# Central and Peripheral Vision

## Overview

This module describes how to test a patient’s peripheral and central vision using the confrontation test and Amsler grid test respectively.

## Indications

1. Patients complaining of loss of vision
2. Conditions with risk of loss of vision such as glaucoma
3. Suspected macular disease (Amsler grid particularly indicated)

## Contraindications

1. None

## Patient information and consent

Always verify your patient’s identity and obtain informed consent before proceeding.

### How do I explain this procedure?

“I need to test your central vision, and what you can see on the outer edges of your vision.”

### What can my patient expect?

“I will give you a chart with a grid to look at using each eye in turn, with the other eye closed. You must focus on the centerpoint and tell me if any part of the gridlines look distorted or disappear in any place.

For the testing of your outer/peripheral visual fields we will sit opposite each other and test each eye in turn. I will ask you to look at my nose and count fingers held on the edges of your vision. Don’t look away from my nose.”

### What is my patient’s role?

“If you use reading glasses, you should put them on for this test. It is important in the grid test that you focus on the center dot, and in the peripheral vision test that you keep eye contact. Don’t look directly at the gridlines or at my fingers during the test.”

## Preparation

###

### Documentation

1. Patient notes

### Equipment

## Site & Positioning

Peripheral vision test: Patient should sit opposite you about 1 m away with your eyes at the same level.

Amsler grid: Patient should wear their reading spectacles, and hold the grid perpendicular to the line of sight, approximately 30-35 cm from the eye.

Perform the tests in normal ambient light.

## Procedure

Follow medical asepsis without gloves.

## Troubleshooting

My patient has an abnormal test result.

Refer the patient to an ophthalmologist.

## Risks

1. None

## References

1. Pons J. How To Examine The Eye. In: Mash B, Blitz-Lindeque J, eds. South African Family Practice Manual. 2nd ed. Pretoria: Van Schaik Publishers; 2010: 134-137.