Visual Field Testing for Pre- and Post-Cataract Surgery

Oftentimes, for patients, there is a lot of anxiety created when discussing cataracts and cataract surgery. Cataract surgeons who communicate what to expect with empathy and visual clinical data make all the difference when helping a patient process next steps. This approach not only will improve overall satisfaction, but it will also put patients’ minds at ease before the operation. Visual field testing is often underutilized when discussing cataracts, surgery, and educating patients about their overall ocular health. Below, we will discuss the pros of incorporating visual fields in general practice and surgical workups. 

Pre-Operative Visual Field Testing for Cataract Patients

Before cataract surgery, a comprehensive understanding of the patient's visual function is critical when choosing which intraocular lens (IOL) is best for them. It is also important for setting expectations and making a treatment plan. While visual acuity tests assess sharpness of vision, they tell us nothing about peripheral vision or overall ocular health. Visual field testing, specifically with advanced technology like Virtual Field, allows ophthalmologists to:

Establish a Baseline

Establishing a baseline visual field is a great idea when a patient is new to a practice. Even if the patient is not pursuing surgery, having a baseline visual field provides a reference point as things will change over time. Testing patients pre-cataract development also creates an opportunity for pre- and post-operative comparison with the total deviation pattern. If the first time you are meeting a patient is for a cataract surgery evaluation, the baseline visual field will show the total deviation loss caused by the cataract, or potentially other field loss, which is pertinent information prior to surgery. Of course, there are cases where obtaining a visual field analysis is too difficult because the cataract is too progressed. But even in those cases, having a visual field can be an aid in showing how significant the cataract is affecting their vision, or show the difference between the two eyes if one cataract is much more advanced than the other.

Differentiate Pathologies that Influence Surgical Planning 

Pre-operatively, visual field testing can help detect underlying ocular or neurological conditions that may affect surgical outcomes. Conditions like glaucoma, optic neuropathies, or retinal issues may coexist with cataracts. Especially when the patient is new or has not had an eye exam in a while (or ever), it is best to be overly comprehensive before referring for surgery or operating. When multiple ocular comorbidities are present, you may need to adjust your treatment plan to mitigate complications and optimize patient outcomes. 

Assessing peripheral vision limitation also helps guide decisions regarding IOL selection and refractive correction, ensuring optimal post-operative visual results. If additional pattern deviation field loss is present, these patients likely have reduced contrast sensitivity. Placing a premium IOL or lenses made of materials known to diminish contrast is likely not in those patients’ best interest.  

Enhance Patient Education

By explaining the results of a visual field test, patients can better understand how cataracts or other conditions impact their vision beyond simple acuity. This can be helpful both before and after surgery, and provides an objective measurement for both providers and patients to better set expectations for results after cataract surgery. Depending on what the field analysis shows, again, this will direct appropriate IOL selection, and allow patients to understand why they are not candidates for certain lens types or why cataract surgery may not solve all their visual complaints. 

‍

Monitoring and Managing Outcomes Post-Cataract Surgery with Visual Field Testing

For patients without pre-existing ocular conditions, doing a visual field after cataract surgery would show improvement in overall total deviation and create a new baseline. Because the media would be clearer, their visual field should reflect that. This can be one tool to show the patient before and after emphasizing overall improvement, not only visual acuity.

For patients with pre-existing visual field loss, establishing a new baseline for this demographic is more important. As mentioned above, cataracts can co-exist with other ocular pathologies, so once the media is clear and that cataract is no longer an issue, testing will be easier and more accurate for the patient, and providers can assess subtle field changes with more accuracy. 

Limitations to Traditional Tabletop Perimetry for Visual Field Testing of Cataract Patients

Conventional visual field testing methods, such as standard automated perimetry, can present challenges for patients and clinicians. These include:

‍

Patient Comfort

Traditional tabletop perimeters often require patients to sit in a fixed position for extended periods, which can be uncomfortable. Particularly for older adults or those with mobility issues, neck and back issues, or patients who require wheelchair assistance, positioning can be very difficult. Oftentimes, there are alignment or fixation issues during the testing, which then prolong the test and lead to unreliable assessments and patient fatigue. 

‍

Patient Test Compliance

Many patients find it difficult to understand and perform traditional visual field testing, leading to inaccurate or inconsistent results. Secondary to the above section, oftentimes if the patient has trouble with positioning, they will also have trouble with compliance. Not because they are choosing to be noncompliant, but their restrictions limit them from completing the test accurately. There are also patients who feel very anxious during visual field testing, causing them to overthink, leading to inaccurate testing. The longer the test runs, the more anxious patients become, and repeated testing is needed. 

‍

Space and Cost Constraints 

Conventional equipment can be bulky and require dedicated space within the practice, which may not be feasible for smaller clinics.  Also, visual field machines are often expensive to purchase and/or maintain, depending on where it is manufactured. Ophthalmologists or optometrists who need to refer patients to separate office locations for visual field testing risk delaying surgical care due to scheduling logistic complications.

‍

Virtual Reality Visual Field Testing as the Modern Standard in Elevating Cataract Care

At Virtual Field, we recognize the importance of comprehensive visual field testing in cataract care. Our VR visual field solution offers several advantages over traditional tabletop perimetry for visual field testing, including the following:

Enhanced Patient Compliance and Comprehension

Virtual reality visual field modalities' immersive and interactive nature reduces patient anxiety and fatigue, leading to more reliable test results. There are also multiple language options, bridging language barrier challenges. Therefore, all patients can understand the testing better and complete it accurately. Providers then have a better comprehension of their total ocular health and provide better care. 

Precise Data Collection

Advanced eye-tracking and stimulus presentation capabilities ensure accurate and detailed visual field mapping. Virtual Field’s technology incorporates advanced algorithms that provide precise assessments and minimize errors caused by patient hesitation or misunderstanding.

Integrated Pupillometry

Simultaneous measurement of pupil size and reactivity provides valuable insights into neurological function, expanding the scope of our assessment.

Portability and Accessibility

Our Virtual Field is portable and easy to use, increasing accessibility for patients with mobility limitations or those in various clinical settings. For providers, the database is all online and can be accessed on any computer, in any/exam lanes, or wherever needed as long as the username and password are accessible. 

‍

Final Thoughts

Cataract surgery is one of the most commonly performed procedures in ophthalmology, restoring vision for millions of patients worldwide each year. By leveraging virtual reality visual field testing as a standard component of your pre- and post-cataract surgical protocols, you will operate with the confidence of knowing you built your surgical treatment plan using the most reliable and comprehensive data.

‍