Barbara Connolly, MD; Wieslaw Oczkowski, MD
How accurate are confrontation visual field tests (CVFTs) for diagnosing visual field abnormalities?
Blinded, random-ordered comparison of 7 CVFTs with automated perimetry.
A neuro-ophthalmology clinic in Auckland, New Zealand.
332 eyes in 172 patients (mean age 59 y, 56% women, based on 301 eyes in 163 patients with complete and reliable data) who had best-corrected visual acuity ≥ 6/60 and ability to perform all tests. Eyes were excluded if perimetric reliability indices were exceeded.
7 CVFTs including face description (detection of distortion/absence of any part of the examiner’s face), finger counting (count of 1 or 2 static fingers presented sequentially in each quadrant), finger comparison (clarity of examiner’s index fingers presented simultaneously on either side of vertical meridian in superior then inferior quadrants), red comparison (clarity of 2 identical red bottle tops presented analogously to finger comparison), static finger wiggle (movement of static, wiggling finger presented as for finger comparison), kinetic finger wiggle (wiggling of examiner’s wiggling finger as it moved inward within each quadrant), and kinetic red target (color of a 5-mm red-topped pin moved inward within each quadrant). Indeterminate results were classified as abnormal. The 7 CVFTs were administered in a random order by 2 neuro-ophthalmology fellows.
Computerized threshold static perimetry to establish the dimmest stimulus that could be seen in preset test-point locations and compared with age-matched normal controls. Visual fields were classified as normal or abnormal.
Included sensitivity and specificity of individual and combined CVFTs.
The prevalence of eye defects was 56%, 63% of which were caused by glaucoma. Diagnostic characteristics of CVFTs are shown in the Table. Kappas ranged from 0.63 to 0.81. The combination of static finger wiggle plus kinetic red target (Table) showed the greatest accuracy of the CVFT combinations.
Confrontation visual field tests, alone and in combination, had low-to-moderate sensitivity but generally high specificity for diagnosing visual field abnormalities.
Confrontation visual field tests compared with automated perimetry for diagnosing visual field loss*
*Diagnostic terms defined in Glossary. LR and CI calculated from sensitivity and specificity reported in article. Analysis by eye.
Connolly B, Oczkowski W. Individual and combined confrontation visual field tests performed poorly as a screen for visual field abnormalities. Ann Intern Med. ;153:JC4–11. doi: 10.7326/0003-4819-153-8-201010190-02011
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Published: Ann Intern Med. 2010;153(8):JC4-11.
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