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Who Should Get Visual Field Testing? A Population-Based Framework · Glaucoma, Vision & Longevity: Supplements & Science

• 0:00
  SPEAKER_00: Who should get visual field testing?
• 0:02
  SPEAKER_00: A population-based framework.
• 0:05
  SPEAKER_00: Visual field testing measures how well a person sees across the central and peripheral parts of the visual field.
• 0:12
  SPEAKER_00: It is especially important because many eye and brain disorders damage peripheral vision gradually without causing obvious symptoms at first.
• 0:19
  SPEAKER_00: However, routine visual field testing is not necessary for every healthy, asymptomatic adult.
• 0:26
  SPEAKER_00: The highest value comes from testing people whose examination, medical history, medication use, or disease pattern creates a meaningful risk of developing or worsening field loss.
• 0:36
  SPEAKER_00: This targeted approach helps detect silent damage while limiting false positive results, unnecessary anxiety, and avoidable testing.
• 0:45
  SPEAKER_00: What visual field testing detects.
• 0:47
  SPEAKER_00: Most clinical visual field tests use automated static threshold perimetry.
• 0:52
  SPEAKER_00: One eye is tested at a time while the patient looks at a central target and presses a button whenever a spot of light is seen.
• 0:59
  SPEAKER_00: The test can identify peripheral blind spots caused by glaucoma, central or paracentral defects affecting reading or fixation, bitemporal defects associated with pituitary or other chiasmol disease, altitudinal defects associated with this chemicoptic neuropathy, enlargement of the blind spot associated with papildema, concentric peripheral loss caused by some toxic retinal disorders, hemifield loss after stroke or damage to the visual pathways.
• 1:25
  SPEAKER_00: Visual field testing is different from a visual acuity test.
• 1:28
  SPEAKER_00: A person may still read the eye chart well while having important peripheral field loss.
• 1:33
  SPEAKER_00: The two eyes also overlap, allowing one eye to compensate for defects in the other.
• 1:38
  SPEAKER_00: Because visual field testing depends on attention, learning, fatigue, and response consistency, one abnormal result should usually be confirmed unless the pattern is clearly urgent.
• 1:50
  SPEAKER_00: National Institute for Health and Care Excellence Glaucoma Guideline.
• 1:54
  SPEAKER_00: The population-based principle, targeted testing rather than universal screening.
• 2:00
  SPEAKER_00: The United States Preventive Services Task Force has found insufficient evidence to recommend routine population-wide screening for primary open-angle glaucoma in asymptomatic adults.
• 2:12
  SPEAKER_00: This does not mean that visual field testing is unhelpful.
• 2:15
  SPEAKER_00: Rather, it means that testing is more useful when directed toward people with identifiable risk factors or suspicious findings.
• 2:23
  SPEAKER_00: United States Preventive Services Task Force recommendation.
• 2:27
  SPEAKER_00: A comprehensive eye examination is still important, particularly as people get older or develop medical risk factors.
• 2:35
  SPEAKER_00: The American Academy of Ophthalmology recommends a baseline comprehensive eye examination around age 40, with follow-up based on individual risk.
• 2:44
  SPEAKER_00: Visual field testing should then be added when there is a suspicious optic nerve, elevated intraocular pressure, irrelevant medication exposure, visual symptoms, or a disorder affecting the optic nerve or brain.
• 2:57
  SPEAKER_00: American Academy of Ophthalmology glaucoma screening information.
• 3:01
  SPEAKER_00: The groups most likely to benefit from routine or repeated testing are glaucoma suspects, people with ocular hypertension, people with established glaucoma, patients with neuroophthalmic disease, patients taking medications that can injure the retina or optic nerve, evidence on asymptomatic visual field loss.
• 3:21
  SPEAKER_00: Glaucoma may be advanced before a patient notices it.
• 3:24
  SPEAKER_00: Glaucoma usually develops slowly.
• 3:26
  SPEAKER_00: Early defects often occur outside the central line of sight, and the brain can partially compensate for missing information.
• 3:34
  SPEAKER_00: As a result, patients may not notice a problem until the disease is advanced.
• 3:39
  SPEAKER_00: Population-based research has found that approximately half of people with manifest glaucoma in developed countries may be unaware that they have the disease.
