Visual Field Defects (Patterns)

Visual field defects are patterns of vision loss that help identify where in the visual pathway damage has occurred. Different locations cause characteristic patterns.

Common Patterns

Central Scotoma

• Blind spot in center of vision
• Causes: optic neuritis, Macular Disease
• Significantly affects reading, detail vision

Arcuate Defect

• Arc-shaped defect above or below fixation
• Causes: glaucoma, ischemic optic neuropathy
• Follows nerve fiber bundle pattern

Altitudinal Defect

• Loss of upper or lower half of vision
• Causes: ischemic optic neuropathy, branch retinal artery occlusion
• Respects horizontal midline

Hemianopia

• Loss of right or left half of vision
• Homonymous—same side affected in both eyes (brain lesion)
• Causes: stroke, tumor, trauma

Bitemporal Hemianopia

• Outer (temporal) fields lost in both eyes
• Causes: pituitary tumor, chiasmal compression
• Affects both outer visual fields

Quadrantanopia

• One quarter of visual field affected
• Localizes to specific area of visual pathway

Generalized Constriction

• Peripheral vision lost all around
• Causes: glaucoma, retinal disease, papilledema

Localization

Defect	Location
Central scotoma	Optic nerve, macula
Bitemporal hemianopia	Optic chiasm
Homonymous hemianopia	Brain (opposite side)
Altitudinal	Optic nerve, retina

Monitoring

Regular visual field testing tracks:

• Stability vs progression
• Response to treatment
• Need for intervention