Joah Brown Manufacturer, Bull City Gymnastics Coaches, Articles H

The modified visual field test was jointly designed by two of our authors, AM and JB. Central and peripheral vision is tested by using visual field tests. Prolapsing fat pads were clamped over with a hemostat and excised. A comprehensive eye examination should be performed on all prospective blepharoplasty patients to determine the best-corrected visual acuity and to prevent any question of decreased postoperative visual acuity. Documented photo of eyelid droop or dermatochlasia (excess skin above the eyelid) 2. For both of these tests, the For patients who underwent ptosis surgery with or without blepharoplasty, 84.2% recorded an improvement in points seen with the test and 81% recorded an improvement in visual field height. In closing, it is important not to assume that patients over age 70, whether they are male or female, are not interested in functional oculoplastic procedures that will also greatly improve their cosmesis. Question 2: Are the visual fields codes unilateral or bilateral? Although there is a great deal of overlap, patients who desire blepharoplasty generally fall into two broad categories. HVF targets come in sizes ranging from 0.25 mm2 to 64.00 mm2 represented by Roman numerals I through V. Typically, a size III stimulus (4 mm2) is used in patients with good visual acuity (usually at least 20/200 or better). Question 3: How should our optometry practice code a VF ordered by an ophthalmologist outside the practice, which will be sent back to the ordering doctor for interpretation? In total, a maximum of 48 will be tested in the superior visual field. Question 4: What diagnosis codes would we use for a VF test to rule out the possibility of glaucoma if the results revealed no definitive diagnosis? There is also a marked difference between males and females. This exposed the underlying orbital septum. volume25,pages 365369 (2011)Cite this article. Maximal Levator Function: 12mm O.D., 12mm O.S. Y@Qt@d``@= dI10@Q^ PxB This is awesome thanks a lot for putting this together Ben! In those cases, a frontalis suspension must be performed. Example 1: A patient presents with high intraocular pressure, a sign of glaucoma, and the eye care specialist decides to perform a visual field (VF) examination. In the majority of cases of involutional ptosis (senile or age-related), patients have good levator function, allowing for levator resection procedures. Its an. While focusing on the light straight in front of you, you have to press when you see the blinking light on the side. Attention was first directed to the right upper lid. This is what every patient will want to know and how you will decide whether to step up drop therapy, add laser, or take the patient to the operating room. Blepharoplasty is one of the top five plastic surgical procedures performed in the United States for both men and women, and it is becoming more and more common every year. This large study clearly demonstrates that ptosis and dermatochalasis may be associated with superior visual field defects and is comparable with other studies.9, 10, 11, 12, 13 We have also shown that ptosis surgery and blepharoplasty will improve the visual field as evidenced by the increase in the height as well as number of points seen in the visual field. Arch Ophthalmol 1989; 107: 840843. This would likely be seen in patients with idiopathic intracranial hypertension (aka pseudotumor cerebri). Finally, maximal levator function shows how high the patient can lift his or her lid voluntarily. Droopy lids often prematurely age a person as well as impair vision. For blepharoplasty, it is for photographs demonstrating dermatochalasis and a visual field showing a defect to at least 30 above the visual axis and which is significantly improved or. The most common early to mid stage glaucomatous field. The number of points missed before blepharoplasty ranged from 2 to 35 (median 17, mean 17.44, SD 8.72), and the height of superior visual field in this group ranged from 0 to 48 (median 24, mean 20.26, SD 12.2). The inferior visual field also serves as a useful guide to the technician that the patient understands the test well enough to perform reliably. This should include inquiries of any periorbital trauma, thyroid conditions, dry eye syndrome and skin conditions. Change in visual field height post-ptosis surgeries with and without blepharoplasty vs blepharoplasty only. It is also necessary to evaluate the position of the brow when evaluating patients with a droopy lid. What do the numbers on your eyeglass frames mean? 0000049173 00000 n Coding involving lab orders, E/M [], Question: Notes indicate that the provider treated a patient with a retinal migraine. Ive never [], Question: Have the modifier 25 rules changed now that the E/M guidelines are different? The objective of this article is to discuss the diagnosis and surgical management of patients in need of functional blepharoplasty in which the primary goal is restoring vision. The area of excision of skin and muscle was outlined and compared for symmetry. Brow and lid ptosis are other important criteria for the preoperative evaluation. Documented clinical exam by a physician 3. 