At the 2025 Optometric Management Symposium, Andrew Lee, MD, gave a lecture on the key clinical and perimetric features of visual field testing to compare and contrast the underlying etiologies for specific localizing visual field defects. Here, he discusses the highlights:

Transcript:

My name is Andy Lee, and I’m here at the OMS meeting in Orlando. We’re talking about visual fields, and what you need to know is how to “find the wolf” in your next visual field examination. The way to find the wolf is by recognizing a few simple rules that help determine whether a visual field defect is due to a problem in the retina, optic nerve, or intracranial pathway.

The key finding is respect for the vertical meridian, which indicates a hemianopsia. This can be bitemporal, meaning the temporal fields are affected in both eyes—typically caused by a pituitary gland lesion. In an acute, painful setting, this suggests pituitary apoplexy.

Alternatively, the hemianopsia can be homonymous—either right or left—also respecting the vertical meridian. Acute homonymous hemianopsias are usually due to hemorrhages, strokes, or acute decompensation from a tumor or other intracranial process.

So, the key to “finding the wolf” in your next visual field is recognizing respect for the vertical meridian—whether homonymous or bitemporal hemianopsia. These are the wolves in your visual field. OM