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Visual Field Test For Early Detections of Visual Disorders The Humphrey FDT Visual Field Test measures the retinal function and sensitivity to light. No eye drops, no discomfort! As you look into the computerized instrument you’ll be asked to press a button each time you see the target. Results are immediately available for our Doctor’s review. Visual Field Testing can assist in important early detections of many disorders such as: • • • Glaucoma Diabetic Retinopathy Retinal Detachment • • Brain Tumors And many more… Our Doctors strongly recommend this quick, yet accurate exam for all patients, especially those who have any of the following: • • • • • Headaches Flashes of light or floaters Family history of diabetes History of high blood pressure Heart problems • • • Taking medications Strong eyeglass prescription Reduced vision without an apparent reason There is an additional charge of $30.00 for this screening exam and is recommended to be tested annually, sooner if deemed necessary by the doctor. You’ll be given a receipt, as your Insurance Plan may reimburse you for this medical procedure. Visual Eyes does not guarantee reimbursement. Check with your insurance company regarding coverage. I have read and understand the information regarding the Humphrey FDT Visual Field Test ______Yes, I do want the Visual Field Exam. Exam. ______ No, I do not want the Visual Field Patient’s Signature: ________________________________________________ Date:________________