0000023882 00000 n Identification of glaucoma-related visual field abnormality with the screening protocol of frequency doubling technology. A neuro-ophthalmologist will be able to test further and potentially treat the underlying condition and, in turn, resolve your ptosis symptoms. Best to check your payer coverage policy. Answer 1: A common mistake ophthalmologists make is billing 92082 when they could legitimately report 92083. Commissioning policy cosmetic plastic surgery procedures 2008. AskMayoExpert. We have defined ptosis as a margin reflex distance (MRD) of 2mm or less.7. The HFA 30-2 tests 76 points in the central 30 degrees of the visual field. Whilst the visual field has been used in some ophthalmic units to prove the presence of ptosis, there is so far no standardized visual field designed for this purpose. The Visual System. Because the results of the VFs were negative they did not confirm glaucoma or any condition you should report the signs and symptoms that prompted the exam, link the diagnosis code(s) to the applicable VF code, and include any additional observations from the VFs in the office notes. Ninety five eyes had aponeurotic repair with or without blepharoplasty and 77 eyes had blepharoplasty alone. And, warn patients not to wear contact lenses or eyelid makeup for one week following blepharoplasty surgery. Many payers no longer require taped visual fields. The Humphrey Field Analyzer central 30-2 threshold test (HFA 30-2) and central 24-2 threshold test (HFA 24-2) are tests that can meet these criteria. For every interpretable, reliable visual field you get, you will also get another in which the patient thinks he should be scanning the dome for lights the whole time, is poorly positioned, is exhausted from waiting in your clinic for hours, or is too elderly and arthritic to push the button in time. 0000003892 00000 n American Society of Plastic Surgeons. But ptosis testing doesnt end at eyelid observation. Visual field testing (92081-92083, Visual field examination) is a big component of what many eye care practices do this test is used on patients from glaucoma suspects to blepharoplasty candidates. Correlation of the vision-related functional impairment associated with blepharoptosis and the impact of blepharoptosis surgery. C=KHoI_!eXbxR;(/c& qOF|yOm0 .Pxc|8?d:1`g80C9@ @^b`o]_"moE&7)}# u Answer 2: When deciding whether to bill for services unilaterally, per eye, or bilaterally, for both eyes, the first thing to do is read the code description in CPT. Wojno TH . If the patient's eyelid(s) doesn't meet your payer's unique requirements for functional surgery, the surgery will be considered cosmetic. Her medical history was also positive for diabetes mellitus, long-term heterotopic ossification joint pain (>45 years). However, the vast majority of patients have normal eyelids when they are born and develop droopy eyelids in adulthood, a condition known as acquired ptosis. Often, this will confirm significant visual field loss. Policy effective from 1 September 2008. In most men, the optimal position of the brow is at the bony rim above the eye. Ezt a tesztet kozmetikai szempontbl annak megllaptsra, hogy a biztosts fedezi-e a szemhjmttet, felbecslhetetlen rtk eszkz a ptosis javtsval s/vagy a blefaroplasztikval kapcsolatos ltselzrds szemlltetsre. Down gaze ptosis. All About Vision does not provide medical advice, diagnosis or treatment. Central 30-2 threshold visual field testing showed markedly improved visual fields with eyelids taped, which underscored the medical necessity of blepharoplasty in this patient. It demonstrates the visual field defects associated with both ptosis and dermatochalasis, and illustrates the improvement in visual function after corrective surgery. Abnormal pupillary response, particularly a smaller-than-normal pupil that has difficulty dilating, could indicate Horners syndrome when paired with a droopy eyelid. When the skin of the upper lids rests across the eyelashes, it is an indication that the vision may be compromised by the eyelid configuration. The upper lid margin should fall 1mm to 2mm below the superior limbus, while the lower lid margin should rest at the level of the lower limbus. Her ocular history was positive for non-proliferative diabetic retinopathy, posterior vitreous detachment, O.D., and asteroid hyalosis, O.S. Direct response (how the pupil in which the light is being shone reacts) and consensual response (if the opposite pupil reacts the same as the one exposed to light) are noted during the exam. For the dry eye syndrome, I prescribed Systane Ultra Preservative-Free (Alcon) b.i.d. Furthermore, she had been using artificial tears copiously with no improvement. Your best bet is