It contains noncrossing fibers from the two temporal hemiretinas and projects fibers to the suprachiasmatic nucleus of the hypothalamus. If there is unilateral blindness or enucleation, visual fields in the remaining eye are scored. Walsh & Hoyt's Clinical Neuro-Ophthalmology. It occurs in syphilis and diabetes. 1980), 42(6), 343348. 3. Any complaint of a fixed missing spot in the visual field (monocular or binocular). Kedar S, Zhang X, Lynn MJ, et al. 2. WebThe bitemporal hemianopia field defect is the classic presentation of a chiasmal lesion. (J J) Argyll Robertson pupil. Definition (NCI) Blurred vision is the loss of visual acuity (sharpness of vision) resulting in a loss of ability to see small details. (F) Paralysis of upward gaze and convergence (Parinauds syndrome). His visual acuity recovered fully, but his visual fields only partially recovered. (4) Right hemianopia. 2. At the chiasm, the temporal retinal nerve fibers remain uncrossed on the same side and travel ipsilaterally on the optic tract. NINDS Know Stroke Campaign - NIH Stroke Scale E. The lateral geniculate body is a six-layered nucleus. 1. Optom Vis Sci 2004 May;81(5):298-307. Ophthalmology 2006 Aug;113(8):1345-53. The visual system is served by the optic nerve, which is a special somatic afferent nerve. It can be associated with a lesion of an optic radiation. [21] Causes [ edit] If you think you see an RAPD but you arent sure, verify your findings. clinical Visual field defects after stroke - Royal Australian Few things provoke more anxiety (for both the patient and the doctor) than noticeable visual field loss. The use of aspirin as a platelet anti-aggregant may be advisable in those with significant intracranial arterial stenosis. Pupillary dilation and its effects on automated perimetry results. Patients who present with an awareness of a loss of visual field need prompt and accurate diagnosis, as management often involves immediate further evaluation and intervention. Natural course of visual field loss in patients with type 2 Usher syndrome. J Neuroophthalmol 1999 Sep;19(3):153-9. 11. It is most often associated with stroke and is more severe and persistent following right hemisphere damage, with reported frequencies in the acute stage of up to 80%. The temporal retinal processes the nasal visual field, while the nasal retina processes the temporal visual field. Convergence remains intact. One study demonstrates congruous visual field defects encountered in 350% of lesions to the optic tract or optic radiations, although 84% of occipital lobe lesions produced congruous field defects.2 Also, the vast majority of incongruous visual field defects occur with lesions to the optic radiations, which are located more anteriorly.2 One important caveat to this rule is that only incomplete homonymous hemianopias may be described as congruous or incongruous. Light shincd into one eye causes both pupils to constrict. 2007 Jan;9(1):41-7. 2. Any kind of head injury or specific This complex includes the following structures: 1. Anatomy of the Visual Pathways. Homonymous Superior Quadrantanopia Goodwin D. Homonymous hemianopia: challenges and solutions. WebQuadrantanopia: vision loss in a quarter of the visual field of both eyes; Unilateral vision field loss indicates a disorder of a structure anterior to the optic chiasm. 22. Pupils were normally reactive and ocular motilities were unrestricted. (5) Ri^ht upper quad* rantanopia. Just consider the cycloplegic effects of the dilating drops when determining which trial lens to use in patients who are not yet absolute presbyopes. As they reach the occipital lobe (the primary visual cortex), the superior and inferior fibers are reunited. Pupils were normally reactive and ocular motilities were unrestricted. Kardon RH, Thompson HS. Right homonymous superior quadrantanopia. *Images generated. Color vision, visual fields and extraocular motilities were normal in both eyes. Homonymous Hemianopsia, Symptoms, Causes, Diagnosis Ultimately, this patient was diagnosed with neurosyphilis, and was treated with penicillin. Damage to the left parietal lobe can result in right-left confusion, agraphia and acalculia referred to as Gerstmanns Syndrome. We learned this principle from professor Lou Catania, OD, quoting Hickams dictum: The patient may have as many diseases as he or she pleases.. If both divisions on one side of the brain are affected, the result is a contralateral homonymous hemianopsia. Also important in the localization of visual field defects is the concept of congruity. a. Ipsilateral hemiparesis occurs as a result of pressure on the corticospinal tract, which is located in the contralateral crus cerebri. Any complaint of a fixed missing spot in the visual field (monocular or binocular). Arch Ophthalmol 2005 Feb;123(2):233-8. 