humphrey visual field test for blepharoplasty

Learn more about the different tests administered when diagnosing ptosis and what happens after youve been diagnosed. 0000041939 00000 n Although it is hard to be dictatic about the extent of the defect before patients are considered eligible for surgery, we propose that any three contiguous points missed up to 48 should be considered a significant defect and that those patients will benefit from intervention. H40.10X2 (moderate stage) An SH, Jin SW, Kwon YH, et al. Our site is most compatible with Chrome, Firefox, or Safari. For the dry eye syndrome, I prescribed Systane Ultra Preservative-Free (Alcon) b.i.d. Maximal Levator Function: 12mm O.D., 12mm O.S. Exceptions to automated testing will be made for children under 12 years old and in rare instances when automated testing is not able to be performed (e.g., developmental disability). The patient must be aware that lubrication may be needed temporarily after the blepharoplasty until the lids loosen a bit. ascertaining that the patients brow and forehead are relaxed. 25K 2`&:c(V;'kSeR_L"'7/_ ON2X%C&W1k6P(7(tZj@ d Hint: Always be sure to differentiate 92082 from 92083. This is another common glaucomatous field. Next, measure the margin reflex distance. It is not appropriate to use code 92083 for documentation prior to blepharoplasty. You should always document medical necessity for the level of visual field testing that is ordered. Nottinghamshire County Teaching Primary Care Trust. The fissure height can range from 7mm to 12mm, with an average height of 10mm. In addition, after being divorced for many years, and choosing not to date, the patient has met a widowed gentleman, and they are a couple. I recently saw an ad from Olleyes (https://olleyes.com/) seems comfortable. And, warn patients not to wear contact lenses or eyelid makeup for one week following blepharoplasty surgery. A comprehensive eye examination should be performed on all prospective blepharoplasty patients to determine the best-corrected visual acuity and to prevent any question of decreased postoperative visual acuity. The patient also expressed an interest in being able to wear eye makeup again. Small RG . For blepharoplasty, it is for photographs demonstrating dermatochalasis and a visual field showing a defect to at least 30 above the visual axis and which is significantly improved or. 0000021311 00000 n Medicaid: Eligibility and Vision Benefits. Her ocular history was positive for non-proliferative diabetic retinopathy, posterior vitreous detachment, O.D., and asteroid hyalosis, O.S. Involvement of the lower eyelids can be quite dramatic; this protruding tissue is known as malar bags or festoons (figure 1). This means that the payment that has been established for the service is for one or two eyes, and you should only submit a bill for one service even if the optometrist performed it on both eyes. 0000004914 00000 n Funding or reimbursement of ptosis surgery and blepharoplasty within the healthcare setting has long been a contentious issue.1 Various arbitrary guidelines have been issued by medical insurers and Primary Health Care Trusts (PCTs).2, 3, 4, 5, 6 The lack of consistency and clarity of these guidelines has created a significant amount of confusion, causing anxiety for patients and raising questions of a postcode lottery. Curious as to what a ptosis test involves? No jargon, very nicely put and clearly explained. Question 2: Are the visual fields codes unilateral or bilateral? The validity of this test was evidenced by the high sensitivity and positive predictive value, which were 98.8 and 96.6%, respectively. A mild to moderate amount of excess eyelid skin results in a tired, sad appearance. In total, a maximum of 48 will be tested in the superior visual field. Page published on Tuesday, September 22, 2020. Identification of glaucoma-related visual field abnormality with the screening protocol of frequency doubling technology. The patient was brought to the operating room and placed on the operating table in the supine position. Thirty six were male and 61 were female. Ophthalmology 1993; 100: 658659. In women, the optimal position of the brow is above this rim, especially on the lateral side. Are contact lenses a good choice for kids? The software automatically varies the intensity of the points of lights at each location to determine the threshold the intensity of light where the patient can see it 50% of the time. A 75-year-old white female, who had been under my care for three years, presented for an emergency visit with a chief complaint of red eye. https://www.plasticsurgery.org/cosmetic-procedures/eyelid-surgery. For patients who underwent ptosis surgery with or without blepharoplasty, 84.2% recorded an improvement in points seen with the test and 81% recorded an improvement in visual field height. %PDF-1.4 % Surgery improves the demonstrated defect, confirming that ptosis and dermatochalasis can be considered a functional rather than cosmetic