Finger Counting Visual Confrontation Field Test

Jul 05, 2023

A confrontation visual field test is a quick and easy way to measure your overall field of vision. A confrontational field test is a preliminary test conducted by your eye doctor or technician as a basic screening tool.

A confrontational field test requires little or no special equipment and can be performed in nearly any situation. This diagnostic exam is also commonly known as the "finger counting" exam because the examiner may use his own fingers during the test.

The fingers are either identified or counted, depending on the extent of the exam. Each eye is tested separately. A defect in vision will be detected if the patient fails to accurately see the fingers.

To begin the test, you will be asked to cover one eye, fixing your gaze on the examiner's eyes. The examiner will then conduct finger movements, bringing his or her hands into your visual field from the sides. Because your vision is divided into four quadrants in your brain, the examiner will hold up fingers in each quadrant. You will say how many fingers you see without actually looking at them, thus testing your peripheral, or side, vision.

Using the results of the test, your healthcare provider will be able to determine if you are having trouble seeing in certain areas of your visual field, as well as possible causes. The confrontation visual field test is also useful for detecting blind spots and eye diseases, as well as other health problems.

Visual field problems have a number of causes that don’t always originate in the eye. Your practitioner may use information from the visual field test to diagnose the following problems or conditions:

Computerized visual field machines give more comprehensive and accurate reports than finger testing methods. During the testing, small points of light appear on the screen and the patient must look straight ahead and click a button when they see the flash of light. Light flashes will vary in brightness. The machine will determine the least amount of brightness necessary for the patient to see the flashes at each point or threshold.

A visual field test is commonly used to diagnose or monitor glaucoma. (Glaucoma is a disease characterized by high eye pressure.) Most types of glaucoma begin with loss of peripheral vision. There is no cure for glaucoma, but stopping the progression of the disease will help preserve vision. Progression of the disease must be monitored closely by watching the visual field and intraocular pressure.

Anderson AJ, Shuey NH, Wall M. Rapid confrontation screening for peripheral visual field defects and extinction. Clin Exp Optom. 2009;92(1):45-8. doi:10.1111/j.1444-0938.2008.00280.x

Glaucoma Research Foundation. Why Do I Need a Visual Field Test?

By Troy Bedinghaus, ODTroy L. Bedinghaus, OD, board-certified optometric physician, owns Lakewood Family Eye Care in Florida. He is an active member of the American Optometric Association.