2013 Feb;27(2):133-41. Color vision, visual fields and extraocular motilities were normal in both eyes. (II) Lower altitudinal hemianopia as a result of bilateral destruction of the cunei. Note that half of the optic nerves cross at the optic chiasm, causing vision loss on one side to be quite different than that in one eye. Clin Ophthalmol. Visual field testing provides insight into the integrity of the visual pathway. Our patient was found to have an incomplete, moderately congruous, left homonymous hemianopia, denser above than below the horizontal midline. (2018). Intracranial optic nerve, junctional and optic chiasm. If you are not comfortable performing such tests, you can refer this patient to a neurologist for them. A Cellulite Cure - How to Get Rid of Cellulite. 5. Compare the afferent anterior pupillary pathway of one eye vs. the fellow eye. CN = cranial nerve. left, O.D. Ring scotoma (usually bilateral). American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, Council on Functional Genomics and Translational Biology, Council on Hypertension. right. Pulsenotes | Visual field defects Double simultaneous stimulation is performed at this point. Neurology 2006; 66: pp. Alert the triage personnel at the hospital that a potentially time-critical patient is on the way. It is most commonly caused by brain tumors, subdural hematoma, or hydrocephalus. Total monocular field loss. THE VISUAL PATHWAY (Figure 17-1) includes the following structures. After the patient has a chance to recover from the transilluminators bleaching effects, do a white light comparison test. Specific visual field deficits can be attributed to the location of compression, which in turn can help clinicians localize lesions based on physical examination and diagnostic testing. [citation needed], Individuals with quadrantanopia often modify their behavior to compensate for the disorder, such as tilting of the head to bring the affected visual field into view. The visual pathway is exquisitely organized as it traverses the entire length of the brain, from an area just beneath the frontal lobe to the tip of the occipital cortex. Optic radiation Lesions of the chiasmmost commonly pituitary gland tumors or craniopharyngiomasresult in bitemporal, heteronymous field defects. A fixed and dilated pupil, ptosis, and a "down-and-out" eye are caused by pressure on the ipsilateral oculomotor nerve. Visual field loss increases the risk of falls in older adults: the Salisbury Eye Evaluation. Imaging for neuro-ophthalmic and orbital disease - a review. (G) Fourth-nerve palsy, right eye. right. 530 Walnut Street, Philadelphia, Pennsylvania 19106 USA; 351 West Camden Street, Baltimore, Maryland 21201-2436 USA:Lippincott Williams & Wilkins; 2005. The pressure cone forces the parahippocampal uncus through the tentorial incisure. The visual pathway from optic chiasm to striate cortex. Webunilateral blindness or enucleation, visual fields in the remaining eye 0 = No visual loss. The nystagmus is in the direction of the large arrowhead. The cone refers to the area created by the four rectus muscles and the intermuscular membrane that joins them and extends posteriorly to the insertion of the muscle tendons on the annulus of Zinn at the orbital apex[1]. Findings of ocular disease will dictate appropriate management strategies based upon the condition. If there is unilateral blindness or enucleation, visual fields in the remaining eye are scored. So macular vision can be spared when only one of the major cerebral vessel distributions is affected. If there is a complete lesion or compression at the optic nerve, patients may experience total monocular vision loss in the affected eye. left, O.D. 906-910, Kedar S, Zhang X, Lynn MJ, et al: Pediatric homonymous hemianopia. Vision was 20/30 O.D. 1. Other localizing signs were The bottom line: From a clinical standpoint, a right positive RAPD means that you should be looking for a problem in the right retina and/or optic nerve. When affecting the visual pathway, mass effect can cause a multitude of changes in a patients visual field. N Engl J Med. History of head trauma. left, O.D. One exception to neurology referral is a patient with visual field loss that you suspect is psychogenic in origin. Temporal defect in one eye, central defect inthe fellow eye. J Am Optom Assoc 1995 Nov;66(11):675-80. Aside from these rare but critical cases, the most important testone that must not be skippedis automated perimetry. Lastly, the junctional scotoma of Traquair (see Junctional Scotoma and Junctional Scotoma of Traquair) may occur. However, the etiology is less commonly from a congenital, traumatic, vascular, inflammatory, infectious, demyelinating, and infiltrative source[5]. Vision restorative training (VRT) may provide a mechanism to regain visual function at the border of the visual field defect, although studies with this system have yielded conflicting and inconclusive results. Nerve fibers originating in the nasal retina cross at the level of the optic chiasm, traveling with contralateral temporal fibers to the lateral geniculate nucleus where they synapse. Besides your normal history and examination sequence, ask: Is the field loss in one eye, or is it on one side of the field? If patient is blind from any cause, score 3. 