• 3:48
  SPEAKER_00: In a screening cohort from the early manifest glaucoma trial, one-third of people with previously undetected glaucoma had advanced visual field loss in at least one eye.
• 3:59
  SPEAKER_00: Early Manifest Glaucoma Trial Population Screening Study.
• 4:03
  SPEAKER_00: The risk is not limited to people with poor visual acuity.
• 4:07
  SPEAKER_00: A patient can have good central vision and still have loss in the upper, lower, nasal, or temporal field.
• 4:14
  SPEAKER_00: Visual field loss has also been associated with reduced mobility, falls, and lower quality of life in population studies.
• 4:21
  SPEAKER_00: Rotterdam study of visual field loss and daily functioning.
• 4:25
  SPEAKER_00: Why asymptomatic loss matters clinically.
• 4:27
  SPEAKER_00: Detecting field loss before a patient notices it can confirm that structural changes are functionally important.
• 4:34
  SPEAKER_00: Establish the stage of glaucoma.
• 4:36
  SPEAKER_00: Identify patients who need pressure-lowering treatment.
• 4:40
  SPEAKER_00: Reveal progression before a major daily life problem develops.
• 4:44
  SPEAKER_00: Prompt neurological imaging when the pattern is not typical for glaucoma.
• 4:48
  SPEAKER_00: Trigger medication review when toxicity is suspected.
• 4:52
  SPEAKER_00: The goal is not simply to find an abnormal test.
• 4:55
  SPEAKER_00: The goal is to find a repeatable, clinically meaningful change that alters care.
• 5:00
  SPEAKER_00: Glaucoma suspects.
• 5:02
  SPEAKER_00: A glaucoma suspect may have one or more of the following elevated intraocular pressure, a large or asymmetric optic nerve cup, suspicious thinning of the retinal nerve fiber layer, a disc hemorrhage, a suspicious or borderline visual field, a strong family history of glaucoma, thin central corneas, myopia, pseudoexfoliation, pigment dispersion, or other risk factors.
• 5:25
  SPEAKER_00: A person can be a glaucoma suspect even when the visual field is normal.
• 5:29
  SPEAKER_00: In this situation, the field provides an important functional baseline against which later tests can be compared.
• 5:35
  SPEAKER_00: Who among glaucoma suspects benefits most?
• 5:38
  SPEAKER_00: Visual field testing is particularly valuable when a patient has a suspicious optic nerve appearance, a symmetry between the two optic nerves, retinal nerve fiber layer, or ganglion cell thinning on imaging, repeatedly elevated intraocular pressure, a first degree relative with glaucoma, a disc hemorrhage, a thin central cornea, high myopia, a previous borderline or abnormal field, a visual complaint that is not explained by glasses, cataract, or retinal disease.
• 6:08
  SPEAKER_00: The American Academy of Ophthalmology recommends that observed primary open angle glaucoma suspects generally be reassessed at least every 12 to 24 months, with more frequent assessment when several risk factors are present.
• 6:21
  SPEAKER_00: American Academy of Ophthalmology, primary open angle glaucoma suspect preferred practice pattern.
• 6:27
  SPEAKER_00: How visual field results change care in a glaucoma suspect.
• 6:31
  SPEAKER_00: Normal and stable field.
• 6:33
  SPEAKER_00: Continued observation may be appropriate.
• 6:36
  SPEAKER_00: One questionable abnormal field.
• 6:38
  SPEAKER_00: Repeat the test, check reliability, and compare it with the optic nerve and imaging.
• 6:43
  SPEAKER_00: Repeatable glaucomatous pattern.
• 6:45
  SPEAKER_00: The diagnosis may change from suspect to glaucoma.
• 6:49
  SPEAKER_00: Field loss that does not match the optic nerve.
• 6:52
  SPEAKER_00: Consider a neurological or retinal cause.
• 6:55
  SPEAKER_00: Paracentral loss.
• 6:56
  SPEAKER_00: Closer monitoring is often needed because central function may be threatened even when the overall field appears mild.
• 7:02
  SPEAKER_00: A visual field should therefore be interpreted together with intraocular pressure, optic nerve examination, retinal imaging, corneal thickness, and the patient's history.
• 7:13
  SPEAKER_00: People with ocular hypertension.
