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'''Confrontation visual field testing''' is a test used in [[ophthalmology]] for rapid and gross detection of large-scale [[visual field]] problems. It is done by asking the patient lookingto look directly at the examiner's eye or nose and compare the patient's visual field with the examiner's field. It can be used to test the binocular visual field (with both eyes open) and or the visual field of each eye separately (with one eye closed).
==Indications==
Confrontation visual field testing is an important part of a routine ophthalmological or neurological examination. It can be used for rapid and gross assessment of large-scale [[visual field]] problems due to ophthalmological or neurological diseases, such as [[Homonymous hemianopsia|homonymous]] and heteronymous hemianopias, [[quadranopsia]], altitudinal visual loss, central/centrocecal [[scotoma]] etc.<ref name="PEC">{{cite book |last1doi=David B10.1016/B978-0-7506-8896-3.50007-9 |first1chapter=ElliottAssessment of Visual Function |title=Clinical proceduresProcedures in primaryPrimary eyeEye careCare |publisherdate=Elsevier/Butterworth Heinemann2007 |isbnlast1=9780750688963Elliott |editionfirst1=3rdDavid B. |yearlast2=2007Flanagan |chapterfirst2=Assessment of visual functionJohn |pages=6829–81 |isbn=978-0-7506-8896-693 }}</ref><ref name="Johnson">{{cite journal |last1=Johnson |first1=L. N. |last2=Baloh |first2=F. G. |title=The accuracy of confrontation visual field test in comparison with automated perimetry |journal=Journal of the National Medical Association |date=October 1991 |volume=83 |issue=10 |pages=895–898 |urlpmid=https://pubmed.ncbi.nlm.nih.gov/1800764/ |issnpmc=0027-96842571584 }}</ref> Test using a red target can detect red-desaturation, a sign of early [[optic nerve]] disease.<ref name="Broadway">{{cite journal |last1=Broadway |first1=David C |last2=Kyari |first2=Fatima |title=Examining visual fields |journal=Community Eye Health |date=2019 |volume=32 |issue=107 |pages=58–59 |urlpmid=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7041825/32123478 |issnpmc=0953-68337041825 }}</ref>
==Procedure==
Confrontation visual field testing diddoes not need a clinical setting to perform. It can be done in any well -illuminated room. Since the visual fields of both eyes overlap in the nasal area, each eye is tested separately.<ref name="uiowa">{{cite web |last1=Allen |first1=Richard C. |title=Confrontation Visual Fields |url=https://webeye.ophth.uiowa.edu/eyeforum/atlas-video/confrontation-visual-field-testing.htm#gsc.tab=0 |website=webeye.ophth.uiowa.eduEyeRounds }}</ref><ref name="medscape">{{cite web EMedicine|article|2094663|title=Visual Field Testing Technique: Confrontation Testing, Simultaneous Confrontation Testing, Perimetry |url=https://emedicine.medscape.com/article/2094663-technique |website=emedicine.medscape.com}}</ref> Patient is asked to sit in front of the examiner, at a distance between 66- and 100 cm, maintaining the eye level same as examiner's.<ref name="PEC"/> Patient is asked to remove his/her spectacles before starting the test. For testing the right eye field, the patient is asked to close his left eye, and look straight at the examiner's left eye (preferably) or nose.<ref name="PEC"/> Examiner should also close his/her right eye.<ref name="PEC"/><ref name="Pollock">{{cite web |last1=Pollock |first1=Stephen C |title=Confrontation Visual Fields A Concise Guide for Ophthalmologists in Training |url=https://aupo.org/system/files/resources/2019-04/Confrontation%20Visual%20Fields%20--%20A%20Guide%20for%20Ophthalmologists%20in%20Training.pdf}}</ref> Move a finger or bead-on-a-stick inwards from an area outside the usual 180º visual field, and ask the patient when they first see the targets.