issue. Very Helpful, but did not explain MD, and pattern deviation. A minimum 12 degree OR 30 percent loss of upper field of vision with upper lid skin and/ or upper lid margin in repose and elevated (by taping of the lid) to demonstrate potential A functional levator resection and blepharoplasty were scheduled. In my state (New Jersey), optometrists are not permitted to comanage functional or cosmetic blepharoplasty. For every interpretable, reliable visual field you get, you will also get another in which the patient thinks he should be scanning the dome for lights the whole time, is poorly positioned, is exhausted from waiting in your clinic for hours, or is too elderly and arthritic to push the button in time. This is ordered for the 10% of glaucoma patients who are so advanced that the HVF 24-2 is mostly black, with only a central island of remaining vision. Comparison of pre-op and post-op points missed after ptosis surgery +/blepharoplasty. 0000049173 00000 n Because the results of the VFs were negative they did not confirm glaucoma or any condition you should report the signs and symptoms that prompted the exam, link the diagnosis code(s) to the applicable VF code, and include any additional observations from the VFs in the office notes. Dermatochalasis, fat herniation or protrusion, brow ptosis, and eyelid ptosis secondary to disinsertion or dehiscence of the levator aponeurosis all contribute to patient perceptions of the need for upper lid blepharoplasty.1. The effect of blepharoptosis on the field of vision. South Staffordshire Primary Care Trust. Whether youre a VF coding newbie or a seasoned expert, the answers to these questions that readers have submitted to Ophthalmology and Optometry Coding Alert can help you get all of your deserved reimbursement for these tests. Rule of thumb: An intermediate test is one of the screening tests that you would use if you suspected neurological damage. Signs and Symptoms May Apply 1. Patients who had surgery for ptosis or dermatochalasis between January 2006 and December 2009 were prospectively invited to perform a modified visual field test pre- and post-operatively. Imagine you are assessing a patient with visual difficulties or optic disc swelling. Can someone tell me what this means? In total, 97 patients amounting to 194 eyes were included in the study. The requirement from some PCT for an individual case review for each procedure has also created a significant workload for those involved in the decision making process. If there is traumatic or neurologic dysfunction, then simply shortening the levator aponeurosis will not fix the problem. The patient was marked with a sterile tip marking pen on the upper lids. Time taken to perform the test post-operatively ranged from 2.20 to 6.17min with the median reduced to 3.27min (mean 3.29min, SD 0.53min). Patients were seated 33cm from the target, without corrective lenses, and the centre of fixation is shifted 15 inferiorly to allow for maximum superior field-testing. There is also a marked difference between males and females. Other sizes and colors are used for patients with late disease or retinal disease. Results of your ptosis test may determine that treatment is required in order to restore clear, unobstructed vision. Individuals with severe ptosis will have difficulty detecting lights in upper regions of their peripheral vision due to an obstructing eyelid. The septum was incised with a Westcott scissor, allowing the preaponeurotic fat pad to prolapse forward. Diagnosing ptosis seems pretty straightforward. Use this order to interpret your Humphrey visual field every time: Great help in understanding the VF pattern. ISSN 0950-222X (print), Modified visual field test for ptosis surgery (Leicester Peripheral Field Test), Prevalence of ocular findings regardless of visual acuity status in older adults from the Brazilian Amazon Region, Diagnostic accuracy of an iPad application for detection of visual field defects, Long-term changes and effect of pterygium size on corneal topographic irregularity after recurrent pterygium surgery, A review of acquired blepharoptosis: prevalence, diagnosis, and current treatment options, Long-term functional outcomes and vision-related quality of life after vitrectomy for epiretinal membrane: a prospective cohort study, An image-based eyelid lesion management serviceevaluation of a pilot, Patient-reported prevalence of metamorphopsia and predictors of vision-related quality of life in vitreomacular traction: a prospective, multi-centre study, Influences of the three-dimensional parameters of pterygium on corneal astigmatism and the intraocular lens power calculation, Long-term follow-up of phacotrabeculectomy surgery in Tanzania, Patient reported psychosocial functioning following successful ptosis surgery. Before a patient can [], Are Your Lab Orders Complete? Central and peripheral vision is tested by using visual field tests. To introduce a modified visual field designed to assess the functional disability associated with ptosis and dermatochalasis and to demonstrate the effectiveness of surgery in improving the visual field. American Society of Plastic Surgeons. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. We therefore designed a modified visual field test specifically to assess ptosis and dermatochalasis. Hint: Always be sure to differentiate 92082 from 92083. A #15 blade was used to incise the skin in the previously demarcated area. Shifting the central fixation 15 inferiorly allows the superior field to be tested up to 48 within the existing Humphrey frame. Google Scholar. Improvement in superior visual field test with tape compared to without. 0000007946 00000 n For blepharoplasty, it is for photographs demonstrating dermatochalasis and a visual field showing a defect to at least 30 above the visual axis and which is significantly improved or restored when the lid is taped.2 Other insurer's guidance reads blepharoplasty will be commissioned for eyelid ptosis and/or excess skin of the upper eyelid, which causes obscured vision.4. Coding involving lab orders, E/M [], Question: Notes indicate that the provider treated a patient with a retinal migraine. Ive never [], Question: Have the modifier 25 rules changed now that the E/M guidelines are different? We are grateful for the help of Mr Bernie Higgins from Portsmouth University for his statistical advice. Blepharoplasty can be performed either in the physicians office or in the hospital operating room. 0000020476 00000 n The inferior visual field also serves as a useful guide to the technician that the patient understands the test well enough to perform reliably. Visual field testing with eyebrows relaxed, patient looking straight ahead, and the eyelids in normal relaxed position; Visual field is repeated with the eyelids taped up. Approximately 2cc to 3cc were used in each upper lid. The results of the visual field were normal, and the doctor ruled out the possibility of glaucoma. Diagnostic Data. H40.10X0 (Unspecified open-angle glaucoma, stage unspecified) After blepharoplasty there was a change in the number of points seen ranging from 4 to +29 (median 12, mean 10.83, SD 7.42). This Part B Payer Is Watching, E/M coding also ranks high on the MACs watch list. Repair of Ptosis, Policy number : SURGERY 018.6 T2. In the second category, patients complain of visual difficulties related to heavy upper eyelid tissue. The pedicle was cauterized before the clamp was released. This was performed without complication. 0000011634 00000 n Automated visual field testing (taped and untaped) is required. Reproduction in whole or in part without permission is prohibited. It was presented as an oral presentation in the European Society of Ophthalmic Plastic and Reconstructive Surgery (ESOPRS) meeting, Munich in September 2010. The anesthetic consisted of a 2:1 mixture of 2% lidocaine with epinephrine and 0.75% marcaine. Biomicroscopy revealed Grade 2+/3 bulbar hypermia and follicular hypertrophy, droopy lids (dermatochalasis O.U. and JavaScript. If the patient can actually see the spot, then its recorded as a fixation loss. Finally, maximal levator function shows how high the patient can lift his or her lid voluntarily. The inferior field test serves as a reference, but is not used in the analysis. for 10 days. This was a prospective study performed on patients who were referred to the Leicester Royal Infirmary Ophthalmology Department with ptosis or dermatochalasis between January 2006 and December 2009. About 10% of fields show this. Dry eye syndrome can be a postoperative complication of blepharoplasty. 0000042287 00000 n H40.10X1 ( mild stage) You can determine lid ptosis using three measurements: First, measure the vertical palpebral fissure (interpalpebral fissure or IPF) in primary gaze, In closing, it is important not to assume that patients over age 70, whether they are male or female, are not interested in functional oculoplastic procedures that will also greatly improve their cosmesis. Brow Ptosis vs. Dermatochalasis Question 2: Are the visual fields codes unilateral or bilateral? the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in hbb2``b``3 7? Quantitating the superior visual field loss associated with ptosis. Rule of thumb: An intermediate test is one of the screening tests that you would use if you suspected neurological damage. The patient was then sedated heavily by the anesthesiologist. Tobradex (tobramycin and dexamethasone, Alcon) ointment was placed over the wounds. Visual field testing (92081-92083, Visual field examination) is a big component of what many eye care practices do this test is used on patients from glaucoma suspects to blepharoplasty candidates. Pontszm: 5/5 ( 49 szavazat). Thanks!! The Visual System. CPT code 92083: Visual . The patient tolerated the procedure well and was moved to recovery room in stable condition. 