University of Edinburgh

Understanding Visual Fields

Presented on Friday 2 November 2007

Fields to Confrontation

Dr Jennifer Skillen Specialist Orthoptist,
Dr Andrew Blaikie, Consultant Ophthalmologist
Queen Margaret Hospital, Dunfermline/ Victoria Hospital, Kirkcaldy

Simple binocular technique: Confrontational

Directly opposite patient with eyes at same level, about 1-2 metres apart

Use face or two hands as target.


Simple binocular technique: Face

  • Move close to patient <50 cm
  • Ask patient to fix on your nose
  • 'Can you see all of my face?'
  • 'Is any bit missing or blurred?'

Simple binocular technique: Palms of hands

Hold up the palms of both hands or two red targets either side of the midline subtending about 90 degrees in total.

  • 'How many hands do you see?'
  • 'Do both hands appear the same?'
  • 'Are both red targets the same?'

Keeping both hands help up alternatively waggle the fingers of either hand then simultaneously to test for neglect, asking the patient which hand is moving.

Confrontation Setup

  • Sit opposite the patient about 1-2m apart with eyes level
  • Ensure background blank and evenly lit with no windows or lights

confrontation setup

  • Ask the patient to cover their left eye with the palm of their hand
  • The may ve a hemiplegia so have a sticky occluder handy
  • Ask the patient to fix on your open right eye and shut your left eye
  • Confirm they can see the target by holding it up in the midline


Counting Fingers

Based on your initial findings confirm the signs and diagnosis.

  • Explain to the patient that you wish them to fixate only on your open eye
  • You are going to hold up fingers and you want them to tell you how many you are holding up (without losing fixation on your open eye)
  • You can confirm if the are losing fixation because you are looking streight into their open eye.

Counting Fingers

Based on your initial findings confirm the signs and diagnosis.

  • Hold up 1 or 2 fingers in the 4 quadrants
  • Ensure your hand is perpendicular to the patient's visual axis and that you are presenting halfway between yourself and the patient
  • Place your hand in a quadrant you think they can see about 45 degrees from fixation
  • Then present the fingers (static test)
  • Repeat this for the other eye.

Think Quadrants


Don't examine near the meridia

It gets confusing

near the meridia

near the meridia

Beware in nasal Quadrants: Field not as big

near the nasal quadrant

nasal quadrants

Think Perpendicular


Fingers perpendicular to patient's line of sight


Try to subtend about 45 degrees


What about central?

Amsler chart - central field defects

amsler chart