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Component Perimetry: A Fast Method to Detect Visual Field Defects Caused by Brain Lesions

¹ From the Sektion Visuelle Sensorik, Department of Neuro-ophthalmology, University Eye Clinic, Tübingen, Germany; the ² Department of Optometry and Visual Science, City University, London, United Kingdom; and the ³ Institute for Brain Research IV, Human Neurobiology; University of Bremen, Germany.

PURPOSE. Noise field campimetry, performed according to Aulhorn and Köst, confronts patients with a large field of irregularly flickering dots, and many patients immediately perceive their visual field defects. The original method had a somewhat low specificity and sensitivity, especially for patients with visual field defects caused by cortical lesions.

METHODS. The method was improved in two ways. First, the grain of the visual noise was increased toward the periphery of the visual field to accommodate the peripheral decrease in visual acuity. Second, the type of stimulus pattern was varied to include separate investigations of different visual components or functions (color, motion, temporal resolution, line orientation, stereoscopic depth, acuity, and figure–ground segmentation). To evaluate the reliability of the method, the visual fields were compared, as assessed by the new method, with those of conventional perimetry in 41 patients with neurologic disorders and 22 normal control subjects.

RESULTS. The results were encouraging. All patients with suprageniculate lesions subjectively experienced visual field defects in component perimetry. Sizes of visual field defects obtained with both methods corresponded qualitatively with each other, with a highly significant correlation. The specificity of component perimetry was higher than that of the original noise field campimetry.

CONCLUSIONS. This pilot study indicates that component perimetry is a subjective but relatively reliable method for detecting disorders of visual perception caused by lesions at different stages along the visual pathway, permitting fast screening of the visual field. In addition, this method seems to allow examination of the visual field, not only for defects in contrast sensitivity, as does conventional light perimetry, but also for the status of other components of vision such as color or motion perception. Further evaluation with larger patient cohorts is needed to allow exact assessment of the clinical usefulness of the method.