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Understanding Visual Field Defects

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0% found this document useful (0 votes)

21 views172 pages

Understanding Visual Field Defects

Uploaded by

Jasmine Nguyen

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as PPTX, PDF, TXT or read online on Scribd

1

Visual Field Defects

? ?
Here is a representation of the VF for each eye. Which is OD, and which OS?
2

Visual Field Defects

OS OD
Here is a representation of the VF for each eye. Which is OD, and which OS?
Remember, VFs are not drawn as if the pt is looking at you; they’re drawn as
if you are the pt!
3

Visual Field Defects

? ?

? ? ? ?

? ?

OS OD
Measured in degrees from fixation, how far does the normal VF extend
superiorly, inferiorly, nasally and temporally?
4

most anterior
Retina
location

Anatomic locations for

lesions producing VF defects
10

Visual Field Defects

Retina

Optic nerve
next location

Anatomic locations for

lesions producing VF defects
11

Visual Field Defects

Retina

Optic nerve

Anatomic locations for

lesions producing VF defects

Optic
next chiasm
location
12

Visual Field Defects

Retina

Optic nerve

Anatomic locations for

lesions producing VF defects

Optic chiasm

general term for all locations

posterior to the previous one
13

Visual Field Defects

Retina

Optic nerve

Clinically obvious dz
Retina Clinically subtle dz
What is meant by clinically obvious vs clinically subtle retinal dz?
In clinically obvious disease, the retina will appear abnormal on
Optic nerve DFE, whereas in clinically subtle disease it will look normal

Optic chiasm

Retrochiasmal
18

Visual Field Defects

Clinically obvious dz (eg…?)

Retina Clinically subtle dz
What is meant by clinically obvious vs clinically subtle retinal dz?
In clinically obvious disease, the retina will appear abnormal on
Optic nerve DFE, whereas in clinically subtle disease it will look normal

What is an example of…

…clinically obvious disease?

Optic chiasm

Retrochiasmal
19

Visual Field Defects

Clinically obvious dz (eg…RP)

What is an example of…

…clinically obvious disease? ‘Typical’ retinitis pigmentosa

Optic chiasm

Retrochiasmal
20

Visual Field Defects

Clinically obvious dz (eg…RP)

Retina Clinically subtle dz (eg…?)
What is meant by clinically obvious vs clinically subtle retinal dz?
In clinically obvious disease, the retina will appear abnormal on
Optic nerve DFE, whereas in clinically subtle disease it will look normal

What is an example of…

…clinically obvious disease? ‘Typical’ retinitis pigmentosa
---clinically subtle disease?

Optic chiasm

Retrochiasmal
21

Visual Field Defects

Do they synapse in the region of the optic nerve head?

Optic chiasm

Retrochiasmal
39

Clinically obvious dz
Retina Clinically subtle dz
Nasal step
Depressions Altitudinal
Temporal wedge
Optic nerve
Scotomas
Superior nasal step

Optic chiasm

Inferior nasal step

Retrochiasmal
43

Visual Field Defects

Clinically obvious dz
Retina Clinically subtle dz
Nasal step
Depressions Altitudinal
Temporal wedge
Optic nerve
Scotomas
Superior altitudinal

Optic chiasm

Another way to think about theClinically

Papillomacular bundle
Optic nerve Arcuate fibers
Nasal radiating fibers
head

Optic chiasm The basic topography

of the RNFL looks a
lot like a fish!

Retrochiasmal
59

Visual Field Defects

Clinically obvious dz
Retina
Which of these VF defects aresubtle
Clinically associated
dz with damage to each group?
Nasal step
Papillomacular bundle Altitudinal
Temporal wedge ?
Optic nerve Arcuate fibers Arcuate

head Nasal radiating fibers Central

Ceco-central ?

Optic chiasm

Retrochiasmal
60

Visual Field Defects

Optic chiasm

Retrochiasmal
61

Visual Field Defects

Toxins that shouldn’t be ingested at all:
--Methanol
--Ethylene glycol
--Lead (in children)
--(many others)
Clinically
Toxins that shouldn’t be ingested obvious
in large dz
quantities

