Treatment of homonymous visual field defects

Opinion statement: A clinical presentation of a retrochiasmal or homonymous visual field defect (HVFD) usually represents a permanent visual impairment. The visual and functional ramifications of HVFD will vary by patient. Comprehensive care-the clinical evaluation and consideration for treatment of HVFD-includes vision rehabilitation provided by optometrists, occupational therapists, or ophthalmologists. On the basis of individual patient needs, the eye care practitioner typically uses one or both of the following approaches to treat the HVFD: (1) field enhancement (also referred to in the literature as "field expansion"), in which optical systems incorporating prism are prescribed to optimize the use of the remaining vision, and (2) rehabilitative techniques including saccadic training ("compensation training") or vision restorative therapy ("restitution training"). Although lacking in strength, the evidence does support benefits from field enhancement and saccadic training for patients with HVFD, but vision restorative therapy has not been shown to be an effective option.