How should a normal confrontation visual field test be documented in the medical record?

How to Document Normal Confrontation Visual Field Testing

Document normal confrontation visual fields as "Visual fields full to confrontation" or "VFFTC" in all four quadrants for each eye, specifying the testing method used (finger counting or visual threat). 1

Documentation Framework

The most straightforward approach based on clinical guidelines is to record:

• "Visual fields: Full to confrontation in all four quadrants OU" (both eyes)
• Or separately: "OD: VFFTC" and "OS: VFFTC"

Specify Your Testing Method

According to the NIH Stroke Scale guidelines, confrontation testing should document 1:

• Method used: Finger counting, visual threat, or toy presentation
• All four quadrants tested: Superior temporal, superior nasal, inferior temporal, inferior nasal
• Each eye tested separately: Document findings for right eye (OD) and left eye (OS) individually

Age-Appropriate Documentation

The 2023 Pediatric Eye Evaluations guidelines provide specific documentation approaches by age 2:

For older children and adults:

• "Patient correctly counted fingers in all four quadrants bilaterally"
• Score as "0 = No visual loss" per NIH Stroke Scale 1

For young children:

• "Patient refixated appropriately to objects of interest presented in all four quadrants"
• "Patient mimicked/stated finger counts correctly in all quadrants while fixating on examiner's face"

For infants:

• "Infant demonstrated appropriate refixation to peripheral visual stimuli in all fields of gaze"

Common Pitfalls to Avoid

1. Don't omit the testing method - Simply writing "visual fields normal" is insufficient; specify confrontation testing was performed
2. Don't forget to test each eye separately - Binocular testing can miss hemianopias
3. Don't skip quadrant specification - Document that all four quadrants were examined
4. Avoid vague terminology - "Grossly intact" is less precise than "full to confrontation"

Clinical Context Matters

While confrontation testing is appropriate for screening, document when formal perimetry is indicated but not performed 3. The standard of care requires threshold visual field testing when:

• Suspicious findings are encountered
• Patient is symptomatic
• Glaucoma or neurological disease is suspected

In these cases, document: "Confrontation fields full; formal perimetry recommended" to demonstrate appropriate clinical judgment and informed consent considerations 3.

Practical Charting Examples

Comprehensive format:

• "Visual fields: Full to confrontation testing by finger counting in all four quadrants OD and OS"

Abbreviated format:

• "VF: VFFTC OU"

With scoring (stroke assessment):

• "NIH Stroke Scale - Visual Field: 0 (no visual loss by confrontation)" 1

The key is consistency in your documentation method and ensuring it clearly communicates that a screening examination was performed with normal results in all testable areas.