As a result, the following neurologic defects occur. You can enhance the reliability of standard finger-counting testing by adding a facial Amsler test (have the patient fixate on your eyes and ask him or her if your other facial features appear distorted or are missing) and by performing double simultaneous stimulation confrontation fields. This complex includes the following structures: 1. WebQuadrantanopia also called quadrantanopsia, refers to a defect in the visual field affecting a quarter of the field of vision. Freeman EE, Muoz B, Rubin G, et al. Kardon R, Kawasaki A, Miller NR. OCT-A Shows Microvascular Glaucomatous Damage, 10-2 Visual Field Testing: A Tool for All Glaucoma Stages, AI-assisted Retinal Screening Shows Promise. Behav Brain Res. Is the patient alert and oriented? By definition, an incomplete hemianopia spares at least part of the vision on the affected side. had been recorded at 20/25. Ultimately, this patient was diagnosed with neurosyphilis, and was treated with penicillin. 906-910, Kedar S, Zhang X, Lynn MJ, et al: Pediatric homonymous hemianopia. It is called the rostral interstitial nucleus of the MLF and is associated with Parinaud's syndrome (see Figures 14-3A and 17-4F). WebDefinition (NCI_CTCAE) A disorder characterized by visual perception of unclear or fuzzy images. The patient underwent neuroradiological evaluation, and a craniopharyngioma was found. (2018). Transection of the upper division (A) results in right lower homonymous quadrantanopia. The patient underwent neuroradiological evaluation, and a craniopharyngioma was found. had been recorded at 20/25. Note that the defect in the right (asymptomatic) eye strongly respects the vertical midline. If there is . [2], In a quadrantanopia that is partial, there also exists a distinct and sharp border between the intact and damaged field within the quadrant. Headache and photophobia have also been known symptoms[4]. Knowledge of the functional anatomy of neurological pathways is essential in the interpretation of examination results. 1. The caudal Edinger-Westphal nucleus, which mediates contraction of the ciliary muscle. Post-geniculate fibers split into superior and inferior pathways, traveling through the parietal and temporal lobes, respectively, as they course posteriorly in the brain. Philadelphia: Mosby, 1998. Any complaint of headaches not explained by the exam. 2007 Jan;9(1):41-7. Before formal visual field testing, however, you must determine several things. The cuneus is the upper bank. contralateral homonymous superior quadrantanopia: 'pie in the sky' visual field defect (due to disruption of Meyer's loop which dips into the temporal lobe) deficits arising from unilateral lesions involving the non-dominant hemisphere: contralateral homonymous superior quadrantanopia; prosopagnosia: failure to recognise faces Nerve fibers originating in the nasal retina cross at the level of the optic chiasm, traveling with contralateral temporal fibers to the lateral geniculate nucleus where they synapse. It receives input from the contralateral frontal eye field. Ali M, Hazelton C, Lyden P, et al; VISTA Collaboration. D. The subcortical center for vertical conjugate gaze is located in the midbrain at the level of the posterior commissure. J Neuroophthalmol 1999 Sep;19(3):153-9. The cortical visual pathway projects from the primary visual cortex (Brodmann's area 17) to the visual association cortex (Brodmann's area 19). White light comparison testing showed a 25% sensitivity in the left eye as compared to the right. Ultimately, an automated field analysis was performed, demonstrating a dense, homonymous hemianopic defect of the left visual field, denser above than below the horizontal midline. A. A unilateral MLF lesion would affect only the ipsilateral medial rectus. (Reprinted with permission from Fix JD: BRS Neuroanatomy. Invest Ophthalmol Vis Sci 2007 Oct;48(10):4445-50. Imaging for neuro-ophthalmic and orbital disease - a review. Post-geniculate fibers split into superior and inferior pathways, traveling through the parietal and temporal lobes, respectively, as they course posteriorly in the brain. Further RecommendationsThe patient was referred to his primary care physician with a request for an MRI with contrast of the area in question, to be performed within 24 to 48 hours. A patient who experiences a large hole in the vision of the right eye immediately upon awakening may be quite different than the patient who noticed vision loss in one eye when the fellow eye was covered after a minor injury. Douglas VP, Douglas KAA, Cestari DM. Ed: Rosen ES, Eustace P, Thompson HS, et al. One study found a five-fold increase of visual field loss between ages 55 and 80.8, An even more surprising finding: