3.19, Fig. [24], Pulfrich phenomenon is a test for stereopsis, non-specific to chiasmal compression. It is characterized by the presentation of acute, severe headache, nausea, and altered consciousness. This is called Wilbrands knee and is responsible for the junctional scotoma in lesions of the posterior optic nerve. 3. Visual field defects caused by retinal disease tend to have well-defined, sharp borders that appear deeper than most glaucoma defects with less variability.2 Common conditions affecting the macular area, such as age-related macular degeneration and central serous chorioretinopathy, can give rise to central scotomas which can be seen on 10-2 as A follow-up of 52 patients. Diagnosis is clinical. 3.6, Fig. What are the findings of bilateral occipital lobe lesions? The representation of this most peripheral 20 to 30 degrees is located in the anterior most portion of the contralateral occipital cortex. It can quickly establish the pattern of visual field loss in the ill, poorly attentive, or elderly patient who requires continued encouragement to maintain fixation and respond appropriately. Place the patients head on a chin rest on the open side of a white hemispheric bowl. 3.8). Tangent Screen [38], Pituitary adenoma debulking, or partial excision, is often carried out via transfrontal, transsphenoidal, or transpterional approaches. * Migraine can cause various visual field defects, although it most commonly causes transient homonymous hemianopia. Symptoms typically last 4 to 72 hours and may be severe. 15. 3.30). Visual field defects seen in each eye's visual field and the image perceived by the patient: a) right HH; b) left HH; c) left HH with macular sparing; d) right superior quadrantanopia, 'pie in the sky'; e) inferior quadrantanopia 'pie on the floor' Figure 2. [37], Somatostatin analogs (octreotide, lanreotide), bromocriptine, and growth hormone receptor agonists (pegvisomant) have been used to treat growth hormone-secreting tumors causing acromegaly. This non-invasive test examines your fields of vision, and it is important for identifying vision problems that could be signs of eye disease or conditions that affect the brain (like a stroke). o [ abdominal pain pediatric ] 5. Rates must be under: As such, they tend to become symptomatic when they grow large enough to cause the associated neurological symptoms of pituitary tumors. [31], The pituitary gland is best seen on coronal sections and normally enhances with contrast. (A) Right optic disc shows mild superior disc oedema; left optic disc has more diffuse swelling and peripapillary haemorrhage. Temporal retina in the left eye ([3green] in Fig. When the macula . What values indicate an unreliable Humphrey Visual Field? A variety of retinal or more central pathologies can cause visual field deficits that are limited to particular regions of visual space. 3.11): 5. The nasal fibers of the ipsilateral eye (53% of all fibers) cross in the chiasm to join the uncrossed temporal fibers (47% of all fibers) of the contralateral eye. The altitudinal defect can be unilateral or bilateral. Some patients with complete bitemporal hemianopsia will complain of a complete loss of depth perception. It can be arteritic or nonarteritic. Tumor extension into the cavernous sinus can affect cranial nerves III, IV, V, or VI and produce a limited or total cavernous sinus syndrome. (B) Automated perimetry in the right eye is normal; left eye shows an inferior altitudinal defect. Interestingly, monocular temporal (uncrossed fibers) or nasal (crossed fibers) hemanopic visual field loss can also occur from a lesion at the junction of the optic nerve and chiasm. Or simply, visual field can be defined as the entire area that can be seen when an eye is fixed straight at a point. 5. 3.22) produce atrophy of three groups of retinal ganglion cell fibers: 1. [6], If the epiphyses have closed (i.e., late adolescence and adulthood), the result is acromegaly rather than gigantism. The most nasal retinal fibers have unpaired cortical representation, which is situated in the most anterior part of the contralateral parieto-occipital sulcus. Lesions of the optic radiations typically produce a contralateral homonymous hemianopia, worse superiorly when the lesion is in the temporal lobe and worse inferiorly when the lesion is in the parietal lobe. Altitudinal field defect. But it can also cause a range of other symptoms, including: distorted sight. [24], Non-paretic binocular diplopiamay occur as the result of a loss in the physiologic linkage between the two functioning hemifields, termed "hemifield slide phenomenon" by Kirkham in 1972. 3.22d) 60 degrees nasally Righi A, Agati P, Sisto A, Frank G, Faustini-Fustini M, Agati R, Mazzatenta D, Farnedi A, Menetti F, Marucci G, Foschini MP. Diagnosis read more , retinal detachment Retinal Detachment Retinal detachment is separation of the neurosensory retina from the underlying retinal pigment epithelium. 