VISUAL FIELD CHANGES IN GLAUCOMA by dr nanish.pptx

glaucoma visual field changes

1. VISUAL FIELD DEFECTS IN GLAUCOMA MODERATOR: DR.SMITHA.K.S DEPARTMENT OF OPHTHALMOLOGY PRESENTER: DR RAMYA.R 06-10-2025 Department of ophthalmology,JNMC 1

2. INTRODUCTION Visual Field- A part of the environment visible simultaneously to a steadily fixing eye Traquair (1930)- Hill of vision surrounded by sea of darkness 06-10-2025 Department of ophthalmology,JNMC 2

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4. NORMAL EXTENT OF VISUAL FIELD Superior 60º Nasal 60º Temporal 100º Inferior 70-75º 06-10-2025 Department of ophthalmology,JNMC 4

5. PERIMETRY Subjective examination method to assess visual field It is broadly classified into 1.Kinetic perimetry 2.Static perimetry 06-10-2025 Department of ophthalmology,JNMC 5

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7. IMPORTANCE OF PERIMETRY Glaucoma: Fundamental test and gold standard in diagnosis and management. Neurology: Functional test to asses the effect of neurological conditions related to optic pathway 06-10-2025 Department of ophthalmology,JNMC 7

8. Retinal diseases: As an ancillary test, as the stereo fundus examination holds the pride of place in retinal diagnosis. Visual disability assessment: Important part for the certification for drivers and navigators. 06-10-2025 Department of ophthalmology,JNMC 8

9. Scotoma - Localized defect or depression in visual field. Absolute scotoma - Field defect that persists when the maximum stimulus of testing apparatus is used. E.g. - Normal blind spot Relative scotoma - Field defect that is present to weaker stimuli but disappears when tested with brighter stimuli. 06-10-2025 Department of ophthalmology,JNMC 9

10. GLAUCOMATOUS DEFECTS Characteristics of glaucomatous fields:- Asymmetrical across horizontal midline. Reproducible Localized Not attributed to other pathology Located in mid-periphery ( 5 to 25º) from fixation. Correlating with Disc and NFL changes. 06-10-2025 Department of ophthalmology,JNMC 10

11. Earliest :- variability of responses Asymmetry of responses 2 . Generalized depression :- Earliest visual field defect Generalized constriction of the central as well as peripheral field Limited diagnostic value as it can occur in host of other conditions like lens opacity(MC), aging and miosis. 06-10-2025 Department of ophthalmology,JNMC 11

12. Enlargement /Baring of the blind spot :- Non- specific but can occur early. Baring of the blind spot means exclusion of the blind spot from the central field due to inward curve of the outer boundary of 30° central field 06-10-2025 Department of ophthalmology,JNMC 12

13. Paracentral scotoma :- Earliest clinically significant defect. Small , steep, MC in superonasally ( defect- infero -temp). May appear either below or above the blind spot in Bjerrum's area (an arcuate area extending above and below the blind spot to between 10º and 20º of fixation point) 06-10-2025 Department of ophthalmology,JNMC 13

14. Seidel’s scotoma :- With the passage of time paracentral scotoma joins the blind spot to form a sickle shaped scotoma known as Seidel’s scotoma 06-10-2025 Department of ophthalmology,JNMC 14

15. . Arcuate or Bjerrum’s scotoma :- It is formed at a later stage by the extension of Seidel’s scotoma in an area either above or below the fixation point to reach the horizontal raphe. 06-10-2025 Department of ophthalmology,JNMC 15

16. Ring or double arcuate scotoma :- It develops when the two arcuate scotomas join together 06-10-2025 Department of ophthalmology,JNMC 16

17. Nasal step of Ronne :- Asymmetric loss of nerve fibres bundles in the superior and inferior hemi fields. Horizontal step is more common than vertical step. 06-10-2025 Department of ophthalmology,JNMC 17

18. Altitudinal defect :- Arcuate defect may break into periphery nasally and may expand further to include the entire quadrant. 06-10-2025 Department of ophthalmology,JNMC 18

19. Temporal step or depression :- May develop as isolated finding or in conjugation with other glaucomatous defects. Due to damage to nasal side of the optic disc. Mainly in late stage . But are rare 06-10-2025 Department of ophthalmology,JNMC 19

20. .ADVANCED : Most of the axons at the superior and inferior poles of the disc are destroyed, leaving only the Papillomacular bundle and some nasal fibers. Characteristic end-stage field, with a small central island and a larger temporal crescent remaining . 06-10-2025 Department of ophthalmology,JNMC 20

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27. REFERNCES BECKER SHAFFER ’ S diagnosis and therapy of glaucoma SHIELD ’ S TEXTBOOK OF GLAUCOMA ATLAS OF VISUAL FIELD BY A.K.GUPTA PARSON ’ S DISEASE OF THE EYE KANSKI 06-10-2025 Department of ophthalmology,JNMC 27

28. THANK YOU 06-10-2025 Department of ophthalmology,JNMC 28