Goldmann kinetic perimetry (GP) is a visual field test in which a target of fixed luminance and size is moved from the periphery toward the center, and the boundary points where the patient first perceives it are connected to draw isopters (lines of equal sensitivity). By superimposing multiple isopters, the sensitivity distribution of the entire visual field can be understood.
While static perimetry (e.g., Humphrey Field Analyzer: HFA) is sensitive for detecting localized abnormalities within the central 30°, GP excels in evaluating the entire visual field extending to nasal 60° and temporal 100° or more 1). Although kinetic perimetry is less suitable for quantitative progression assessment, it is appropriate for patients in whom static perimetry is difficult to perform 1).
The patient profiles for which GP is particularly recommended are as follows.
| Item | Goldmann kinetic perimetry (GP) | Static perimetry (e.g., HFA) |
|---|---|---|
| Measurement principle | Depicts isopters (lines of equal sensitivity) | Measures threshold at fixed points |
| Evaluation range | Entire visual field (temporal 100° or more) | Central 30° or 60° |
| Detection of local abnormalities | Inferior to static perimetry | Sensitive (early glaucoma) |
| Handling of fatigue | Examiner can adjust flexibly | Fixed program, difficult to adjust |
| Main indications | Advanced glaucoma, retinal diseases, neuro-ophthalmology, children | Early glaucoma, quantitative assessment of visual field defects |
| Psychogenic visual field disorders | Useful for evaluation | Difficult to evaluate |
HFA is superior for detecting localized visual field defects within the central 30° (e.g., arcuate scotoma, nasal step in early glaucoma). In contrast, GP is suitable when evaluation of the entire visual field including the periphery is needed (e.g., advanced glaucoma, retinitis pigmentosa, pituitary adenoma). Additionally, static perimetry is often difficult to perform in elderly patients, children, those with low vision, or cataract patients, and GP is useful in such cases as well.
GP stimuli are defined by two parameters: area and luminance.
Six different areas are available; larger stimuli are easier to perceive (the isopter expands outward).
| Symbol | Area (mm²) | Notes |
|---|---|---|
| V | 64 | Used for screening |
| IV | 16 | Used as auxiliary |
| III | 4 | Used as auxiliary |
| II | 1 | Used as auxiliary |
| I | 1/4 | Standard stimulus for inner isopter |
| O | 1/64 | When high sensitivity evaluation is needed |
Four levels (4, 3, 2, 1 from brightest) are set in 0.5 log steps. Additionally, finer steps of 0.1 log (e to a: 5 levels) can be selected.
Standard examinations use the following stimulus combinations:
To ensure examination accuracy, perform the following luminance checks without fail. If the prerequisites are not met, follow-up of the visual field becomes impossible.
| Precaution | Details |
|---|---|
| Refractive correction | Appropriately set corrective lenses for presbyopia, hyperopia, myopia, and astigmatism |
| Eyelid lifting | Drooping of the upper eyelid can obstruct the visual field; manage with taping |
| Occlusion of the non-examined eye | Use an eye patch and be careful not to press on the eyeball |
| Posture adjustment | Uncomfortable posture leads to decreased concentration. Perform in a comfortable position |
| Verbal encouragement | Continuously check fixation on the fixation point and provide repeated verbal cues |
| Bjerrum area | Pay attention to scotomas within the central 30° and arcuate areas extending from the blind spot. |
First, it is essential to perform a luminance check (V/4e → 1000 asb) before the examination. During the test, do not neglect fixation monitoring; confirming the Mariotte blind spot early can detect poor fixation. Ptosis and uncorrected refractive errors also significantly affect results, so prior confirmation is important. Additionally, since accuracy varies with the examiner’s experience, standardization of stimulus movement speed and procedures is required.
A normal visual field shows a “hill of vision” with highest sensitivity at the center. By evaluating the spacing, shape, and symmetry of each isopter, the location and nature of visual field abnormalities can be identified.
During screening, it is important not to overlook the following three patterns: hemianopsia, concentric constriction, and ring scotoma.
Hemianopsia
Bitemporal hemianopsia: Typically caused by compression of the optic chiasm midline, such as from a pituitary adenoma. Because nasal nerve fibers cross, the temporal visual field is lost.
Homonymous hemianopsia: Visual field defect on the same side as the lesion due to pathology posterior to the optic chiasm (optic radiations or occipital lobe). Occurs in cerebrovascular disease and brain tumors.
Concentric Constriction and Ring Scotoma
Ring scotoma: A characteristic pattern seen in early stages of retinitis pigmentosa (RP). Central and peripheral visual fields are preserved, but the intermediate annular area is defective.