<ref name="PEC"/><ref>{{cite web |title=Visual Field Test |url=https://www.aao.org/eye-health/tips-prevention/visual-field-testing |website=American Academy of Ophthalmology |language=en |date=10 March 2022}}</ref> Alternatively, the patient may be asked to count the number of fingers the examiner shows, or identify wiggling fingers.<ref name="Pollock"/> For an accurate assessment of the patient's visual field, it is essential that the distance of all test objects from the patient is the same as the distance from the examiner.<ref name="Pollock"/> The Examiner should compare thisthe point at which the patient sees the target with his own visual field.<ref name="PEC"/> Repeat the procedure for all eight meridians.<ref name="PEC"/>
Record the type of target used and whether there are any significant abnormalities in the patient's visual field. Colored targets such as red are more sensitive than a white test targetstarget.<ref name="medscape"/> The test reliability may improve when techniques like finger counting, finger wiggling, identifying a target etc. are combined together.<ref name=Prasad2010>{{cite webnews |last1=Prasad |first1=Sashank |title=How Accurate Is Confrontation Visual Field - ProQuestTesting? |websiteid=www.proquest.com{{ProQuest|1284220446}} |url=https://www.proquestjwatch.comorg/docviewjn201008240000003/1284220446?sourcetype2010/08/24/how-accurate-confrontation-visual-field-testing |work=Scholarly%20JournalsNEJM Journal Watch |languagedate=en24 August 2010 }}</ref><ref name="Kerr Chew Eady et al 2010">{{cite journal |last1=Kerr |first1=N.M. |last2=Chew |first2=S.S.L. |last3=Eady |first3=E.K. |last4=Gamble |first4=G.D. |last5=Danesh-Meyer |first5=H.V. |title=Diagnostic accuracy of confrontation visual field tests |journal=Neurology |date=13 April 2010 |volume=74 |issue=15 |pages=1184–1190 |doi=10.1212/WNL.0b013e3181d90017 |urlpmid=https://www.neurology.org/doi/abs/10.1212/wnl.0b013e3181d9001720385890 |language=en |issn=0028-3878}}</ref>
Confrontation testing can be done with both eyes open also. It is done for testing the binocular visual field.<ref name="Broadway"/>
==Advantages and disadvantages==
The Confrontation visual field testing is a simple, easy, quick and inexpensive clinical technique that can be used for gross assessment of large-scale visual field problems, such as homonymous and heteronymous hemianopias, [[quadranopsia]] etc.<ref name="PEC"/> But testing is less useful for detecting arcuate scotoma, bitemporal hemianopsia, and visual field loss associated with [[Neoplasm|parasellar tumors]], [[glaucoma]], and [[Optic neuropathy|compressive optic neuropathies]].<ref>{{Cite journal |last=Johnson |first=L. N. |last2=Baloh |first2=F. G. |date=October 1991 |title=The accuracy of confrontation visual field test in comparison with automated perimetry. |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2571584/ |journal=Journal of the National Medical Association |volume=83 |issue=10 |pages=895–898 |issn=0027-9684 |pmc=2571584 |pmid=1800764}}</ref><ref name="Johnson"/> The test reliability may improve when techniques like finger counting, finger wiggling, identifying a target etc. are combined together.<ref>{{cite web |title=How Accurate Is Confrontation Visual Field - ProQuest |website=www.proquest.com |urlname=https:Prasad2010//www.proquest.com/docview/1284220446?sourcetype=Scholarly%20Journals |language=en}}</ref><ref>{{cite journal |last1name="Kerr |first1=N.M. |last2=Chew |first2=S.S.L. |last3=Eady |first3=E.K.et |last4=Gamble |first4=G.D. |last5=Danesh-Meyer |first5=H.V. |title=Diagnostic accuracy of confrontation visual field tests |journal=Neurology |date=13 Aprilal 2010 |volume=74 |issue=15 |pages=1184–1190 |doi=10.1212"/WNL.0b013e3181d90017 |url=https://www.neurology.org/doi/abs/10.1212/wnl.0b013e3181d90017 |language=en |issn=0028-3878}}</ref> To compare a patient's visual field with their own visual field, the examiner should have a full field of vision without any defects.<ref name="Broadway" />
==References==
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