Retina
for prolonged periods:
Which of these VF defects
--Ethanol
aresubtle
Clinically associated
dz with damage to each group?
--Tobacco Nasal step
Toxins you were told to ingest by a doc:
--Amiodarone
Papillomacular bundle Altitudinal
Temporal wedge
Optic nerve
--Ethambutol
--Isoniazid
Arcuate fibers Arcuate
Nasal radiating fibers
head --Linezolid
--(many others)
Central
Ceco-central
Nutrients that weren’t ingested in sufficient quantity:
--
--
--
Optic chiasm
Inherited mitochondrial diseases:
--
Which
-- sorts of optic neuropathy are implicated if a P-M bundle VF defect is present?
Conditions involving compromised cellular metabolism: Think toxic/metabolic,
nutritional deficiencies, inherited mitochondrial dz, etc

Visual Field Defects

Toxins that shouldn’t be ingested at all:
--Methanol
--Ethylene glycol
--Lead (in children)
--(many others)
Clinically
Toxins that shouldn’t be ingested obvious
in large dz
quantities

Retina
for prolonged periods:
Which of these VF defects
--Ethanol Clinicallyaresubtle
associated
dz with damage to each group?
--Tobacco Nasal step
Toxins you were told to ingest by a doc:
--Amiodarone
Papillomacular bundle Altitudinal
Temporal wedge
Optic nerve
--Ethambutol
--Isoniazid
Arcuate fibers Arcuate
Nasal radiating fibers
head --Linezolid
--(many others)
Central
Ceco-central
Nutrients that weren’t ingested in sufficient quantity:
--
--
--
Optic chiasm
Inherited mitochondrial diseases:
--
Which
-- sorts of optic neuropathy are implicated if a P-M bundle VF defect is present?
Conditions involving compromised cellular metabolism: Think toxic/metabolic,
nutritional deficiencies, inherited mitochondrial dz, etc

Visual Field Defects

Toxins that shouldn’t be ingested at all:
--Methanol
--Ethylene glycol
--Lead (in children)
--(many others)
Clinically
Toxins that shouldn’t be ingested obvious
in large dz
quantities

Optic chiasm
--Thiamine
Inherited mitochondrial diseases:
--
Which
-- sorts of optic neuropathy are implicated if a P-M bundle VF defect is present?
Conditions involving compromised cellular metabolism: Think toxic/metabolic,
nutritional deficiencies, inherited mitochondrial dz, etc

Visual Field Defects

Toxins that shouldn’t be ingested at all:
--Methanol
--Ethylene glycol
--Lead (in children)
--(many others)
Clinically
Toxins that shouldn’t be ingested obvious
in large dz
quantities

Visual Field Defects

Toxins that shouldn’t be ingested at all:
--Methanol
--Ethylene glycol
--Lead (in children)
--(many others)
Clinically
Toxins that shouldn’t be ingested obvious
in large dz
quantities

Optic chiasm
--Thiamine
Inherited mitochondrial diseases:
--Leber’s hereditary optic neuropathy
Which sorts of optic
--Autosomal neuropathy
dominant are implicated if a P-M bundle VF defect is present?
optic atrophy
Conditions involving compromised cellular metabolism: Think toxic/metabolic,
nutritional deficiencies, inherited mitochondrial dz, etc

Visual Field Defects

Optic chiasm
Which sorts of optic neuropathy are implicated if a P-M bundle VF defect is present?
Conditions involving compromised cellular metabolism: Think toxic/metabolic,
nutritional
In additiondeficiencies, inherited mitochondrial
to central/ceco-central dz, etc
VF defects, what other aspects of visual function
are invariably degraded by pathology affecting the P-M bundle?
Retrochiasmal
Why
-- do conditions affecting metabolism preferentially affect the P-M bundle?
Because
-- the P-M fibers are small, unmyelinated, and extremely active metabolically.
Taken together, these characteristics make them more vulnerable than the rest of
the optic nerve to factors that adversely impact metabolism.
76

what condition should you consider first?
Glaucoma
Retrochiasmal
Why does glaucoma preferentially damage arcuate fibers?
It’s unclear at this time
84
Compare the distribution of arcuate-fiber defects with those associated with a P-M bundle dysfunction.
Visual Field Defects
What important difference do you see?
Unlike P-M defects, arcuate fiber bundle defects do not cross (ie, they ‘respect’) the horizontal midline

Why not?
Because fibers on the temporal side of the ONH approach, but do not cross, the horizontal midline. The
arcuate fibers arc around the P-M bundle, and meet along a horizontal demarcation line. Thus, damage
Clinically
to these fibers always result in VF defects obvious
that are limited dz the superior or the inferior portion of
to either
Retina
the field.
Which of these VF defects aresubtle
Clinically associated
dz with damage to each group?
What is this ‘horizontal demarcation line’ called? Nasal step
The horizontal raphe
Papillomacular bundle Altitudinal
Temporal wedge
Optic nerve Arcuate fibers Arcuate
Nasal radiating fibers
head Central
Ceco-central

