Visual Field Test for Blepharoplasty: Humphrey, Taped vs Untaped, Criteria

A Humphrey visual field test for blepharoplasty maps how far you can see above the centre of your vision, first with the eyelids in their natural position (untaped) and then with the eyelid skin or lid lifted with tape (taped). Which visual field test for blepharoplasty is used matters less than doing both conditions: the difference shows how much the drooping lid blocks your upper field, and it is the main evidence insurers and Medicare use to decide whether eyelid surgery is medically necessary rather than cosmetic: a Medicare policy, for example, asks for a 12 to 15 degree superior field loss or a 24% to 30% superior field impairment (Sources: CMS LCD L35004, EyeWiki (AAO)).

A visual field test assesses how wide an area your eye can see when you look at one central point, and it helps detect blind spots and other problems of vision. Doctors often ask for a visual field test before blepharoplasty, which is eyelid surgery that removes excess skin or fat and can be cosmetic or functional, when the upper lids may be limiting vision (Source: AAO).

Many methods are available to test the visual field. Some of these methods are simple screening checks, while others are automated and technical. People who plan to have functional upper eyelid surgery are usually asked for a field test of the upper (superior) field, often called a "ptosis visual field test" or a field vision test for droopy eyelids.

Two different problems can make the upper lid block vision, and the test is used for both. Ptosis is drooping of the upper eyelid margin itself, usually because the levator muscle that lifts the lid stretches or separates with age, injury or eye surgery. Dermatochalasis is loose, redundant eyelid skin that hangs over the lid; it is treated with blepharoplasty, while true ptosis needs ptosis repair, which tightens or reattaches the lifting muscle (Sources: AAO, EyeWiki (AAO)).

See our guide to upper eyelid ptosis surgery and its cost for the second case.

Visual Field Test for Blepharoplasty

Which visual field test is used for blepharoplasty? Most surgeons use either automated static perimetry on a Humphrey analyser or manual kinetic perimetry (Goldmann or a tangent screen), always performed untaped and taped. EyeWiki of the American Academy of Ophthalmology lists both automated and manual testing for quantifying the obstruction caused by severe dermatochalasis and fat herniation, and there is no single standardised field designed only for this purpose (Sources: EyeWiki (AAO), PLoS One, 2017).

Although the Humphrey visual field test is commonly used to assess ptosis, the standard glaucoma programs are not ideal for it. A team at Leicester Royal Infirmary pointed out that the routine Humphrey 24-2 program covers only a limited part of the superior field, so in 2011 they published a modified "Leicester Peripheral Field Test" on the Humphrey analyser that tests 35 superior points up to 48 degrees with fixation shifted 15 degrees downward. In 97 patients it detected ptotic eyes with 98.8% sensitivity and 92.5% specificity, and took about 3 to 4 minutes per test (Source: Eye, 2011).

A ptosis visual field test assesses more than the eyelid: the doctor also sees other defects in the field, which is why an unexpected result should be reviewed by an ophthalmologist before eyelid surgery is planned. The same test, repeated after surgery, shows how much of the upper field was gained (Sources: Eye, 2011, AAO).

Humphrey Superior 36-Point and 64-Point Programs

When an insurer or surgeon asks for a "superior 36-point" or "superior 64-point" field, they mean a screening program on the Humphrey analyser that concentrates its test points in the upper field instead of around the centre, so that a hanging lid shows up as a band of missed points along the top of the chart. These superior-weighted programs are clinic and insurer conventions rather than a single published standard; the peer-reviewed example is the Leicester test above, with 35 superior points (Source: Eye, 2011).

Do not confuse them with the Humphrey glaucoma patterns: the 24-2 tests 54 points, the 30-2 tests 76 points and the 24-2C tests 64 points including 10 extra macular points. A "64-point" printout from a 24-2C glaucoma test is not a ptosis field and usually will not be accepted for an eyelid claim (Source: EyeWiki (AAO)).

Taped vs Untaped Visual Field Test

The untaped field shows what you see with your lids as they are; the taped field shows what you would see if the obstruction were removed. In a 2000 study of 12 patients with ptosis, the superior field at the 12 oclock meridian was 24 degrees untaped and 38 degrees taped on the Humphrey analyser, and 28 degrees untaped and 46 degrees taped on Goldmann perimetry; the Humphrey ptosis fields took about 50 minutes for both eyes against 10 minutes for Goldmann (Source: Archives of Ophthalmology, 2000).

A 2017 tangent-screen study reported a similar pattern: the vertical field was 8 degrees in the natural lid position, 23 degrees with the lid taped up and 22 degrees after surgery, so the taped field predicted the result well in that group (Source: PLoS One, 2017).