• 7:16
  SPEAKER_00: Ocular hypertension means that the pressure inside the eye is consistently elevated, but there is not yet definite optic nerve damage or visual field loss.
• 7:25
  SPEAKER_00: Many people with ocular hypertension never develop glaucoma.
• 7:28
  SPEAKER_00: The ocular hypertension treatment study found that about 9.5% of untreated participants developed glaucoma over five years, compared with about 4.4% of participants who received pressure-lowering treatment.
• 7:41
  SPEAKER_00: Risk was not equal among all participants.
• 7:44
  SPEAKER_00: Higher pressure, older age, larger cup to disc ratio, and thinner central corneas increase the likelihood of conversion.
• 7:51
  SPEAKER_00: American Academy of Ophthalmology iWiki, ocular hypertension.
• 7:55
  SPEAKER_00: Why visual fields are still needed when the field is initially normal?
• 8:00
  SPEAKER_00: A normal field helps confirm that elevated pressure has not yet caused detectable functional damage.
• 8:06
  SPEAKER_00: Repeated testing can later identify conversion from ocular hypertension to glaucoma.
• 8:11
  SPEAKER_00: For a low-risk patient with normal optic nerves and stable pressure, visual field testing does not need to be performed at every visit.
• 8:19
  SPEAKER_00: In contrast, a patient with very high pressure, a thin central cornea, a strong family history, older age, suspicious imaging, or a disc hemorrhage generally deserves closer surveillance.
• 8:31
  SPEAKER_00: The National Institute for Health and Care Excellence recommends reassessment approximately every 18 to 24 months for treated ocular hypertension with controlled pressure and no detected conversion, but approximately every 6 to 12 months when conversion is uncertain or pressure control is inadequate.
• 8:50
  SPEAKER_00: These intervals are guides rather than rigid rules.
• 8:55
  SPEAKER_00: National Institute for Health and Care Excellence Reassessment Guidance.
• 8:59
  SPEAKER_00: Practical approach for ocular hypertension.
• 9:02
  SPEAKER_00: A reasonable approach is obtain a reliable baseline visual field, often repeating it to confirm consistency.
• 9:09
  SPEAKER_00: Document the optic nerve and retinal nerve fiber layer.
• 9:13
  SPEAKER_00: Measure central corneal thickness.
• 9:15
  SPEAKER_00: Estimate conversion risk using the full clinical picture.
• 9:18
  SPEAKER_00: Repeat the field approximately every 12 to 24 months if risk is low and all findings remain stable.
• 9:25
  SPEAKER_00: Test every 6 to 12 months when risk is moderate or high.
• 9:29
  SPEAKER_00: Repeat sooner when pressure rises, the optic nerve changes, or a disc hemorrhage appears.
• 9:34
  SPEAKER_00: Established glaucoma patients with established glaucoma benefit most consistently from routine visual field testing because treatment decisions depend on both structural damage and visual function.
• 9:45
  SPEAKER_00: Visual fields help clinicians.
• 9:47
  SPEAKER_00: Confirm the diagnosis.
• 9:49
  SPEAKER_00: Stage glaucoma as early, moderate, or advanced.
• 9:53
  SPEAKER_00: Establish a baseline before or soon after treatment.
• 9:56
  SPEAKER_00: Measure the rate of progression.
• 9:58
  SPEAKER_00: Determine whether the target intraocular pressure is low enough.
• 10:02
  SPEAKER_00: Decide whether medication, laser treatment, or surgery should be intensified.
• 10:06
  SPEAKER_00: Assess whether central vision is at risk.
• 10:10
  SPEAKER_00: The early manifest glaucoma trial found that visual field testing detected progression before optic disc photography in most eyes that eventually progressed.
• 10:19
  SPEAKER_00: In another analysis, visual field progression was detected first in approximately 80% of progressing eyes with early, moderate, or advanced field loss.
• 10:29
  SPEAKER_00: Early Manifest Glaucoma Trial Progression Study, newly diagnosed glaucoma.
• 10:35
  SPEAKER_00: Early in the disease, several tests may be needed to distinguish true progression from normal test-to-test variability.
• 10:42
  SPEAKER_00: The European Glaucoma Society has described a practical strategy of obtaining approximately three standard automated fields per year during the first two years after diagnosis, followed by a schedule tailored to the observed rate of change and disease stage.