Optic chiasm

Retrochiasmal
85
Compare the distribution of arcuate-fiber defects with those associated with a P-M bundle dysfunction.
Visual Field Defects
What important difference do you see?
Unlike P-M defects, arcuate fiber bundle defects do not cross (ie, they ‘respect’) the horizontal midline

Optic chiasm

Retrochiasmal
86
Compare the distribution of arcuate-fiber defects with those associated with a P-M bundle dysfunction.
Visual Field Defects
What important difference do you see?
Unlike P-M defects, arcuate fiber bundle defects do not cross (ie, they ‘respect’) the horizontal midline

Optic chiasm

Retrochiasmal
87
Compare the distribution of arcuate-fiber defects with those associated with a P-M bundle dysfunction.
Visual Field Defects
What important difference do you see?
Unlike P-M defects, arcuate fiber bundle defects do not cross (ie, they ‘respect’) the horizontal midline

Why not?
Because fibers on the temporal side of the ONH approach, but do not cross, the horizontal midline. The
arcuate fibers arc around the P-M bundle, and meet along a horizontal demarcation line. Thus,
Clinically
damage to these fibers always result in VF obvious
defects that dz to either the superior or the inferior
are limited
Retina
portion of the field.
Which of these VF defects aresubtle
Clinically associated
dz with damage to each group?
What is this ‘horizontal demarcation line’ called? Nasal step
The horizontal raphe
Papillomacular bundle Altitudinal
Temporal wedge
Optic nerve Arcuate fibers Arcuate
Nasal radiating fibers
head Central
Ceco-central

Optic chiasm

Retrochiasmal
88
Compare the distribution of arcuate-fiber defects with those associated with a P-M bundle dysfunction.
Visual Field Defects
What important difference do you see?
Unlike P-M defects, arcuate fiber bundle defects do not cross (ie, they ‘respect’) the horizontal midline

Optic chiasm

Retrochiasmal
89
Compare the distribution of arcuate-fiber defects with those associated with a P-M bundle dysfunction.
Visual Field Defects
What important difference do you see?
Unlike P-M defects, arcuate fiber bundle defects do not cross (ie, they ‘respect’) the horizontal midline

Why not?
Because fibers on the temporal side of the ONH approach, but do not cross, the horizontal midline. The
arcuate fibers arc around the P-M bundle, and meet along a horizontal demarcation line. Thus, damage
Clinically
to these fibers always result in VF defects obvious
that are limited dz the superior or the inferior portion of
to either
Retina
the field.
Which of these VF defects aresubtle
Clinically associated
dz with damage to each group?
What is this horizontal demarcation line called? Nasal step
The horizontal raphe
Papillomacular bundle Altitudinal
Temporal wedge
Optic nerve Arcuate fibers Arcuate
Nasal radiating fibers
head Central
Ceco-central

Optic chiasm
?

Retrochiasmal
90
Compare the distribution of arcuate-fiber defects with those associated with a P-M bundle dysfunction.
Visual Field Defects
What important difference do you see?
Unlike P-M defects, arcuate fiber bundle defects do not cross (ie, they ‘respect’) the horizontal midline

Why not?
Because fibers on the temporal side of the ONH approach, but do not cross, the horizontal midline. The
arcuate fibers arc around the P-M bundle, and meet along a horizontal demarcation line. Thus, damage
Clinically
to these fibers always result in VF defects obvious
that are limited dz the superior or the inferior portion of
to either
Retina
the field.
Which of these VF defects aresubtle
Clinically associated
dz with damage to each group?
What is this horizontal demarcation line called? Nasal step
The horizontal raphe
Papillomacular bundle Altitudinal
Temporal wedge
Optic nerve Arcuate fibers Arcuate
Nasal radiating fibers
head Central
Ceco-central

Optic tract
LGN
Retrochiasmal Optic radiations
Occipital cortex
105

Visual Field Defects

Optic chiasm
Binasal hemianopia
Junctional common
?
exceptions, will
not cross the
vertical meridian
Junctional rare

Optic tract With few

Retrochiasmal LGN
Optic radiations
?
exceptions, must
be homonymous
hemianopia-like

