Abstract
BackgroundVisual field loss occurs frequently in neurological conditions and perimetry is commonly requested for patients with suspected or known conditions. There are currently no guidelines for how visual fields in neurological conditions should be assessed. There is a wide range of visual field programs available and the wrong choice of program can potentially fail to detect visual field loss. We report the results of a systematic review of the existing evidence base for the patterns of visual field loss in four common neurological conditions and the perimetry programs used, to aid the design of future research and clinical practice guidelines.MethodsA systematic search of the literature was performed. The inclusion criteria required studies testing and/or reporting visual field loss in one or more of the target conditions; idiopathic intracranial hypertension, optic neuropathy, chiasmal compression and stroke. Scholarly online databases and registers were searched. In addition articles were hand searched. MESH terms and alternatives in relation to the four target conditions and visual fields were used. Study selection was performed by two authors independently. Data was extracted by one author and verified by a second.ResultsThis review included 330 studies; 51 in relation to idiopathic intracranial hypertension, 144 in relation to optic neuropathy, 105 in relation to chiasmal compression, 21 in relation to stroke and 10 in relation to a mixed neuro-ophthalmology population.ConclusionsBoth the 30–2 and 24–2 program using the Humphrey perimeter were most commonly reported followed by manual kinetic perimetry using the Goldmann perimeter across all four conditions included in this review. A wide variety of other perimeters and programs were reported. The patterns of visual field defects differ much more greatly across the four conditions. Central perimetry is used extensively in neurological conditions but with little supporting evidence for its diagnostic accuracy in these, especially considering the peripheral visual field may be affected first whilst the central visual field may not be impacted until later in the progression. Further research is required to reach a consensus on how best to standardise perimetry for neurological conditions.
Highlights
Visual field loss occurs frequently in neurological conditions and perimetry is commonly requested for patients with suspected or known conditions
Fifty-one of the studies reported on intracranial hypertension (IIH), 144 studies reported on optic neuropathy, 105 studies reported on chiasmal compression, 21 studies reported on stroke and 10 studies reported on a mixed neuro-ophthalmology population
For the purposes of identifying perimetry programs, papers which were clearly associated with the same study i.e. Idiopathic Intracranial Hypertension Treatment Trial (IIHTT)[23–27] and Optic Neuritis Treatment Trial (ONTT)[19, 28–40], the study was counted once as the same protocol applied to all papers
Summary
Visual field loss occurs frequently in neurological conditions and perimetry is commonly requested for patients with suspected or known conditions. There are currently no guidelines for how visual fields in neurological conditions should be assessed. We report the results of a systematic review of the existing evidence base for the patterns of visual field loss in four common neurological conditions and the perimetry programs used, to aid the design of future research and clinical practice guidelines. Perimetry programs can be chosen to measure the central or peripheral visual field, or both [1]. Assessment of the central visual field tends to show the majority of visual field loss caused by common ophthalmic disease/ conditions. Peripheral visual field assessment is indicated where pathology is known to affect the visual field outside the central 30 degrees
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