Currently, no standardized guidelines for assessing visual fields in neurological conditions exist. With the number of visual field programs available, an unsuitable choice could possibly fail to detect field loss. 

To aid the design of future research and clinical guidelines, researchers reported the results of a systematic review of the existing evidence base for the patterns of visual field loss in four common neurological conditions—idiopathic intracranial hypertension (IIH), optic neuropathy, chiasmal compression and stroke—and the perimetry programs used.

The review of 330 studies found that the 30-2 and 24-2 programs using the Humphrey perimeter were the most commonly reported, followed by manual kinetic perimetry using the Goldmann perimeter, across all four conditions included in this study. The team is wary, however. While central perimetry is used extensively in neurological conditions, there is little supporting evidence for its diagnostic accuracy in these cases, especially considering the peripheral visual field may be affected first whilst the central visual field may not be impacted until later in the progression.

Researchers observed that the patterns of visual field defects differ much more greatly across the four conditions. IIH patients manifested blind spot enlargement, constriction, nasal loss and arcuate defects. In optic neuropathy, altitudinal defects, arcuate defects, diffuse depression, central and cecocentral scotomas were most commonly reported. Chiasmal compression patients experienced bitemporal hemianopia, unilateral temporal hemiaopia and other temporal defects. Following a stroke, homonymous hemianopia and quadrantaopia were the most-reported defects.

The review concludes that a consensus on using perimetry for neurological conditions requires much more research.

Hepworth LR, Rowe FJ. Programme choice for perimetry in neurological conditions (PoPiN): a systematic review of perimetry options and patterns of visual field loss. BMC Ophthalmol. 2018;18:241.