What Is the Test for Eyelid Surgery?

The test for eyelid surgery is a superior visual field test performed twice for each eye, untaped and taped, usually together with external photographs and an eyelid examination. Functional disability from loose eyelid skin is documented by external photography and visual field testing with and without eyelid taping or elevation (Source: EyeWiki (AAO)).

The ptosis visual field test explores the degree to which your eyelids obstruct your vision, so it doubles as a field vision test for droopy eyelids. The doctor also measures the margin reflex distance (MRD1), the distance from the light reflex on the cornea to the upper lid margin; a Medicare policy notes that an MRD1 of 4 to 5 mm is generally considered normal and that 2 mm or less indicates functional visual field impairment (Source: CMS LCD L35004).

Both the left and right eyes are tested twice during the examination. First, the eyelids are tested in their natural drooping position. Next, the technician gently tapes the eyelid skin or the brow upward with tape that is safe for the skin around the brow and eyelids, so that the lid clears the pupil. Finally, the field is retested to see how much your vision improves (Source: PLoS One, 2017).

Test time depends on the program: a superior screening program takes a few minutes per eye, while a full-threshold Humphrey ptosis protocol for both eyes, taped and untaped, can take much longer. Asking for lubricating drops or a short break during the test is normal (Sources: Eye, 2011, Archives of Ophthalmology, 2000).

The Procedure of Visual Field Test for Blepharoplasty

The ptosis visual field test is done one eye at a time while the other eye is covered, and each eye is tested in two conditions: taped and untaped. Visual field testing taped and untaped is needed because insurers compare the two results, and Aetna, for example, asks for both taped and untaped fields to be submitted for each eye for which surgery is requested (Source: Aetna CPB 0084). You look at a central target inside the bowl-shaped perimeter and press a button each time you see a small light, with your lens prescription placed in front of the tested eye (Source: AAO).

Doctors perform two steps to assess each eye:

The First Step

The eyelids are tested in their normal droopy position, without lifting them or the eyebrow. The goal is to measure your upper field exactly as it is in daily life; you should look straight at the target and not raise your brows to "help", because the test records your natural position (Source: EyeWiki (AAO)).

The Second Step

The eyelid skin, the lid margin or the brow is then taped up with gentle tape and the field is retested to measure the difference. This gives a fairly accurate idea of what your vision would be like without the droopy skin in the way; in one study the taped field (23 degrees) was almost identical to the field after surgery (22 degrees) (Source: PLoS One, 2017).

Blepharoplasty Visual Field Criteria: What Medicare and Insurers Require

Insurers do not use one universal rule, but the published criteria cluster around a superior field loss of about 12 degrees or about 30%, shown untaped, with clear improvement when taped. The table summarises policies we actually read; always check the policy that applies to you (Sources: CMS LCD L35004, Aetna CPB 0084, PLoS One, 2017).

In the UK, NHS criteria are set separately and differ from these US numbers; our guide on how to qualify for eyelid surgery, including NHS and insurance criteria, covers candidacy in detail. Aetna also notes that an MRD of 2 mm corresponds to a superior field impairment of 12 to 15 degrees, which is why the lid measurement and the field result are expected to agree (Source: Aetna CPB 0084).

Ptosis Visual Field Test Interpretation: How to Read the Results

To read a ptosis visual field test, compare the height of the seen area above fixation in the untaped and taped charts: a lid that blocks vision shows a row or band of missed points along the top of the untaped chart that disappears when the lid is taped. Points missed in the same place on both charts are not caused by the eyelid and need an eye examination (Sources: Eye, 2011, PLoS One, 2017).

• Superior field height: how many degrees above fixation you still see, the number used by most insurers.
• Points seen: on a screening program, how many superior points you saw untaped and taped; some policies ask for a percentage improvement.
• Reliability indices: fixation losses, false positives and false negatives. High rates suggest poor cooperation or attention and make the result inaccurate; fields with rates above 33% were excluded from the Humphrey normative database.
• Artefacts: a thick lens rim or poor head position can block peripheral points and create a false defect, often an abrupt drop to 0 dB (Source: EyeWiki (AAO)).

The field result is read together with the eyelid examination and photographs. In the 2017 study, MRD1 correlated moderately with the field in ptosis repair (r = 0.62) but weakly in blepharoplasty for loose skin (r = 0.2), which is why skin hooding is judged mainly on the field and photographs (Source: PLoS One, 2017).