In one study of 61 post-stroke patients suffering from homonymous visual field loss (as determined by Humphrey visual field analysis), none were aware of the visual field loss.9 Also, only two of those 61 patients were identified as having field loss using the National Institutes of Health Stroke Scale (NIHSS) technique, which is a finger-counting confrontation visual field screening. O.S. Human Neuropsychology, Sixth Edition, p.361; Worth Publishers (2008), William J. Weiner: Neurology for the Non-Neurologist, p.526; Lippincott Williams & Wilkins (July 2010), Rehabilitation for Homonymous Hemianopia and Quadrantanopia, Visual Fields in Brain Injury - Hemianopsia.net Everything you need to know about Hemianopsia, "Hemianopic and quadrantanopic field loss, eye and head movements, and driving", Thygeson's superficial punctate keratopathy, Chronic progressive external ophthalmoplegia, https://en.wikipedia.org/w/index.php?title=Quadrantanopia&oldid=1139493898, Short description is different from Wikidata, Articles with unsourced statements from December 2020, Creative Commons Attribution-ShareAlike License 3.0. B. 4. Dalla Via P, Opocher E, Pinello ML, et al. It contains noncrossing fibers from the two temporal hemiretinas and projects fibers to the suprachiasmatic nucleus of the hypothalamus. 2. (J) Third-nerve palsy with ptosis, right eye. WebA visual world of someone with normal vision. Occlude the abnormal eye and shine the light in the normal eye. C. The Edinger-Westphal nucleus of CN III, which gives rise to preganglionic parasympathetic fibers. The response in the stimulated eye is called the direct pupillary light reflex. He later revealed hed been suffering from a headache on the right side, behind his ear (the occipital region). Note the bilateral involvement despite unilateral (O.S.) To fully appreciate the potential underlying causes for various visual field defects, it is important to have a working knowledge of the anatomy of the visual system (figure 1). Dont waste precious minutes before sending the patient for evaluation and care. It includes the following structures: A. American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, Council on Functional Genomics and Translational Biology, Council on Hypertension. Optic tract lesions are relatively uncommon[9], with lateral geniculate nucleus (LGN) lesions being even more rare but when seen, are due to ischemic, demyelinating, or traumatic etiologies. This syndrome consists of miosis, ptosis, apparent enophthalmos, and hemianhidrosis. Destruction causes transient ipsilateral conjugate deviation of the eyes (i.e., toward the lesion). Barton JJS. In homonymous hemianopsia, an injury to the left part of the brain results in the loss of the right half of the visual world of each eye. [Updated 2021 Aug 11]. Lesion A of visual radiations to sup. The visual field defect seen in the chiasmal syndrome is typically a bitemporal hemianopsia. The tips of the occipital cortices are supplied by both the MCA and posterior cerebral artery (PCA). Current Opinion in Ophthalmology, 14(6), 325331. Examination revealed corrected acuity of 20/25 OU. WebQuadrantanopia, quadrantanopsia, refers to an anopia (loss of vision) affecting a quarter of the visual field . Traumatic chiasmal syndrome: A meta-analysis. To understand these field defects, its necessary to know how the eye processes the visual field. If you think you see an RAPD but you arent sure, verify your findings. Depending upon the degree of the RAPD in the other eye, this may appear to even out the signals being carried in both afferent systems. Am J Ophthalmol 2007 Jun;143(6):1013-23. CN = cranial nerve. bank of calcarine sulcus, Figure 17-2. Abstract. Goodwin D. Homonymous hemianopia: challenges and solutions. Bilateral constricted fields may be seen in hysteria. It usually affects a Otherwise, many of these cases are considered to be urgencies rather than emergencies, and require referral within a few days to a week. The optic nerve then courses posteriorly until the two optic nerves meet at the chiasm. Is there a color vision defect? The amount of compensatory movements and the frequency with which they are employed is believed to be dependent on the cognitive demands of the task; when the task is so difficult that the subject's spatial memory is no longer sufficient to keep track of everything, patients are more likely to employ compensatory behavior of biasing their gaze to the afflicted side. The clinical manifestations of orbital tumors may include gaze-evoked amaurosis (due to reduction in the flow of blood to the optic nerve and retina), proptosis, optic disc swelling (direct compression of the optic nerve), optociliary shunt (actually retinochoroidal venous collateral) vessels, and choroidal folds[13]. In essence, the more the field loss in one eye appears to be a carbon copy of the other, the greater the level of congruity. Hold the ND filter over the normal eye, and shine the light through the filter. Chiasmal syndromes. This presents with loss of both temporal fields and is due to compression of the bilateral decussating nasal fibers at the chiasm, since the nasal fibers correspond with the temporal visual fields[5]. WebQuadrantanopia. 