to check with your local carrier to determine if billing guidelines exist. Dermatochalasis constitutes a special group as blepharoplasty has long been considered as cosmetic surgery. In this case, the appropriate ICD-10 diagnosis code is one of the following, depending on which eye is affected: A #15 blade was used to incise the skin in the previously demarcated area. Patients enrolled in the study underwent a complete oculoplastic evaluation prior to and at 4-6 weeks after their procedure. The patient was undergoing treatment for several months by her otolaryngologist for a blocked salivatory gland on the right side. All rights reserved. Answer 3: Report only the technical component of the visual field test if your optometrist performs the test but doesnt do the interpretation. An SH, Jin SW, Kwon YH, et al. Post-operatively the number of points missed ranged from 0 to 33, but the median improved to 4 (mean 7, SD 7.62). Therefore, a dry eye evaluation must be part of the preoperative work-up. We aim to use this new assessment tool to demonstrate the functional disability associated with these conditions and the effectiveness of surgery in improving the superior visual field. Slider with three articles shown per slide. It was also being presented in Midlands Ophthalmological Society in September 2010. H40.10X3 ( severe stage) 0000001782 00000 n Answer 4: Because the results of the VFs were negative they did not confirm glaucoma or any condition you should report the signs and symptoms that prompted the exam, link the diagnosis code(s) to the applicable VF code, and include any additional observations from the VFs in the office notes. 0000048252 00000 n If you plotted three isopters, however, that would be an extended examination, which would qualify for 92083. Although Goldmann test is sensitive and comprehensive, it is also time consuming, operator dependent and less specific, as some patients can predict the next point. Imagine you are assessing a patient with visual difficulties or optic disc swelling. At this point, many patients still have great central vision of 20/20 to 20/50, but peripheral vision is nearly gone. 2000-2023 AAV Media, LLC. Twenty healthy individuals (40 eyes) with an average age of 51 were also tested; only three eyes in three separate patients showed just three contiguous absolute missed points. Find out When Technical, Professional Components Apply. 0000062377 00000 n skin in cases of dermatochalasis, However, this is difficult to achieve without a trained photographer in a standardised setting, which has significant cost implications. Glaucoma causes a loss of vision like a light bulb slowly becoming dimmer and dimmer, while trauma often causes sudden, complete loss of central or peripheral vision. Leitlinien der Kommission fr Okuloplastik (Orbita + Dakryologie) der OG, Brow ptosis: are we measuring the right thing? All About Vision and AllAboutVision.com are registered trademarks of AAV Media, LLC. If the procedure is determined to be medically necessary, it may be covered by medical insurance. We also chose not to perform taped and untaped measurements as published data does not support the idea that improved fields with taping or manual elevation of the eyelid is predictive of improved function after surgery.18 Many experts also feel that manually elevating the upper eyelid will underestimate the actual visual field improvement after ptosis surgery and simply adds to the time and expense of the pre-operative assessment.6. Im curious to see how VR based perimetry is implemented in the coming years. Advancing clinical efficiency in glaucoma. Humphrey's visual field testing, dilation procedures, auto refract. A visual field test can also help the doctor find out more about the part of the nervous . Example 2: The eye care physician performs visual fields for a patient who presents with high intraocular pressure, open angle, and the VFs confirm the presence of small scotomas in the areas of the VF related to glaucoma. A HVF-teszt szmos lehetsges szembetegsg, pldul a glaukma diagnosztizlsban hatkony. Mayo Clinic; 2021. Learn more about the different tests administered when diagnosing ptosis and what happens after youve been diagnosed. 0000009758 00000 n However, since Medicare will only pay for functional dermatochalasis or ptosis, a visual field is necessary before a referral can be made for a functional eyelid lift. What are your thoughts on the VR based perimeters vs HFA (or as a complement)? Furthermore, she had been using artificial tears copiously with no improvement. Whether youre a VF coding newbie or a seasoned expert, the answers to these questions that readers have submitted to Ophthalmology and Optometry Coding Alert can help you get all of your deserved reimbursement for these tests. Grid A (above the x axis) has the following co-ordinates: Grid B (below the x axis) has the following co-ordinates: Further information about the setting-up of the test can be obtained