How to Fail a Visual Field Test for Eyelid Surgery: Why You Should Not Try

You cannot honestly "fail" a visual field test on purpose, and trying to do so is a bad idea for three reasons: it can be detected, it can harm you, and when the result is sent to an insurer or Medicare it is fraud. CMS defines Medicare fraud to include knowingly submitting, or causing to be submitted, false claims or misrepresenting facts to get a payment where no entitlement would otherwise exist, with possible civil and criminal penalties (Source: CMS, 2026).

Deliberately missing lights, closing the eyes or dropping the brows during the untaped test leaves traces. Perimetry reports reliability indices, and non-organic field loss tends to produce illogical patterns such as a "cloverleaf" chart on automated perimetry, spiralling isopters on Goldmann testing, or a field that does not widen at a greater distance; examiners also compare the field with the eyelid measurements and photographs (Sources: EyeWiki (AAO), EyeWiki (AAO)).

A falsified field can also hide a real disease. Field defects can come from glaucoma, stroke, pituitary problems and other conditions, and a result that is not real makes them harder to find (Source: AAO).

If your eyelids genuinely block your vision, relax, look straight at the target and let the test show it; if they do not, the honest options are cosmetic eyelid surgery paid privately or no surgery. For realistic expectations, see our celebrity blepharoplasty before and after photos, which show what eyelid surgery can and cannot change.

The Importance of Visual Field Test for Blepharoplasty

The optical or visual field is the whole area a person can see, centrally and to the sides, without moving the eyes. In other words, the visual field is seeing a thing and its surroundings while you look at one point (Source: AAO).

When you drive a car, for example, you need to see the road and check the mirrors at the same time. You can do that through your visual field. The same is true for parents watching children and for people in jobs that rely on side vision, such as security work.

If the visual field test shows a defect caused by droopy eyelids, eyelid surgery or ptosis repair may solve the problem, and the test documents that the operation is functional. But it doesnt end here: the same chart can reveal field defects that have nothing to do with the eyelids.

A visual field test may need to be repeated if the result is unreliable, for example because of tiredness, poor fixation or a learning effect on a first test. Tiredness can make the lids droop more and reduce attention, so the technician will check the reliability indices before the result is used (Source: EyeWiki (AAO)).

Conditions That Can Affect the Visual Field

You can have a visual field test for blepharoplasty, but the test can also detect other diseases and conditions that cause problems in the visual field. The American Academy of Ophthalmology lists glaucoma, multiple sclerosis, thyroid eye disease, pituitary gland disorders, central nervous system problems such as a tumour pressing on visual areas of the brain, stroke, eyelid problems such as ptosis, and blocked blood vessels in the optic nerve or retina (Source: AAO).

Other conditions include:

Cataracts

A cataract is a cloudy area in the lens of the eye. Early cataracts often cause no symptoms; later, vision becomes cloudy or blurry, colours look faded, glare or halos appear around lights and night vision gets worse, which can reduce sensitivity across the visual field (Source: NEI).

The main risk factor is age, and risk is higher with diabetes, smoking, heavy drinking, a family history, eye injury or certain eye surgeries, radiation to the upper body, a lot of time in sunlight and steroid medicines. Surgery is the only way to remove a cataract; doctors commonly suggest cataract surgery with phacoemulsification when the cataract interferes with daily life (Source: NEI).

Eye Tumors

Eye tumours can limit the visual field when they affect the eyelid, the eye socket, the retina or the conjunctiva. They may be primary, meaning they start in the eye itself, or metastatic, meaning they spread from cancers elsewhere in the body, such as the breast or lung.

Eye tumours may be benign or malignant, and the type and location decide whether and how the field is affected.

They are diagnosed by an eye specialist with examination and tests such as ultrasound imaging, fluorescein angiography and, when needed, a biopsy.

Glaucoma

Glaucoma is a group of eye diseases that damage the optic nerve and one of the most common causes of visual field loss. The most common type, open-angle glaucoma, usually has no early symptoms; half of people with glaucoma do not know they have it, and the first change is a gradual loss of side vision, especially near the nose (Source: NEI).

Angle-closure glaucoma is different: it can cause sudden intense eye pain, nausea, a red eye and blurry vision, and needs emergency care. Risk is higher over the age of 60, in African Americans over 40 and with a family history of glaucoma (Source: NEI).

Raised eye pressure is a major risk factor, and genetic factors play a role. To diagnose glaucoma, your doctor performs a dilated eye exam that includes a glaucoma visual field test of side vision. Treatment uses eye drops, laser or, if they fail, glaucoma surgery; it cannot reverse damage but can prevent further loss (Source: NEI).