12. Compare the afferent anterior pupillary pathway of one eye vs. the fellow eye. In such cases, refer the patient to a neurologistor better yet, a neuro-ophthalmologist. Other localizing signs were Webunilateral blindness or enucleation, visual fields in the remaining eye 0 = No visual loss. Definition (NCI) Blurred vision is the loss of visual acuity (sharpness of vision) resulting in a loss of ability to see small details. complaints.Causes of Visual Field Loss. (B) Horner's syndrome, left eye. Doc Ophthalmol 2003 Nov;107(3):281-7. WebSudden unilateral quadrantanopia caused by retinal diseases often has characteristic presentations, such as acute onset and severe visual acuity defect. Webunilateral blindness or enucleation, visual fields in the remaining eye are scored. To fully appreciate the potential underlying causes for various visual field defects, it is important to have a working knowledge of the anatomy of the visual system. Lesions cause contralateral hemianopia with macular sparing. [7] Drivers with quadrantanopia, who were rated as safe to drive, drive slower, utilize more shoulder movements and, generally, corner and accelerate less drastically than typical individuals or individuals with quadrantanopia who were rated as unsafe to drive. Neurology 2006; 66: pp. 17. ), III. If the patient displays disturbances in speech, gait, memory, facial symmetry or behavior, an immediate referral to the ER is essential. Patients with residual field deficit following stroke may benefit from vision rehabilitation, including such elements as prismatic correction and compensatory training to improve visual search abilities. After the patient has a chance to recover from the transilluminators bleaching effects, do a white light comparison test. Nearly one out of every 20 people past age 55 has visual field loss that is significant enough to impair daily functioning. Nerve fibers originating in the nasal retina cross at the level of the optic chiasm, traveling with contralateral temporal fibers to the lateral geniculate nucleus where they synapse. How the actual referral is carried out will vary based on the patients insurance, availability of neurologists in your area and other factors. The chiasm lies in the suprasellar cistern above the sella turcica, and is surrounded by the hypothalamus superiorly and the infundibulum and pituitary gland inferiorly[3]. It is caused by lesions of the retrochiasmal Quadrantanopia can be associated with a lesion of optic tract bank of calcarine sulcus, Lesion B of visual radiations to inf. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. IV. It contains input from the inferior retinal quadrants, which represent the superior visual field quadrants. Neglect is primarily a disorder of attention whereby patients characteristically fail to orientate, to Next, hold the ND filter over the suspect eye and repeat the test. A significant visual field defect was present in not only the left eye, consistent with the patients case history, but also in the right eye. Dr. Reed is an associate professor at Nova Southeastern University, where she teaches ocular disease and primary clinical care. WebUnilateral lesions can lead to homonymous hemianopias and scotomas. 2013 Feb;27(2):133-41. Glaucoma, branch retinal artery occlusion, anterior ischemic optic neuropathy. Retrochiasmal Disorders. In: Zhang X, Kedar S, Lynn MJ, et al: Homonymous hemianopias: clinical-anatomic correlations in 904 cases. According to research, the majority of recovery occurs within the first 60 days after the initial event, and recovery after six months is highly unlikely.5 Patients with residual field deficit following stroke may benefit from vision rehabilitation, including such elements as prismatic correction and compensatory training to improve visual search abilities.1 Vision restorative training (VRT) may provide a mechanism to regain visual function at the border of the visual field defect, although studies with this system have yielded conflicting and inconclusive results.6,7. J Amer Geriatr Soc 2007 Mar;55(3):357-64. J AAPOS 2006; 10: pp. The monocular temporal crescent is represented in the most anterior mesial portion of the occipital lobe. If there is unilateral blindness or enucleation, visual