June 7, 2013 | POSTED BY | Clinical Pearls

Confrontation visual fields with finger counting is NOT for me…

I really just think it is poorly SENSITIVE (number of people that the test says have a problem, actually have a problem) and SPECIFIC (number of people that the test says do not have a problem, actually do not have a problem).

So instead of finger counting I do this… I find it to be more sensitive and specific if done right.

  1. Sit about 2 feet from the patient
  2. Turn on your transilluminator to the dim setting
  3. Ask the patient to cover one eye and look into your open eye
  4. Ask the patient to tell you “when they see the instrument or light”
  5. With your instrument half way between you and the patient, move the tranilluminator out of your field of view in Superior/Inferior/Temporal/Nasal views and slowly move it in on a horizontal or vertical axis towards the center.
  6. You should see the transilluminator at the same time the patient sees it, if not, they or you, likely have field loss.

You can check inferior nasal and superior nasal fields more thoroughly in suspected advanced glaucoma patients and superior and inferior field in ischemic optic nueropathy patients and temporal fields in possible pituitary adenoma patients.

In summary, lets face it… Finger counting is silly. It is more cognitive then it is visual, it takes too much time and never picks up much. Even if they call out the wrong answer you typically move on to your next test and ignore it because you know deep down inside that finger counting confrontations are silly. So why do it? Try the transilluminator test, you will see how much more objective, sensitive and specific a test it really is. Ideally, you can run an automated visual field screening during pre-testing.

– Matthew Geller O.D.


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