2012. The patient should perform the task equally well in all four quadrants. Only the central 10, 24, or 30 degrees is usually tested. The homogenicity of the images suggests the relative solidity of the tumor. It looks like an almost complete inferior altitudinal defect. Special attention should be directed to the horizontal and vertical axes of the visual field to see if there is a change in vision across an axis. Follow https://twitter.com/NeuroOphthQandA to be notified of new neuro-ophthalmology questions of the week. In interpreting a visual field test, you need to ask the following questions (Fig. Ezzat S, Asa SL, Couldwell WT, Barr CE, Dodge WE, Vance ML, McCutcheon IE. A consistent difference in color perception (use a red object) across the horizontal or vertical meridian may be the only sign of an altitudinal or hemianopic defect, respectively. Learning points These keywords were added by machine and not by the authors. [25], In prefixed chiasms or tumors that preferentially grow posteriorly, selective compression of macular fibers may cause a bitemporal hemianopsia involving the central visual field while sparing the peripheral field.[30]. [6], There are many complications associated with excess growth hormone, including:[3][4][5]. Rarely, pituitary adenomas can compress the optic tract and produce a homonymous hemianopsia. Present stimuli consisting of dots of white light projected one at a time onto the inner surface of the bowl, usually moving from the unseen periphery into the patients field of view. The test involves the following steps: [20][21], Nelson syndrome describes the enlargement of an ACTH-secreting pituitary adenoma following surgical removal of the adrenal glands for treating Cushing syndrome. Most ACTH-secreting pituitary adenomas are small, with detection of the tumor earlier due to the significant systemic changes. Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada) dedicated to using leading-edge science to save and improve lives around the world. By varying the distance of the patient from the screen, it is possible to differentiate organic from nonorganic constriction of the visual field: in organic patients, the visual field enlarges when the patient is placed farther away from the screen (see Chapter 18). [5] Vison loss due to compression first affects the superotemporal visual fields, then inferotemporal, inferonasal and finally superonasal fields. 1. Relative to the point of fixation: Because more fibers in the optic tract come from the opposite eye (crossed fibers), a relative afferent pupillary defect (RAPD) is often observed in the eye contralateral to an optic tract lesion (see discussion later in this chapter). Retro-chiasmal lesions almost always give rise to homonymous field defects with only one, exception. Having a high basal hormonal level postoperatively was predictive of recurrence in functional adenomas, but there are no known predictive factors for recurrence in nonfunctioning adenomas. Altitudinal defects occur in retinal vascular disease, glaucoma, and other disorders that affect the eye itself. 1.27) when stimuli are moved in the direction of the damaged parietal lobe (Fig. IIH) * Generalised d epression or severe loss * Altitudinal (Eg. 3.20, and Fig. . These tests average about 3minutes (fast) and 6 minutes (standard) per eye. What is the visual field defect of a junctional scotoma? Occipital Lobe: Sparing the Temporal Crescent. Humphrey perimetry uses computerized programs to randomly test points in the patients central visual field with a standard stimulus size but varying stimulus intensities (Fig. It can be arteritic or nonarteritic. At the level of the chiasm, the crossing inferonasal fibers travel anteriorly toward the contralateral optic nerve before passing into the optic tract. Fig. Thyrotrophic adenomas are one of the rarest types of secreting pituitary adenomas. 6. The higher the number, the better the vision at that point in the field. A left optic tract syndrome includes the following: Bowtie atrophy of the right optic nerve, Mostly temporal pallor of the left optic nerve. Automated Static Perimetry "Tumors of the Pituitary Gland." Pearls When bilateral lesions of the retrochiasmal visual pathways produce a decrease in visual acuity, the degree of visual acuity loss is always symmetric in both eyes, unless there are other, more anterior, reasons for a decrease in visual acuity (e.g., asymmetric refractive errors, cataracts, or a superimposed asymmetric or unilateral retinopathy or optic neuropathy). Automated static perimetry or kinetic perimetry are used to formally assess visual fields. The incidence of pituitary adenomas presenting as monocular visual field defects was reported to be 9% (in a series of 1,000 patients). Ophthalmology is typically consulted to evaluate the patient's visual fields. The nasal visual field extends to 60% of the horizon, whereas the temporal fieldextends to a further 3040 beyond that; this part of the visual field is represented on the contralateral anterior parieto-occipital sulcus. Reliability measurements are reported in the upper left corner and include the number of fixation losses (2/13), false-positive errors (0%), and false-negative errors (3%) during the test. Previously, pituitary tumors were classified by their hormone content and structural features. Rarely compression of the third ventricle can produce Increased intracranial pressure. 