6. The patient underwent neuroradiological evaluation, and a craniopharyngioma was found. Depending on the results of the visual field, patients can have further imaging performed. Occlude the abnormal eye and shine the light in the normal eye. If there is extinction, patient receives a 1, and the results are used to respond to Glaucoma is the leading cause of field loss across all adult age groups when tested using automated threshold or supra-threshold perimetry.8, Other leading causes of visual field loss in patients past age 55 are non-glaucomatous optic nerve disease, stroke, age-related macular degeneration (AMD) and retinal vascular occlusive disease.1,8 Stroke is the leading cause of homonymous hemianopias, followed by trauma, tumor, brain surgery and demyelination.10, In younger age groups, prevalence of visual field loss is much lower, and causes are more varied and may be functional or psychogenic in nature. [7] Drivers with quadrantanopia, who were rated as safe to drive, drive slower, utilize more shoulder movements and, generally, corner and accelerate less drastically than typical individuals or individuals with quadrantanopia who were rated as unsafe to drive. Ask what the patient was doing when he or she first noticed the loss. Bilateral deficits are caused by chiasmal lesions or lesions affecting the retrochiasmal pathways. The patient was advised that he had likely suffered an isolated stroke which caused him to experience vision loss. Lam BL, Thompson HS. The use of aspirin as a platelet anti-aggregant may be advisable in those with significant intracranial arterial stenosis.3 Smoking cessation (including avoidance of second-hand smoke), a low-fat diet and regular exercise are also typically encouraged.4, Optometric management depends on the extent of field loss and the degree of recovery following the stroke. 1. Bitemporal field loss. Score 1 only if a clear-cut asymmetry, including quadrantanopia, is found. Perimetric homonymous visual field loss post-stroke. Common and/or Classic Visual Field Patterns and Their Causes. Of course, this test should be interpreted relative to other potential findings, such as corneal edema, cataracts, or other conditions that can affect the patients perception of brightness. An Am J Ophthalmol 2007 Jun;143(6):1013-23. 2014 Dec;45(12):3754-832. Foroozan, R. (2003). (10) Upper altitudinal hemianopia as a result of bilateral destruction of the lingual gyri. This occurs due to a lesion of the ipsilateral optic nerve, causing an optic neuropathy, and of the contralateral decussating inferior nasal retinal fibers, causing loss of the superior and temporal field in the opposite eye. Visual outcome of a cohort of children with neurofibromatosis type 1 and optic pathway glioma followed by a pediatric neuron-oncology program. It includes the following structures: A. Ganglion cells of the retina, which project bilaterally to the pretectal nuclei, B. Sign or Symptom ( T184 ) SnomedCT. Optic radiations exit dorsally from the LGN into two separate fascicles: Inferior (known as Meyers loop) and Superior (known as the parietal fascicles). This presents with loss of both temporal fields and is due to compression of the bilateral decussating nasal fibers at the chiasm, since the nasal fibers correspond with the temporal visual fields[5]. [1] While quadrantanopia can be caused by lesions in the temporal and parietal lobes of the brain, it is most commonly associated with lesions in the occipital lobe. Visual field recovery after vision restoration therapy (VRT) is independent of eye movements: an eye tracker study. If patient is blind from any cause, score 3. Fixed scotomas usually signal retinal, optic nerve, or neurological involvement.16. WebHomonymous hemianopia is a visual field defect involving either the two right or the two left halves of the visual fields of both eyes. At a visit in our clinic several months prior, vision O.S. Ed: Rosen ES, Eustace P, Thompson HS, et al. 2. Lindenmuth KA, Skuta GL, Rabbani R, et al. J Clin Neurosci 2007 Aug;14(8):754-6. G. Papilledema (choked disk) is noninflammatory congestion of the optic disk as a result of increased intracranial pressure. Layers 1, 4, and 6 receive crossed fibers; layers 2, 3, and 5 receive uncrossed fibers. 