Visual Field Redux

Last time I wrote about visual field analysis was summer of 2015.  I concluded the piece with the following:

So as you can see visual field loss can be “silent.” Most people don’t have notable visual field complaints. As you can also see, automated visual fields should be the standard at every eye exam. It is a tool often reserved only for glaucoma but can be a valuable asset to any office. Please come in and be a part of the most comprehensive eye care team. Send your loved ones in too. His or her 'eyesight' might be fine but vision is so much more than that."

Recently we had another case that speaks to the importance of annual automated field analysis:

A 50 year old woman presented to our office with no visual complaints. She wanted to get more contact lenses as her supply was running low. As with all of our patients we ran a Humphrey 76 automated visual field screening on her. Of note, her health history was remarkable for breast cancer.

Her results looked like this:

Since some patients just aren’t “good” at the test, if I have any concerns I tend to repeat them with a more in-depth test. After looking at her results we decided to do another visual fields that day.

The second test looked like this:

As you can see there was a problem with her upper left side (the black area). Since we see visual field loss with both eyes in the same area we suspected that there was something going on with her brain. She denied having seizures, motor issues or headaches (ones that seemed out of the ordinary). The goal for us in this case was to have the patient get an MRI. She did, and here are some of the images:

As you can see the MRI showed a brain tumor that was about 3 cm in size. The visual pathway extends throughout the brain and was impacted due to the location of the tumor. Since she had no other symptoms this might have gotten larger had she not had an eye exam at our office.

I suspect the tumor was relatively fast growing since her visual fields were full last year. You can also see a fair amount of edema (swelling) surrounding the tumor, which might be a sign that it had been growing.

The swelling can also be seen more clearly on this sequence:

Another view demonstrating the size of the mass:

Health care is changing. The most notable change is insurance and how insurance coverage is convoluted within health care. Many of my colleagues are forced to see a lot of patients in order to maintain the same levels of reimbursement. Often times it is easy to sacrifice tests that take a lot of time and are statistically not likely to show anything. I believe strongly that automated visual fields are an under-utilized test in eye care. The cost to the doctor in time isn’t worth it especially if several exams within an hour are necessary to keep the business open. To me, however, there is great value. There may be very few patients that are walking around with a 3cm brain tumor and have no symptoms, but if it were your mother, wife, daughter, sister, or any loved one, the earliest possible detection would be worth every penny.

I am also happy to report our patient had a successful surgery and is recovering at home. I am told she is doing well, and we are all wishing her the very best in her recovery. I am very grateful for her willingness in allowing me to share her story and images.