fields in the remaining eye are scored. This contraction increases the refractive power of the lens. Bitemporal (either inferior or superior) quadrantanopia affects either the upper or lower outer visual quadrants in both eyes. b. Transection of both lingual gyri causes an upper altitudinal hemianopia (al-titudinopia). E. The lateral geniculate body is a six-layered nucleus. One exception to neurology referral is a patient with visual field loss that you suspect is psychogenic in origin. Barboni P, Savini G, Valentino ML, et al. and 20/80 O.S. 2. Unilateral deficits are caused by retinal and optic nerve disease. Because of this extraordinarily detailed and consistent arrangement, lesions of the visual pathway result in predictable and repeatable visual field defects. Philadelphia: Mosby, 1998. Temporal defect in one eye, central defect inthe fellow eye. right. Arch Ophthalmol 2005 Feb;123(2):233-8. Turano KA, Broman AT, Bandeen-roche K, et al. Mass effect is the compression of nearby structures by a mass (aneurysm, tumor, hematoma, abscess). Visual neglect (also called hemispatial neglect or unilateral A value of 80% or less is considered clinically significant. Type of field defect O.S. McKean-Cowdin R, Varma R, Wu J, et al. Transection causes contralateral hemianopia. The junctional scotoma (see Junctional Scotoma and Junctional Scotoma of Traquair) manifests as a central scotoma in the ipsilateral eye and a superior temporal visual field defect in the contralateral eye. 21. The pattern of the visual field defect is also more indicative of stroke than other intracranial abnormalities, such as traumatic brain injury, cerebral hemorrhage or compressive tumor. Bilateral deficits are caused by chiasmal lesions or lesions affecting the retrochiasmal pathways. It also involves the occipital lobe concerned with vision. Few things provoke more anxiety (for both the patient and the doctor) than noticeable visual field loss. (/) Destructive lesion of the right frontal eye field. Ring scotoma (usually bilateral). 10. (5) Ri^ht upper quad* rantanopia. WebIt can be caused by a lesion, particularly, in the temporal and parietal lobes although it is more commonly associated with occipital lobe lesions. 2. 9nNa6>yKEV Bilateral visual field loss Ask what the patient was doing when he or she first noticed the loss. Understand that the presence of anisocoria doesnt create a clinically observable pseudo-APD until anisocoria of 2mm or more is present.19 So, dont dismiss subtle or trace RAPD responses to a 0.5mm anisocoria. 1. The patient was advised that he had likely suffered an isolated stroke which caused him to experience vision loss. In: StatPearls [Internet]. Neuro Oncol 2007 Oct;9(4):430-7. left, O.D. [4], Homonymous inferior quadrantanopia is a loss of vision in the same lower quadrant of visual field in both eyes whereas a homonymous superior quadrantanopia is a loss of vision in the same upper quadrant of visual field in both eyes. WebQuadrantanopia refers to the loss of vision in one of the quarters of the visual field. In general, you can link the findings from color vision and pupil testing together. EvaluationExamination revealed corrected acuity of 20/25 OU. Total monocular field loss. INTRODUCTION. This includes tighter control of comorbidities such as diabetes, hypertension, hypercholesterolemia, hyperlipidemia and obesity. Quadrantanopia can also result in significant constraints of ones vision and ability to The hypothalamus. (Convergence is normal.) The nystagmus is in the direction of the large arrowhead. 2006 Nov 25;175(1):18-26. 2. Patient with MLF syndrome cannot adduct the eye on attempted lateral conjugate gaze, and has nystagmus in abducting eye. The visual system is served by the optic nerve, which is a special somatic afferent nerve. (A) Relative afferent (Marcus Gunn) pupil, left eye. Vision was 20/20 O.D. Does the missing area or spot remain the same size, or does it change? 492-507, Posner JB: Intracranial metastases. It projects through the geniculocalcarine tract to layer IV of the primary visual cortex (Brodmann's area 17). D. The optic tract contains fibers from the ipsilateral temporal hemiretina and the contralateral nasal hemiretina. Congruity refers to the similarity in shape and depth of the visual field defect in each eye. Patients who present with an awareness of a loss of visual field need prompt and accurate diagnosis, as management often involves immediate further evaluation and intervention. I. Lesions of the medial longitudinal fasciculus (MLF) between the abducent and oculomotor nuclei result in medial rectus palsy on attempted lateral conjugate gaze and horizontal nystagmus in the abducting eye. By Alan G. Kabat, OD, and Joseph W. Sowka, OD. Lesion