19. Ed: Rosen ES, Eustace P, Thompson HS, et al. This visual defect is caused by damage to superior fibers of the optic radiations. The section of the optic nerve at the optic chiasm transects all fibers from the ipsilateral retina as well as fibers from the contralateral inferior nasal quadrant that loop into the optic nerve. A normal scan sometimes turns out to be not so normal when re-evaluated with more critical parameters! Optic tract lesions are relatively uncommon[9], with lateral geniculate nucleus (LGN) lesions being even more rare but when seen, are due to ischemic, demyelinating, or traumatic etiologies. This page was last edited on 15 February 2023, at 12:25. Invest Ophthalmol Vis Sci 2007 Oct;48(10):4445-50. A. It includes the following structures: A. 18. neglect EvaluationExamination revealed corrected acuity of 20/25 OU. Optic nerve sheath meningioma. In homonymous hemianopsia, an injury to the left part of the brain results in the loss of the right half of the visual world of each eye. A significant visual field defect was present in not only the left eye, consistent with the patients case history, but also in the right eye. https://doi.org/10.1097/IJG.0b013e3182934978, Takahashi, M., Goseki, T., Ishikawa, H., Hiroyasu, G., Hirasawa, K., & Shoji, N. (2018). The incidence of visual field loss increases with age. Glaucoma is the leading cause of visual field loss across all age groups.1 However, glaucoma patients often dont present with an initial chief complaint of visual field loss, unless the disease is quite advanced. Any other clinical finding (subjective or objective) that does not correlate with other examination findings.In many cases, attention to proper hydration and caloric intake, along with awareness of the effects of postural changes (e.g., standing up quickly from a seated or reclined position) is sufficient for managing the symptoms. WebConclusion : Unilateral quadrantanopia appears to have been caused by pituitary tumor with intratumor hemorrhage, or pituitary apoplexy, that compressed the posterior portion of Neglect is primarily a disorder of attention whereby patients characteristically fail to orientate, to The junctional scotoma (see Junctional Scotoma and Junctional Scotoma of Traquair) manifests as a central scotoma in the ipsilateral eye and a superior temporal visual field defect in the contralateral eye. McKean-Cowdin R, Wang Y, Wu J, et al. Prechiasmal lesion on thesame side as the eye with the visual field defect. 3. Lesions of the occipital lobe result in homonymous hemianopias, contralateral to the side of the lesion (i.e., a right-sided field defect with a left-sided lesion and vice-versa). (B) Horner's syndrome, left eye. WebThis loss is unilateral and homonymous: this implies that the visual deficit affects the same region of the visual field in both eyes; this is due to the fact that fibers from the nasal hemi-retinas (representing the lateral or temporal visual field) from each eye cross in the optic chiasm, while fibers from the temporal hemi-retina (representing Origin of the relative afferent pupillary defect in optic tract lesions. quadrantanopia, inferior. Ophthalmology 2005 Oct;112(10):1821-8. Is the patient alert and oriented? All rights reserved. [4], Homonymous inferior quadrantanopia is a loss of vision in the same lower quadrant of visual field in both eyes whereas a homonymous superior quadrantanopia is a loss of vision in the same upper quadrant of visual field in both eyes. If there is damage to the optic nerve then complete unilateral anopia can develop. To further complicate matters, 30% of those subjects with significant visual field loss were still driving.9, Red Eye, Red Herring Ophthalmology 1990 Mar;97(3):367-70. 17. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Ali M, Hazelton C, Lyden P, et al; VISTA Collaboration. Curr Treat Options Neurol. Is there a color vision defect? A 49-year-old Hispanic male presented with complaints of a red, irritated left eye with significantly reduced vision in the same eye. 6. Quadrantanopia It occurs in the days or hours leading up to profound vision loss. The etiologies of retrochiasmal lesions are different between adults and children. This presents with loss of both temporal fields and is due to compression of the bilateral 4. WebQuadrantanopia refers to the loss of vision in one of the quarters of the visual field. 