Eccentricity compensated dark-on-bright stimuli in screening for neuro-ophthalmic visual field loss

One hundred and sixty-nine (87 right, 82 left) eyes of 98 consecutive patients aged 9-78 years (mean 42 yrs) were examined with both dark-on-bright and standard Goldmann bright-on-dark stimuli in a neuroophthalmology clinic. Single intensity suprathreshold static dark-on-bright stimuli were successively presented on a high resolution monitor under computer control at pre-selected coordinates in the central visual field, and the stimulus awareness was recorded by the patient pressing a button. Conventional luminous stimuli revealed a visual field abnormality in 110 eyes (57 right, 53 left) from 75 patients, and the dark stimuli correctly detected the presence of scotomas in 90% of eyes, with good or fair topographical correlation in 82% of eyes and poor correlation in 18% of eyes. Among the 59 eyes (30 right and 29 left, 36 patients) with no visual field defect, the dark stimuli produced a normal result in 86.5% of eyes. Dark-on-bright stimuli allow accurate diagnostic visual field examination in neuro-ophthalmic practice.