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Molly L Fuller, César A Briceño, Elizabeth A Bradley, Christine Nelson; Tangent visual fields are an efficient and sensitive method for detecting the loss of superior visual field caused by blepharoptosis and dermatochalasis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3120.
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To show that tangent visual fields (TVFs) are a more time efficient method of superior visual field (SVF) testing than Humphrey or Goldmann testing and have good correlation to clinical exam and surgical outcomes.
In this prospective study, patients referred to a single surgeon for upper eyelid malposition underwent visual acuity testing, superior margin-to-reflex distance measurements (MRD1), and TVFs. Patients were included in the study if evaluation led to blepharoplasty, blepharoptosis repair, or a combination, resulting in analysis of 97 eyes from 51 patients. Clinical testing was repeated at a postoperative visit. TVF duration was timed, and SVFs were analyzed for intact vision in the vertical meridian and area under the curve of the TVF tracing. Pre- and postoperative SVFs were compared to preoperative fields performed with a taped eyelid, to historical data using Humphrey or Goldmann visual fields, and to patients’ pre- and postoperative MRD1.
The average time to complete TVFs in one eye was 2m57s and in both eyes was 5m44s. The maximum time for testing one eye and both eyes was 6m36s and 11m52s, respectively. SVF loss (taped-natural position) in the vertical meridian was 15.5 degrees with a loss of area under the curve of 689 degrees2. Surgery induced a change in MRD1 from an average of 1.5mm to 3.1mm (p<7.9-15), an increase in vertical SVF of 12.9 degrees (p<2.3-29), and an increase in area of 579 degrees2 (p<2.2-29). SVFs with eyelids taped predicted greater gain than surgery actually provided by 2.1 degrees in the vertical meridian (p<0.0015) and 106 degrees2 of area (p<0.0016).
We show that TVFs are a more time efficient method of testing SVFs, while maintaining sensitivity to superior visual field loss. TVF testing is the quickest method of testing in common clinical use today. There is good correlation between MRD1 and SVF changes as measured by vertical meridian and area under the curve. Blepharoplasty and blepharoptosis repair lead to excellent functional increases in these variables. Finally, eyelid taping during preoperative testing is a reasonable way to predict surgical outcomes but tends to overestimate the final postoperative result.
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