From the Guidelines
The eye test that assesses peripheral vision by wiggling a finger in the periphery is called the confrontation visual field test. This test is a simple and effective way to evaluate peripheral vision, especially in children, as noted in the pediatric eye evaluations preferred practice pattern study 1. The test involves the examiner moving their finger or hand in different areas of the patient's peripheral visual field, asking them to indicate when they can see the movement, and can be performed on one eye at a time with the other eye covered.
Key Points About the Confrontation Visual Field Test
- The test is used to detect visual field defects that might indicate conditions like glaucoma, stroke, brain tumors, or other neurological problems affecting the visual pathway.
- It is a valuable quick screening tool during routine eye exams or neurological assessments, as mentioned in the primary open-angle glaucoma suspect preferred practice pattern study 1.
- If abnormalities are detected, more comprehensive testing would typically follow, such as automated perimetry tests.
- The confrontation visual field test can be adapted for use in children, using toys or asking them to count fingers in each quadrant, as described in the pediatric eye evaluations preferred practice pattern study 1.
From the Research
Visual Field Test Description
- The eye test that assesses peripheral vision by wiggling a finger in the periphery is commonly known as the confrontation test or Visual Field test 2, 3, 4, 5, 6.
Test Methodology
- The confrontation test involves a procedure for finger-counting confrontation screening that tests the periphery of all visual field quadrants of each eye 2.
- The test simultaneously screens for the extinction phenomenon that can accompany unilateral brain damage 2.
- The test can be performed using a small red target, finger counting, or a laser pointer 3, 5.
Test Effectiveness
- The sensitivity of the confrontation test varies depending on the type of visual field loss present, with higher sensitivity for detecting hemianopias and lower sensitivity for detecting arcuate scotomas 4.
- The test is relatively insensitive unless a moderate to dense defect is present, but when visual field defects are identified, the defects often are real 4.
- Combining the monocular static finger wiggle test and the kinetic boundary perimetry can return high sensitivity and specificity for detecting visual hemifield deficits in right-brain-damaged stroke patients 6.