Visual Fields

[Allibaby78]

A bit confusing...

[MPH272]

"fantastic"

[trin0345]

@secretgeekyaccount Most commonly: Neurosurgeons, Neurologists, Neuro-ophthalmologists, and us Ophthalmologists.

[mybabyandme08]

nice vid



[a7medmohamedbadawy89]

there are some books state that the examiner must cover his eye opposite to patient closed eye?idonot know why we do this ?what for?

[trin0345]

@a7medmohamedbadawy89 You have 2 options:

1. Occlude your non-testing eye with your hand (as you describe).

2. Occlude your non-testing eye by closing your own eye with your own orbicularis muscle.

Either is fine. The reason is to test your monocular field against your patient's monocular field.

[a7medmohamedbadawy89]

@trin0345 hhhhhhhhhhh ithought u did it wrongly

in any event, great thanks dr

[cariad81]

FAN TAS TIC

[Verghinho]

Lovely little nod at the end. Thanks, good video.

[hush2088]

wtf

[stugallimore]

Fantastic!

[jeopardy59]

asomw

[hehmonkey]

Hi, What are you testing when you ask the patient when the Red hat pin is bright red?

[trin0345]

Macula function. Perception of the "red colour" of the red hat pin para-centrally is dependent on cones.

Whilst perception of the white hat pin in the extreme periphery is dependent on rods.

[SuperMonkeyboy91]

"looking at me, How many hands do you see?" "2" How many hands do you have?!?1 ahah, that made me laugh.

Excellent though.

[trin0345]

It's a basic screen for a homonymous hemianopia.

[CasterTroy2]

fantastic

[lebleualto]

"FANTASTIC!"

[sliceadice]

nice video! Just to ask, were you mapping out the blindspot with the red hat pin? And is there really any difference between using white neurotip to map the fields and using your 'wagging' finger?

[trin0345]

1. Yes. The red hat pin is looking for an enlarged blind spot. You might get that with optic neuritis for example. Or a high myope with a REALLY large amount of peripapillary atrophy.

2. A waggling finger is only a rough and ready way to map out fields (eg. for a busy A&E doctor etc). For MRCOphth and other membership examinations, it would best to be armed with a formal white and red hat pin.

[sliceadice]

@trin0345 cheers, I can do this exam well now thanks to your video

[trin0345]

@sliceadice

No problem. Glad to be of help.

[Moonlovefairy]

this was helpful :)

[angelivia2]

Very helpful, have not seen that performed before!

[trin0345]

Thank you!

[sara0med]

very helpful, but I have a question. Why were u testing the vision in the four quadrants?

[trin0345]

To look for the major neurological field defects (eg. quadrantanopias; hemianopias)

For example:

- bitemporal = pituitary

- "pie in the sky"; homonymous superior quadrantanopia = contralateral temporal lobe defect.

- "pie on the floor"; homonymous inferior quadrantanopia = contralateral parietal lobe defect.

hope that helps!

[Shiney2808]

Brilliant, really helpful and not a lot of these on the net. Cheers!

[magiccatalyst]

fantastic

[kamikaz67]

Fantastic!

[cranbrook]

What cranial nerve is this testing?

[trin0345]

Visual fields.

Thus part of 2nd cranial nerve (optic nerve).

[cranbrook]

Ah, I see. Thanks dude.

Oh, is it also testing abducens and occulomotor nerves? Or are they tested separately?

[trin0345]

No. 3rd and 6th do eye movements.

So that's a seperate test.

You can do either an H shape. Or an X/union jack shape for eye movements. Ask your friendly neighbourhood medic/ophthalmologist to show you that.

[cranbrook]

I am the friendly medic next door...got a neuro exam in a few days and was a little confused!

Thanks for the help dude.

[trin0345]

Techniques NOT shown:

7. Neglect.

Ask your friendly neighbourhood neurologist to demonstrate this.

8. Amsler grid.

Distortion would have been picked up on history. And a dilated fundal exam would have picked up macular pathology.

9. Paracentral scotomas. Can be picked up with white/red hat pins if you just logically extend the above techniques. You would have followed things up with a Humphrey 24:2 visual field anyway. Or 30:2 if you are feeling keen.

[trin0345]

3. Rough kinetic screening with fingers. Could continue to midline if you were hunting for central/paracentral scotomas etc.

4. Kinetic screening with white hat pin. As above. Slightly finer.

5. Kinetic screening with red-hat pin. Check theoretical rough area of cone/macular function. And possibility of macular sparing theoretically in homonoymous hemianopias.

6. Blind spot mapping. With red hat pin. To look for enlarged blind spot (eg. optic neuritis).

[trin0345]

Dear all,

For the record. Unfortunately I didn't quite have enough time to put in full explanations for everything I'm doing here. But it's a mixed-bag of screening techniques I'm demonstrating. Feel free to chop & change to create your own routine.

Techniques shown are:

1. Initial screening. For obvious homonymous hemianopia.

2. Static screening. Check visual acuity is at least counting fingers. And hunt for obvious quadrantanopias (eg. early pituitary lesions, pies in the sky/floor etc).