via e-mail at joyce.burns@uhl-tr.nhs.uk. ISSN 0950-222X (print), Modified visual field test for ptosis surgery (Leicester Peripheral Field Test), Prevalence of ocular findings regardless of visual acuity status in older adults from the Brazilian Amazon Region, Diagnostic accuracy of an iPad application for detection of visual field defects, Long-term changes and effect of pterygium size on corneal topographic irregularity after recurrent pterygium surgery, A review of acquired blepharoptosis: prevalence, diagnosis, and current treatment options, Long-term functional outcomes and vision-related quality of life after vitrectomy for epiretinal membrane: a prospective cohort study, An image-based eyelid lesion management serviceevaluation of a pilot, Patient-reported prevalence of metamorphopsia and predictors of vision-related quality of life in vitreomacular traction: a prospective, multi-centre study, Influences of the three-dimensional parameters of pterygium on corneal astigmatism and the intraocular lens power calculation, Long-term follow-up of phacotrabeculectomy surgery in Tanzania, Patient reported psychosocial functioning following successful ptosis surgery. Cosmetic blepharoplasty. Ophthalmology 1993; 100: 658659. It has a wider angle and can capture peripheral field defects. Blepharoplasty can remove excess skin in cases of dermatochalasis, as seen here. If you simply cannot get a visual field due to patient cooperation or attention, you can order an optic nerve OCT to follow the optic nerve head objectively (though thinning does not always necessarily correlate to field loss). The surgeon to whom I referred my patient confirmed the significant ptosis and dermatochalasis. O.U. The two most important to look at are the Grayscale Map and the Pattern Deviation. The significance of down gaze ptosis causing difficulty in reading and fine work has been emphasized in recent literature.9, 16, 17. Most major insurance companies will pay for surgery when excess eyelid skin produces a functional visual impairment. Name, demographics, etc: Make sure you are looking at the right patient! Often, the skin of the upper eyelids rests across the lashes and obscures vision. Funding or reimbursement of ptosis surgery and blepharoplasty within the healthcare setting has long been a contentious issue.1 Various arbitrary guidelines have been issued by medical insurers and Primary Health Care Trusts (PCTs).2, 3, 4, 5, 6 The lack of consistency and clarity of these guidelines has created a significant amount of confusion, causing anxiety for patients and raising questions of a postcode lottery. Visual field testing (92081-92083, Visual field examination) is a big component of what many eye care practices do this test is used on patients from glaucoma suspects to blepharoplasty candidates. Contact an eye doctor if you need medical attention. Its possible that during ptosis testing, it is discovered that an underlying condition is causing your eyelid to droop. The inferior field test serves as a reference, but is not used in the analysis. endstream endobj 296 0 obj <>/Metadata 52 0 R/Outlines 47 0 R/Pages 51 0 R/StructTreeRoot 54 0 R/Type/Catalog/ViewerPreferences<>>> endobj 297 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/Properties<>/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 298 0 obj [299 0 R 300 0 R 301 0 R] endobj 299 0 obj <>/Border[0 0 0]/H/N/Rect[325.42 543.235 395.044 529.826]/StructParent 1/Subtype/Link/Type/Annot>> endobj 300 0 obj <>/Border[0 0 0]/H/N/Rect[412.001 543.235 481.625 529.826]/StructParent 2/Subtype/Link/Type/Annot>> endobj 301 0 obj <>/Border[0 0 0]/H/N/Rect[190.203 530.635 265.57 517.226]/StructParent 3/Subtype/Link/Type/Annot>> endobj 302 0 obj <> endobj 303 0 obj <> endobj 304 0 obj <> endobj 305 0 obj <> endobj 306 0 obj <> endobj 307 0 obj <> endobj 308 0 obj <> endobj 309 0 obj <>stream 0000001301 00000 n Patients in this category notice improved vision when they elevate the flaps of skin with their fingertips and are candidates for functional blepharoplasty. Medically necessary procedures are more likely to have some or all costs covered by insurance, depending on your insurance carrier and plan. Small R, Sebates NR, Burrows D . Small RG . However, those with brow ptosis, asymmetry with unilateral anophthalmic socket or other known ocular pathology associated with a visual field defect, such as glaucoma, optic neuropathy, diabetic retinopathy (eg, previous panretinal photocoagulation) or other neurological problems were excluded. The Humphrey uses fixed points of light which are shown at different intensity levels. ICD-10 Coding: Can You Accurately Diagnose These 3 Infrequently-Seen Eye Conditions. 