Occipital cortex
110

Visual Field Defects

VF defect

Clinically obvious dz Anything except

Optic tract With few

Retrochiasmal LGN
Optic radiations
?
exceptions, must
be homonymous
hemianopia-like

Occipital cortex
111

Visual Field Defects

VF defect

Clinically obvious dz Anything except

Retrochiasmal LGN
Optic radiations
?
exceptions, must
be homonymous
hemianopia-like

Occipital cortex
112

Visual Field Defects

VF defect

Clinically obvious dz Anything except

Optic tract With few

exceptions,
LGN must be
Retrochiasmal Optic radiations
homonymous
hemianopia-like

Occipital cortex
113

Visual Field Defects

Clinically obvious dz
Retina Clinically subtle dz
Nasal step
Depressions Altitudinal
Temporal wedge
Optic nerve Arcuate
Scotomas Central
Ceco-central

Bitemporal hemianopia
Binasal hemianopia
Optic chiasm Junctional common
In basic terms, what is the difference between chiasmal
Junctional rare in a bitemporal VF defect vs those
lesions resulting
producing a binasal defect?
Optic tract defects are the result of a lesion impacting
Bitemporal
LGNthe central portion of the chiasm, whereas binasal
Retrochiasmal defects stem from lesions affecting the lateral portions
Optic radiations
of the chiasm
Occipital cortex
114

Visual Field Defects

Clinically obvious dz
Retina Clinically subtle dz
Nasal step
Depressions Altitudinal
Temporal wedge
Optic nerve Arcuate
Scotomas Central
Ceco-central

Bitemporal hemianopia: Central aspect of chiasm

Binasal hemianopia: Lateral portions of chiasm
Optic chiasm Junctional common
In basic terms, what is the difference between chiasmal
Junctional rare in a bitemporal VF defect vs those
lesions resulting
producing a binasal defect?
Optic tract defects are the result of a lesion impacting
Bitemporal
LGNthe central portion of the chiasm, whereas binasal
Retrochiasmal defects stem from lesions affecting the lateral portions
Optic radiations
of the chiasm
Occipital cortex
115

Here’s why:

Bitemporal hemianopia: Central aspect of chiasm

Binasal hemianopia: Lateral portions of chiasm
In basic terms, what is the difference between chiasmal
lesions resulting in a bitemporal VF defect vs those
producing a binasal defect?

Bitemporal defects are the result of a lesion impacting

the central portion of the chiasm, whereas binasal
defects stem from lesions affecting the lateral portions
of the chiasm
116

Temporal VF Temporal VF
The nasal retinas are responsible
for the temporal visual fields.

Here’s why:

Bitemporal hemianopia: Central aspect of chiasm

Binasal hemianopia: Lateral portions of chiasm
In basic terms, what is the difference between chiasmal
lesions resulting in a bitemporal VF defect vs those
producing a binasal defect?

Bitemporal defects are the result of a lesion impacting

the central portion of the chiasm, whereas binasal
defects stem from lesions affecting the lateral portions
of the chiasm
117

Temporal VF Temporal VF
The nasal retinas are responsible
for the temporal visual fields.

Here’s why:

Optic
Bitemporal hemianopia: Central aspect of chiasm
Binasal hemianopia: Lateral portions of chiasm
Chiasm
In basic terms, what is the difference between chiasmal
lesions resulting in a bitemporal VF defect vs those
producing a binasal defect?
Fibers originating Bitemporal defects are the result of a lesion impacting
in the nasal retinas the central portion of the chiasm, whereas binasal
cross at the chiasm. defects stem from lesions affecting the lateral portions
of the chiasm
118

Temporal VF Temporal VF
The nasal retinas are responsible
for the temporal visual fields.

Here’s why:
So a lesion of the central chiasm will bag
these fibers, and thus tend to cause
bitemporal defects

The temporal retinas are responsible

for the nasal visual fields.

Nasal VF Nasal VF

Here’s why:

Bitemporal hemianopia: Central aspect of chiasm

Binasal hemianopia: Lateral portions of chiasm
In basic terms, what is the difference between chiasmal
lesions resulting in a bitemporal VF defect vs those
producing a binasal defect?

Bitemporal defects are the result of a lesion impacting

the central portion of the chiasm, whereas binasal
defects stem from lesions affecting the lateral portions
of the chiasm
120

The temporal retinas are responsible

for the nasal visual fields.

