Visual field losses in eye health

Visual field loss may occur due to disease or disorders of the eye, optic nerve, or brain. Classically, there are four types of visual field defects:

• Altitudinal field defects, loss of vision above or below the horizontal - associated with ocular abnormalities
• Bitemporal hemianopia, loss of vision at the sides (see below)
• Central scotoma, loss of central vision
• Homonymous hemianopia, loss at one side in both eyes - defect behind optic chiasm (see below)
• In humans, confrontational testing and other forms of perimetry are used to detect and measure visual field loss. Different neurological difficulties cause characteristic forms of visual disturbances, including hemianopsias (shown below without macular sparing), quadrantanopsia, and others.

It is also important to note that it also matters whether you avert right or left. The most effective direction is that which places the object on the nasal side of the vision. So, for right-eyed observers it is best to shift to the right, and for left-eye observers it is best to shift to the left. Some people also claim that it is better to avert up instead of down. The best thing to do is practice and find the best location for one's own eyes.

The normal human visual field extends to approximately 60 degrees nasally (toward the nose, or inward) in each eye, to 100 degrees temporally (away from the nose, or outwards), and approximately 60 degrees above and 75 below the horizontal meridian. In the United Kingdom, the minimum field requirement for driving is 60 degrees either side of the vertical meridian, and 20 degrees above and below horizontal. The macula corresponds to the central 13 degrees of the visual field; the fovea to the central 3 degrees.

The visual field is measured by perimetry. This may be kinetic, where points of light are moved inwards until the observer sees them, or static, where points of light are flashed onto a white screen and the observer is asked to press a button if he or she sees it. The most common perimeter used is the automated Humphrey Field Analyzer.

Patterns testing the central 24 degrees or 30 degrees of the visual field, are most commonly used. Most perimeters are also capable of testing the full field of vision. In the United Kingdom, the minimum field requirement for driving is 60 degrees either side of the vertical meridian, and 20 degrees above and below horizontal. The macula corresponds to the central 13 degrees of the visual field; the fovea to the central 3 degrees.