The accuracy of confrontation visual field test in comparison with automated perimetry

The accuracy of confrontation visual field testing was determined for 512 visual fields using automated static perimetry as the reference standard. The sensitivity of confrontation testing excluding patchy defects was 40% for detecting anterior visual field defects, 68.3% for posterior defects, and 50% for both anterior and posterior visual field defects combined. The sensitivity within each group varied depending on the type of visual field defect encountered. Confrontation testing had a high sensitivity (75% to 100%) for detecting altitudinal visual loss, central/centrocecal scotoma, and homonymous hemianopsia. Confrontation testing was fairly insensitive (20% to 50% sensitivity) for detecting arcuate scotoma and bitemporal hemianopsia. The specificity of confrontation testing was high at 93.4%. The high positive predictive value (72.6%) and negative predictive value (75.7%) would indicate that visual field defects identified during confrontation testing are often true visual field defects. However, the many limitations of confrontation testing should be remembered, particularly its low sensitivity for detecting visual field loss associated with parasellar tumors, glaucoma, and compressive optic neuropathies.