• 10:58
  SPEAKER_00: European Glaucoma Society Guidelines.
• 11:01
  SPEAKER_00: This does not mean every patient must have three tests every year indefinitely.
• 11:05
  SPEAKER_00: Once a stable rate of change is known, testing can often be reduced.
• 11:09
  SPEAKER_00: Stable glaucoma.
• 11:11
  SPEAKER_00: For stable early glaucoma, a visual field every 6 to 12 months is often reasonable, although some low-risk patients may be tested less often.
• 11:21
  SPEAKER_00: The National Institute for Health and Care Excellence describes reassessment at approximately 12 to 18 months for patients with controlled pressure, low clinical risk, and no detected progression.
• 11:32
  SPEAKER_00: National Institute for Health and Care Excellence, Glaucoma Monitoring Guidance, Progressing or Advanced Glaucoma.
• 11:40
  SPEAKER_00: Testing should be more frequent when the field is worsening, the rate of change is rapid, a defect is close to fixation, the patient has advanced loss in one eye, the patient has only one seeing eye, pressure remains above target, a disc hemorrhage has occurred.
• 11:57
  SPEAKER_00: The patient is young and has a long expected lifetime of risk.
• 12:00
  SPEAKER_00: When progression is suspected, the entire treatment plan should be reviewed.
• 12:05
  SPEAKER_00: This may include checking medication use, measuring pressure at different times, lowering the target pressure, adding treatment, performing laser treatment, or considering surgery.
• 12:16
  SPEAKER_00: The visual field is particularly important when deciding whether continued medical treatment is enough.
• 12:22
  SPEAKER_00: The American Optimetric Association Guideline notes that disease severity and stability should guide follow-up and that periodic visual field testing is part of monitoring treatment effectiveness.
• 12:34
  SPEAKER_00: American Optometric Association Glaucoma Guideline.
• 12:38
  SPEAKER_00: Neuroophthalmic Disorders.
• 12:40
  SPEAKER_00: Visual field testing is central to the assessment of many disorders affecting the optic nerve, brain, or visual pathways.
• 12:47
  SPEAKER_00: In these conditions, the pattern of loss may be more important than the overall severity.
• 12:52
  SPEAKER_00: Optic neuritis and multiple sclerosis.
• 12:55
  SPEAKER_00: In optic neuritis, an automated visual field can quantify the initial deficit and track recovery.
• 13:01
  SPEAKER_00: It can also help identify recurrence or an unexpectedly severe course.
• 13:06
  SPEAKER_00: The American Academy of Ophthalmology describes automated visual fields as useful for establishing the progression and recovery of visual field loss in optic neuritis.
• 13:16
  SPEAKER_00: American Academy of Ophthalmology iWiki, demyelinating optic neuritis.
• 13:21
  SPEAKER_00: Testing is generally performed at diagnosis or soon after presentation, during recovery, when the deficit is changing, if symptoms recur.
• 13:31
  SPEAKER_00: When the course is atypical, when visual function needs to be compared with magnetic resonance imaging or optic nerve imaging.
• 13:38
  SPEAKER_00: Papilledema and idiopathic intracranial hypertension.
• 13:42
  SPEAKER_00: Patients with papilledema may have relatively good central visual acuity while losing peripheral field.
• 13:48
  SPEAKER_00: Enlargement of the blind spot may occur early, followed by more serious peripheral loss if pressure remains uncontrolled.
• 13:54
  SPEAKER_00: Visual field testing is therefore important for establishing a baseline, measuring the effect of treatment, detecting worsening before central acuity declines, deciding whether urgent treatment escalation is needed.
• 14:09
  SPEAKER_00: Patients with active or worsening papilledema may need testing every few weeks to several months, depending on severity and the specialist's assessment.
• 14:18
  SPEAKER_00: A sudden worsening field, new central defect, or rapidly declining visual function is urgent.
• 14:24
  SPEAKER_00: American Academy of Ophthalmology eyeWiki, papilledema.
• 14:28
  SPEAKER_00: Compressive optic neuropathy and pituitary disease, a tumor or other lesion near the optic nerve or optic chiasm may produce bite temporal field loss, asymmetric field loss, progressive loss in one eye, defects respecting the vertical meridian, central or junctional defects.
