Performing the Confrontational Visual Field Exam
Title: Performing the Confrontational Visual Field Exam
Author: Brian Kirk, 4th Year Medical Student, University of Utah School of Medicine
The visual field encompasses all that can be seen when fixated on a single point. This includes the central vision and the peripheral vision. There are several methods for measuring the visual field. Some common ways include using specialized instruments (i.e. Humphrey Visual Field Machine) that are capable of sensitive measurements that can detect small defects throughout the entire visual field. Another less sensitive but highly specific test is known as the confrontational visual field exam1. This is a simple and quick way to assess the peripheral vision of the patient without the use of expensive specialized equipment. It is useful as there are a variety of conditions that can affect the peripheral vision such as glaucoma, retinal detachment, stroke, vascular occlusions within the eye and certain brain tumors.
Performing the exam:
- Have the patient remove their hat or anything that could interfere with their peripheral vision.
- Sit approximately three to four feet away and directly in front of the patient. If possible, adjust your seat height until you are at eye level with the patient.
- Ask the patient to gently cover their left eye with their left hand and instruct the patient to fix their gaze directly on your left eye throughout the test.
- While the patient is focusing on your eye, close your right eye and maintain fixation on the patients open eye. Raise your hand to the inferior temporal edge of your peripheral vision halfway between yourself and the patient, while holding up 1, 2, or 5 fingers. Using only 1, 2, and 5 fingers helps to make the number more easily distinguished by the patient. Ask the patient how many fingers are seen.
- Repeat step 4, testing all four visual quadrants of the left eye: Inferior temporal, inferior nasal, superior temporal, and superior nasal.
- Repeat steps 3, 4, and 5 for the patient’s right eye.
- Johnson LN, Baloh FG. The accuracy of confrontation visual field test in comparison with automated perimetry J Natl Med Assoc. 1991 Oct; 83(10): 895–898. When compared to automated perimetry confrontational field testing was found to have an overall sensitivity of 50% and a specificity of 93.4% when examining 512 patients with both tests.