Ptosis is a relatively common condition that can interfere with upper peripheral vision and lead to functional challenges in daily life. When ptosis surgery is being considered, ptosis visual field testing—particularly the Superior 36 visual field test—is key in demonstrating the need for intervention. In this post, we’ll explain what ptosis is, how it affects visual field, why eyelids are sometimes taped during testing, and how modern tools like the Virtual Field headset are improving access to visual field screening tests.
What is Ptosis?
Ptosis, also called blepharoptosis, is a drooping of the upper eyelid(s). This drooping can interfere with the upper portion of your visual field, reducing the ability to see objects above eye level. Even mild cases can disrupt peripheral vision, making it harder to read, drive, or perform everyday tasks.
While sometimes dismissed as cosmetic, ptosis can limit vision significantly enough to require treatment. Identifying the cause — whether age-related, neurological, or muscular — is essential, and functional testing is a critical part of confirming diagnosis and treatment need.
Types of Ptosis
Ptosis may be present from birth or acquired over time. Acquired types include:
- Aponeurotic ptosis – the most common type, resulting from the stretching of the eyelid-lifting tendon.
- Myogenic ptosis – due to muscle weakness, often related to conditions like myasthenia gravis.
- Neurogenic ptosis – caused by nerve dysfunction, such as third nerve palsy or Horner syndrome.
- Mechanical ptosis – from excess weight on the eyelid, such as a tumor or swollen tissue.
- Traumatic ptosis – from injury that affects eyelid muscles or nerves.
- Pseudoptosis – overhanging skin mimics eyelid droop, even though the lid position is technically normal.
Each form can restrict the upper visual field, which is often evaluated using a peripheral vision test.
What Is a Visual Field Test?
What is a visual field test? It's a functional assessment of how much you can see while looking straight ahead. The test maps your central and peripheral vision, essential for detecting changes caused by ptosis or other eye conditions.
In cases of drooping eyelids, a visual field screening test helps determine whether the condition is limiting your ability to see in the upper field. That’s why insurance companies often require formal ptosis visual field testing before approving surgery.
Why Does the Eye Doctor Tape Eyelids for Peripheral Vision?
Patients often ask, "Why does the eye doctor tape eyelids for peripheral vision?" The answer lies in comparing visual field results with and without the obstruction of the eyelid.
During ptosis visual field testing, the Superior 36 test is typically done twice:
- First, with the eyelids taped upward to simulate post-surgical results.
- Second, with the eyelids untaped to capture the true impact on peripheral vision.
By measuring the difference, eye doctors can document visual improvement and determine whether surgical correction would restore meaningful vision.
The Superior 36: A Targeted Peripheral Vision Test
The Superior 36 visual field test is a focused peripheral vision test that evaluates the upper field—the area most often blocked by drooping eyelids. It is ideal for documenting ptosis-related vision loss without overtaxing the patient.
Here’s how it works:
- The test presents 6 dB light stimuli at multiple points up to 52 degrees above the eye.
- Each stimulus is shown once, and retried if not seen.
- Two test conditions—taped and untaped eyelids—allow comparison of function with and without ptosis obstruction.
This test is preferred for its ability to clearly and quickly assess upper peripheral vision loss in patients with eyelid drooping.
Challenges in Ptosis Visual Field Testing
Ptosis visual field testing can be complex. Factors that affect test accuracy include:
- Difficulty maintaining eye fixation
- Delays or confusion in response
- Uneven pupil size or other technical variables
These challenges may require retesting, but accurate results are crucial. Providers use this data to determine medical necessity for ptosis surgery and to rule out other vision disorders.
From Screening to Surgery: Making Treatment Decisions
Once visual field screening tests and photos confirm limited upper peripheral vision, providers assess whether surgery or other treatment is appropriate. Insurance typically requires:
- Measurable visual field improvement when eyelids are taped
- Patient-reported impacts on activities like reading or driving
- Documentation that visual field obstruction impairs daily living
In some cases, nonsurgical options such as oxymetazoline 0.1% eye drops (which stimulate eyelid elevation) may be considered.
Virtual Field: A Modern Tool for Peripheral Vision Testing
The Virtual Field headset is a portable solution that simplifies peripheral vision test administration. Especially useful in busy practices, it offers:
- Fast, easy-to-administer visual field screening tests
- Accurate ptosis visual field testing with patient comfort in mind
- Elimination of bulky traditional equipment
Providers using Virtual Field can deliver efficient, standardized testing while improving patient access and satisfaction.
References
Aakalu, V. K., & Setabutr, P. (2011). Current ptosis management: A national survey of ASOPRS members. Ophthalmology Plastic Reconstructive Surgery, 0(0). 1-7. https://chicago.medicine.uic.edu/wp-content/uploads/2017/08/AAKALU-21346664.pdf
Bacharach, J., Lee, W. W., Harrison, A. R., & Freddo, T. F. (2021). A review of acquired blepharoptosis: prevalence, diagnosis, and current treatment options. Eye. 35, 2468-2481. https://www.nature.com/articles/s41433-021-01547-5
Bacharach, J., Wirta, D. L., Smyth-Medina, R., Korenfeld, M.S., Kannarr, S. R., Foster, S., Jaros, M. J., & Slonim, C. B. (2021). Rapid and sustained eyelid elevation in acquired blepharoptosis with Oxymetazoline 0.1%: Randomized phase 3 trial results. Clinical Ophthalmology, 15, 2743-2751. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240850/
Bedinghaus. T. (2022, June 3). Your visual field test results. VeryWellHealth. https://www.verywellhealth.com/understanding-your-visual-field-test-3421843
Centers for Medicare and Medicaid Services. (2018, January 1). Blepharoplasty medical policy-article. Medicare Coverage Database. https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52837&ver=15&DocID=A52837&bc=gAAAABAAAAAA&
Nichols, K. K., Malloy, K. A., Karpecki, P. M., Bacharach, J., Douglas, R. S., Foster, S. Gromacki, S. J., & Whitley, W. O. (2022).Topical review: An update of diagnostic and management algorithms for acquired blepharoptosis. Optometry and vision science, 99(3), 230-240. https://journals.lww.com/optvissci/fulltext/2022/03000/topical_review__an_update_of_diagnostic_and.5.aspx
Reinhard, E., & Spampinato, H. (2020, April 15). The OD’s guide to ptosis workup. Review of Optometry. https://www.reviewofoptometry.com/article/the-ods-guide-to-ptosis-workup
Resnick, S. (2020, November 9). How to identify ptosis in clinical practice. Optometry Times. https://www.optometrytimes.com/view/how-to-identify-ptosis-in-clinical-practice
Shahzad, B., & Siccardi, M. A. (2023, August 8). Ptosis. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK546705/
Yorn, K. H., Ricca, A. M., & Ko, A. C. (2018, July 31). Phenylephrine response in upper eyelid ptosis. Ophthalmology and Visual Sciences. https://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/phenylephrine-response-upper-eyelid-ptosis.htm
About Virtual Field
Virtual Field delivers an exceptional eye exam experience. Eye care professionals including ophthalmologists and optometrists examine patients faster, more efficiently, and more comfortably than ever before. Exams include Visual Field, 24-2, Kinetic Visual Field (Goldmann Perimetry), Ptosis, Esterman, Color Vision, Pupillometry, Extraocular Motility (EOM), and more.