0 The time taken to perform the test pre-operatively was 2.206.47min, with a median of 4.18min (mean 4.04min, SD 0.58min). Normal wetting is 10mm to 30mm in five minutes in patients less than 50 years of age. We therefore believe it to be a useful assessment tool providing evidence for reimbursement by medical insurers or PCT. A 75-year-old white female, who had been under my care for three years, presented for an emergency visit with a chief complaint of red eye.. Margin Reflex Distance: 0.5mm O.D., 0.0mm O.S. 0000047814 00000 n Begin with a thorough medical and ocular history. skin in cases of dermatochalasis, The patient was then prepped and draped in the usual sterile fashion. Risk of dry eye should be objectively measured by evaluating the patients tear film break-up time (TFBUT) and by performing a Schirmers tear test. series when the diagnostic testing does not confirm glaucoma. You should avoid reporting multiple units of the code if you address both eyes, and you also should avoid appending modifier 50 (Bilateral procedure) or the LT (Left side) and RT (Right side) modifiers. There is lack of consensus among Primary Health Care Trusts (PCTs) and health insurers on how to reimburse ptosis surgery and upper lid blepharoplasty, as these procedures can be regarded as cosmetic. 0000004802 00000 n Some payers require a code from the H40.001-H40.009 (. ) If the eyelids begin sagging into the field of vision, a functional blepharoplasty may be required. Question 1: How many isopters do I need to plot on the Goldman perimeter to be able to report CPT code 92083 (Visual field examination, unilateral or bilateral, with interpretation and report; extended examination (eg, Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30, or quantitative, automated threshold perimetry, Octopus program G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2))? Yes, there are a lot of graphs. The routine Humphrey 24-2 only tests a limited superior 24 field, which is far less than that used by most people for normal activities of daily living. 0000006786 00000 n Meanwhile, various custom Humphrey field tests so far reported in the literature, which test more points superiorly have limitations such as not testing points in inferior field,9, 10 which may induce bias, and threshold static testing,8, 11 which is time consuming. Please switch to one of those browsers if available. If a patient presents with signs and symptoms of glaucoma, and a VF confirms the condition, you should report the code for the confirmed diagnosis. SCODI: 92132-92134 She was sedated, but awake during the entire procedure because the surgeon needed to ask her to look in different positions of gaze to check the symmetry of the lid margins between the right and left eye. You should avoid reporting multiple units of the code if you address both eyes, and you also should avoid appending modifier 50 (Bilateral procedure) or the LT (Left side) and RT (Right side) modifiers. If results show a significant amount of eyesight is affected by ptosis, corrective surgery (blepharoplasty) becomes medically necessary rather than cosmetic. Slider with three articles shown per slide. 0000043036 00000 n 2000-2023 AAV Media, LLC. This is supported by Small et al's study showing that 97% of patients with a marginal reflex distance of 2mm or less had upper visual field restriction of 30 or less.7 In the United States, our American colleagues use Goldmann or automated static perimetry, which is either a 10dB threshold (Humphrey analyzer) or a 7dB threshold (Octopus analyzer).8 Although the latter is accurate, it is time consuming and subject to a huge learning curve with high false positives and negatives. The slightly down gaze position also counteracts the involuntary frontalis over action in some ptotic patients and therefore reduces this bias. 0000023882 00000 n Is formal visual field testing essential prior to upper eyelid surgery in a post-COVID-19 era? Attention was first directed to the right upper lid. Visual fields were assessed by a 114 point threshold related screening test of the superior visual field on the Humphrey Allergan Model 640 visual field analyzer. The most common early to mid stage glaucomatous field. Ophthalmology 1999; 106: 17051712. 0000018300 00000 n 0000003005 00000 n Your eye doctor will be able to evaluate the position of your eyelids during the exam and recommend the best course of action to help resolve your ptosis. S F Ho. Blepharoplasty is one of the top five plastic surgical procedures performed in the United States for both men and women, and it is becoming more and more common every year. 1998;125:819-829. You are using a browser version with limited support for CSS. Copyright 2023 Jobson Medical Information LLC unless otherwise noted. People in this category are good candidates for cosmetic blepharoplasty. Fixation loss: The HVF will routinely flash dots in the patients physiological blind spot to check if the patient has his / her gaze fixated on the center. It is essential to differentiate dermatochalasis from the less common blepharochalasis, which is the expansion of the orbital septum and preseptal muscles secondary to repeated angioneurotic edema and is seen less commonly in younger patients. 