3. The equivalent concept for optical instruments and image sensors is the field of view (FOV).. [28] Patients may experience overlapping images or divergent images corresponding to esodeviation, exodeviation, or hyperdeviation. Kumar V, Ramanathan US, Mushtaq B, Shah P (2002) Artefactual uniocular altitudinal visual field defect. 6. Face: Ask the patient to look at your nose and tell you if any parts of your face are missing. A Homonymous hemianopia denser superiorly (pie in the sky), 1. Dopamine agonists (e.g., bromocriptine or cabergoline) have been shown to normalize hyperprolactinemia as well as shrink tumors. 7. [36], Cabergoline is a newer medication that also binds to D2 dopamine receptors. 2. Deep lesions of the parietal lobe often impair optokinetic nystagmus when stimuli are moved in the direction of the damaged parietal lobe. The laboratory tests may vary depending on the clinical presentation. 3.3.2 Assessing the Quality of the Visual Field. 3.22b). Thus the nasal visual field extends to 60% of the horizon, whereas the temporal field extends to a further 30-40. Visual Field Defects Symptoms Vision loss in one eye may indicate a problem in the eye, whereas the same visual field defect in both eyes may signal a problem in the brain. Zhang X, Horwitz GA, Heaney AP, Nakashima M, Prezant TR, Bronstein MD, Melmed S. Pituitary tumor transforming gene (PTTG) expression in pituitary adenomas. Left Superior Homonymous Quadrantanopia: This visual defect is often referred to as pie in the sky. Modest elevations in prolactin however can occur without prolactin secreting tumor because of the effect of compression of the stalk (removing the inhibition from dopamine) and is called the stalk effect. We report a case of bilateral superior altitudinal hemianopsia (BSAH) secondary to pituitary microadenoma related inferior optic chiasm damage. [4][5] Skin manifestations include sweating, pigmented skin tags, acanthosis nigricans and cutis verticis gyrata. Natural history of nonfunctioning pituitary adenomas and incidentalomas: a systematic review and metaanalysis. Tell the patient to fixate on a central spot. Sellar lesions and visual loss: key concepts in neuro-ophthalmology. An altitudinal visual field defect is a condition in which there is defect in the superior or inferior portion of the visual field that respects the horizontal midline. 3.4). Often patients are unaware of peripheral field loss; directed questions towards functional changes such as increased rate of car accidents due to being unaware of cars approaching in the periphery, etc., may alert the clinician to a visual field deficit. Goldmann visual field showing a bitemporal hemianopsia. The diplopia is binocular (only present when both eyes are open), and can have horizontal, vertical, or torsional components depending on the affected cranial nerve(s). Superior 60 Brow Inferior 75 Cheek bone Temporal 100 - Nasal 60 Nose . Ischemia of the optic nerve can produce a similar defect. Optic Tract [5], Also arising from Pit-1 lineage, somatotroph adenomas mainly express growth hormone (GH). The temporal crescent syndrome. Gonadotrophic adenomas secrete lutenizing hormone (LH) and follicle-stimulating hormone (FSH). [5], The patient may have a unilateral or bilateral optic neuropathy or develop an optic neuropathy in one eye and a contralateral superotemporal defect in the fellow eye (i.e., the junctional scotoma). 3. Pearls The physiologic blind spot corresponds to the optic disc (which has no overlying photoreceptors) and is located approximately 15 degrees temporally in each eye. The visual loss can be due to a unilateral or bilateral optic neuropathy, bitemporal hemianopsia from chiasmal compression, or rarely homonymous hemianopsia from optic tract involvement. Case 1: Bilateral blindness due to early. 3.10, the left eye was tested (as indicated by the word left in the upper right corner). Present stimuli consisting of dots of white light projected one at a time onto the screen, randomly presented (not moving). Case presentation A 48-year-old man complained of visual disturbance on wakening following radiofrequency catheter ablation. 