Clinical and Neuroimaging Findings in Patients with Atypical Visual Field Defects

To investigate the clinical presentations and neuroimaging findings of patients with atypical visual field defects (VFDs).

This retrospective cross-sectional study included 159 patients who underwent brain magnetic resonance imaging for evaluation of atypical VFDs between 2013 and 2022. Clinical characteristics were compared based on neuroimaging results, and logistic regression was performed to identify independent risk factors for significant findings.

Twenty-nine patients (18.2%) exhibited significant findings responsible for their atypical VFDs, most commonly intracranial tumors and cerebrovascular accidents. Older age [odds ratio (OR) 1.049, 95% confidence interval (CI) 1.018-1.081, p=0.002], symptom of decreased visual acuity (OR 5.790, 95% CI 2.361-14.195, p<0.001), incomplete homonymous hemianopsia (OR 15.167, 95% CI 3.096-74.300, p=0.001), absence of peripapillary atrophy (PPA) (OR 0.353, 95% CI 0.136-0.919, p=0.033) and rapidly progressive VFDs (OR 4.385, 95% CI 1.266-15.189, p=0.020) were independently associated with significant findings. Subgroup analysis based on the presence of glaucoma revealed that, among glaucoma patients, incomplete homonymous hemianopsia (p=0.001) and absence of PPA (p=0.016) were more prevalent among those with significant neuroimaging results. Among non-glaucoma patients, those with significant findings had greater pattern standard deviation (p=0.003) and more frequent rapidly progressive VFDs (p=0.041).

Atypical VFDs may indicate lesions along the visual pathway. Neuroimaging is recommended for patients with atypical VFDs, particularly those of older age or presenting with decreased visual acuity, rapid progression or incomplete homonymous hemianopsia.