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Visual fields are examined by the use of static or kinetic perimetry.  The procedure is performed separately for each eye and measures the combined function of the retina, the optic nerve and the intracranial visual pathway.  It is used clinically to detect or monitor field loss due to disease at any of these locations.  Visual fields may be determined by several methods including a tangent screen, Goldmann perimeter and computerized automated perimeters.

The visual field is the area within which objects may be seen when the eye is fixed.  To standardize testing, several automated and computerized perimeters are available.  However, manual perimeters are also utilized.

Visual field examinations may be considered medically necessary under any of the following conditions:

• The patient has inflammation or disorders of the eyelids potentially affecting the visual field
• The patient has a documented diagnosis of glaucoma (Please note that the stabilization or progression of glaucoma can be monitored only by a visual field examination, and the frequency of such examinations is dependent on the variability of intraocular pressure measurements (i.e., progressive increases despite treatment indicate a worsening condition), the appearance of new hemorrhages, and progressive cupping of the optic nerve)
• The patient is a glaucoma suspect as evidenced by an increase in intraocular pressure, asymmetric intraocular measurements of greater than 2-3 mm Hg between the two eyes, or has optic nerves suspicious for glaucoma which may be manifested as asymmetrical cupping, disc hemorrhage, or an absent or thinned temporal rim
• The patient has a documented disorder of the optic nerve, the neurologic visual pathway, or retina (Please note that patients with a previously diagnosed retinal detachment do not need a pretreatment visual field examination. Additionally, patients with an established diagnosed cataract do not need a follow-up visual field unless other presenting symptomatology is documented.  In patients who are about to undergo cataract extraction, who do not have glaucoma and are not glaucoma suspects, a visual field would not be indicated)
• The patient has a recent intracranial hemorrhage, an intracranial mass or a recent measurement of increased intracranial pressure with or without visual symptomatology
• The patient has a recently documented occlusion or/and stenosis of cerebral and precerebral arteries, a recently diagnosed transient cerebral ischemia or giant cell arteritis
• The patient having an initial workup for buphthalmos, congenital anomalies of the posterior segment or congenital ptosis
• The patient has inflammation or disorders of the orbit, potentially affecting the visual field
• The patient has sustained a significant eye injury
• The patient has an unexplained visual loss which may be described as “trouble seeing or vision going in and out”
• The patient has a pale or swollen optic nerve documented by a visual exam of recent origin
• The patient is having some new functional limitations which may be due to visual field loss (i.e., reports by family that patient is running into things)
• The patient is being evaluated initially for macular degeneration or has experienced central vision loss resulting in vision measured at or below 20/70 (Please note that repeated examinations for a diagnosis of macular degeneration or an experienced central vision loss are not necessary unless changes in vision are documented or to evaluate the results of a surgical intervention)
• Repeat visual field examinations for patients undergoing surgery of the upper eyelid(s) and brow are considered reasonable and medically necessary.  The initial (taped) and repeat (untaped) visual field examination should be performed on the same date of service.
• The patient is receiving or has completed treatment of a high-risk medication that may cause visual side effects, (i.e., a patient on plaquenil may develop retinopathy)