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Do cataracts invalidate field tests?

Question:

- Hide quoted text — Show quoted text -halt…@aol.com (Halterb) wrote in message <news:20031123075209.08361.00000725@mb-m24.aol.com>… > Thanks to Dr. Rick for his reply: > >Cataracts certainly can have an effect on visual field results.  I > >simply put less emphasis on this test in patients with cataracts and > >more on the appearance of the optic nerve.  If I am having a great > >deal of difficulty > >seeing the nerve, then it is likely that the patient is having a tough > >time seeing the outside world.  At that point it is time to remove the > >cloudy lens…doesn’t sound like you’re quite ready for this yet with > >20/20 vision.  One point to note is that cataracts will cause a > >greater central loss on the field test while glaucomatous changes tend > >to involve an arcuate or "arch-shaped" loss involving the upper or > >lower mid-peripheral vision.  That is one way to tell field loss in > >cataracts from field loss from glaucoma.  Hope that helps.< > It helps, but seems to tip the scale back toward glaucomatous loss rather than > cataract, since at least in bright light my central vision is perfect. The dark > area on the field test is rather clearly defined in the entire hemisphere below > the horizontal midline. But, as in my original post, in dimly lit surroundings > my actual field of vision is no different between the eye showing a perfect > field and the one showing diminished vision; also, even in brighter light while > staring straight ahead, I notice I can see fingers wiggled at the extreme > bottom of my visual field whereas I can’t between the extreme bottom and close > to the center horizontal line. In bright light it’s like a semi circlular area > is missing (scotoma?), although I can see above it and below it. But, again, in > dim light there is no missing area. It appears that my total visual field > exceed that measurable by the field test. The white globe in the field test > instrument creates quite a glare which seems to obscure the contrast between > the white background and the brighter spot of light.

I would agree here, Bryan, the field loss you describe (quite well, I might add…don’t recall asking you if you’re an engineer) does sound more like glaucomatous loss than from cataracts.  Given the choice I’d prefer the latter. Wishing you and all our readers here a Happy Thanksgiving, Rick Cohn, MD

Response:

My recent field tests have shown deterioration in the lower part of one eye, the eye which has developed a cataract. I can notice lessend quality of vision in the lower area when outside in bright light. Yet when I am in bed, in a totally darkened room, I notice I can see my illuminated clock across the room perfectly clearly while looking directly at it. If I focus on the wall above it, where the ceiling joins, I can still see the clock in the lower part of the questioned eye. If I focus on various areas of the room, while observing the response in the lower area, I don’t notice any difference between the "bad" eye and the eye which has a totally perfect field test. This would seem to me to suggest that the poor field test is more the result of the cataract than a problem with the optic nerve or retina. Is this a reasonable conclusion? I’ve consulted more than one specialist and get differing opinions as to what is going on, however I get the idea that the cataract is making it difficult to examine the interior of the eye. (My pressures in the "bad" eye have run 12 to 24 over time, currently 16 Goldmann; the "good" eye runs 18 to 24, currently 18; corneal thickness is 539; vision runs around 20/20 uncorrected in both eyes.) TIA

Response:

Thanks to Dr. Rick for his reply: >Cataracts certainly can have an effect on visual field results.  I >simply put less emphasis on this test in patients with cataracts and >more on the appearance of the optic nerve.  If I am having a great >deal of difficulty >seeing the nerve, then it is likely that the patient is having a tough >time seeing the outside world.  At that point it is time to remove the >cloudy lens…doesn’t sound like you’re quite ready for this yet with >20/20 vision.  One point to note is that cataracts will cause a >greater central loss on the field test while glaucomatous changes tend >to involve an arcuate or "arch-shaped" loss involving the upper or >lower mid-peripheral vision.  That is one way to tell field loss in >cataracts from field loss from glaucoma.  Hope that helps.<

It helps, but seems to tip the scale back toward glaucomatous loss rather than cataract, since at least in bright light my central vision is perfect. The dark area on the field test is rather clearly defined in the entire hemisphere below the horizontal midline. But, as in my original post, in dimly lit surroundings my actual field of vision is no different between the eye showing a perfect field and the one showing diminished vision; also, even in brighter light while staring straight ahead, I notice I can see fingers wiggled at the extreme bottom of my visual field whereas I can’t between the extreme bottom and close to the center horizontal line. In bright light it’s like a semi circlular area is missing (scotoma?), although I can see above it and below it. But, again, in dim light there is no missing area. It appears that my total visual field exceed that measurable by the field test. The white globe in the field test instrument creates quite a glare which seems to obscure the contrast between the white background and the brighter spot of light.

Response:

- Hide quoted text — Show quoted text -halt…@aol.com (Halterb) wrote in message <news:20031118065113.26041.00000466@mb-m05.aol.com>… > My recent field tests have shown deterioration in the lower part of one eye, > the eye which has developed a cataract. I can notice lessend quality of vision > in the lower area when outside in bright light. Yet when I am in bed, in a > totally darkened room, I notice I can see my illuminated clock across the room > perfectly clearly while looking directly at it. If I focus on the wall above > it, where the ceiling joins, I can still see the clock in the lower part of the > questioned eye. If I focus on various areas of the room, while observing the > response in the lower area, I don’t notice any difference between the "bad" eye > and the eye which has a totally perfect field test. > This would seem to me to suggest that the poor field test is more the result of > the cataract than a problem with the optic nerve or retina. Is this a > reasonable conclusion? I’ve consulted more than one specialist and get > differing opinions as to what is going on, however I get the idea that the > cataract is making it difficult to examine the interior of the eye. (My > pressures in the "bad" eye have run 12 to 24 over time, currently 16 Goldmann; > the "good" eye runs 18 to 24, currently 18; corneal thickness is 539; vision > runs around 20/20 uncorrected in both eyes.)

Cataracts certainly can have an effect on visual field results.  I simply put less emphasis on this test in patients with cataracts and more on the appearance of the optic nerve.  If I am having a great deal of difficulty seeing the nerve, then it is likely that the patient is having a tough time seeing the outside world.  At that point it is time to remove the cloudy lens…doesn’t sound like you’re quite ready for this yet with 20/20 vision.  One point to note is that cataracts will cause a greater central loss on the field test while glaucomatous changes tend to involve an arcuate or "arch-shaped" loss involving the upper or lower mid-peripheral vision.  That is one way to tell field loss in cataracts from field loss from glaucoma.  Hope that helps. –Rick Cohn, MD Glaucoma Specialist Winter Park, FL – Hide quoted text — Show quoted text -> TIA

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