• 14:45
  SPEAKER_00: A formal visual field can be required before surgery, after surgery, and during follow-up.
• 14:51
  SPEAKER_00: For patients with non-functioning pituitary adenomas, the Congress of Neurological Surgeons recommends ophthalmologic assessment when visual symptoms or anatomical concern exists.
• 15:02
  SPEAKER_00: Congress of Neurological Surgeons Guideline on Pituitary Adenomas.
• 15:07
  SPEAKER_00: A field pattern that is strongly suggestive of a neurological lesion should prompt appropriate imaging or neuroophthalmic referral rather than simply repeating glaucoma testing.
• 15:17
  SPEAKER_00: Other neuroophthalmic conditions, routine or repeated testing, may also be useful in ischemic optic neuropathy, optic nerve compression, stroke affecting the visual pathways, traumatic optic neuropathy, hereditary optic neuropathies, toxic or nutritional optic neuropathy, inflammatory optic nerve disease, optic disc swelling of uncertain cause.
• 15:40
  SPEAKER_00: In these settings, testing frequency should follow the disease course.
• 15:44
  SPEAKER_00: A stable, remote injury may need occasional documentation, while active swelling, compression, or treatment-related change may require testing every few weeks or months.
• 15:54
  SPEAKER_00: Patients taking retinatoxic medications.
• 15:57
  SPEAKER_00: Not every medication with a possible eye side effect requires routine automated visual field testing.
• 16:03
  SPEAKER_00: The correct test depends on the tissue affected and the pattern of expected damage.
• 16:08
  SPEAKER_00: Hydroxychloroquine and chloroquine.
• 16:11
  SPEAKER_00: Hydroxychloroquine and chloroquine can cause permanent retinal toxicity, particularly with higher doses, long treatment duration, kidney disease, tamoxifen use, or pre-existing macular disease.
• 16:22
  SPEAKER_00: The American Academy of Ophthalmology's 2025 revision changed the emphasis of screening.
• 16:28
  SPEAKER_00: Baseline examinations soon after treatment begins.
• 16:31
  SPEAKER_00: Annual screening during ongoing treatment, spectral domain optical coherence tomography, and wide pattern from the autofluorescence as the primary screening tests, visual field testing as a secondary or confirmatory test, a 10-2 pattern for paraphobial disease, a 24-2 or 32 pattern when pericentral disease is possible.
• 16:52
  SPEAKER_00: Repeat testing when results are subtle, inconsistent, or unexpected.
• 16:57
  SPEAKER_00: This is an important distinction.
• 16:59
  SPEAKER_00: Visual field testing remains useful, but it is no longer the primary screening test by itself.
• 17:04
  SPEAKER_00: American Academy of Ophthalmology, 2025, Hydroxychloroquine Screening Revision.
• 17:10
  SPEAKER_00: American Academy of Ophthalmology Full Screening Report.
• 17:14
  SPEAKER_00: An abnormal field should be interpreted with the retinal imaging pattern.
• 17:18
  SPEAKER_00: A questionable result should generally be repeated or confirmed before a valuable systemic medicine is stopped.
• 17:24
  SPEAKER_00: Decisions about changing hydroxychloroquine or chloroquine should be coordinated with the prescribing physician.
• 17:31
  SPEAKER_00: Vigabitrin.
• 17:32
  SPEAKER_00: Vigabatrin can cause irreversible bilateral peripheral visual field loss.
• 17:37
  SPEAKER_00: The United States Food and Drug Administration prescribing information recommends baseline visual assessment no later than four weeks after treatment begins.
• 17:47
  SPEAKER_00: Vision assessment at least every three months while treatment continues.
• 17:51
  SPEAKER_00: Follow-up approximately three to six months after treatment ends.
• 17:54
  SPEAKER_00: Automated threshold visual field testing when the patient is able to cooperate.
• 17:59
  SPEAKER_00: In infants and very young children, formal perimetry may be difficult or impossible, so clinicians may use age-appropriate visual behavior assessments and retinal imaging.
• 18:11
  SPEAKER_00: United States Food and Drug Administration Vigabetrin prescribing information, E.
• 18:16
  SPEAKER_00: thambutol.
