Visual field defects in dementia: A scoping review.

Introduction: This review aimed to systematically assess the literature reporting the relationship between dementia and standard automated perimetry results, including sensitivity, global indices, patterns of visual field defect and reliability indices.

Design: A scoping review and meta-analysis were conducted.

Setting And Participants: Published studies in any setting which reported on standard automated perimetry results (any of: global indices, pointwise sensitivities, reliability indices and/or patterns of visual field defects) in participants with ('cases') or without ('controls') dementia due to neurodegenerative disease.

Methods: Four databases were searched (to July 2024) and included published studies comparing the perimetry results of cases and controls. Standardised mean differences with 95% confidence intervals were calculated where data were available. Studies with qualitative visual field results were identified and described. The Joanna Briggs Institute checklists were used for quality assessment.

Results: Four studies were included in the meta-analysis component of the study. Standardised mean differences between cases and controls were -1.16 (-1.47, -0.86) and -0.96 (-1.26, -0.67) for mean deviation and pattern standard deviation, respectively. The standardised mean differences for fixation loss, false positive and false negative rates were -0.30 (-0.57, -0.04), -0.33 (-0.60, -0.06) and -1.12 (-1.40, -0.83), respectively. In all instances, cases had poorer results than controls. Hemianopias were the most common visual field defect pattern, followed by quadrantonopia, with left-sided defects more common than right. Several studies illustrated visual field sensitivity and deviation maps, from which examples of inattentive defects were identified.

Conclusions: Cross-sectional studies, case series and case reports demonstrated worse visual function and reliability indices in patients with dementia in comparison to controls. Several knowledge gaps and opportunities for further study were identified, including potentially using patterns of poor test reliability and inattention as surrogate markers of cognitive impairment and its relationship with quantitative evaluation of cognitive function.