• Users Online: 128
  • Print this page
  • Email this page

 Table of Contents  
Year : 2022  |  Volume : 1  |  Issue : 2  |  Page : 95-99

Is visual field test important in hypertensive-diabetics?

ECWA Eye Hospital, Kano, Nigeria

Date of Submission06-Aug-2021
Date of Decision28-May-2022
Date of Acceptance31-May-2022
Date of Web Publication27-Dec-2022

Correspondence Address:
Mayor O Atima
ECWA Eye Hospital, P. O. Box 14, Kano
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jnam.jnam_7_21

Rights and Permissions

Keywords: Diabetes, Hypertension, Infarcts, Vision, Visual field

How to cite this article:
Atima MO, Orugun AJ, Ugbede I, Komolafe OO. Is visual field test important in hypertensive-diabetics?. J Niger Acad Med 2022;1:95-9

How to cite this URL:
Atima MO, Orugun AJ, Ugbede I, Komolafe OO. Is visual field test important in hypertensive-diabetics?. J Niger Acad Med [serial online] 2022 [cited 2023 Jun 9];1:95-9. Available from: http://www.jnam.com/text.asp?2022/1/2/95/365603

  Introduction Top

Bilateral reduction in vision is a common presenting complaint in an ophthalmic clinic. Normal vision is 6/6, but patients could present with less visual acuity. The International Classification of Disease (ICD11) classified vision into two groups: distance and near visual impairment. Distance visual impairment is graded into:

  • Mild = visual acuity worse than 6/12–6/18

  • Moderate = visual acuity worse than 6/18–6/60

  • Severe = worse than 6/60–3/60

  • Blindness = visual acuity worse than 3/60

Near vision impairment is graded into:

  • Near visual acuity worse than N6 at 40 cm

  • Common causes of reduction in vision include refractive errors, cataract, and glaucomatous optic atrophy.[1]

Visual field is the entire area that can be seen when an eye is fixed straight at a point or target that extend 90° temporally, 60° nasally, and 70° and 50° inferiorly and superiorly, respectively. The visual pathway is divided into afferent and efferent pathways. The afferent pathways consist of retinal ganglion cells, optic nerve, chiasma, optic tract, and optic radiation extending from the lateral geniculate body to the visual cortex. The afferent consist of the pupil and its associated autonomic pathways and neural mechanisms for ocular motility. Visual field tests are primarily indicated in neurological and neuro-ophthalmic diseases but not usually in diabetic cases.[2]

The visual cortex is located in the occipital lobe (Brodmann area 17 and 18). Occipital lobe infarctions commonly present with a total loss of vision (cerebral visual impairment), which could be gradual or sudden.[3],[4]

We saw a diabetic case with a bilateral moderate visual impairment with normal ocular findings. We present a case of bilateral occipital lobes stroke who presented only with a reduction in vision in both eyes.

  Case Presentation Top

A 56-year-old man, known hypertensive and diabetic for 10-year duration, presented with a progressive painless reduction in vision in both eyes of a month duration with no other ocular complaints. There was no other history to suggest confabulation or hallucination There was no history of trauma or known past history of cerebrovascular accident.

The general examination showed a middle-aged man, not pale, not ill-looking, afebrile, acyanosed, and no peripheral edema. His body mass index was 29.

Ophthalmic examination showed a visual acuity of 6/36 in the right eye (RE) and 6/24 in the left eye (LE) with best-corrected visual acuity of 6/24 and 6/18 with refraction in the RE and LE, respectively. Perceptual visual dysfunction test was not done as the patient had a good cognitive and motor function.

Extra-ocular motility was full in all directions of gaze, and the anterior segments were normal. Intraocular pressures were 12 mmHg in both eyes.

Posterior segment showed a clear vitreous. Fundal examination with an indirect ophthalmoscopy using a 78D lens revealed a pink disc, normal neuroretinal rim with a vertical cup disc ratio of 0.6 bilaterally, which was normal. The retinal arteries showed an obvious narrowing with focal irregularities (Scheie grade 2 hypertensive vasculopathy) and normal foveal reflex. The color vision test using Ishihara chart was normal The Humphrey visual field (Carl Zeiss Model 750 3605) was used in assessing the visual field. A Swedish interactive thresholding algorithm fast 24-2 threshold test, with stimulus size III, 31.5 Asb, was used. This revealed mainly congruous superior homonymous quadrantanopia [Figure 1]A and B and normal retinal nerve fiber layers [Figure 2] with optical coherence tomography (Carl Zeiss).
Figure 1: (A): Right eye visual field test and (B): left eye visual field test

Click here to view
Figure 2: Optical coherence tomography of both eyes

Click here to view

The Transasia CE machine (model: Chem 5 v 3 SR NO: S0873) was used to access the lipid profile: cholesterol, 4.00 mmol/L (3.80–6.50); triglyceride, 1.0 mmol/L (0.84–1.97); high density lipoprotein, 1.20 mmol/L (0.81–1.33); low density lipoprotein, 1.56 mmol/L (2.03–3.29). The patient had a well-controlled blood sugar with fasting blood sugar been 6.0 mmol/L.

Computerized tomography scan of the brain without contrast and angiography revealed bilateral hypodensities affecting 20%–40% of the occipital lobe [Figure 3]A and B.
Figure 3: (A and B): Computerized tomography scan of the brain

Click here to view

A diagnosis of cerebral visual impairment secondary to the bilateral occipital lobes infarction was made. A consult was sent to a neurologist and cardiologist to co-manage the patient. However, no feedback was received. Follow-up phone calls were also not successful.

  Discussion Top

Our patient presented with only reduction in the central vision without any other clinical signs of neurological deficits.

Occipital lobe stroke patients mainly showed cortical blindness (this is bilateral) or unilateral loss of vision.[3],[4] Other forms of presentation that have been reported include ptosis,[5] vivid visual hallucinations, auditory hallucinations, and psychosis.[6]

  Conclusion Top

Bilateral reduction in vision is a common complaint in an ophthalmic setup. Having excluded the common causes of decreased visual acuity in a middle-age patient with thrombotic predispositions, it is mandatory that visual field test be done in order to detect any potentially more debilitating nonocular pathologies. At the point of establishing a diagnosis of chronic systemic conditions, it is expected that best/evidence practices be applied. This includes a comprehensive eye/vision check as baseline parameters, which will include a visual field test, even though more emphasis is placed on the fundal photography.

With any nonrefractive visual loss, a central visual field is mandatory especially in the presence of normal anterior and posterior segment examinations.

Subsequent eye/vision checks depend on the eye/vision condition at the first consultation.

Financial support and sponsorship


Conflict of interest

There are no conflicts of interest.

  References Top

Vision Loss Expert Group of the Global Burden of Disease Study. Causes of blindness and vision impairment in 2020 and trends over 30 years: Evaluating the prevalence of avoidable blindness in relation to “Vision 2020: The right to sight”. Lancet Glob Health 2020;9:144-60.  Back to cited text no. 1
Boyd K Visual Field Testing. American Academy of Ophthalmology. Available at: https://www.aao.org/eye-health/tips-prevention/visual-field-testing. January 27, 2019.  Back to cited text no. 2
Kiu KY, Sanihah A, Sharmini-Liza T, Tharakan J Recurrent bilateral occipital infarct with cortical blindness and Anton syndrome. Case Rep Ophthalmol Med 2014;2014:1-3.  Back to cited text no. 3
Galetović D, Karlica D, Bojić L, Znaor L Bilateral cortical blindness—Anton syndrome: Case report. Coll Antropol 2005;29(suppl 1):145-7.  Back to cited text no. 4
Vanikieti K, Poonyathalang A, Jindahra P, Cheecharoen P, Chokthaweesak W Occipital lobe infarction: A rare presentation of bilateral giant cavernous carotid aneurysms: A case report. BMC Ophthalmol 2018;18:25.  Back to cited text no. 5
Flint AC, Loh JP, Brust JC Vivid visual hallucinations from occipital lobe infarction. Neurology 2005;65:756.  Back to cited text no. 6


  [Figure 1], [Figure 2], [Figure 3]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Case Presentation
Article Figures

 Article Access Statistics
    PDF Downloaded34    
    Comments [Add]    

Recommend this journal