A comparison of tangent screen, Goldmann, and Humphrey perimetry in the detection and localization of occipital lesions

Objective: To compare manual kinetic perimetry with tangent screen and Gold mann techniques and automated static perimetry with the Humphrey Field Anal yzer in the detection and localization of occipital lobe lesions. Design: Prospective consecutive comparative case series, Participants: Twelve patients with well-defined occipital lobe infarcts on magnetic resonance (MR) imaging were studied. Main Outcome Measures: The patients were tested by tangent screen, Goldmann , and Humphrey perimetry (central 30-2 threshold program). The three visual fields were compared and correlated with MR images. Results: All three perimetric techniques detected the presence of postchias mal lesions. However, localization of lesions differed with perimetric tech nique. Visual fields obtained from tangent screen and Goldmann perimetry we re similar and corresponded well with the location of lesions on MR images in all 12 patients, Humphrey perimetry inaccurately localized the lesion to the proximal part of the postchiasmal pathway by revealing incongruous fie lds in two patients, failed to detect sparing of the posterior occipital co rtex or occipital pole in four patients, and estimated a larger extent of d amage in one patient when compared with MR images and manual perimetry, Conclusions: All three perimetric techniques are satisfactory screening tes ts to detect occipital lesions. However, tangent screen and Goldmann perime try provide information about the location and extent of lesions that is mo re consistent with prevailing knowledge of the effects of the lesion in the postgeniculate visual pathway, (C) 2000 by the American Academy of Ophthal mology.