The effect of ocular dominance on visual field testing.

Abstract

During standard automated perimetry (SAP), some patients experience visual disturbances in the tested eye while the other eye is covered with an opaque occluder. It is possible that a binocular interaction producing an inhibitory response in the nonoccluded eye, such as rivalry or Ganzfeld blankout, may be the causative factor, particularly when the dominant eye is occluded. The objective of this experiment was to determine whether subjective visual disturbances occurring during conventional perimetric test conditions were related to ocular dominance and to investigate the effect of these disturbances on measurements made during threshold visual field analysis. Ocular dominance was determined by questioning and objective testing on 55 normal subjects. Each subject underwent program 24-2 Full Threshold SAP on a Humphrey Field Analyzer, and an opaque black patch was used to occlude the nontested eye. After testing, patients were asked to report symptoms of visual disturbance characteristic of rivalry or blankout, and the relationship between ocular dominance and visual disturbances was investigated. To determine whether symptoms of rivalry or blankout had affected visual field quantification, comparisons of short-term fluctuation, mean deviation, and false-negative errors were performed between eyes with and without visual disturbances. A total of 24 of 55 subjects reported visual disturbances consistent with rivalry or blankout (44%). Sixteen subjects complained of the phenomenon in one eye, and eight complained of the phenomenon in both eyes. Of the 16 experiencing disturbances in one eye only, nine cases occurred during occlusion of the dominant eye. The association between ocular dominance and visual disturbances was not found to be significant (p > 0.10). No significant differences in short-term fluctuation (p = 0.78), mean deviation (p = 0.64), or false-negative errors (p = 0.10) were found between eyes with and without visual disturbances. Patients undergoing standard automated perimetry with opaque patch occlusion of the nontested eye often experience visual disturbances consistent with rivalry or blankout, although these disturbances do not cause increased within-test variability or reduced sensitivity as quantified by visual field global indices. In terms of summary visual field indices, ocular dominance does not appear to affect visual field test results.