• 18:30
  SPEAKER_00: There is no universally validated screening protocol that reliably prevents every case.
• 18:36
  SPEAKER_00: Higher risk patients, such as those receiving higher doses, prolonged treatment, or those with kidney disease, nutritional deficiency, or other eye disease, may require more frequent assessment.
• 18:47
  SPEAKER_00: Patients should report blurred vision, reduced color discrimination, difficulty reading, or a central blind spot immediately.
• 18:54
  SPEAKER_00: Expert consensus on ethambutol-induced optic neuropathy.
• 18:58
  SPEAKER_00: American Academy of Ophthalmology eyeWiki, ETHambutol, optic neuropathy.
• 19:03
  SPEAKER_00: Other potentially toxic medications, pentosin polysulfate, tamoxifen, phenothiazines, amiodarone, linidzolid, and several other medications have been associated with retinal or optic nerve injury.
• 19:15
  SPEAKER_00: However, there is not one universal visual field schedule for all of them.
• 19:20
  SPEAKER_00: Testing should be based on treatment duration and dose, kidney or liver disease, symptoms.
• 19:26
  SPEAKER_00: The expected pattern of toxicity, retinal imaging findings, the patient's ability to perform reliable perimetry.
• 19:33
  SPEAKER_00: American Academy of Ophthalmology, iWiki, drug-induced maculopathy.
• 19:37
  SPEAKER_00: How visual field results change management.
• 19:40
  SPEAKER_00: They may confirm or reject a glaucoma diagnosis.
• 19:43
  SPEAKER_00: A repeatable field defect that matches optic nerve or retinal nerve fiber layer damage supports a glaucoma diagnosis.
• 19:51
  SPEAKER_00: A normal field does not eliminate risk when pressure or structural findings are suspicious, but it may support continued observation.
• 19:58
  SPEAKER_00: They help determine disease stage.
• 20:00
  SPEAKER_00: Glaucoma is commonly described as early, moderate, or advanced according to the extent of field loss.
• 20:07
  SPEAKER_00: A defect near the central fixation point may be more clinically important than a larger defect farther in the periphery.
• 20:14
  SPEAKER_00: They show whether treatment is working.
• 20:16
  SPEAKER_00: Lowering intraocular pressure reduces the risk of glaucoma progression.
• 20:21
  SPEAKER_00: The early manifest glaucoma trial found that pressure lowering treatment delayed progression compared with observation or delayed treatment.
• 20:30
  SPEAKER_00: Early manifest glaucoma trial, treatment results.
• 20:33
  SPEAKER_00: A worsening field despite apparently acceptable pressure may lead the clinician to confirm adherence, recheck pressure measurement, look for pressure peaks, reassess the target pressure, add or change medication, consider laser or surgery, search for another cause of visual loss.
• 20:51
  SPEAKER_00: They help estimate the rate of progression.
• 20:54
  SPEAKER_00: A single field shows status at one moment.
• 20:56
  SPEAKER_00: A series of reliable fields shows the direction and speed of change.
• 21:01
  SPEAKER_00: A rapidly worsening field may require treatment escalation even when the defect is still small.
• 21:07
  SPEAKER_00: The patient's age and expected lifetime also matter.
• 21:10
  SPEAKER_00: A slow rate of loss may still become important if the patient is young or has many decades of expected vision ahead.
• 21:18
  SPEAKER_00: They can reveal a non-glaucomatous disease.
• 21:21
  SPEAKER_00: Certain patterns should prompt consideration of a neurological cause, defects respecting the vertical meridian, bitemporal loss, severe asymmetry between the eyes, central loss with optic nerve pallor, a defect that does not match the optic nerve appearance, a field that worsens despite controlled pressure, sudden or rapidly progressive loss.
• 21:42
  SPEAKER_00: They can trigger medication review.
• 21:44
  SPEAKER_00: In suspected medication toxicity, field results may support a decision to repeat testing, obtain additional retinal imaging, involve the prescribing physician, or change the treatment plan.
• 21:56
  SPEAKER_00: Risk factors that inform visual field frequency.
• 22:00
  SPEAKER_00: Risk factors should not be treated as isolated yes or no items.
• 22:03
  SPEAKER_00: The overall risk depends on the number, strength, and combination of findings.