2003. Bromocriptine is the first-line agent used in treating prolactinomas and suppresses prolactin secretion by binding to D2 dopamine receptors. An embolic infarction of either a distal MCA or PCA branch can result in exclusive ischemia of the tip of the occipital lobe, thereby producing only a small homonymous hemianopia if there is inadequate collateral circulation. Freda PU, Beckers AM, Katznelson L, Molitch ME, Montori VM, Post KD, Vance ML. Wilbrands knee is composed of fibers originating in the inferonasal retina which after traversing via the optic nerve and crossing in the chiasm go anteriorly into the contralateral optic nerve up to 4 mm before passing posteriorly to the optic tract. What are the monocular VF defect patterns? When bilateral lesions of the retrochiasmal visual pathways produce a decrease in visual acuity, the degree of visual acuity loss is always symmetric in both eyes, unless there are other, more anterior, reasons for a decrease in visual acuity (e.g., asymmetric refractive errors, cataracts, or a superimposed asymmetric or unilateral retinopathy or optic neuropathy). Diagnosis read more with cilioretinal artery sparing, bilateral occipital lobe infarction with macular sparing, nonphysiologic vision loss, carcinoma-associated retinopathy, Loss of part or all of the left half or right half of both visual fields; does not cross the vertical median, Optic tract or lateral geniculate body lesion; lesion in temporal, parietal, or occipital lobe (more commonly, stroke or tumor; less commonly, aneurysm or trauma); migraine Migraine Migraine is an episodic primary headache disorder. Why are altitudinal visual field defects common in ischemic optic neuropathies? Identifier: 926-4: Title: Release Hallucinations: Ocular Movements: Normal: Creator: Shirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School . Deep lesions of the parietal lobe often impair optokinetic nystagmus when stimuli are moved in the direction of the damaged parietal lobe. The life-threatening emergency associated with pituitary apoplexy is adrenal crisis, as well as other acute endocrine abnormalities. 3.22d). 2. For example, the pituitary tumor-transforming gene (PTTG) has been shown to be overexpressed in hormone-secreting adenomas. [3], Pituitary adenomas have a monomorphic appearance and are arranged in sheets or cords. A lesion of Wilbrands Knee results in what visual field defect? The cytoplasm of these cells may be acidophilic, basophilic, or chromophobic, and is generally uniform in its appearance. 3.9). It is the technique of choice for patients with optic nerve lesions, papilledema, chiasmal compressive lesions, and other progressive visual disorders. 9. [6], Most pituitary adenomas are soft, well-circumscribed lesions that are confined to the sella turcica. 13. What are the findings of a temporal lobe lesion? More incongruent fields may point towards lesion of the optic tracts, while congruent defects point more towards the visual cortex of the occipital lobe. Automated perimetry is more sensitive, quantitative, and reproducible, but it is more time consuming and requires good patient cooperation and attention (Fig. 4. Mostly temporal pallor of the left optic nerve from atrophy of the temporal retina in the left eye. The test involves the following steps: Some atrophy is reported to be present in approximately 50% of pituitary lesions with visual field defects. The lower visual field falls on the superior retina (above the fovea). What are the bilateral VF defect patterns? [1][3] Various articles have reported both male and female predilections. Instruct the patient to count fingers presented within the central 30 degrees (in each of four quadrants around fixation). In interpreting a visual field test, what questions should be asked? In 2017, the World Health Organization (WHO) updated their classification of pituitary tumors. It appears in people with damage to one hemisphere of their visual cortex, and occurs simultaneously with bilateral homonymous hemianopia or homonymous quadrantanopia. Can we ever stop imaging in surgically treated and radiotherapy-naive patients with non-functioning pituitary adenoma? Where is the lesion of a junctional scotoma? Prechiasmal damage to the visual pathway usually involves the optic nerve (e.g., optic neuritis , optic atrophy, AION , papilledema Bedside visual field testing is quick and easy but has relatively poor reliability, depending on the patients ability to identify and describe the visual field defect. Visual fields are also commonly documented prior and following neurosurgical intervention. The ocular symptomatology of pituitary tumours. If it respects the vertical meridian, is the defect bitemporal or homonymous? Incomplete homonymous hemianopias may help localize the lesion based on their congruity: The test involves the following steps: 3.2.1 Visual Field Testing at Bedside 3. Grid: Present a square grid of lines and ask the patient to fixate on a central point and to draw any area in which the lines disappear (Fig. It is the technique of choice for patients with optic nerve lesions, papilledema, chiasmal compressive lesions, and other progressive visual disorders. Automated perimetry is more sensitive, quantitative, and reproducible, but it is more time consuming and requires good patient cooperation and attention (Fig. [27], A few case reports have reported photophobia as the main presenting symptom in some patients with chiasmal disease.