at or near the optic chiasm (not always a pituitary adenoma). D. Horner's syndrome is caused by transection of the oculosyuipatheik; pathway at any level (see IV). Vision flickering off and on is a common symptom of patients with giant cell arteritis. The Academy uses cookies to analyze performance and provide relevant personalized content to users of our website. Layers 1, 4, and 6 receive crossed fibers; layers 2, 3, and 5 receive uncrossed fibers. Visual field loss increases the risk of falls in older adults: the Salisbury Eye Evaluation. N Engl J Med 2008; 359: pp. It includes the following structures: A. Ganglion cells of the retina, which project bilaterally to the pretectal nuclei, B. Double simultaneous stimulation is performed at this point. Occasionally, patients will spontaneously recover vision in the affected field within the first three months after the brain injury; however, vision loss remaining after this period of spontaneous recovery is traditionally thought to be permanent, certain companies now claim to be able to induce recovery of vision after this three-month period. Damage to the optic radiations in the temporal or parietal lobe results in a quadrantanopia, impacting the superior or inferior field, respectively. B. These field defects will cross neither the vertical midline nor the horizontal midline. Some authorities place the "center" in the paramedian pontine reticular formation. 9. At the junction of the optic nerve and the chiasm, there are two different types of fibers on the optic nerve that can be affected: the nasal crossing fibers and the temporal non-crossing fibers. In general, most mass lesions compressing the visual system require surgery both for diagnostic (pathologic confirmation) and therapeutic (relieve mass effect) indications. Partial hemianopia means the patient has no visual stimulus in one quadrant of the visual field. (II) Lower altitudinal hemianopia as a result of bilateral destruction of the cunei. Webfingers appropriately, this can be scored as normal. Optic nerve sheath meningioma. 22. Automated perimetry (e.g., Humphrey Visual Field (10-2, 24-2, and 30-2)) is recommended for all patients with unexplained visual loss. At a visit in our clinic several months prior, vision O.S. Aside from these rare but critical cases, the most important testone that must not be skippedis automated perimetry. right. Clin Ophthalmol. Visual field testing provides insight into the integrity of the visual pathway. Sometimes, however, the most obvious diagnosis is not the correct one. Is there a relative afferent pupillary defect (RAPD)? This visual defect is caused by damage to superior fibers of the optic radiations. Unexplained visual acuity loss. Did the loss occur suddenly or gradually? Optic chiasm field defects Lesions at the optic chiasm are characterised by bitemporal hemianopia. If there is unilateral blindness or enucleation, visual fields in the remaining eye are scored. Note that half of the optic nerves cross at the optic chiasm, causing vision loss on one side to be quite different than that in one eye. Transection causes ipsilateral blindness, with no direct pupillary light reflex. Ophthalmology 2008 Jun;115(6):941-48.e1. *Images generated. He later revealed hed been suffering from a headache on the right side, behind his ear (the occipital region). WebThe syndrome of visuospatial neglect is a common consequence of unilateral brain injury. Perimetric homonymous visual field loss post-stroke. Unfortunately, during resection of the tumor, the right optic nerve was damaged, and the patient was left with partial visual field loss in both eyes. Retina 2007 Jun;27(5):601-8. [5], A lesion affecting one side of the temporal lobe may cause damage to the inferior optic radiations (known as the temporal pathway or Meyer's loop) which can lead to superior quadrantanopia on the contralateral side of both eyes (colloquially referred to as "pie in the sky"); if the superior optic radiations (parietal pathway) are lesioned, the visual loss occurs on the inferior contralateral side of both eyes and is referred to as an inferior quadrantanopia. Kedar S, Zhang X, Lynn MJ, et al. 2. Identification of field loss using screening techniques. Ultimately, this patient was diagnosed with neurosyphilis, and was treated with penicillin. Vision was 20/30 O.D. If patient is blind from any cause, score 3. Any other clinical finding (subjective or objective) that does not correlate with other examination findings.In many cases, attention to proper hydration and caloric intake, along with awareness of the effects of postural changes (e.g., standing up quickly from a seated or reclined position) is sufficient for managing the symptoms. In (eds): Neurologic