2. Quickly switch the occluder to the normal eye, and shine the light in the abnormal eye. Wise clinicians analyze patients complaints within the context of the ocular and medical history to arrive at a logical presumptive diagnosis. THE PUPILLARY DILATION PATHWAY (Figure 17 4) is mediated by the sympathetic division of the autonomic nervous system. Retina 2007 Jun;27(5):601-8. (6) Right lower quadrantanopia. Note that the defect in the right (asymptomatic) eye strongly respects the vertical midline. Douglas VP, Douglas KAA, Cestari DM. bank of calcarine sulcus, Lesion B of visual radiations to inf. Score 1 only if a clear-cut asymmetry, including quadrantanopia, is found. This is often from an anterior chiasmal lesion[6]. Lesion at or near the optic chiasm (not always a pituitary adenoma). A trace relative afferent pupillary defect was seen O.S., but both pupils were of normal size. When a patient presents complaining of loss of some or all of the vision in one eye or in a particular part of the field of vision, the most critical step is to determine if this is a neurological emergency. II. Additionally, a comprehensive neurological evaluation was requested to rule out any additional compromise. The posterior area receives macular input (central vision). complaints.Causes of Visual Field Loss. Left Inferior Quadrantanopia - Cerebral Artery - GUWS Medical Sometimes, however, the most obvious diagnosis is not the correct one. Davis, 1995. pp. Ultimately, an automated field analysis was performed, demonstrating a dense, homonymous hemianopic defect of the left visual field, denser above than below the horizontal midline. 15. Neuro-Ophthalmology (Amsterdam: Aeolus Press. The clinical manifestations of an optic chiasm lesion can manifest with varying visual field defects and decreased visual acuity. Continue reading here: Tuberoinfundibular Tract, Feminessence: Meditation For Your Feminine Voice, Beat Procrastination for Once and For All, Boost your Bust Natural Breast Enlargement, Candida Crusher Permanent Yeast Infection Solution, Axial Image Through The Thalamus And Internal Capsule, Tongue Deviation Lesion - Cerebral Artery. (3) Bitemporal hemianopia. C. The subcortical center for lateral conjugate gaze is located in the abducent nucleus of the pons (Figure 17-5). Such knowledge will enhance proper triage of these often-critical patients. a. Transection causes a contralateral upper quadrantanopia ("pie in the sky")-. The bitemporal hemianopia field defect is the classic presentation of a chiasmal lesion. Homonymous hemianopia - UpToDate NIH Stroke Scale - - RN.org Due to the abrupt onset of symptoms, we suspected a cerebrovascular accident affecting the posterior optic radiations or anterior occipital cortex. 7. Is there a relative afferent pupillary defect (RAPD)? WebUnilateral cortical lesions involving the occipital lobe will usually produce a hemi-field cut contralateral to the site of the lesions. Vellayan Mookan, L., Thomas, P. A., & Harwani, A. Congruency in homonymous hemianopia. Field defects from damage to the optic nerve tend to be central, asymmetrical and unilateral; visual acuity is Our thanks to the following individuals for helping to inspire this article: Mr. Matthew Hennen (SCO 16), Dr. Leah Stevens and Dr. Robert Goodwin (via ODs on Facebook). Complete homonymous hemianopias have no localizing value, except to say that they are post-chiasmal.1. In other cases, medical evaluation and treatment are necessary; vertebrobasilar insufficiency (VBI) and ocular ischemic syndrome (OIS) secondary to internal carotid artery insufficiency are far more serious potential causes of transient binocular (caused by VBI) and monocular (caused by OIS) scotomas. [8] Teaching individuals with quadrantanopia compensatory behaviors could potentially be used to help train patients to re-learn to drive safely. Due to the abrupt onset of symptoms, we suspected a cerebrovascular accident affecting the posterior optic radiations or anterior occipital cortex. Postganglionic sympathetic fibers pass through the tympanic cavity and cavernous sinus and enter the orbit through the superior orbital fissure. Visual pathway lesions He later revealed hed been suffering from a headache on the right side, behind his ear (the occipital region). THE PUPILLARY LIGHT REFLEX PATHWAY (Figure 17-3) has an afferent limb. At a visit in our clinic several months prior, vision O.S. Suprasellar and sellar lesions can produce optic neuropathies in one or both eyes; a junctional scotoma (ipsilateral visual loss and contralateral superotemporal visual field loss) or the junctional scotoma of Traquair (monocular hemianopic visual field loss); or chiasmal bitemporal hemianopsia (including paracentral bitemporal hemianopsia from crossing macular fiber in posterior chiasm). (1) Ipsilateral blindness. Biomicroscopy revealed healthy anterior segment structures; dilated funduscopy showed moderate nonproliferative DR, but no evidence of neovascular scaffolding, vitreous hemorrhage or retinal detachment in either