Nasal VF Nasal VF

Here’s why:

Optic
Bitemporal hemianopia: Central aspect of chiasm
Binasal hemianopia: Lateral portions of chiasm
Chiasm
In basic terms, what is the difference between chiasmal
lesions resulting in a bitemporal VF defect vs those
producing a binasal defect?
Fibers originating Bitemporal defects are the result of a lesion impacting
in the temporal the central portion of the chiasm, whereas binasal
retinas do not cross defects stem from lesions affecting the lateral portions
of the chiasm
at the chiasm.
121

The temporal retinas are responsible

for the nasal visual fields.

Nasal VF Nasal VF

Here’s why:
So lesions of the central chiasm will miss
these fibers… lesions of the lateral
chiasm will bag them, thereby causing
binasal defects (note that two lesions are
required
Bitemporal to do this)Central aspect of chiasm
hemianopia:
Optic
Binasal hemianopia: Lateral portions of chiasm
Chiasm
In basic terms, what is the difference between chiasmal
lesions resulting in a bitemporal VF defect vs those
producing a binasal defect?
Fibers originating Bitemporal defects are the result of a lesion impacting
in the temporal the central portion of the chiasm, whereas binasal
retinas do not cross defects stem from lesions affecting the lateral portions
of the chiasm
at the chiasm.
122

The temporal retinas are responsible

for the nasal visual fields.

Nasal VF Nasal VF

Here’s why:
So lesions of the central chiasm will miss
these fibers…But lesions of the lateral
chiasm will bag them, thereby causing
binasal defects (note that two lesions are
required
Bitemporal to do this)Central aspect of chiasm
hemianopia:
Optic
Binasal hemianopia: Lateral portions of chiasm
Chiasm
In basic terms, what is the difference between chiasmal
lesions resulting in a bitemporal VF defect vs those
producing a binasal defect?
Fibers originating Bitemporal defects are the result of a lesion impacting
in the temporal the central portion of the chiasm, whereas binasal
retinas do not cross defects stem from lesions affecting the lateral portions
of the chiasm
at the chiasm.
123

The temporal retinas are responsible

for the nasal visual fields.
What structures are located at the lateral
Nasal VF Nasal VF
aspects of the chiasm?
The internal carotid arteries

? ? Binasal hemianopia: Lateral portions of chiasm

Chiasm
In basic terms, what is the difference between chiasmal
lesions resulting in a bitemporal VF defect vs those
producing a binasal defect?
Fibers originating Bitemporal defects are the result of a lesion impacting
in the temporal the central portion of the chiasm, whereas binasal
retinas do not cross defects stem from lesions affecting the lateral portions
of the chiasm
at the chiasm.
124

The temporal retinas are responsible

for the nasal visual fields.
What structures are located at the lateral
Nasal VF Nasal VF
aspects of the chiasm?
The internal carotid arteries

Visual Field Defects

What is the classic cause of a bitemporal hemianopia?

Pituitary adenoma
Clinically obvious dz
Retina Is the hemianopia usually inferior, superior or complete?
Clinically subtle dz
Superior
Nasal step
Why usually superior?
Depressions
The pituitary gland
Altitudinal
is belowwedge
the chiasm, therefore, pituitary
Temporal
Optic nerve lesions affect the inferior chiasmal fibers primarily. These
fibers account forArcuate
the superior VF.
Scotomas Central
Ceco-central
Is it usually congruous or incongruous?
Incongruous

What is the classic cause of a bitemporal hemianopia?

Pituitary adenoma
Clinically obvious dz
Retina Is the hemianopia usually inferior, superior or complete?
Clinically subtle dz
Superior
Nasal step
Why usually superior?
Depressions
The pituitary gland
Altitudinal
is belowwedge
the chiasm, therefore, pituitary
Temporal
Optic nerve lesions affect the inferior chiasmal fibers primarily. These
fibers account forArcuate
the superior visual field.
Scotomas Central
Ceco-central
Is it usually congruous or incongruous?
Incongruous

Bitemporal hemianopia
Binasal hemianopia
Optic chiasm Junctional common
Junctional rare

Optic tract
LGN
Retrochiasmal Optic radiations
Occipital cortex
132

Visual Field Defects

What is the classic cause of a bitemporal hemianopia?

