The patient and the visual field test

Dr Lindsay Rountree discusses making the patient’s experience of visual field testing a positive one

Lady on visual fields machine

A recent study confirmed what practitioners have long suspected – that patients dislike doing visual field tests. In comparison with other clinical tests, such as visual acuity, intraocular pressure, and retinal imaging, patients perceive visual field tests to be old-fashioned and tedious. Likewise, practitioners can find visual field tests to be challenging, as results can be difficult to interpret, and the test may need to be repeated for an accurate diagnosis.

However, visual field tests give us valuable insight into what our patients are actually seeing, or more importantly, not seeing. When the brain processes information from the eyes, it is very good at masking problems. As such, many patients can be completely unaware that they have a problem with their vision until they do a visual field test. Imaging and scans may be more popular with patients, and of course are important in identifying structural changes in the eye, but it is the functional changes in vision that have the potential to affect the patient’s life. In addition, a visual field test can help to identify problems further along the visual pathway, which may not be detectable by examining the eyes themselves, so it is an invaluable piece of technology.

A positive experience

  • There are two key areas where we can positively influence our patients’ experience with visual field tests, which may in turn lead to more accurate results: 
  • Environment – background noise, such as people moving around, chatting, or other patients doing different tests in the same room, can make it more difficult to concentrate
  • Communication – as with so many things, communication is key, and patients appreciate the benefits of communication from the practitioner at all stages of the test, even if they have performed a visual field test many times before.

Application to practice

  • Locate the machine in a quiet area of the practice
  • Make sure the patient is seated comfortably. A chair with a backrest is often safer and more comfortable, and arms can help unsteady patients in and out of a seated position. Be careful with chairs on wheels – a mat can be useful in preventing unwanted movement
  • Explain the purpose of the test, and what the patient will need to do, irrespective of how many times the patient has performed the test before
  • Ensure the patient understands and encourage them to ask questions before the test begins Monitor the patient during the test and give approximate time points, for example, at the halfway point. If fixation is poor, remind the patient to keep looking at the fixation target, and pause the test to give the patient a break if required
  • To conclude the test, ask the patient if they have any questions but avoid giving an opinion on the outcome until the optometrist has reviewed the result.

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