Evaluation Of Visual Fields

    Peripheral visual fields are evaluated if a loss of peripheral vision is suspected. The purpose is to document any loss of peripheral vision from upper eyelid dermatochalasis or brow ptosis that causes the upper eyelid skin fold to overhang the upper eyelid margin. This skin fold acts as an 'awning' that usually leads to a loss of vision in the superior or superotemporal periphery. Visual fields are also helpful in establishing the amount of peripheral vision loss in patients with blepharopto-sis. Documentation of these problems can be helpful to patients in obtaining insurance benefits for surgery. Many insurance companies will pay for surgical excision of excessive upper eyelid skin or brow or upper eyelid elevation that results in a legitimate improvement in vision. Many companies, however, want proof in the form of peripheral visual field examination results and preoperative photographs. They also usually want the visual field done with and without the brow and lid being elevated with tape.


    Many different perimeters can determine peripheral visual field loss. Many insurance companies require the use of automated equipment, such as the Goldman and Humphrey perimeters, with tests performed both with the upper eyelid taped upward and untaped (Fig. 3-13). Currently, I use the A-Mark perimeter, an arc that is moved to various positions as a light is shifted from the extreme peripheral visual field toward central areas and the patient notes when he or she first sees the light. In my experience, this method provides a satisfactory documentation of visual field loss.



Figure 3-13 Peripheral visual fields are performed in patients with upper eyelid ptosis and upper eyelid skin folds that hang over the upper eyelid margin. Loss of superotemporal vision is common in patients with marked upper eyelid dermatochalasis, and diffuse loss of superior vision is common in ptosis.