As many of us have learned, visual field testing can be tedious and difficult for patients. This is a problem, because defects in a visual field in one or both eyes can be some of the most important information gathered on exam to help pinpoint where deficiencies are located.

This article will discuss ways to improve the experience for patients to get accurate testing.

First, some definitions

The "visual field" is the area an eye sees when looking at a point straight ahead. A "normal" visual field is measured in terms of degrees, which should be approximately 95 degrees temporally and 60 degrees nasally in each eye.

For this article, we will be focusing on the automated field analyzers. Automated perimetry was developed to minimize operator errors in performing manual perimetry to assess visual function. Unfortunately, these devices come with their own problems: patients can lose focus, become uncomfortable, stop blinking — which can cause blurring — or become distracted by something happening outside of the test.

Success is in our hands

We have all had patients who blanch the moment they learn they have to undergo visual field testing. They then usually follow up by stating, "I hate this test." The technician response at this moment can make or break the whole visit. I usually respond, "Everyone does, but let’s make this fun and quick and then you will be done for another year!"

Instructing the patient before starting the test is very important so they understand what to expect. The fear of missing something or failing the test can cause anxiety for the patient, worsening an already stressful test.

Step by step

Here's the instruction I give patients:

• We test each eye separately; the other will be patched. Your physical comfort is very important while doing this test, but we also need you to maintain a stable posture. Your chin and forehead will be in contact with the machine so your gaze can be monitored; please keep your teeth together to keep your head still. The test will take 5-10 minutes per eye, so please don’t slouch or stretch.
• You will be looking at a target light for the entire test. To get the best result, it is very important you do not look around during the testing. I am watching your eye on a monitor and will be checking if you are moving your eye during the test. I may make slight adjustments to your head position during the test; try to move with the headrest but without any quick movements.
• You will hold a "clicker;" go ahead and try it out a few times when I hand it to you, so you get a feel for it. If during the test you need a break, please hold the button down, which will pause the test.
• A series of lights will display on the white screen; every time you see one flash hit your button. If you think you see a light, hit the button — do not wait. The test will check each area several times if inconsistent responses are given. The machine is "tricky" — you may hear a shifting sound right before you see a light. Occasionally the machine will make this sound without flashing a light. There is not a set pattern, so the lights may come quickly, with one light after the other, or there may a pause between them.
• Remember to blink — the speed of a regular blink is not enough to make you miss any of the lights. If you do not blink regularly, your eye can become dry and you may have blurry vision. I will also routinely remind you to blink.

Comfort is crucial

Make sure your visual field machine is in a dark environment and away from ambient noise that could distract the patient. When putting lenses in the trial frame, put the cylinder power lens toward the back of the holder (farthest from patient’s eye) and then the spherical lens. Watch the handles on the trial lenses so they do not poke the patient's nose.

I prefer to get the patient completely comfortable and aligned, then I patch and move the trial lens in front of the eye. Always make sure the patient can blink easily, and that the lens is at an appropriate distance from the patient's eye.

Chairside manner

If the patient seems open to a little humor, by all means this is a great time to break out the pirate jokes while placing the patch ("While this is on you must speak like a pirate, I wish we had a parrot for your shoulder for the test"). Commiserate with patients on the "boring" yellow fixation light and ask what they think would be a better something to fixate on — I have had some fun responses. Liken the test to a video game. I have found breaking the ice often will get the patient’s mind off the anxiety of the test and improve their overall experience.

For those more serious or frightened patients, a large dose of TLC can make all the difference. Explain why the test is being done and why it is so important. Be extra mindful of getting them positioned correctly. Having a cushion or a pillow that can be used behind a patient’s back can make all the difference in their comfort. If they are coughing or clearing their throat, offer a cup of water before starting the test. Ask if they prefer to be kept updated on where they are during the test ("We are halfway through; you’re doing great!") or prefer minimal comments from the operator.

In between eyes, I always have the patient sit back and give me a wiggle or a toe touch to help them relax and make sure they are ready to reposition for the second eye. I have had some patients uncomfortable and unable to stay still as a result of quickly starting the other eye without proper positioning. Remember to recheck the trial lens holder and their eye, as each eye can sit a little differently.

Once the test is completed: Celebrate! The patient finished. Remind them that this is passing the test. OP

Ms. Waggoner is a certified ophthalmic medical technologist with 30 years of experience, currently serving patients in a multispecialty practice in Fort Collins, CO. She is a past program director for Northern Colorado Rocky Mountain Ophthalmic Personnel and CORE speaker for Allergan.