Neuropsychologic assessment of visual disorders

This article introduces the reader to a sample of visual tests used in the neuropsychologic assessment of patients who present with various visual deficits. As discussed, patients often present with visual abnormalities that cannot be assessed exclusively during the opthtalmologic examination, partly because these problems extend beyond the fundamental aspects of visual processing. Visual problems occur in the context of focal or diffuse brain damage. Neuropsychologic evaluation can provide valuable diagnostic information and information regarding functional strengths and weaknesses. Many visual tests have been developed for clinical use. Some of these tests have been validated with lesion analytic or neuroimaging studies, which highlight the areas of the brain presumed necessary for task performance. Knowledge regarding the neural substrates of test performance allows the clinician to identify the neuropathologic correlates of test failure, which, in turn, is relevant to differential diagnosis. A profile of functional strengths and weaknesses emerges contributing to the treatment of the patient with a visual disorder. In this article, the authors present a subset of visual tests used primarily in the clinical setting. Some of these tests measure lower-level visual deficits (e.g., Judgment of Line Orientation) and others measure higher-level visual/cognitive deficits (e.g., ROCF). Although no firm delineation of test subtypes exists, the authors divide the tests into general categories of visuoperceptual, visuospatial, visuoconstructive, and visual attention/memory. Ultimately, it is incumbent on a trained neuropsychologist to select appropriate visual tests based on the patient's described symptoms and the referral question.