Concentric visual field constriction: As RP progresses, the ring scotoma expands and merges, causing the visual field to shrink from the periphery. End-stage glaucoma also shows a similar pattern.
Glaucomatous visual field defects
Paracentral scotoma: A scotoma occurring in the Bjerrum area (arcuate area within 30° of the center). It starts from the blind spot and expands in an arcuate shape.
Nasal step: A horizontal step-like defect in the nasal visual field. A characteristic pattern in early to moderate glaucoma.
Optic nerve and intracranial diseases
Central scotoma: A central scotoma seen in optic neuritis, toxic optic neuropathy, and Leber hereditary optic neuropathy. GP is useful as an alternative to static perimetry when fixation is difficult.
Brain tumors and cerebrovascular disorders: Various visual field patterns depending on the lesion site. Bitemporal hemianopia at the optic chiasm, homonymous hemianopia posteriorly.
Concentric visual field constriction is a pattern in which the entire visual field shrinks concentrically, characteristic of retinitis pigmentosa and end-stage glaucoma. Vision is lost in all directions from the center to the periphery. In contrast, hemianopia is a pattern in which the visual field is lost to the left/right or up/down with a vertical or horizontal border, caused by lesions in the optic chiasm, optic radiations, or occipital lobe. In GP, the shapes of the isopters are clearly different between the two, making differentiation relatively easy.
Based on the visual field abnormality pattern detected by GP, take the following clinical actions.
Concentric visual field constriction (retinitis pigmentosa)
Hemianopia (suspected brain tumor or cerebral infarction)
Progressive glaucoma
Psychogenic visual field defect
In kinetic perimetry, a stimulus of fixed luminance and size is moved at a constant speed from the periphery toward the center of the visual field. The point where the patient first detects the stimulus becomes a point on the isopter. By repeating this process from multiple directions, a single isopter (line of equal sensitivity) is completed. By changing the luminance or size of the stimulus, multiple isopters are plotted, constructing a sensitivity map of the entire visual field.
While static perimeters measure thresholds at fixed test points, Goldmann perimetry directly plots isopters themselves. Static perimetry is sensitive for detecting localized threshold reductions but has limitations in assessing the peripheral visual field extensively. Goldmann perimetry plays a complementary role, and in moderate to advanced glaucoma, it may be the only means of visual field assessment.
The normal visual field shows a hill-shaped sensitivity distribution (island of vision) with highest sensitivity at the center. Larger and brighter stimuli produce isopters that extend further outward, allowing measurement of the visual field’s “height” at different levels. The Mariotte blind spot (physiologic blind spot) corresponds to the optic disc and is identified as an absolute scotoma located approximately 15° temporal and slightly inferior to the fixation point.
| Characteristic | GP (Kinetic) | HFA (Static) |
|---|---|---|
| Measurement target | Isopters (lines of equal sensitivity) | Threshold (sensitivity) at each point |
| Stimulus movement | Moves from periphery to center | Flashes at fixed points |
| Information obtained | Outline of the entire visual field | Sensitivity map of central 30–60° |
| Reproducibility | Depends on examiner skill | High (automated) |
| Scope of application | Full visual field (advanced cases, neuro-ophthalmology) | Central visual field (early to moderate glaucoma) |
Automated perimeters such as the Octopus 900 are equipped with a Kinetic mode that enables computer-controlled kinetic perimetry. This is expected to reduce examiner dependency and improve standardization and reproducibility. However, further clinical studies are needed to establish clinical value equivalent to conventional manual GP.
By regularly measuring and recording the visual field area in RP patients, research is being conducted on its application for individual assessment of progression rate and evaluation of the efficacy of gene therapy and drug therapy. Standardization of visual field area measurement methods and establishment of statistical evaluation criteria for measured values are future challenges.
In cases of advanced glaucoma where static perimetry such as HFA becomes difficult to measure, GP may be the only means of visual field assessment. The clinical significance of using GP to evaluate residual visual field and central fixation protection in end-stage glaucoma is expected to increase in the future1).
日本緑内障学会. 緑内障診療ガイドライン（第5版）. 日眼会誌. 2022;126:85-177.
American Academy of Ophthalmology. Primary Open-Angle Glaucoma Preferred Practice Pattern®. 2020.
Barnes CS, Schuchard RA, Birch DG, Dagnelie G, Wood L, Koenekoop RK, et al. Reliability of Semiautomated Kinetic Perimetry (SKP) and Goldmann Kinetic Perimetry in Children and Adults With Retinal Dystrophies. Transl Vis Sci Technol. 2019;8(3):36. PMID: 31211001.