[29]. [6] The term, pituitary carcinoma is reserved forcases with metastatic spread, either local or systemic invasion, and comprise of <1% of tumors. She later presented with right-sided visual disturbance; her examination confirmed temporal crescent syndrome. Macular sparing is visual field loss that preserves vision in the center of the visual field, otherwise known as the macula. These numbers are then converted to a gray scale representation of the field (upper right, Fig. 3.25). In interpreting a visual field test, what questions should be asked? Nasal retina of the right eye ([2red]) in Fig. A lesion in this area will give rise to monocular visual field defect affecting the contralateral eye. Mete O, Lopes MB. If it is homonymous and incomplete, is the defect congruent (same defect shape and size in each eye)? 3.6, Fig. What field defect results when a stroke only affects the anterior portion of the occipital lobe? Non-arteritic ischemic optic neuropathy (NAION) is presumed to be caused by lack of perfusion to the optic nerve and subsequently causes an acute, unilateral vision loss that is painless. 5. 1. Altitudinal hemianopia comprises defective vision in the upper or lower horizontal half of the visual field. 3.13). The information below is from: The temporal crescent syndrome. 3.10 indicates the amount each point deviates from the age-adjusted normal values. Well, the visual field defect affects both eyes, which tells you that it is behind the optic chiasm. In optometry, ophthalmology, and neurology, a visual . 3.2). Extraocular muscle paresis may also suggest Pituitary apoplexy, which must considered in the setting of rapidly progressive vision loss and diplopia. The chiasm can herniate into this space, rarely causing secondary visual loss. These tumors can also have decreased pituitary hormones, most commonly related to decreased LH. Patients will complain of symptoms consistent with the mass effects of a pituitary tumor. The stimulus size is kept the same, but the brightness varies. A 46-year-old woman with a monocular superior altitudinal visual defect due to an aneurysm in the supraclinoid portion of the internal carotid artery appeared to have compressed the optic nerve and secondarily caused posterior ischemic optic neuropathy. They tend to be macroadenomas at time of clinical diagnosis due to the subtle manifestations of excess growth hormone. The lesion is at the most posterior portion of the optic nerve ipsilateral to the central scotoma at its junction with the chiasm. Once the lesion is localized anatomically, a directed workup looks for an etiology. The number scale labeled Total Deviation in Fig. Depending on the etiology of the optic neuropathy, arcuate defects, altitudinal defects, and central, paracentral, or centrocecal scotomas are observed (Fig. 3. The visual field and retina have an inverted and reversed relationship. Humphrey perimetry uses computerized programs to randomly test points in the patients central visual field with a standard stimulus size but varying stimulus intensities (Fig. 2. The Academy uses cookies to analyze performance and provide relevant personalized content to users of our website. [26] Patients with chiasmal disease will experience Pulfrich phenomenon physiologically. 6. Aetiology 60 degrees superiorly 8. Occlusion of the PCA often results homonymous hemianopia of the contralateral visual field with macular sparing. 3.19, Fig. False Positive 33%. [5] While both medications have similar mechanisms of action, the other medication may be tried if there is a minimal response from the first drug. View High Prevalence of Pituitary Adenomas: A Cross-Sectional Study in the Province of Liege, Belgium. The far periphery can be assessed by finger wiggle. 4. We do not control or have responsibility for the content of any third-party site. 3.22d) ACTH triggers the adrenal glands to secrete cortisol. Occipital Lobe: Bilateral If binocular, does the defect respect the vertical meridian? (This rule does not apply to optic tract lesions that are suspected when the homonymous hemianopia is associated with a RAPD on the side of the hemianopia and bilateral optic nerve pallor). The link you have selected will take you to a third-party website. Retrochiasmal lesions normally cause homonymous visual field defects; the only exception is the temporal crescent or half moon syndrome, caused by a lesion in the anterior part of the contralateral parieto-occipital sulcus. [11] Mutations in the aryl hydrocarbon receptor interacting protein (AIP) gene are associated with an increased