Pituitary adenoma
Clinically obvious dz
Retina Is the hemianopia usually inferior, superior or complete?
Clinically subtle dz
Superior
Nasal step
Why usually superior?
Depressions
The pituitary gland
Altitudinal
is belowwedge
the chiasm, therefore, pituitary
Temporal
Optic nerve lesions affect the inferior chiasmal fibers primarily. These
fibers account forArcuate
the superior visual field.
Scotomas Central
Ceco-central
Is it usually congruous or incongruous?
Incongruous

Bitemporal hemianopia
Binasal hemianopia
Optic chiasm Junctional common
Junctional rare

Optic tract
LGN
Retrochiasmal Optic radiations
Occipital cortex
133

Visual Field Defects

Clinically obvious dz
Retina Clinically subtle dz
Nasal step
Depressions Altitudinal
Temporal wedge
Optic nerve Arcuate
Scotomas Central
Ceco-central

Bitemporal hemianopia
Binasal hemianopia
Optic chiasm Junctional common
What is the classic cause of a chiasmal
Junctional rarebinasal hemianopia?
Bilateral carotid disease

What is the actual etiology

Opticfor tract
the vast majority of real-world binasal defects?
Glaucoma
LGN
Retrochiasmal Optic radiations
Occipital cortex
134

Visual Field Defects

OD OS

Clinically obvious dz
Retina
Optic
Clinically subtle dz
Nasal step
Depressions Altitudinal
Chiasm Temporal wedge
Optic nerve Arcuate
Scotomas Central
Ceco-central

Clinically obvious dz
Retina Clinically subtle dz
Nasal step
Depressions Altitudinal
Temporal wedge
Optic nerve Arcuate
Scotomas Central
Ceco-central

An elderly vasculopath presents c/o things ‘sneaking up obvious
on her fromdzthe left.’ You check her CVFs—they’re
a vertical
Retina
fine. You get a 24-2—WNL OU. You send her on her way with reassurances that everything’s fine.
Clinically subtle dz
weeks later she’s on your schedule again with the same complaint. Just to be sure you repeat thechance)
meridian
Two cut
(unless by pure
VF, but
with the rarely-used 30-2 protocol—again, WNL. Reassure, discharge. Back
Nasal stepthe next week. Sigh. This
visit, for the first time in your career, you orderDepressions
the never-used 60-2 Altitudinal
protocol—again, nothing. YOU’RE
FINE, YOU CRAZY OLD BAT! you yell at her. (Not really.) To placate her, youwedge
Temporal refer her to a neuro-oph,
Anything except
Optic nerve
who… Sends you a consult note detailing both her VF loss and theArcuate location of the CNS changesa(dx: vertical
meridian cut
ischemic CVA) that produced it. What did you
Forget miss?
Scotomas
all of these specificCentral
VF findings (unless by pure
You missed a classic case of loss of the fortemporal crescent . The
just a minute…In the temporal visual field of the eye chance)
Ceco-central
most general ipsilateral
to the field in question extends much farther (~ 100
of terms,
o
what ) than
candoes the contribution
we say about VF from the fellow eye (~
60 ). Thus, there is a roughly 40 crescent
o o
in theassociated
defects ipsilateral eye that
with has noin
lesions corresponding contribution
from the fellow eye—it is hemianopia-like, each but
ofnot homonymous.
Bitemporal
these No commercially-available automated VF
hemianopia
locations?
analyzer is capable of detecting a temporal crescent; the only technology that can is Goldmann With few
Binasal are hemianopia
exceptions, will
Optic chiasm
perimetry. Lesions of the anterior occipital cortex responsible for this finding.
Junctional common
not cross the
vertical meridian
Junctional rare

Optic
Let’s tractone of these exceptions now
address With few
exceptions,
LGN must be
Retrochiasmal Optic radiations
homonymous
hemianopia-like

Occipital cortex
153

Visual Field Defects

Optic
Let’s tractone of these exceptions now
address With few
exceptions,
LGN must be
Retrochiasmal Optic radiations
homonymous
hemianopia-like

Occipital cortex
158

Visual Field Defects

Images showcasing the location of a lesion producing Temporal Crescent Syndrome

159

 Whichof the following is not associated with

bitemporal visual-field loss?
 Sectoral RP
 Glaucoma
 Fuchs coloboma
 Chiasmal lesion
 Toxic/hereditary/nutritional optic neuropathy
160

Q/A
 Which of the following is not associated with bitemporal visual-field loss?
 Sectoral RP
 Glaucoma
 Fuchs coloboma
 Chiasmal lesion
 Toxic/hereditary/nutritional optic neuropathy

 Glaucoma. Hemianopic (= respects the vertical midline) bitemporal VF

loss is associated exclusively with lesions compressing the chiasm,
specifically the mid-chiasm .
mid- vs lateral chiasm
161