Pituitary Gland Disorders

Pituitary gland disorders disturb the hormones the gland controls, including growth hormone, adrenocorticotropic hormone, prolactin, luteinising hormone, thyroid-stimulating hormone and antidiuretic hormone. Because the pituitary sits just below the crossing of the optic nerves, a pituitary tumour can press on them and cause visual field loss, which is why the AAO lists pituitary disorders among the conditions a field test detects (Source: AAO).

Cerebrovascular Accident

A cerebrovascular accident, or stroke, happens when blood flow to part of the brain is blocked or a blood vessel bleeds, which causes brain cells to die. Risk factors include high blood pressure, smoking, diabetes, obesity and atrial fibrillation.

Symptoms of a stroke include a sudden severe headache, slurred speech, problems in the field of vision, numbness or weakness in the face, arm or leg, difficulty walking and loss of balance. Stroke is among the conditions the AAO lists for visual field testing (Source: AAO).

Retinal Detachment

Retinal detachment is a medical emergency in which the retina, the light-sensing tissue lining the back of the eye, pulls away from its normal position. Without fast treatment, more of the retina can detach and the risk of permanent vision loss rises (Source: NEI).

Warning signs are a sudden burst of new floaters, flashes of light and a dark shadow or "curtain" over part of the field of vision. Risk is higher after a previous detachment, a serious eye injury, eye surgery such as cataract surgery, extreme nearsightedness or diabetic retinopathy (Source: NEI).

Multiple Sclerosis

Multiple sclerosis damages the protective covering of nerve fibres in the brain and spinal cord, which disturbs communication between the brain and the body. Inflammation of the optic nerve can cause blurred vision, loss of part of the visual field or, less often, loss of vision in one eye; other symptoms include numbness, persistent fatigue, speech difficulties and tingling. The AAO lists multiple sclerosis among the conditions monitored with visual field tests (Source: AAO).

Retinal Hemorrhage

The retina is a thin layer of light-sensitive tissue at the back of the eye. Retinal haemorrhages often occur with diabetes, high blood pressure or blockage of the retinal blood vessels, and they can cause visual field defects; the AAO notes that people with diabetes and high blood pressure are at risk of blocked vessels in the retina or optic nerve (Source: AAO).

Benign and Malignant Brain Tumors

Brain tumours are abnormal growths of cells in the brain. They can be benign or malignant, and they may start in the brain itself or spread there from cancers elsewhere in the body. A tumour pressing on the visual pathways can cause a field defect (Source: AAO).

The major types of brain tumours include, but arent limited to, choroid plexus carcinoma, acoustic neuroma, craniopharyngioma, meningioma, neuroblastoma, oligodendroglioma and astrocytoma.

Brain Abscess

A brain abscess is a collection of pus in the brain tissue caused by an infection that reaches the brain through the blood or spreads from the teeth, sinuses or ears. Symptoms vary and may include fever, headache, weakness in the limbs, speech problems and blurred vision or field defects, depending on where the abscess is.

Macular Degeneration

Age-related macular degeneration (AMD) is a common eye disease that blurs central vision when ageing damages the macula, the part of the retina that controls sharp, straight-ahead vision. People aged 55 and older are more likely to have it (Source: NEI).

AMD affects central vision, not side vision, so it shows as a central defect rather than the upper-field loss caused by the eyelids. The macula is part of the retina, the light-sensitive tissue at the back of the eye, and helps you read, see details and recognise faces (Source: NEI).

Dry AMD, in which the macula thins with age, is the most common type. Wet AMD is less common and always late stage: abnormal blood vessels grow in the back of the eye. A warning sign of late AMD is that straight lines look wavy. A macular degeneration surgery page explains the treatment options (Source: NEI).

Types of Visual Field Tests

There are at least 6 types of visual field tests, from a quick screening in the consulting room to automated perimetry. The AAO describes them as follows (Source: AAO):

Automated Static Perimetry Test

This test creates a detailed map of how you see objects in your field of vision. You sit in front of a bowl-shaped "perimeter", look at a central target and press a button when you see a small, dim light; the lights do not move. Your head is kept in position so the machine can record which lights you see outside your central vision. The visual field test for blepharoplasty commonly uses this method on a Humphrey analyser (Source: AAO).

Kinetic Visual Field Test

Instead of a blinking light, a moving light target is brought in from the periphery until you see it. Goldmann perimetry is the classic kinetic test and was faster than automated testing for ptosis fields in one comparison (Sources: AAO, Archives of Ophthalmology, 2000).

Frequency Doubling Perimetry

This test uses an optical illusion: vertical black-and-white bars that flicker at a fast rate. Not seeing the bars at certain points in the test can indicate vision loss in that part of the field (Source: AAO).

