VISUAL FIELD DETERMINATION

In the emergency room, visual field testing in an awake and fully cooperative patient can be more revealing than measuring visual acuity. There are three parts to the visual field assessment.

The first, central visual field, evaluates overall central retinal (or macular) function. There are several formal testing mechanisms, such as the Amsler grid. A simplified test is to stand roughly 2 feet from the patient, cover one of the patient's eyes, ask the patient to focus on your nose, and while doing so, the patient should be able to see all the features of your face, including your ears, without any dark or blurry spots. Repeat this test for the patient's second eye. Secondly, to assess peripheral visual field, position yourself 2 to 3 feet in front of the patient with both of you covering mirror eyes (if the patient covers the left eye, you should cover your right eye). Then, with your contralateral hand equidistant between your two heads, bring a wiggling finger in from the far periphery. Have the patient say when the moving finger is first visible. You and the patient should see the finger at approximately the same time. This assumes that you don't have any peripheral vision problems. The third part of visual field analysis, double simultaneous confrontation, more properly belongs as part of a complex neurologic evaluation.