Objective Assessment of Visual Field Defects Caused by Optic Chiasm and Its Posterior Visual Pathway Injury

doi:10.12116/j.issn.1004-5619.2023.230309

Abstract

Abstract:

Objective To investigate the characteristics and objective assessment method of visual field defects caused by optic chiasm and its posterior visual pathway injury. Methods Typical cases of visual field defects caused by injuries to the optic chiasm, optic tracts, optic radiations, and visual cortex were selected. Visual field examinations, visual evoked potential （VEP） and multifocal visual evolved potential （mfVEP） measurements, craniocerebral CT/MRI, and retinal optical coherence tomography （OCT） were performed, respectively, and the aforementioned visual electrophysiological and neuroimaging indicators were analyzed comprehensively. Results The electrophysiological manifestations of visual field defects caused by optic chiasm injuries were bitemporal hemianopsia mfVEP abnormalities. The visual field defects caused by optic tract, optic radiation, and visual cortex injuries were all manifested homonymous hemianopsia mfVEP abnormalities contralateral to the lesion. Mild relative afferent pupil disorder （RAPD） and characteristic optic nerve atrophy were observed in hemianopsia patients with optic tract injuries, but not in patients with optic radiation or visual cortex injuries. Neuroimaging could provide morphological evidence of damages to the optic chiasm and its posterior visual pathway. Conclusion Visual field defects caused by optic chiasm, optic tract, optic radiation, and visual cortex injuries have their respective characteristics. The combined application of mfVEP and static visual field measurements, in combination with neuroimaging, can maximize the assessment of the location and degree of visual pathway damage, providing an effective scheme for the identification of such injuries.

Key words: forensic medicine, wounds and injuries, visual electrophysiology, visual pathway, field of view, optic chiasma, multifocal visual evoked potential （mfVEP）, optic nerve injury

CLC Number:

Jian XIANG, Xu WANG, Li-li YU, Kang-jia JIN, Ying-kai YANG. Objective Assessment of Visual Field Defects Caused by Optic Chiasm and Its Posterior Visual Pathway Injury[J]. Journal of Forensic Medicine, 2023, 39(4): 350-359.

Figures/Tables 18

Fig. 1 Reciprocal diagram of mfVEP stimulus unitsand static visual field test sites

Fig. 2 Binocular static visual field imagesin the case with optic chiasm injury

Fig. 3 Binocular OCT images of optic disc in the case with optic chiasm injury

Fig. 4 Binocular FVEP images in the casewith optic chiasm injury

Fig. 5 Binocular mfVEP images in the casewith optic chiasm injury

Fig. 6 Craniocerebral CT images in the case with optic chiasm injury

Fig. 7 Binocular fundus photographs in the casewith right optic tract injury

Fig. 8 Binocular static visual field imagesin the case with right optic tract injury

Fig. 9 Binocular OCT images of optic disc in the case with right optic tract injury

Fig. 10 Binocular OCT images of posterior pole ofeyeball in the case with right optic tract injury

Fig. 11 Binocular FVEP images in the casewith right optic tract injury

Fig. 12 Binocular mfVEP images in the casewith right optic tract injury

Fig. 13 Binocular static visual field imagesin the case with left optic radiation injury

Fig. 14 Binocular mfVEP images in the casewith left optic radiation injury

Fig. 15 Craniocerebral MRI images in the casewith left optic radiation injury

Fig. 16 Binocular static visual field imagesin the case with left visual cortex injury

Fig. 17 Binocular mfVEP images in the casewith left visual cortex injury

Fig. 18 Craniocerebral CT images in the casewith left visual cortex injury

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