In the increasingly automated world of optometry, is there still a place for functional field testing, such as confrontation, when screening for visual field defects? 

Confrontation is the simplest way to assess a visual field and is still taught during optometry and medical training. But its use in practice is waning, mostly because of the routine use of sophisticated standard automated perimetry, such as the Humphrey field analyser. Automated perimetry is more sensitive and reproducible and enables field loss monitoring quantitatively over time (see Visual field assessment techniques, overleaf).

But confrontation, a skill that can be used almost everywhere and on everyone, would be lost at our peril. Many patients cannot access, or use, visual field screening: infants, those with learning disabilities, people with dementia, stroke patients and those confined to home or residential care. And that’s not to mention its use in regions where access to advanced optometry services is limited.