Diagnostic yield of Humphrey visual field 30-2 testing for neurological versus non-neurological visual disorders: A tertiary-care retrospective study

PURPOSE: To evaluate the diagnostic yield of Humphrey visual field (HVF) 30-2 automated perimetry in differentiating neurological from non-neurological causes of visual dysfunction. METHODS: Design: Retrospective observational record-based study. Setting: Department of Ophthalmology at a tertiary-care referral institute in Central India. Study population: All HVF tests performed between July 2023 and June 2025 were reviewed. Of 1,438 tests performed, 383 reliable HVF tests using the 30-2 program with the Swedish Interactive Threshold Algorithm (SITA) Standard or SITA Fast strategy were included. Tests with fixation losses >20%, false positive or negative responses >15%, incomplete records, or media opacities were excluded. Observation procedure: Visual field tests were categorized according to indication as neurological or non-neurological causes. Field patterns were analyzed and correlated with clinical findings and neuroimaging results. Main outcome measure: The primary outcome was diagnostic yield, defined as the proportion of HVF (30-2 program) contributing to confirmation of neurological disease. RESULTS: Among 383 HVF 30-2 tests, 226 (59.0%) were performed for neurological indications. Abnormal fields were detected in 132/226 (58.4%) neurological cases compared with 42/157 (26.8%) non-neurological cases (P < 0.001; odds ratio [OR] 3.84; 95% confidence interval [CI]: 2.48-5.95). Confirmed neurological diseases were identified in 118 (52.2%) neurological referrals versus 3 (1.9%) non-neurological referrals (OR 56.6; 95% CI: 17.4-184.0). Bitemporal hemianopia (23.5%), homonymous hemianopia (19.7%), and central scotoma (16.7%) were the most common field patterns, with >90% radiological correlation. HVF 30-2 testing demonstrated high diagnostic performance for neurological disorders (OR 56.6; 95% CI: 17.4-184.0; P < 0.001). CONCLUSION: HVF 30-2 perimetry demonstrates high diagnostic yield for neurological disorders and serves as a reliable, noninvasive functional investigation for neuro-ophthalmic evaluation.