Electroretinography

Electroretinography (ERG) measures the electrical activity of the light-sensitive cells of the retina (photoreceptors). The eyes are dilated and numbed, a small instrument holds them open and an electrode is placed on the cornea; it is used for retinal conditions, not for eyelid fields (Source: AAO).

Amsler Grid

This is one of the simplest tests: you look at a dot in the middle of a grid of straight lines and report areas that look wavy, blurry or blank. It tests only central vision and is often used at home by people with AMD, so it cannot assess the upper field for eyelid surgery (Source: AAO).

Confrontational Visual Field Exam

This might be the simplest test in the list. The doctor sits in front of you, you cover one eye and look at the doctors nose, and the doctor holds up fingers in different parts of your side vision and asks you how many you see. It is a quick screening, not a measurement for an insurance claim (Source: AAO).

Other Types of Eye Tests

There are various eye tests other than visual field tests, and a full eye examination before eyelid surgery includes visual acuity, pupils, eye movements, eye pressure, the front of the eye and the retina (Source: EyeWiki (AAO)).

They include the following:

Refractive Test

A refraction test measures how the eye focuses light and finds the lens power you need. If the eye does not focus light correctly on the retina (a refractive error), it can be corrected with glasses, contact lenses or refractive surgery such as LASIK. Correct refraction matters for perimetry too, because uncorrected refractive error defocuses the stimuli (Source: EyeWiki (AAO)).

Visual Acuity Test

This test measures the sharpness and clarity of vision. The doctor often uses a Snellen chart, which shows rows of letters that get smaller from top to bottom at a set distance from the patient. Each eye is examined separately, and you read the smallest line you can.

Eye Muscles Test

Doctors use this test to evaluate the control and coordination of the eye muscles. The doctor watches the movement of your eyes as they follow a moving target, and then assesses the condition based on that. Eye movements are part of the routine examination before eyelid surgery (Source: EyeWiki (AAO)).

Retinal Examination

This examination looks for problems at the back of the eye. Doctors also call it "ophthalmoscopy" and use it to evaluate the retina, optic nerve and blood vessels. Eye drops are often used to dilate the pupil so the doctor can see more. The examination of the retina is divided into:

• Direct ophthalmoscopy: The doctor uses a hand-held ophthalmoscope and shines a light through the pupil to see the back of the eye.
• Indirect ophthalmoscopy: The doctor wears a headband with a bright light and holds a lens in front of the eye to see a wider view of the retina.

Glaucoma Testing

Glaucoma testing combines measuring the fluid pressure inside the eye with examining the optic nerve and testing side vision, because glaucoma damages the optic nerve and raised pressure is a major risk factor (Source: NEI).

Prominent methods to measure pressure include:

• Applanation tonometry: This is one of the most common methods to examine eye pressure. After numbing drops, a small probe mounted on a slit lamp gently touches the cornea and measures the pressure inside the eye.
• Non-contact tonometry: A puff of air is directed at the eye to estimate the pressure without touching it. It does not require anaesthetic drops; you only feel a brief puff of air.

Color Blind Test

The colour vision test evaluates your ability to distinguish between colours. The doctor shows plates made of coloured dots that form numbers or shapes. People with normal colour vision identify them accurately; difficulty seeing them suggests a colour vision deficiency.

The Bottom Line

A visual field test for blepharoplasty, often a Humphrey superior field or "ptosis visual field test", is not needed for purely cosmetic eyelid surgery, but it is the key document when you want surgery recognised as functional. It is done untaped and taped, and most insurer criteria look for about 12 degrees or 30% of superior field loss that improves when the lid is lifted (Sources: CMS LCD L35004, Aetna CPB 0084).

Blepharoplasty visual field testing is different from other eye tests, such as visual acuity tests and ophthalmoscopy. If your surgeon finds it necessary to check your eyes and screen for eye diseases before blepharoplasty, they may add some of the other tests described above, and they should check for dry eye and brow position as part of the same assessment (Source: EyeWiki (AAO)).

Through International Clinics, patients with droopy eyelids reach eye and plastic surgeons contracted by International Clinics, who arrange the eyelid examination and, when it is relevant, a visual field test before surgery. International Clinics is not a treatment centre but the link between you and the right doctor and hospital, selected against strict medical quality standards. If you are planning surgery in Istanbul, see our guide to upper eyelid surgery cost in Turkey: upper blepharoplasty through International Clinics costs about $1,650–2,800 (approx. £1,250–2,100). You can reach us directly by using the Contact Us buttons below.

Read more:

How to Qualify for Eyelid Surgery?

Blepharoplasty in Turkey

Upper Blepharoplasty Cost: what eyelid surgery costs in the US, UK and Turkey