Visual field defects in neuro-ophthalmological diseases at a tertiary hospital in Nepal

Purpose: This retrospective study aims to describe the pattern of visual field defects among patients presenting with neuro-ophthalmological diseases in a tertiary hospital of Kathmandu. Materials and Methods: Medical records of patients undergoing Goldmann visual fields (GVF) for neuro-ophthalmological diseases from July 2019 to June 2021 were retrospectively reviewed. Patient demographics, laterality of the disease, clinical diagnosis and pattern of visual field defect were evaluated and entered and analyzed using SPSS version 20 using descriptive univariate and bivariate analysis. Results: A total of 216 subjects (378 eyes) with the mean age 34.52±14.80 years were included in the study. The visual field defects were divided 4 categories: optic nerve disorders (76.4%, n=165), chiasmal disorders (17.6%, n=38), retrochiasmal disorders (2.8%, n=6) and miscellaneous (3.2%, n=7). Disc edema/papilledema was the most common diagnosis in optic nerve disorders with enlarged blind spot (79.1%) and constriction of visual fields (18.3%) as pattern of visual field defects followed by optic neuritis. Common lesions affecting the chiasma in our study were craniopharyngioma on whom 50% had the classical temporal field involvement (bitemporal-20%, inferotemporal-20% and superotemporal-10%) and pituitary lesions where 30% showed constriction of peripheral fields, 57.5% showed temporal field defects (mostly superotemporal) in both eyes. Retrochiasmal lesions were less common but all showed a bilateral and homonymous pattern of visual field defect. Conclusion: Optic nerve disorders were the most common group of conditions undergoing visual fields. Understanding the varied patterns of visual field defects can aid in early diagnosis and guide timely treatment of common neuro-ophthalmological diseases.