• 22:07
  SPEAKER_00: For the full table, please open this article on VisualFieldtest.com.
• 22:12
  SPEAKER_00: The American Academy of Ophthalmology lists elevated pressure, older age, family history, thinner central cornea, disc hemorrhage, myopia, lower corneal hysteresis, and other factors among established risks for primary open-angle glaucoma.
• 22:28
  SPEAKER_00: American Academy of Ophthalmology Glaucoma Suspect Guideline, a tiered schedule for visual field testing.
• 22:35
  SPEAKER_00: The following schedule is a practical synthesis of major guideline recommendations.
• 22:40
  SPEAKER_00: It is not a substitute for individualized care, and the interval should be shortened when progression is suspected or when central vision is threatened.
• 22:48
  SPEAKER_00: For the full table, please open this article on visualfieldtest.com.
• 22:54
  SPEAKER_00: Important practical rules.
• 22:56
  SPEAKER_00: Use the same test strategy whenever possible.
• 22:59
  SPEAKER_00: Once a defect has been identified, using the same visual field strategy makes comparison more meaningful.
• 23:05
  SPEAKER_00: Switching repeatedly between different test patterns can make it harder to determine whether a real change has occurred.
• 23:12
  SPEAKER_00: National Institute for Health and Care Excellence Visual Field Reassessment Guidance.
• 23:17
  SPEAKER_00: Repeat unreliable or unexpected results.
• 23:20
  SPEAKER_00: Fatigue, poor fixation, cataract, incorrect glasses correction, misunderstanding the instructions, and excessive button pressing can all distort results.
• 23:30
  SPEAKER_00: An abnormal field that does not fit the examination should be repeated or confirmed with another test.
• 23:35
  SPEAKER_00: Match the field pattern to the suspected disease.
• 23:38
  SPEAKER_00: 24-2 or 24-2C, commonly used for glaucoma.
• 23:42
  SPEAKER_00: 10-2.
• 23:43
  SPEAKER_00: Useful for central or pericentral defects.
• 23:46
  SPEAKER_00: 32.
• 23:47
  SPEAKER_00: Useful when a wider central field or neurological pattern is suspected.
• 23:51
  SPEAKER_00: Specialized or wider testing may be needed for pericentral hydroxychloroquine toxicity or advanced disease.
• 23:58
  SPEAKER_00: Do not replace clinical judgment with a schedule.
• 24:01
  SPEAKER_00: A schedule is only a starting point.
• 24:03
  SPEAKER_00: Testing should be more frequent when there is a new symptom, a new disc hemorrhage, a pressure spike, a new imaging abnormality, a medication change, or a field defect near fixation.
• 24:14
  SPEAKER_00: Conclusion.
• 24:15
  SPEAKER_00: The strongest case for routine visual field testing is not simply being older.
• 24:20
  SPEAKER_00: It is having a meaningful risk of silent or progressive damage.
• 24:24
  SPEAKER_00: Routine or repeated testing is most valuable for glaucoma suspects with suspicious optic nerves or imaging, people with ocular hypertension and additional conversion risks.
• 24:36
  SPEAKER_00: Patients with established glaucoma, people with optic nerve, brain, or visual pathway disease, patients taking medications known to cause retinal or optic nerve toxicity.
• 24:46
  SPEAKER_00: The most effective framework is risk-based and dynamic.
• 24:49
  SPEAKER_00: Low-risk patients can often be tested infrequently, while medium-risk patients generally need annual or semi-annual monitoring.
• 24:58
  SPEAKER_00: High-risk patients, newly diagnosed patients, and those with progression may need several fields per year.
• 25:04
  SPEAKER_00: The visual field is not interpreted in isolation.
• 25:08
  SPEAKER_00: The best decisions come from combining the field with intraocular pressure, optic nerve examination, retinal imaging, corneal thickness, medication history, symptoms, and the patient's expected lifetime risk of vision loss.
• 25:21
  SPEAKER_00: All links to sources are available in the text version of this article.
• 25:25
  SPEAKER_00: You can find the full article at VisualFieldTest.com.
• 25:29
  SPEAKER_00: Thanks for listening.
• 25:30
  SPEAKER_00: To check your visual field, click the link at the bottom of this article or visit VisualFieldTest.com.