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Biomedical subjects

J M Enoch

Publications and source records attributed to J M Enoch.

At least 55 records · Page 3Linked to original sources
PubMed1989

Visual field defects detected in patients with Gilles de la Tourette syndrome: preliminary report.

The presence of visual field anomalies was measured using Goldmann kinetic perimetry in twelve patients, age 7 to 39 with Gilles de la Tourette syndrome. Refraction to the cupola was carefully controlled. The visual acuity of the group was good to excellent. Visual field alterations were prechiasmal, generally non-symmetric, and best described as arcuate defects, steps, baring of the blind spot and enlargement of the blind spot. Central fields were most commonly affected, i.e., I/2e to I/1B isopters. There was no evidence of glaucoma in any of the patients although two patients exhibited keratoconus and another one manifested moderate to high astigmatism. Visual involvement other than ocular and lid tics have not been reported in Tourette syndrome. This research represents clear evidence of additional physical components in this condition. Automated visual field measurements are not recommended in this population because of the presence of non-predictable tic and vocal behavior (both may result in head/eye movements). Suppression of tic behavior can be very fatiguing. (Eight of twelve of the patients reported exhibited signs of marked fatigue during testing.)

Adolescent↗
PubMed1988

Measurement of metamorphopsia in the presence of ocular media opacities.

Opacities in the cornea, crystalline lens, and vitreous may make conventional measurements of retinal/visual function of little value. Here, we present two psychophysical hyperacuity tests that are designed to detect and quantify retinal distortions even in the presence of substantial opacities. One test makes use of a two-dot vernier display in which directional bias as well as vernier acuity can be estimated. The second test is a multi-dot hyperacuity bisection task, which resembles a simplified Amsler grid test. By varying the spatial parameters of these stimuli, metamorphopsia may be quantified. The method is applicable both in clear and occluded ocular media.

Adult↗
PubMed1987

Effect of monocular light exclusion on the Stiles-Crawford function.

Contrary to previously published studies, monocular light exclusion did not alter the shape of the Stiles-Crawford function in a substantial manner in four subjects who were patched in this laboratory for one full week. In order to rule out methodological differences, an experimenter from each of the two sets of experiments (current and prior) patched one eye for 1 week, then tested each other. For one subject, there was little effect of patching. For the other, patching had a measurable effect, but it was different from that originally reported. However, the much larger, symmetrical broadening of the Stiles-Crawford function reported in earlier studies was not replicated. A testable working hypothesis to explain the earlier results is discussed.

Female↗
PubMed1987

Comparison of two fast quantitative methods for evaluating the Stiles-Crawford function.

Stiles-Crawford (SCE) functions are determined using an increment threshold procedure. The customary technique requires considerable time to obtain a full SCE function and in many situations, both clinical and experimental, it is imperative that the SCE function be evaluated at many retinal loci in as short a time as possible. We have been using two different variants of the standard method, one requiring a very limited number of threshold settings at five fixed entry points in the entrance pupil (5-point method) and in the other, thresholds are determined at only three preselected entry points (3-point method). The time required to obtain a complete SCE function is the order of 5 to 8 min using either method. Comparison and statistical evaluation of the techniques are presented.

Evaluation Studies as Topic↗
PubMed1986

Refractive changes induced by intraocular lens tilt and longitudinal displacement.

There is a tendency for the posterior chamber intraocular lens to tilt about the points of insertion. This is found clinically and in postmortem studies of eyes that have had intraocular lenses surgically implanted. One end is often located in the lens capsule and the other end is located in the ciliary sulcus. The possibility of anteroposterior displacement also exists. Using a modified Gullstrand schematic model eye, we have computed the amount of spherical and cylindrical errors that are induced due to the tilt and/or displacement of the intraocular lens. If a cylindrical error of approximately 90 degrees from the axis of insertion (lens plus haptic loops) and/or axis of tilt is detected, further careful investigation is warranted.

Astigmatism↗
PubMed1986

Vision through nuclear and posterior subcapsular cataract.

We have developed a new set of tests for evaluation of visual function through media opacities, based on vernier acuity measurements (hyperacuity). In this paper, results of one of these tests, the 'gap test', are compared in patients with posterior subcapsular (PSC) cataract versus nuclear cataract (NC). Patients with PSC cataract often report multiple images or significant 'star burst' effects. We hypothesized the presence of 'multi-prismatic' and/or high frequency spurious resolution phenomena due to PSC cataract characteristic substructure. We were able to minimize these effects by using a pinhole held close to the eye, a large (adapting) background field of white light superimposed on the vernier test targets, a low-pass spatial filter applied to the targets. When the particular problems associated with PSC cataract are not present or are adequately addressed and when patients are matched for visual acuity, the hyperacuity 'gap test' shows less functional effect due to the opacity for PSC cataract than NC in all the cases we have tested. These findings, moreover, indicate that visual acuity provides an insufficient description of the effects of intraocular scattering on image formation. The results emphasize the importance and the necessity of developing models that better clarify the specific effects of different types of ocular media opacities.

Aged↗
PubMed1986

The Stiles-Crawford effect of the first kind (SCE I): studies of SCE I in an aniridic observer.

