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Abstract
Purpose
To report the result of Fresnel prism application and adaptation for visual field relocation and functional vision improvement in homonymous hemianopsia patients.
Methods
Fifteen homonymous hemianopsia patients were prescribed Fresnel prism. To expand the visual field, Fresnel prism was placed base-out toward the defective field and patients were given an adaptation period of 1 month. The effects of the prism on field expansion was evaluated using Goldmann perimetry. In addition, the NEI-VFQ25 questionnaire was utilized asking patients regarding their subjective functional vision and satisfaction in daily life before and after using the Fresnel prism.
Results
After 1 month of Fresnel prism prescription, 53% of patients showed objective visual field expansion to the defective field of 12.5 degrees on average. Monocular or macular splitting hemianopsia patients showed more visual field expansion than binocular macular sparing hemianopsia patients. The NEI-VFQ25 score increased significantly and abnormal head position decreased or disappeared after 1 month of using the prism. However, 47% of patients failed to adapt to the prism.
Conclusions
Using Fresnel prism in homonymous hemianopsia patients effectively expands the visual field, corrects abnormal head position, and improves functional vision. However, to improve the success rate, for certain patients the proper choice of prism application method, prism diopters, and constant management are necessary.
References
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Figure 1.
Visual fields have been expanded from the seeing side into the defected side after using prisms on a 27 years old male patient with left side homonymous hemianopsia. Prisms were prescribed as right side 20 prism diopters base-in, and left side 20 prism diopters base-out (Blue line: Before using prism, Red line: After using prism, (A) Visual field of the right eye, (B) Visual field of the left eye).
Table 1.
The characteristics of patients with homonymous hemianopsia patients before and after Fresnel prism
Table 2.
Visual field change of homonymous hemianopsia patients before and after prism application
Table 3.
National Eye Institute – Visual Function Questionnaire 25 score of Fresnel prism applied homonymous hemianopsia patients
|
Before prism apply |
After prism apply |
p-value | |
|---|---|---|---|
| VFQ 25 score (Average ± SD) | VFQ 25 score (Average ± SD) | ||
| VFQ25 Total score* | 38.7 ± 3.76 | 47.7 ± 4.23 | 0.01 |
| Sub-scale score | |||
| General health | 15.0 ± 12.9 | 22.5 ± 21.9 | 0.10 |
| General vision | 34.0 ± 9.7 | 44.0 ± 12.6 | 0.06 |
| Eye pain* | 66.3 ± 18.6 | 73.8 ± 15.1 | 0.01 |
| Near vision | 59.5 ± 22.1 | 60.8 ± 17.0 | 0.08 |
| Distant vision* | 36.7 ± 26.0 | 50.0 ± 17.4 | 0.01 |
| Social function* | 53.8 ± 18.6 | 62.5 ± 15.2 | 0.01 |
| Mental health* | 23.1 ± 19.9 | 32.5 ± 18.9 | 0.01 |
| Role limitations* | 12.5 ± 12.8 | 28.8 ± 14.7 | 0.01 |
| Dependency* | 35.8 ± 17.0 | 46.7 ± 17.0 | 0.01 |
| Color vision | 65.0 ± 12.9 | 67.5 ± 12.1 | 0.37 |
| Peripheral vision | 25.0 ± 20.4 | 30.0 ± 19.7 | 0.16 |
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