COT Visual Field Testing 3 — Questions and Answers
Question 1: The Esterman binocular visual field test is most commonly used to assess:
- Glaucoma severity staging
- Driving fitness and functional visual disability (Correct answer)
- Macular degeneration progression
- Pediatric amblyopia screening
Correct answer: Driving fitness and functional visual disability
The Esterman binocular test evaluates the functional visual field for activities like driving and is used in disability and legal assessments.
Question 2: A patient with a nasal step defect on automated perimetry most likely has damage to which structure?
- Macular ganglion cells
- Superior arcuate nerve fiber bundle
- Retinal nerve fiber layer at the horizontal raphe (Correct answer)
- Optic radiation
Correct answer: Retinal nerve fiber layer at the horizontal raphe
Nasal step defects occur because the horizontal raphe divides the superior and inferior retinal nerve fiber layers, and asymmetric damage creates a step at the nasal horizontal midline.
Question 3: When testing a patient with a dense central scotoma, which test pattern is most appropriate for monitoring residual peripheral field?
- 10-2 program
- 24-2 program
- 30-2 program (Correct answer)
- Macula program
Correct answer: 30-2 program
The 30-2 program tests out to 30° and is better suited for monitoring peripheral field when central vision is severely compromised.
Question 4: Which reliability index specifically measures the frequency at which a patient fails to respond to a previously seen suprathreshold stimulus?
- False positive rate
- False negative rate (Correct answer)
- Fixation loss rate
- Gaze tracking score
Correct answer: False negative rate
The false negative rate measures how often a patient does not respond to stimuli significantly brighter than their established threshold, suggesting inattention or fatigue.
Question 5: Goldmann kinetic perimetry uses moving stimuli from non-seeing to seeing areas. This technique is especially useful for:
- Detecting early focal glaucomatous loss
- Mapping large or irregular scotomas and testing patients who cannot perform static perimetry (Correct answer)
- Measuring contrast sensitivity
- Evaluating the optic nerve head
Correct answer: Mapping large or irregular scotomas and testing patients who cannot perform static perimetry
Kinetic perimetry excels at mapping the full extent of scotomas and is ideal for patients with very poor vision, neurological conditions, or who cannot maintain fixation for static testing.
Question 6: What does the Mean Deviation (MD) value on a Humphrey Field Analyzer report represent?
- The average sensitivity across all test points compared to age-matched normals (Correct answer)
- The standard deviation of threshold values within the field
- The number of depressed points on the Total Deviation plot
- The difference between the best and worst threshold values
Correct answer: The average sensitivity across all test points compared to age-matched normals
Mean Deviation is the average deviation of all measured thresholds from age-corrected normal values, with negative values indicating overall field depression.
Question 7: A homonymous hemianopia affecting the right visual field in both eyes indicates a lesion in which location?
- Right optic nerve
- Optic chiasm
- Left optic tract or left occipital cortex (Correct answer)
- Right lateral geniculate nucleus only
Correct answer: Left optic tract or left occipital cortex
Right homonymous hemianopia results from damage to the left visual pathway posterior to the chiasm (left optic tract, left LGN, left optic radiation, or left occipital cortex).
COT Visual Field Testing 3
The Esterman binocular visual field test is most commonly used to assess: