Artifactual Visual Field Defects Identified on Technically “Reliable” Visual Field Studies in a Neuro-Ophthalmology Practice

PURPOSE: To assess the reliability of automated visual field studies with neurological abnormalities and normal reliability indices that were inconsistent with the remainder of the neuro-ophthalmic assessment. METHODS: Retrospective observational study from the clinical practice of a neuro-ophthalmologist at a tertiary referral center. RESULTS: From 2230 patient charts, ten cases were identified that met the inclusion criteria. In eight of the cases repeat visual field testing had no reproducible abnormality. Four of these cases were concerning for a bitemporal or homonymous hemianopia. None of the patients, including the two cases with a reproducible defect, developed any convincing manifestations of an organic disease related to the visual field defect. CONCLUSION: Our findings suggest that even marked neurological abnormalities on reliable automated visual field tests can be false. When the remainder of the neuro-ophthalmic evaluation is inconsistent with the test result, we recommend that clinicians attempt to immediately repeat the visual field study.