Visual fields
Retinal fields
Retinal Disorders
1. Central Scotama : Defect involving fixation.
2. Ceco-central scotama : Defect emcopassing the physiological blind spot and
fixation.
3. Cecal scotoma : Defect not invoving fixation.
Causes of Central scotoma
1. Macular Degeneration
2. Central serous Retinopathy
3. Macular Oedema (any macular disease)
4. Stargardt’s dystrophy
Retinal disorders also present with
Contraction & Tubular fields as in
1. Retinitis pigmentosa
2. High myopia
3. PRP
4. Aphakic correction
VALUE ADDED
1. To correctly identify different field effects.
2. To perfectly learn to draw and prepare charts for each eye separately.
3. Glaucoma fields.
Papillo macular bundle
a. In the retina visual fibers are arranged in a pattern.
b. Fibers from macula travel in a papillo macular bundle
to the optic disc.
c. Superior & inferior arcuate fibres travel around the
papillo macular bundle
d. Nasally, nasal fibres transmit to optic disc.
e. Defects involving papillo macular bundle are macular Temporal fibres
Nasal Fibres
fibres which give centrocecal (or) central scotoma.
Papillomacular bundle
f. Arcuate defects are seen when arcuate fibres are
damaged.
Glaucoma -Field Defect
g. Arcuate (bjerrum area)
h. Superior para central scotoma
i. Seidel’s scotoma
j. Bjerrum’s (arcuate) scotoma
k. Double Arcuate (Ring) scotoma with superior central nasal
step.
l. Roenne’s nasal step.
m. Tubular field
n. Only temporal island of vision
* Isopter contraction : Peripheral isopter contraction may be significantly smaller
prior to any field loss.
* Baring paracentral scotoma : One or more isolated paracentral scotoma develop
in the Bjerrum or arcuate area.
* Siedel’s scotoma : A sickle shape defect arises from the blind spot that tapers to
a point in a curved course with concavity towards the fixation point.
* Bjerrum’s or arcuate scotoma : A relatively larger area of defect in the form of
arching scotoma, which eventually fills the entire arcuate area, from blind spot to the
horizontal median. With further progression, a double arcuate (ring or annular) scotoma
will develop.
* Roenne’s nasal step : The arcuate defects may not proceed at the same rate in the
upper and lower portion of the eye. Consequently, a step like defect is frequently
created where the accurate defects meet at the median. This is called Ronne’s nasal
step and it is mostly a superior nasal step, as the superior field is involved more
frequently.
* Generalized constriction of peripheral field : Double arcuate scotoma leads to
tubular field of vision (tubular vision) in which only the central vision remains clear.
Lastly, only a paracentral temporal island of vision persists, central vision being
destroyed.
Ultimately, all the nerve fibres are eventually destroyed with no perception of light.
VALUE ADDED
To correctly identify different field effects.
To perfectly learn to draw and prepare charts for each eye separately Congenital
and hereditary.
Neuro fields
Congenital Field defects
Mylinated nerve fiber defect
Coloboma
Hypoplasia
Drusen
Optic nerve pits
Tilted disc
Mylinated nerve fiber
Blind spot enlargement
Paracecal scotoma
Ring scotoma
Central scotoma
Coloboma
Superior nasal depression
Contraction
Superior altitudinal hemianopia
Hypoplasia:
Central scotoma
Bi-nasal & Bi-temporal hemianopia
Bilateral inferior extension of blind spot
Drusen:
Blind spot enlargement
Irregular nerve fiber bundle scotoma
Optic nerve pits:
Blind spot enlargement with or without macula involvement.
Central scotoma
Altitudinal hemianopia
Upper temporal field defect
Tilted disc:
Upper temporal defect which may be mistaken for chiasmal compression
Hereditary Field defect
Optic atrophy (Lepers)
Contraction
Tubular Field
Retinitis Pigmentosa
Contraction
Ring scotoma
Tubular field
Traumatic
Traumatic optic neuropathy:
Superior altitudinal defect
Total blindness
Tumour
Glioma:
o Blind spot enlargement
o Contraction
o Tubular field
Meningioma:
o Junctional scotoma
o Central scotoma
o Upper temporal field defect
Inflammatory
Papillitis:
o Central scotoma
o Centro-cecal scotoma
o Para central scotoma
o Blind spot enlargement
Retro bulbar neuritis:
o Central scotoma
o Para central scotoma
o Sectoral scotoma
o Ring scotoma
Neuro retinitis:
o Central Scotoma
o Centro- cecal scotoma
Vascular lesions
Anterior Ischemic optic neuropathy:
o Altitudinal hemianopia ( mainly involving the inferior half)
Toxic
Mild Toxic :
o Central scotoma
o Centro- cecal scotoma (BE)
Severe Toxic :
o Peripheral contraction
o Total blindness
Field defects in various parts of the visual pathways
Optic Nerve : Blindness on side of lesion with normal Contralateral field.
Chiasm : Bi temporal hemianopia.
Optic tract : Contralateral incongruous homonymous hemianopia.
Optic Nerve and chiasamal junction : Blindness on side of lesion with
contralateral temporal hemianopia or hemianoptic scotoma.
Posterior optic tract, external geniculate ganglion, posterior limb of internal
capsule: Complete contralateral homonymous hemianopsia or incomplete
incongruous contralateral homonymous hemianopsia.
Optic Radiation: Anterior loop in temporal lobe, incongruous contralateral
homonymous hemianopia or superior quardantanopia.
Medulated fibers of optic radiation: Contralateral incongruous inferior
homonymous quardantanopia.
Optic radiation in parietal lobe : Contralateral homonymous hemianopia
sometimes slightly incongruous with minimal macular sparing.
Mid portion of calcarine cortex: Contralateral congruous homonymous
hemianopia with macular sparing and sparing of contralateral temporal crescent.
Tip of occipital lobe : Contralateral congruous homonymous hemianoptic
scotoma.
Anterior tip of calcarine fissure: Contralateral loss of temporal cresent with
otherwise normal visual fields.
VALUE ADDED
To correctly identify different field effects.
To perfectly learn to draw and prepare charts for each eye separately.
To draw the diagram for the first eye which is diagnosed and then measure the
second eye.
For example: Right homonymous hemianopia and left homonymous
hemianopia.