risk of aggressively invasive growth hormone-secreting pituitary adenomas. [2], Microadenomas may present as less-enhancing lesions within the substance of the pituitary gland, whereas macroadenomas are more variable in their appearance. DeKlotz TR, Chia SH, Lu W, Makambi KH, Aulisi E, Deeb Z. Meta-analysis of endoscopic versus sublabial pituitary surgery. I explain the pathophysiology of this rare neurological syndrome in this report. If there's a problem superiorly, you're gonna cause a problem inferiorly. Bilateral hypertensive optic disc edema in the setting of Cushing's disease may mimic papilledema. Lesions of the parietal lobe often impair optokinetic nystagmus (see Fig. The lower visual field falls on the superior retina (above the fovea). Thammakumpee K, Buddawong J, Vanikieti K, et al. 14. 2. Lesions of the optic tract cause a contralateral homonymous hemianopia, which may or may not be congruent. More common: Ischemic optic neuropathy. Visual field testing is useful when evaluating patients complaining of visual loss (especially when the cause of visual loss is not obvious after ophthalmic examination) or patients with neurologic disorders that may affect the intracranial visual pathways (e.g., pituitary tumors, strokes involving the posterior circulation, and traumatic brain Other pituitary tumors can also cause elevated prolactin levels by the decrease in dopaminergic inhibition as these tumors enlarge and compress the pituitary stalk. 3.10), which provides a gross picture of the size and severity of the field defects present. Applied anatomy for pituitary adenoma resection. The normal visual field in each eye is approximately (Fig. Face: Ask the patient to look at your nose and tell you if any parts of your face are missing. The most nasal retinal fibers have unpaired cortical representation, which is situated in the most anterior part of the contralateral parieto-occipital sulcus. We report a patient with bilateral superior altitudinal hemianopia. Superior extension of the pituitary mass can cause sudden vision loss or visual field loss. As discussed above, a significant portion of pituitary adenomas are asymptomatic or indolent, leading their discovery to be incidental. 15. The number scale to the right in Fig. In this case, the more negative a number, the more abnormal that point. The normal extent of field of vision is 50 superiorly, 60 nasally, 70 inferiorly and 90 temporally. Hypercortisolism now most commonly results as a result of iatrogenic therapeutic modalities. False Negative 33% Causes of visual field defects are numerous and include glaucoma, vascular disease, tumours, retinal disease, hereditary disease, optic neuritis and other inflammatory processes, nutritional deficiencies, toxins, and drugs. Relative scotoma - an area where objects of . Nasal retina of the right eye ([2red]) in Fig. Two patterns of visual field loss occur when the lesion is secondary to an ischemic lesion in the territory of the choroidal arteries (anterior or posterior) (Fig. 3.7). Corticotroph adenomas derive from Tpit lineage and express adrenocorticotropic hormone (ACTH) plus other hormones from the same precursor, proopiomelanocortin (POMC). Silent-type III pituitary adenomas can be clinically aggressive but has good treatment response to radiation and temozolomide. [12] There is evidence as well that adult pituitary stem cells may contribute to the development of pituitary adenomas. 3. Questions with answers: They are variable in their secretion, and often do not cause clinical symptoms related to their hormone products. extends to a further 3040 beyond that; this part of the visual field is represented on the contralateral anterior parieto-occipital sulcus. A RAPD is often observed in the eye contralateral to the optic tract lesion. 6. Retro-chiasmal lesions normally cause homonymous visual field defects; the only exception is the temporal crescent or half moon syndrome, caused by a lesion in the anterior part of the contralateral parieto-occipital sulcus. 4. (altitudinal) visual field defect? [3] One review found an average incidence of 16.7% (14.4% in autopsy studies and 22.5% in radiologic studies). The nasal visual field extends to 60% of the horizon, whereas the temporal field. Microincidentalomas (<1 cm) have been reported to be more common than macroincidentalomas (4-20% vs. 0.2% on CT, 10-38% vs. 0.16% on MRI, respectively). My Education Find an Ophthalmologist Home Coronavirus For Ophthalmologists Meetings AAO 2022 Meeting Information Past and Future Meetings Mobile Meeting Guide Contact Information Marini F, Falchetti A, Luzi E, Tonelli F, Luisa BM. Ali K. Pract Neurol 2015;15:5355. In interpreting a visual field test, you need to ask the following questions (Fig. What are the findings of a parietal lobe lesion? ABSTRACT Stacy Smith, Andrew Lee, Paul Brazis. Defects are more difficult to quantify than with automated perimetry.