0000003158 00000 n The key to choosing the correct VF code is in the code descriptors themselves. What does a 1% VFI percentage mean? It also looks like they are partnered with Keeler. Title: Blepharoplasty Author: CGS Subject: J15 Created Date: 7/18/2014 10:36:28 AM As a very, very general guideline, you can look at the density / size of the field defect, the pattern standard deviation, and the mean deviation (MD) to see if it is worsening. Norcom Commissioning Policy Specialist Plastic Surgery Procedures 2007. This is ordered for 90% of glaucoma patients. As this test is a screening test rather than a threshold test, it may not be able to identify a visual field defect associated with more subtle degrees of ptosis.11 Therefore, the few patients complaining of a reduced visual field who have no measured defect could be offered ancillary tests, such as photographs, a threshold visual field test or a quality of life questionnaire. First, your eye doctor will observe your eyes in different levels of lighting to check for anisocoria (different sized pupils). If the eyelids begin sagging into the field of vision, a functional blepharoplasty may be required. In a further 37 eyes (39%) the improvement in points seen was between 11 and 20, and in the remaining 23 eyes (24.2%) there was an improvement in 10 or less points. Fifteen eyes (15.8%) had no improvement, whilst 3 eyes (3.1%) had a reduction (within 24) in visual field height post-ptosis surgery (Figure 4). Append modifier TC (Technical component) to the code to report your work. Question 2: Are the visual fields codes unilateral or bilateral? Small RG . H40.012 ( left eye) Do eye exercises work for droopy eyelids. startxref 0 Effects of upper lid blepharoplasty on visual quality in patients . Local anesthetic was infiltrated into each upper lid. Proper management requires a meticulous preoperative analysis with special regard to brow position, lid crease and lid fold, levator function, tightness of the canthal ligaments, tarsal plate and orbital septum, because these factors will determine the type and extent of procedure. Following surgery, patients should be advised to apply ice to the eyelids for 15 minutes per hour for the first 72 hours. 0000047814 00000 n A binary statistical calculation was performed to identify the relationship between the presence of a visual field defect and ptosis. Involvement of the lower eyelids can be quite dramatic; this protruding tissue is known as malar bags or festoons. A 75-year-old white female, who had been under my care for three years, presented for an emergency visit with a chief complaint of red eye.. The most commonly used one is the Humphrey visual field which is a fixated light that is positioned central and some blinking lights on the site. In total, 80 out of 95 eyes (84.2%) improved, 5 eyes (5.2%) were unchanged and 10 eyes (10.5%) had deterioration in the number of points seen (Figures 2 and 3). Department of Ophthalmology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK, You can also search for this author in Results of your ptosis test may determine that treatment is required in order to restore clear, unobstructed vision. All of the visual field testing codes have in their description the phrase unilateral or bilateral. Now, with both upper lid levators ressected on adjustable sutures, the patient was asked to open her eyes and the lids were checked for height, contour and symmetry. Patients were seated 33cm from the target, without corrective lenses, and the centre of fixation is shifted 15 inferiorly to allow for maximum superior field-testing. The patient was then prepped and draped in the usual sterile fashion. Are contact lenses a good choice for kids? Worsening of blepharoptosis in down gaze. Macular diseases including plaquenil toxicity exams also need 10-2. Differentiate Unilateral, Bilateral Rules. But ophthalmologists use the threshold exam (92083) when they suspect something that causes a slow, progressive dimming of peripheral vision, like glaucoma. Two grids were created on either side of the x axis. Book an Appointment Find A Doctor Locations During this test, lights of varying intensities appear in different parts of the visual field while the patient's eye is focused on a certain spot. A person may be born with drooping of one or both eyelids, a condition known as congenital ptosis. Here, we switch patients over to an HVF 10-2 to better follow their progression, Confirm its the right patient with name and date of birth, Look at the GHT, mean deviation, VFI, and pattern standard deviation. hb```b``b`c` @1v5"n significant ptosis and dermatochalasis. Ophthal Plast Reconstr Surg 1992; 8: 250255. If a patient presents with signs and symptoms of glaucoma, and a VF confirms the condition, you should report the code for the confirmed diagnosis. Can you tell us [], Copyright 2023. The test therefore has a positive predictive value of 96.6%, negative predictive value of 97.4% and false positive rate of 7.5% (Table 1). For those who had blepharoplasty alone, 90.9% recorded an improvement in points seen in the modified visual field test and 80.6% had improvement in visual field height. Careful detection of visual field defects can be diagnostic of many eye and/or neurological conditions, including glaucoma or retinitis pigmentosa. The patient complained of constant headaches, bloodshot eyes and tearing. As the gold standard of perimetry, Humphrey Field Analyzer 3 (HFA3) is your trusted diagnostic partner. 