ASOPRS 2014 Fall Syllabus - page 165

ASOPRSFall Scientific SymposiumSyllabus
165
T12
Tangent Visual Fields are aPrecise, Time andCost EfficientMethod for
Detecting theChanges inSuperior Visual FieldCausedByBlepharoptosis
andDermatochalasis andTheir Surgical Correction
Molly Fuller
1,2
, César Briceño
1
, ElizabethBradley
2
, ChristineNelson
1
.
1
Ophthalmology, Kellogg EyeCenter, University ofMichigan,
AnnArbor,MI, UnitedStates, 
2
Ophthalmology,MayoClinic, Rochester,MN, UnitedStates
Introduction:
Superior visual field testing is a common practice during the evaluation of blepharoptosis and dermatochalasis, but
studies show the use of Humphrey andGoldmann visual field testing predominates
1
withmanual testing preferred by patients
2
.We
hypothesized that tangent visual fields (TVFs) aremore time and cost efficient,whilemaintaining good correlationwith clinical exam
and surgical outcomes.
Methods:
In this prospective study, patients referred to a single surgeon for upper eyelidmalpositionwere evaluatedwith visual
acuity testing, superiormargin-to-reflex distancemeasurements (MRD1), andTVFs. Patientswere included in the study if evaluation
led to surgical correction by blepharoplasty, blepharoptosis repair, or a combination of both. Clinical testingwas repeated at a
postoperative visit.TVF durationwas timed, and superior visual fields (SVFs) were analyzed for intact vision in the superior vertical
meridian and area under the curve of theTVF tracing. Pre- and postoperative SVFs andMRD1were comparedwith paired t-tests.
Duration and cost of theTVF examwas also compared to historical data.
Results:
One hundred nine eyes from 57 patientswere included in the study.The average time to completeTVFs in one eye
was 3:11,while the average time to complete testing of both eyeswas 6:03.Thiswas significantly less than published times for
Humphrey or Goldmann testing. SVF lossmeasured in the vertical meridianwas extremelywell correlatedwithmeasurement by
area under the curve (r=0.87). Both preoperative taped-eyelid SVFs and postoperative SVFs showed significantly greater intact
visual field (p<0.001) with surgery providing an average 12.9 degree improvement in the vertical meridian. Surgery induced a
significant increase inMRD1 consistent with the preoperative diagnosis: 0.6mm for blepharoplasty and 2.8mm for blepharoptosis
repair or combination surgery (p<0.001 for all 3 surgeries).A tangent screen is themost inexpensive form of testing equipment
available today.
Conclusions:
We show that tangent visual fields are a time and cost efficient method of testing superior visual fields.TVF testing
is the quickest andmost economical method of testing in common clinical use today.Additionally, post-operative testing shows
an increase in degrees of vision in the vertical meridian, area of superior visual field, and surgically appropriatemargin-to-reflex
distance, supporting the high success rate of these surgical interventions.There is excellent correlation between SVF changes
measured by degrees in the vertical meridian and area under the curve.
References:
1.AakaluVK, Setabutr P. Current ptosismanagement: a national survey of ASOPRSmembers. Ophthal Plast Reconstr
Surg. 2011 Jul-Aug;27(4):270-6.
2.Alniemi ST, PangNK,Woog JJ, Bradley EA. Comparison of automated andmanual perimetry in patientswith blepharoptosis.
Ophthal Plast Reconstr Surg. 2013 Sep-Oct;29(5):361-3.
DetailedProgram
—Thursday,October 16, 2014
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