Complications of Cancer. WebA superior quadrantanopia results from an insult to the optic radiation inferiorly in the temporal lobe, resulting in a pie in the sky type of visual field defect (Figure 1d), while an Mass lesions in parietal lobe produces contralateral inferior homonymous quadrantic field defect also referred as pie on the floor. [2], An interesting aspect of quadrantanopia is that there exists a distinct and sharp border between the intact and damaged visual fields, due to an anatomical separation of the quadrants of the visual field. Has this ever happened before? Optic nerve and significant retinal disease in one eye can create color vision disturbances and positive RAPD results in that eye. Whether you perform the dilated fundus examination before or after automated visual fields is your choice; you can find support for both sides of the issue.20-22 As long as the patients pupils are at least 3mm in diameter, you can probably evaluate the visual fields in these non-glaucoma cases regardless of the state of pupillary dilation. Visual outcome of a cohort of children with neurofibromatosis type 1 and optic pathway glioma followed by a pediatric neuron-oncology program. THE VISUAL PATHWAY (Figure 17-1) includes the following structures. This presents with loss of both temporal fields and is due to compression of the bilateral B. One-and-a-half syndrome consists of bilateral lesions of the MLF and a unilateral le* sion of the abducent nucleus. Common and/or Classic Visual Field Patterns and Their Causes. This occurs due to a lesion of the ipsilateral optic nerve, causing an optic neuropathy, and of the contralateral decussating inferior nasal retinal fibers, causing loss of the superior and temporal field in the opposite eye. Light shincd into one eye causes both pupils to constrict. The diagnosis can be made with the swinging flashlight test (see Figure 17-4A). Lim SA, Siatkowski RM, Farris BK. 5. left, O.D. Also important in the localization of visual field defects is the concept of congruity. Philadelphia: F.A. Ed: Rosen ES, Eustace P, Thompson HS, et al. WebQuadrantanopia is a condition associated with the temporal and parietal region of brain. 2005 Mar 31.;352(13):1305-16. Multidisciplinary evaluation and treatment including orbital or neurosurgery may be necessary depending on the underlying lesion producing the visual field defect. However, the etiology is less commonly from a congenital, traumatic, vascular, inflammatory, infectious, demyelinating, and infiltrative source[5]. E. Relative afferent (Marcus Gunn) pupil results from a lesion of the optic nerve, the afferent limb of the pupillary light reflex (e.g., retrobulbar neuritis seen in multiple sclerosis). Clinicians should be aware of the localizing value of specific visual field defects and perform neuroimaging to exclude a structural lesion including mass lesions[15]. O.S. McKean-Cowdin R, Wang Y, Wu J, et al. If there is a complete lesion or compression at the optic nerve, patients may experience total monocular vision loss in the affected eye. Common and/or Classic Visual Field Patterns and Their Causes Graefes Arch Clin Exp Ophthalmol 1999 Feb;237(2):117-24. A Cellulite Cure - How to Get Rid of Cellulite. Examining visual field defects in the paedriatric population exposed to vigabatrin. Note the bilateral involvement despite unilateral (O.S.) Clin Exp Ophthalmol. White light comparison testing showed a 25% sensitivity in the left eye as compared to the right. WebUnilateral cortical lesions involving the occipital lobe will usually produce a hemi-field cut contralateral to the site of the lesions. 2. The defect is usually bilateral as it is typically caused by a lesion past the optic chiasma. Neuro-Ophthalmology (Amsterdam: Aeolus Press. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Baltimore, Williams &. Such knowledge will enhance proper triage of these often-critical patients. As they reach the occipital lobe (the primary visual cortex), the superior and inferior fibers are reunited. Partial vs. complete hemianopia. Temporal defect in one eye, central defect inthe fellow eye. When affecting the visual pathway, mass effect can cause a multitude of changes in a patients visual field. Another way to help confirm subtle RAPDs is to purchase an inexpensive 0.3 log unit neutral density (ND) filter. (from MedlinePlus Medical Encyclopedia) Concepts. Glaucoma and mobility performance: the Salisbury Eye Evaluation Project. Ophthalmology 2007 Dec;114(12):2232-7. Binocular visual-field loss increases the risk of future falls in older white women. Patients are often unable to accurately determine the location of field loss. Glaucoma, branch retinal artery occlusion, anterior ischemic optic neuropathy.