1) Nonspecific / low Reliability / inattention / patient hungry, 4) Severe constriction with a central island, Unfortunately, this is end stage glaucoma. Its normal for your eye doctor to test your pupillary reaction when diagnosing ptosis. Here, well only talk about the Humphrey visual field perimeter, which is used for 99% of visual field tests. In total, 80 out of 95 eyes (84.2%) improved, 5 eyes (5.2%) were unchanged and 10 eyes (10.5%) had deterioration in the number of points seen (Figures 2 and 3). The authors declare no conflict of interest. Its never appropriate to plot additional isopters just to boost your code level. One eye remains covered while the other eye is to stay focused on a central fixation point. The VF code should be linked to the appropriate glaucoma ICD-10 code in this case, one of the following: Answer 1: A common mistake ophthalmologists make is billing 92082 when they could legitimately report 92083. A visual field test can also help the doctor find out more about the part of the nervous . H40.10X3 ( severe stage) Commissioning policy and Referral guidelines for provision of Aesthetic Surgery for NHS Patients. This is what every patient will want to know and how you will decide whether to step up drop therapy, add laser, or take the patient to the operating room. All About Vision and AllAboutVision.com are registered trademarks of AAV Media, LLC. However, your decision should also take into account the normal variability between each visual field, the optic nerve head appearance, pressures, patient compliance, OCT, visual symptoms, etc. O.U. Note the shape and location of the brow; it should be at the orbital rim. Every log order change in light intensity corresponds to 10 dB, such that the machine can measure sensitivities over a 50 dB range. Although there is a great deal of overlap, patients who desire blepharoplasty generally fall into two broad categories. Post-operatively the number of points missed ranged from 0 to 33, but the median improved to 4 (mean 7, SD 7.62). Example 2: The eye care physician performs visual fields for a patient who presents with high intraocular pressure, open angle, and the VFs confirm the presence of small scotomas in the areas of the VF related to glaucoma. Along with the eyelids themselves, your eye doctor will check the effectiveness of the levator muscles: the muscles responsible for lifting your eyelids and keeping them open. A person may be born with drooping of one or both eyelids, a condition known as congenital ptosis. Whilst the visual field has been used in some ophthalmic units to prove the presence of ptosis, there is so far no standardized visual field designed for this purpose. 0000000016 00000 n Question 1: How many isopters do I need to plot on the Goldman perimeter to be able to report CPT code 92083 (Visual field examination, unilateral or bilateral, with interpretation and report; extended examination (eg, Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30, or quantitative, automated threshold perimetry, Octopus program G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2))? Dermatochalasis constitutes a special group as blepharoplasty has long been considered as cosmetic surgery. It's an automated, static perimeter (unlike Goldmann kinetic perimetry which requires a human operator, and uses a moving target). This was tied with an adjustable suture. CPT code 92082: Visual field ex-amination, unilateral or bilateral, with interpretation and report; intermediate examination (e.g., at least 2 isopters on Goldmann perimeter, or semiquantita - tive, automated suprathreshold screen-ing program, Humphrey suprathreshold automatic diagnostic test, Octopus pro - gram 33). It was also being presented in Midlands Ophthalmological Society in September 2010. H40.012 ( left eye) Policy effective from 1 September 2008. Find out When Technical, Professional Components Apply. While this is done in all comprehensive eye exams, its especially important when testing for ptosis because it can indicate nerve weakness. In order for a photograph to be considered, it is stipulated that the reflected light from the flash used to illuminate the subject must be in the central area of the patient's face. Her medical history was also positive for diabetes mellitus, long-term heterotopic ossification joint pain (>45 years). Differentiate Unilateral, Bilateral Rules Question 3: How should our optometry practice code a VF ordered by an ophthalmologist outside the practice, which will be sent back to the ordering doctor for interpretation? These are probably 25%-35% of the fields we see. But ophthalmologists use the threshold exam (92083) when they suspect something that causes a slow, progressive dimming of peripheral vision, like glaucoma. and 20/40 O.S., with no improvement upon pinhole testing. Answer 4: Because the results of