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[Examination of central vision. Visual acuity, contrast sensitivity, color vision].

In the neurophysiological organization of the visual system, form, color, movement, and depth perception are processed separately. Therefore, sensorial examination methods should test each of these basic functions separately, since they may be affected individually or to different extents by pathologic processes. For diagnosis the limit of visual acuity, i.e., the capacity for discrimination must be searched for, using Paliaga's "limits method". Visual acuity can also be tested in infants by the preferential looking method. Contrast sensitivity is tested using sinusoidal grid patterns of varying contrast and spatial frequency. In routine practice, however, this is usually achieved more easily with acuity cards on which contrast is reduced in several stages. The "two-equation method" is a colorimetric test combining two metameric matches, red + green = yellow, and blue + green = cyan, for testing color vision. The test requires an anomaloscope or anomalometer with four light channels. With this method it is possible to test the "red", "green", and "blue" cones and the "red-green" and "blue-yellow" opponents. The test provides a qualitative and quantitative evaluation of color vision disorders. If no colorimeter is available, classic printed test can be used. However, they might never achieve the same qualitative and quantitative precision.

Color Perception Tests↗

The effect of glaucoma on central visual function.

Glaucoma has traditionally been thought to affect peripheral visual function in its early stages and to spare central visual function until late in the disease process. The basis for this assumption has been the reliance on Goldmann-type perimetry, a rather sensitive method for assessing the peripheral visual function, and on Snellen-type visual acuity measurements, a rather insensitive method of assessing central visual function. This belief has persisted despite frequent complaints from patients with glaucoma that their central vision is disturbed. Over the past two decades, several investigations of central visual functions and their anatomic substrate have challenged this assumption. Histologic studies of the nerve fiber layer in eyes with glaucoma suggest that the number of ganglion cells subserving macular function is decreased even in early stages of the disease. In addition, afferent pupillary defects (a gross measurement of macular nerve fiber function) may also be present in eyes with early glaucoma. Several studies have demonstrated that color perception (largely mediated by the fovea) is defective in glaucoma. Furthermore, defects in color perception may even precede the development of visual field abnormalities. Seventy-eight percent of patients with early glaucomatous visual field defects were found to have a defect in color perception when tested with a desaturated D-15 color panel that tests only the central 1.5 degrees. In addition, both chromatic and achromatic foveal perception channels are defective in eyes with glaucoma and even in some eyes of those with suspected glaucoma. Contrast sensitivity has become recognized as an important component of visual function. Partial loss of contrast sensitivity may cause a degradation in the quality of perception even though the Snellen visual acuity remains normal. Although contrast sensitivity is not entirely a macular function, it has been shown that as little as 3 degrees of disturbance of the macula (eg, with macular degeneration or with an artificial central scotoma) will reduce the contrast sensitivity, suggesting that this modality is indeed mediated to a significant extent by this portion of the retina. Spatial contrast sensitivity appears to be reduced in patients with glaucoma. However, because of overlap and lack of a sharp cutoff measurement, present testing procedures fail to allow a clear distinction between the glaucomatous and normal populations. Although reduced temporal contrast sensitivity has been demonstrated in glaucomatous eyes by others, I undertook a systematic investigation of this function in a large group of patients with glaucoma and with suspected glaucoma.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

[Disorders of color perception and increase glare sensitivity in phenytoin and carbamazepine therapy. Ocular side effects of anticonvulsants].

Advanced psychophysical tests, performed in 42 epileptic patients, show that the antiepileptic drugs phenytoin and carbamazepine can specifically affect the retinal function, while Valproic Acid and the epileptic seizures do not. The Farnsworth-Munsell 100-Hue and Panel D-15 désaturé tests revealed an accumulation of errors along the tritan/tetartan axis (blue colour vision deficiencies) and a high total error score. The same defect was shown by measurement of the spectral sensitivity functions. The results obtained for mesopic vision and especially glare sensitivity measured by nyktometry were markedly affected in these patients compared to a normal population. The enhanced sensitivity to glare is mainly the only one symptom complained by the patient. We propose a screening method for early detection of phenytoin- and carbamazepine-induced neurotoxicity. The literature of ocular side effects of anticonvulsant drugs is carefully reviewed.

Adolescent↗

[Early diagnosis of congenital disorders of color vision with the Velhagen "Pflügerhaken Color Charts for evaluating color perception" in 3,375 preschool children].

In three series of examinations, 3375 male preschool-age children and 93 adult normal trichromates were tested using the Velhagen Pflügerhaken charts. The authors recommend modifying the evaluation of the results slightly by introducing a "doubteful" category for children who make one mistake or who show hesitation and lack of assurance in interpreting the charts. Using this modified form of assessment, diagnoses of "probably achromatopic" and "doubtful" were made in 7.16% and 2.13% respectively of 1689 preschool-age boys. The failure rate during the test and the duration of the examination were age-dependent, and declined with increasing age from 4.15% to 0.45% and from 1.18 min to 0.59 min, respectively. Most mistakes were made with charts nos. 9, 3, and 5. The results of tests with Pflügerhaken charts are fully comparable with those of other internationally used tests for adults. They can be recommended for screening preschool-age children.

Adult↗