Visual Field Testing for Contact Lens Wearers: What Eye Care Professionals Should Know

Visual field testing is a cornerstone of comprehensive eye care, offering essential insights into peripheral vision and detecting early signs of glaucoma, neurological disorders, and retinal disease. While this diagnostic is standard in most eye care practices, special considerations are needed when patients wear contact lenses during a visual field test.

Understanding the interaction between contact lenses and visual field results is key to ensuring test accuracy, minimizing false positives or variability, and optimizing the patient experience. Below, we explore key factors for eye care professionals and practice administrators to consider when conducting visual field testing for contact lens wearers.

Can Patients Wear Contact Lenses During a Visual Field Test?

The short answer: it depends. Soft contact lenses generally do not interfere significantly with the accuracy of standard visual field testing, particularly when using automated perimetry platforms like Virtual Field. However, hard contact lenses or specialty lenses (e.g., scleral lenses) may create distortion, reduce contrast sensitivity, or limit peripheral visual input—especially during threshold testing.

Instruct patients to remove rigid gas-permeable (RGP) or scleral lenses before testing unless clinically justified. For soft lens wearers, confirm the prescription is up to date and that the lenses are properly fitted and not causing dryness or surface irregularities during the exam. This is especially important when running a visual field test for glaucoma monitoring or neurological assessment.

If the patient also needs correction for near vision (reading), consider providing a trial lens with the appropriate add power. The Virtual Field analyzer comes with a set of trial lens adapters to accommodate this common patient need.

Impact of Contact Lens Use on Peripheral Field Measurements

Contact lens type, fit, and condition can all influence visual field test results, especially for tests designed to measure peripheral sensitivity. Poorly centered or edge-defective lenses may induce artificial field defects. Similarly, dirty or dry lenses can cause reduced light transmission, resulting in unreliable responses or increased fixation losses.

Visual field testing platforms like Virtual Field use high-contrast stimuli and ergonomic headset designs to minimize these issues. Still, patient comfort and ocular surface quality should be evaluated before testing. Instruct patients to blink naturally during the exam and pause the test if excessive dryness or lens displacement occurs.

Tips for Optimizing Visual Field Testing in Contact Lens Users

Whether you’re conducting a baseline visual field exam or monitoring progression, follow these best practices when testing patients who wear contact lenses:

• Pre-Test Check: Assess contact lens fit, centration, and comfort before the exam begins.
  
  
• Hydration Matters: Consider using preservative-free lubricating drops in cases of contact lens-related dryness.
  
  
• Lens Removal: Ask patients to remove RGP or scleral lenses unless specifically indicated to remain in place.
  
  
• Education: Let patients know how their lenses might affect test performance and explain why removal may be necessary.
  
  
• Document Lens Use: Always document whether the test was performed with or without contact lenses for consistency across serial testing.
  
  

Why Accuracy Matters for Clinical and Billing Success

Accurate visual field testing is not only essential for proper diagnosis and care, it’s also vital for billing and reimbursement. Inconsistent results due to contact lens interference can lead to test repetition, delayed treatment, or complications in meeting medical necessity requirements for CPT codes such as 92081, 92082, and 92083.

For more on visual field billing, in view these resources:

• Visual Field Billing and Coding Procedures for Eye Care Professionals in the United States
• Visual Field Billing and Coding Procedures for Eye Care Professionals in Canada

Ensuring reliable test data helps support clinical decision-making and improves your documentation for audits or insurance claims. With portable, VR-based visual field testing platforms like Virtual Field, practices can reduce test variability and streamline diagnostics—even for patients with contact lenses.

Special Considerations for Visual Field Testing in Keratoconus Contact Lens Wearers

Keratoconus presents unique challenges when performing a visual field test due to irregular corneal surfaces and reduced contrast sensitivity. For patients with keratoconus, especially those who are also glaucoma suspects, contact lenses often provide the best correction to ensure reliable visual field testing results.

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Why Contact Lens Correction Matters for Keratoconus Patients Receiving a Visual Field Test

Rigid gas permeable (RGP) lenses or other specialty lenses used in keratoconus provide a more uniform refractive surface compared to spectacles. These lenses correct for the irregular astigmatism that characterizes keratoconus, improving both visual acuity and contrast sensitivity — two critical factors in achieving reliable threshold test results during visual field exams.

Even in cases of forme fruste keratoconus, a milder, subclinical form of the condition, many experts recommend using contact lens correction if it results in better acuity. While some believe spectacles are acceptable in early-stage keratoconus, most agree that as the condition advances, contact lenses become essential for test accuracy.

Testing Tips and Setup Guidance Unique to Visual Field Testing Keratoconus Patients

There is no special equipment setup required on visual field testing devices like Virtual Field for keratoconus patients. However, there are a few essential procedural adjustments to consider:

• Test before dilation to avoid any compounded visual distortion.
  
  
• Remind patients to blink naturally and often to prevent contact lens dryness during the exam, which can reduce test reliability.
  
  
• Document the correction method used during the test — contact lenses or spectacles — so that future field tests are comparable.
  
  

Final Thoughts

Contact lens wearers represent a large portion of your patient base, and with a few simple adjustments, you can ensure your visual field testing protocols are optimized for this population. Whether you’re using the exam for glaucoma visual field testing, neurologic screening, or diabetic eye monitoring, staying aware of how contact lenses affect outcomes helps preserve data integrity and improve patient care.

Looking to modernize your visual field testing workflows? Book a demo with Virtual Field and discover how our solutions support clinical accuracy, flexible workflows, and a better patient experience.

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