the VFs were negative they did not confirm glaucoma or any condition you should report the signs and symptoms that prompted the exam, link the diagnosis code(s) to the applicable VF code, and include any additional observations from the VFs in the office notes. There was a tendency for ptosis patients to have a more central defect as opposed to the more temporal defect seen in dermatochalasis, but this was not found to be statistically significant. Most insurance companies will cover blepharoplasty if 3 requirements are met. Question 4: What diagnosis codes would we use for a VF test to rule out the possibility of glaucoma if the results revealed no definitive diagnosis? Your doctor will then typically use a flashlight from the side of your face to direct light into each of your eyes to test how your pupils respond to light. The two most important to look at are the Grayscale Map and the Pattern Deviation. This is significantly faster than the custom static full-threshold 60 test strategy as suggested by Meyer et al11 and has advantages for patients with ptosis as they are often elderly and may have other health co morbidities causing difficulty with prolonged concentration. Overall, she is doing great and continues to be pleased with her surgical result. Testing your visual field with a Humphrey Visual Field Analyzer will determine how much vision is affected. Ophthal Plast Reconstr Surg 1993; 9: 8389. 0000003892 00000 n Patients who were referred for surgery were requested to perform a modified Humphrey visual field test. A visual field test assesses the integrity and health of vision, which helps detect physiological dysfunctions. A 6-0 vicryl suture on an S-29 needle was then passed through the anterior surface of the tarsal plate over the pupil. 0000006942 00000 n Visual Field Testing Demonstrate a significant loss of superior visual field and potential correction of the visual field by the proposed procedure(s). The Humphrey uses fixed points of light which are shown at different intensity levels. Grid A (above the x axis) has the following co-ordinates: Grid B (below the x axis) has the following co-ordinates: Further information about the setting-up of the test can be obtained via e-mail at joyce.burns@uhl-tr.nhs.uk. The greater number of points being tested in the superior visual field provides improved sensitivity in detecting superior visual loss associated with upper lid malposition. We are also grateful for the help of Mr Jonathan Bhargava and Mrs Katya Tambe for their initial work on this project. ICD-10 Coding: Can You Accurately Diagnose These 3 Infrequently-Seen Eye Conditions. The machine keeps track of when the button is pushed during the test and analyzes the results to create a map of the size and shape of the patients visual field. Codes 92081 and 92082 are bundled with blepharoplasty when performed on the same day. Dermatochalasis is a condition in which there is excess upper eyelid skin. lower lid blepharoplasty; 7. This is awesome thanks a lot for putting this together Ben! 295 0 obj <> endobj Evaluating the visual field effects of blepharoptosis using automated static perimetry. For example, if the eye care specialist plots only two isopters on the Goldmann perimeter, CPT would call that intermediate, based on its description of 92082. By Autumn Sprabary; reviewed by Gary Heiting, OD. While focusing on the light straight in front of you, you have to press when you see the blinking light on the side. A standard Schirmer test uses a strip of Whatman #41 filter paper, 5mm in width x 30mm in length, with a fold 5mm from the end. Internet Explorer). This is the distance between the edge of your upper eyelid and the center of your pupil. A relative defect identifies a stimulus not seen at 6dB above the reference threshold, but seen at an intensity of 0dB. HVF targets come in sizes ranging from 0.25 mm2 to 64.00 mm2 represented by Roman numerals I through V. Typically, a size III stimulus (4 mm2) is used in patients with good visual acuity (usually at least 20/200 or better). In cases of decreased visual acuity, a size V (64 mm2) target is used to garner useful information. 0000017999 00000 n Visual field testing can detect blind spots A visual field test can determine if you have blind spots (called scotoma) in your vision and where they are. Eyeglass temples: How do you know if they're the right length? American Medical Association. Answer 2: When deciding whether to bill for services unilaterally, per eye, or bilaterally, for both eyes, the first thing to do is read the code description in CPT. This large study clearly demonstrates that ptosis and dermatochalasis may be associated with superior visual field defects and is comparable with other studies.9, 10, 11, 12, 13 We have also shown that ptosis surgery and blepharoplasty will improve the visual field as evidenced by the increase in the height as well as number of points seen in the visual field.

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