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M. Lalezary, M. Melson, L. Mawn; Blepharoptosis Associated Superior Visual Field Loss Detected With an Automated Screening Test. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5048.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate blepharoptosis related superior visual field deficits as measured by the Humphrey Field Analyzer (HFA) Superior 64 point screening pattern (ptosis test). Previous studies have suggested that Goldmann perimetry is faster with an average time of 10 ± 2 minutes in detecting ptosis related visual field deficits than automated peripmetry.1 Both automated static and Goldmann kinetic perimetry are used to assess superior visual field (SVF) loss caused by blepharoptosis.1-2 No available studies exist addressing the utility or validity of the HFA ptosis test for detecting SVF loss associated with ptosis.
Both eyes of 6 adult healthy volunteers were examined. Measurements of palpebral fissure (PF), marginal reflex distance (MRD), levator excursion, and lid crease were performed. Photographic documentation of the eyes was obtained. SVF were assessed using the ptosis screening pattern. A 1.4 g gold weight was then taped on the upper eyelid to induce ptosis with an induced MRD in all subjects of < 2.5 mm and the lid position photographed. The HFA ptosis test was then repeated. The number of the 64 points seen for both the baseline and induced ptosis was noted and the percentage of the number seen of calculated. The ratio of the MRD to the PF was calculated. The student t-test for paired data was used for data analysis.
A significant difference between the number of the total 64 points seen on the HFA with lid open versus the number of points seen with the gold weight in place was noted 57.2 ± 3.61 versus 31.6 ± 12.4 (p= 0.0001). Also the difference in the ratio of the MRD to PF was found to be significantly different 39.6% ± 7.10% versus 23.2% ± 7.78% (p = .0001). The mean examination time for the baseline field was 3:02 ± 0.02 minutes and with the weight was 3:56 ± 0.03 minutes ( p = 0.0007); this difference was significantly longer for the visual field performance for the gold weight.
The HFA Superior 64 point screening pattern for assessing visual field loss associated with ptosis showed a linear relationship in the amount of SVF loss detected to the amount of induced ptosis. This relationship supports the validity of this test for measuring visually significant ptosis. The performance time of less than 4 minutes per eye compares favorably to times reported for Goldmann visual field ptosis screening.
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