eye. WebQuadrantanopia is a condition associated with the temporal and parietal region of brain. Identification of field loss using screening techniques. Chiasmal syndromes. It may be homonymous (binasal, It also receives fibers from the ipsilateral temporal hemiretina and the contralateral nasal hemiretina. IV. B. One-and-a-half syndrome consists of bilateral lesions of the MLF and a unilateral le* sion of the abducent nucleus. Less commonly, the uncrossed temporal fibers are compressed, manifesting with a monocular nasal field defect in the ipsilateral eye. 2009;37(1):30-53. Freeman EE, Muoz B, Rubin G, et al. If you do order neuroradiology studies for your patient, its a good idea to work with the neurologist the first few times so that you dont end up with equivocal results. Traumatic chiasmal syndrome: A meta-analysis. Retinitis pigmentosa. Ramrattan RS, Wolfs RC, Panda-Jonas S, et al. Confrontation visual field testing is not 100% reliable, even when done properly and carefully. By Alan G. Kabat, OD, and Joseph W. Sowka, OD. 2. Copyright 2023 Jobson Medical Information LLC unless otherwise noted. The frontal eye field is located in the posterior part of the middle frontal gyrus (Brodmann's area 8). The locations and associated tumors along the visual pathway include: The orbit can be divided into 3 different zones: intraconal, extraconal, and intercompartmental. Acute Monocular Quadrantanopia and Retinal Diseases They project from the nasal hemiretina to the contralateral lateral geniculate body and from the temporal hemiretina to the ipsilateral lateral geniculate body. Next, hold the ND filter over the suspect eye and repeat the test. Disorders of the visual pathway - Knowledge @ AMBOSS Invest Ophthalmol Vis Sci 2006 Dec;47(12):5303-9. ), III. Figure 17-4. It also involves the occipital lobe concerned with vision. For example, information in the left half of visual field is processed in the right occipital lobe and information in the right half of the visual field is processed in the left occipital lobe. The visual pathway. WebIt can be caused by a lesion, particularly, in the temporal and parietal lobes although it is more commonly associated with occipital lobe lesions. This contraction increases the refractive power of the lens. To fully appreciate the potential underlying causes for various visual field defects, it is important to have a working knowledge of the anatomy of the visual system. WebQuadrantanopia. WebPost-chiasmal lesions result in homonymous field defects, i.e., affecting the same side (right or left) of the visual field and respecting the vertical midline. Altitudinal. The underlying diagnosis is often serious and can threaten long-term vision and even the patients well-being. hemorrhagic stroke, trauma)on the side opposite the, AI Algorithms Successful in Diagnosing DR, Peripheral Retinal Lesion Detection Improves With UWF Imaging, Rapid Macular Thinning an Early Sign of HCQ Toxicity. had been recorded at 20/25. Association of visual field loss and mobility performance in older adults: Salisbury Eye Evaluation Study. Temporal defect in one eye, central defect inthe fellow eye. All rights reserved. The pattern of the visual field defect is also more indicative of stroke than other intracranial abnormalities, such as traumatic brain injury, cerebral hemorrhage or compressive tumor.2 The patient was advised that he had likely suffered an isolated stroke which caused him to experience vision loss. right. A 55-year-old black male with a history of Type 2 diabetes and hypertension presented urgently for evaluation. Neoplasms in the region of the optic tract can produce contralateral incongruous homonymous hemianopia, often with a relative afferent pupillary defect and band atrophy of the optic nerve (in the eye with the temporal visual field defect). The optic nerve projects from the lamina cribrosa of the scleral canal, through the optic canal, to the optic chiasm. The upper division (Figure 17-2) projects to the upper bank of the calcarine sulcus, the cuneus. On this Wikipedia the language links are at the top of the page across from the article title. 5. (E) Sixth-nerve palsy, right eye. HVr6}WX0. This simulates a normal swinging flashlight test; in effect, the pupils appear to respond equally. Consultation with the appropriate medical caregiver is prudent. Visual Field Defects Dr. Reed is an associate professor at Nova Southeastern University, where she teaches ocular disease and primary clinical care. In essence, the more the field loss in one eye appears to be a carbon copy of the other, the greater the level of congruity. Glaucoma is the leading cause of field loss across all adult age groups when tested using automated threshold or supra-threshold perimetry.