Ill. optometrist finds numerous visual field defects, considers testing part of comprehensive careJuly 17, 2013
There’s been a bit of debate amongst ODs on Facebook group members about routine testing of visual fields. R. Scott Wooley, O.D., of Flora, Ill., a former Illinois Optometric Association president, said he considers it part of everyday exceptional patient care.
Dr. Wooley has been in practice almost 25 years and offers several anecdotes supporting his belief.
“A young man came in for his annual eye exam, and I do screening visual fields every year,” Dr. Wooley said. “I found a few spots he had missed, and in last year’s I saw he had only missed one spot, so I saw the progression. I talked to his parents and decided to do a full threshold visual field. His parents said he had just had his physical to go to school—he was going to be a freshman—and everything was found normal.”
The patient had no symptoms. The results just showed up on his visual field.
“I said it may be nothing, but wanted him to see his family doctor about a scan,” Dr. Wooley said. “A tumor did show up, and he was sent to Barnes in St. Louis. It was not malignant, but it was growing. After it was removed, he had a bigger visual field defect, but that’s not uncommon.”
Dr. Wooley also noted the doctors at Barnes kept asking the patient who had discovered this and were in disbelief that an optometrist had found this.
The only residual problem the patient faces is his inability to pass the driver’s exam.
“We tried yoked prism and neuro-rehabilitation, but he still couldn’t pass his test,” Dr. Wooley said. “He was a bit bitter when he was turning 16, but I said at least you are still here.”
Tumors aren’t the only things Dr. Wooley has discovered through routine visual field testing.
“I had a case where screening visual fields were really bad, and the full field was really bad,” he said. “He was in hypertensive crisis and needed kidney surgery.”
Another patient had a monocular defect as a result of a really large retinal detachment.
“It would have been found later, but this way we knew right away,” Dr. Wooley said.
Dr. Wooley encouraged all optometrists to perform visual field testing as part of each comprehensive eye exam.
“We all already own the instrument, and it doesn’t take any more of our time to have the tests run,” he said. “It should be a standard of care. I find visual field defects all the time. It’s not only better patient care, but your patients will know it’s more comprehensive care than anywhere else. It’s a practice builder. I really encourage all ODs to do it.”
To add to the debate on Facebook, join the group by searching for “ODs on Facebook.” Discussion groups are also online at connect.aoa.org.