The Stiles-Crawford effect of the first kind (SCE I), discovered in 1933, represented a major breakthrough in our understanding of retinal physiology and the modern beginning of the science of photoreceptor optics. The current status of knowledge in this area is briefly reviewed. A study is presented of a white adult female observer with aniridia, clear media, only traces of nystagmus, rather good visual acuity, and good fixation. It is shown that this individual exhibits approximate alignment of her photoreceptors with the center of the retinal sphere, clear evidence of side lobes on functions, and surprisingly steep SCE I functions. The implications of these findings are considered.

Adult↗
PubMed1985

Functional visual effects of lesions located near the optic nerve head.

Three patients with retinal lesions near or impinging on the optic nerve head are presented. Three different functional disruptions are demonstrated by quantitative layer-by-layer perimetry. In one, a patient who primarily exhibited subretinal neovascularization, inner retinal functions were anomalous; but the overlying nerve fiber bundle was as yet not affected. In the second patient, an individual with possible histoplasmosis causing an outer retinal/choroidal lesion, the overlying nerve fiber bundle was affected causing apparent retrograde changes in inner retinal function at remote visual field locations; but another aspect of optic nerve function (time-dependent response) was not anomalous. These apparently retrograde changes were essentially identical to functional changes previously demonstrated in patients with established open-angle glaucoma. In the third patient, with presumed toxoplasmosis, there were clear-out time-dependent anomalous responses consistent with optic nerve involvement, as previously reported in patients with optic neuritis. There were also modest, time-stable, nerve fiber bundle defects present in this third patient. Together, these results demonstrate that lesions in the area of the disc can have very different functional consequences, and that quantitative psychophysical techniques can elucidate these differences.

Adult↗
PubMed1985

Joint application of hyperacuity perimetry and gap tests to assess visual function behind cataracts: initial trials.

We have developed two related clinical tests that offer potential in better assessing visual function behind an ocular opacity. The tests are resistant to the effects of opacities because they utilize a localization task (vernier acuity) rather than a resolution task. In this paper we report the initial trials in which we apply the two tests together. Results from six case studies (some with actual opacities and some with simulated opacities) illustrate both the conduct of the tests and their potential capabilities in detecting even very modest retinal dysfunction in the presence of opacities. These techniques offer considerable potential in the separation of a given acuity loss observed in the presence of cataract into a portion due to the opacity and a portion due to retinal dysfunction.

Aged↗
PubMed1985

Helping the aphakic neonate to see.

The treatment of the infant who is born with sensory deprivation amblyopia is one of the most difficult therapeutic problem sets facing the ophthalmologist today. This group of anomalies has many forms, the most common of which seems to be unilateral and bilateral cataracts. Substantial advances have been made, however, in many aspects of therapy for infants who have this set of problems. We have come to realize that it is essential to address these conditions at the first moment that is consistent with the safety of the child. New techniques in cataract extraction have reduced the time course of surgical treatment, reduced the frequency of secondary cataracts, and sustained the patency of the visual pathway. Unfortunately, practitioners who engage in the surgery may not have the back-up skills in advanced contact lens fitting, correction of aniseikonia, and, in some instances, the strabismological complications which are encountered. Further, improved means of assessment of visual acuity, binocular vision, and other visual characteristics of these infants are only in the developmental stages at this time. Thus, we propose to present the problem in an orderly manner. We shall first review the types of cases and problems. We will then discuss surgical techniques and the information which must be determined during examination under anesthesia (EUA) for the purposes of visual correction. We will then describe the designs of the spectacle lens and/or spectacle/contact lens combinations that are used to correct the resultant aniseikonia and anisometropia. We will address the approaches to patching and techniques on how to best achieve binocular vision in these patients. Separately, means and methods of assessment of vision by preferential looking, visual evoked response, optokinetic nystagmus, and tests of other visual functions will be explored. In summary, we will try to tie together the entire therapeutic regimen that can be used in the treatment of these patients.

Amblyopia↗
PubMed1985

Temporal modulation of the background affects the sensitization response of X- and Y-cells in the dLGN of cat.

The responses of X- and Y-cells to a small flashing test probe modulated at 2 Hz were measured as a function of the diameter of a concentric circular background. The background was either a static homogeneous disk, a flickered homogeneous disk, a static radially-vaned disk, or a rotating vaned disk, all of equivalent space- and time-averaged luminance. Variation of background diameter produced systematic changes in response that reflected general X- and Y-cell receptive field differences. Initial increases in background diameter decrease the response to the test probe ("desensitization") of both X- and Y-cells to a minimum level at a diameter that approximates the size of the receptive field center. Further increases in the background diameter result in an increase of the response to the test probe ("sensitization") that is very large for X-cells and much less for Y-cells. Temporal modulation of the background does not alter the desensitization of X- or Y-cells, but strongly reduces the sensitization of X-cells. Temporal modulation of the background by flicker and by motion produced equivalent effects. These results are compared to similar human psychophysical tests used clinically. Implications concerning the mediation of psychophysical sensitization are also considered.

Action Potentials↗