Effectiveness of testing visual fields by confrontation

Many tests are used to examine visual fields by confrontation, but such met hods have not been thoroughly compared with an accepted reference standard. The choice of test might affect the identification of subtle defects in th e visual field. We prospectively compared seven confrontation field tests w ith full-threshold automated static perimetry among 138 outpatients in an e ye clinic. Our primary outcome was detection of a defect in the visual fiel d. With automated perimetry, most field defects were small or shallow. Most confrontation field tests were insensitive in the identification of field loss. The most sensitive method was examination of the central 20 degrees v isual field with a small red target (73% [95% CI 63-82]). Assessment of the visual field should thus Include such a test.