of fundus perimetry (microperimetry) to quantify macular sensitivity
Micro- or fundus perimetry offers the option to test retinal sensitivity while directly observing the fundus.Missing: stimulation authoritative
[45]
Fundus-driven perimetry (microperimetry) compared to conventional ...
Fundus-driven perimetry, commonly known as microperimetry is a technique for measuring visual field sensitivity, whilst simultaneously viewing the fundus.Missing: authoritative papers
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Digital health and wearable devices for retinal disease monitoring
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Types of Visual Field Defects - Merck Manuals
Types of Visual Field Defects ; Arcuate scotoma. A small, bow-shaped (arcuate) visual field defect that follows the arcuate pattern of the retinal nerve fibers; ...
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Patterns of visual field loss in optic neuropathies
A, Cecocentral scotoma (left; arrow); paracentral scotoma (right; arrow). B, Central scotoma (arrow). C, Arcuate scotoma (arrow). D, Broad arcuate (altitudinal) ...
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Differential diagnosis of visual impairment | STROKE MANUAL
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The Mode of Progression of Visual Field Defects in Glaucoma
In those eyes showing progression the scotomas became denser in 79% whereas enlargement occured in 52% and 50% developed new scotomas.
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Decoding Visual Pathway Lesions
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Visual Field Deficits - Neuroscience - NCBI Bookshelf - NIH
A variety of retinal or more central pathologies can cause visual field deficits that are limited to particular regions of visual space.
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Visual fields in neuro-ophthalmology - PMC - PubMed Central - NIH
Visual field defects can adversely affect activities of daily living such as personal hygiene, reading, and driving and should be taken into consideration when ...
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Neuroanatomy, Bitemporal Hemianopsia - StatPearls - NCBI - NIH
Some of the most common causes are neoplasms, including pituitary adenomas, craniopharyngiomas, and meningiomas.[14]. Pituitary adenomas are benign tumors of ...
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Aug 5, 2025 · Pituitary adenomas are a collection of tumors that arise from the pituitary gland. These tumors are the most common cause of optic chiasm compression in adults.
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The Mechanism of Macular Sparing - PMC - PubMed Central
Patients with homonymous hemianopia sometimes show preservation of the central visual fields, ranging up to 10°. This phenomenon, known as macular sparing, ...
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Akinetopsia - an overview | ScienceDirect Topics
Akinetopsia is an acquired defect of visual motion perception produced by bilateral lesions of the lateral occipitotemporal cortex, where the human homolog of ...
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Akinetopsia - EyeWiki
Akinetopsia refers to motion blindness, which is a higher visual processing disorder from an extra-striate lesion, in which a patient has difficulty ...Missing: V4 | Show results with:V4
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Migraine-like Visual Aura Due to Focal Cerebral Lesions - PubMed
Features such as photopsia, fortification spectra, and the slow propagation of a scintillating scotoma across the visual field are usually considered diagnostic ...
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Scintillating Scotoma: Causes, Duration & Treatment
Oct 17, 2024 · A scintillating scotoma is a blind spot in your vision covered by a distinct distorting or obscuring effect.
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Anton Syndrome - EyeWiki
Anton Syndrome is a manifestation of bilateral occipital lobe damage in cortically blind patients. These patients lack insight into their disease and deny ...
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Anton-Babinski Syndrome: A Visual Anosognosia | Cureus
Mar 6, 2024 · Anton-Babinski syndrome is a rare extension of cortical blindness following injury to the occipital lobe. The patient behaves as sighted but has visual ...
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Tobacco-alcohol amblyopia: a maculopathy? - PMC - PubMed Central
Tobacco-alcohol amblyopia or toxic-nutritional optic neuropathy is a condition characterised by papillomacular bundle damage, central or caecocentral scotoma, ...
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Toxic and Nutritional Optic Neuropathy - StatPearls - NCBI Bookshelf
In most cases, vision loss progresses over months rather than days to weeks, and vision decreases slowly. A thorough history is crucial to making a diagnosis.
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Comprehensive Evaluation of Visual Function in Patients With ...
Orbital floor fracture can lead to optic nerve damage and also may be associated with decreased macular function. The combination analysis of visual ...
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Ocular Manifestations, Visual Field Pattern, and ... - PubMed Central
Jan 7, 2022 · TBI- and stroke-related visual dysfunction, which includes sensory dysfunction such as visual acuity and visual field (VF) impairment, motor ...
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Visual field abnormalities in nonarteritic anterior ischemic optic ...
Our study demonstrated that NA-AION eyes may initially show a variety of optic nerve-related visual field defects.
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Fungal Infection in Patients with Serpiginous Choroiditis or Acute ...
In the early stages of the disease, visual acuity and angiographic test results are normal despite marked deterioration of the visual field. Some patients ...
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Peripheral visual field shifts after intraocular lens implantation - PMC
Ray-tracing analyses show that IOL implantation can shift the peripheral visual field by more than 5 degrees.
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Dysphotopsias or Unwanted Visual Phenomena after Cataract Surgery
Negative dysphotopsias are manifested as an arc-shaped shadow or line usually located in the temporal part of the visual field, similar to a temporal scotoma.
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Visual Field Deficits in Albinism in Comparison to Idiopathic Infantile ...
Feb 1, 2024 · Purpose: This is the first systematic comparison of visual field (VF) deficits in people with albinism (PwA) and idiopathic infantile nystagmus ...