Abstract
PurposeTo determine if tangent visual fields gathered during assessment of superior visual field deficits caused by blepharoptosis and dermatochalasis offer good correlation to clinical exam in a time and cost efficient manner.MethodsProspective, observational case series. Subjects included all patients referred to a single surgeon (CCN) who underwent surgical correction of blepharoptosis and/or dermatochalasis. Preoperatively and postoperatively, upper margin-to-reflex distances were assessed. Tangent visual fields were performed in a timed fashion and analyzed for degrees of intact vision in the vertical meridian and degrees squared of area under the curve. Data were compared by Student t-tests and Pearson correlation coefficients.ResultsMean preoperative superior visual fields with the eyelid in the natural position measured 8° in the vertical meridian. Measurements in the vertical meridian and area under the curve showed excellent correlation (r = 0.87). Patients with ptosis showed strong correlation between margin-to-reflex distance and superior visual fields. Patients completed field testing faster than reported times for automated or Goldmann testing. Finally, tangent screens were the least expensive type of equipment to purchase.ConclusionsTangent visual fields are a rapid and inexpensive way to test for functional loss of superior visual field in patients with upper eyelid malposition. Our data revealed potential differences between tangent screen results and published results for automated or Goldmann visual field testing which warrants further studies.
Highlights
Tangent visual fields are a rapid and inexpensive way to test for functional loss of superior visual field in patients with upper eyelid malposition
Superior visual field testing is a common practice during the evaluation of blepharoptosis and dermatochalasis as it provides objective evidence of functional visual limitation
Many insurance providers require this type of evidence to authorize payment for surgical correction of upper eyelid malposition, categorizing the issue as “functional” rather than “cosmetic.” Medicare’s visual field testing requirements vary by region based on differences prescribed by local coverage determinations
Summary
Superior visual field testing is a common practice during the evaluation of blepharoptosis and dermatochalasis as it provides objective evidence of functional visual limitation. Many insurance providers require this type of evidence to authorize payment for surgical correction of upper eyelid malposition, categorizing the issue as “functional” rather than “cosmetic.” Medicare’s visual field testing requirements vary by region based on differences prescribed by local coverage determinations. ASOPRS (American Society of Ophthalmic Plastic and Reconstructive Surgeons) released a white paper offering guidelines for the evaluation and testing of patients with blepharoptosis and dermatochalasis.[2] Recommendations were offered to create more uniformity on the part of surgeons and insurers, with reliable, consistent, evidence-based information to support surgical planning. Eyelid malposition and field defects have been consistently correlated with decreased patient functioning and quality of life.[3,4,5, 11,12,13] most studies describing eyelid related decreases in superior visual fields have been performed by automated perimetry
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