295 0 obj <> endobj 0000040668 00000 n Little or no adjustment was needed because good height and contour and symmetry were achieved. The patient tolerated the procedure well and was moved to recovery room in stable condition. South Staffordshire Primary Care Trust. ), scant tear meniscus, and Grade 2+/3 nuclear sclerotic and posterior subcapsular cataracts in both eyes. 343 0 obj <>stream The rest of this article will explain how to interpret these. Thirty five points are tested in the superior field whilst 14 points are tested in the inferior field. 0000043036 00000 n Copyright 2023 Jobson Medical Information LLC unless otherwise noted. In contrast to dermatochalasis, ptosis refers to an abnormal position of the eyelid margin. Eyeglass temples: How do you know if they're the right length? Google Scholar. People in this category are good candidates for cosmetic blepharoplasty. Answer 2: When deciding whether to bill for services unilaterally, per eye, or bilaterally, for both eyes, the first thing to do is read the code description in CPT. This was a prospective study performed on patients who were referred to the Leicester Royal Infirmary Ophthalmology Department with ptosis or dermatochalasis between January 2006 and December 2009. 0000000016 00000 n 0000002139 00000 n This is the distance between the edge of your upper eyelid and the center of your pupil. We have chosen the Humphrey visual field analyzer as it is available in most ophthalmic units in the United Kingdom and therefore has minimal impact on the cost of assessing patients once referred. Guide to the evaluation of permanent impairment 3rd Ed (rev). 0000013473 00000 n ISSN 1476-5454 (online) The otolaryngologist prescribed eardrops that were compounded at a local pharmacy. A similar procedure was now performed on the left upper lid to bring the left upper lid to the same point in surgery as the right upper lid. After all, the condition is characterized by drooping eyelids, which are fairly simple to detect. Visual field testing can detect blind spots A visual field test can determine if you have blind spots (called scotoma) in your vision and where they are. The results of the visual field were normal, and the doctor ruled out the possibility of glaucoma. Comparison of frequency doubling perimetry with humphrey visual field analysis in a glaucoma practice. If these errors are not too bad, the general gist of the field can be deduced, especially if compared to prior fields. Patients who had surgery for ptosis or dermatochalasis between January 2006 and December 2009 were prospectively invited to perform a modified visual field test pre- and post-operatively. xref Reduce visual field testing time with SITA Faster. Understand Isopters (95% Confidence interval: 93.6100%) Meanwhile, 37 eyes out of 40 eyes who did not have ptosis or dermatochalasis did not have a visual field defect (specificity of 92.5% with 95% confidence interval of 79.698.4%). It includes the area straight ahead as well as the peripheral vision. American Journal of Ophthalmology. Photographs of frontal plane and oblique view; Flash photography documents the MRD and corneal light reflex as well any eyelid skin resting on the eyelashes. Internet Explorer). The patient was undergoing treatment for several months by her otolaryngologist for a blocked salivatory gland on the right side. Anderson RJ, Holds JB . Change in points seen after ptosis surgeries +/ blepharoplasty vs blepharoplasty only. This is your baseline exam that all glaucoma suspects and glaucoma patients need at routine intervals. Improvement in superior visual field test with tape compared to without. When diagnosing ptosis, your eye doctor will closely examine the position of your upper eyelids in relation to each other and to the pupil of each eye. 0000016434 00000 n History CPT code 92082: Visual field ex-amination, unilateral or bilateral, with interpretation and report; intermediate examination (e.g., at least 2 isopters on Goldmann perimeter, or semiquantita - tive, automated suprathreshold screen-ing program, Humphrey suprathreshold automatic diagnostic test, Octopus pro - gram 33). 0000049511 00000 n However, we acknowledge that although our modified visual field is a good assessment tool for ptosis, it has limitations. Shifting the central fixation 15 inferiorly allows the superior field to be tested up to 48 within the existing Humphrey frame. The goal is to determine how much of an individuals vision is inhibited by the droopy eyelid. A functional blepharoplasty removes the excess skin that obscures your field of vision. The height of the defect is defined as the lowest point in degrees where there are three horizontal contiguous absolute defects.