[Studies on suppression scotoma. Part. 3. Suppression scotoma in microtropia (author's transl)].
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Binocular perimetry with Aulhorn's Phase difference haploscope is described. Of 62 patients with primary micro-squint, 21 patients showed no scotoma, 15 patients showed a fixation or zero point scotoma of 0.5-1 degrees, 26 patients showed a larger scotoma (average: 3.7 degrees). In addition, 15 patients with larger angle and deep amblyopia were examined. The scotoma average was 8.8 degrees. A zero point scotoma was always present, whereas the central foveal scotoma was often missing.
Objective determination of accommodation in 38 children with permanent central scotoma due to amblyopia on one side (with central and eccentric fixation) revealed: 1. The physiological adaptation of refraction for far and near distances did not serve its purpose. 2. There was either no or an irregular response on hyperopia, which was produced by placing concave lenses in front of the eye while fixing a far object, or on myopia produced by placing convex lenses in front of the eye while fixing a near object. 3. On hindering clear vision which could not be compensated by accommodation there was contrary to normal eyes no reactive change of refraction at all or only a poor one. The accommodation behavior in eyes with permanent central scotoma due to amblyopia does not differ from that in eyes with permanent central scotoma due to organic lesions when using the same test methods.
Anomalous optic discs may be associated with relative temporal visual field defects that need to be distinguished from bitemporal field defects of chiasmal compression. Two patients with both anomalous discs and suprasellar tumors were hospitalized with temporal hemianopic scotomatous visual field defects. A 19-year-old woman with a chromophobe adenoma had a monocular temporal hemianopic scotoma in the eye exhibiting an inferior-nasal disc crescent. A 22-year-old man with a hypothalamic-chiasmal germinoma causing bitemporal hemianopic scotomas had minor disc colobomas bilaterally. Careful study of the optic discs and posterior fundus, as well as evaluation of the characteristics of the temporal field defects, should distinguish chiasmal compression in the occasional case where suprasellar tumor and anomalous optic discs coincide.
The traditional scotoma hypothesis for functional amblyopia is modified to state: whereas the central visual field of a normal visual system and that of an organic amblyope become increasingly scotomatous as light level is decreased from high to low photopic levels, the reverse is true for the central field of a functionally amblyopic visual system. An attempt is made to show how this hypothesis provides a unifying explanation for several seemingly different visual performances observed in functional amblyopes. The paper deals with (1) field inhomogeneities and threshold measures, and (2) threshold changes with light adaptation level. Implications of the modified scotoma hypothesis are discussed for (1) the neutral-density-filter test to distinguish functional from organic amblyopia, (2) the reduced CFF threshold for amblyopic eyes, (3) expectations of stereopsis for amblyopes, and (4) possible mechanisms for amblyopia.
Objective determination of monocular accommodation in young eyes revealed a different behaviour in strabismus alternans from that in normal binocular vision. This manifested itself by strongly differing individual responses, less correct values in physiological and unphysiological accommodation tests, and different reactions on hindering clear vision that cannot be compensated by refraction changes. The possibility of central scotoma, persisting during fixation and varying in density, occurring in alternating strabismus, is discussed.
Scintillating scotomas are frequently seen without an associated headache and in general should be considered a benign symptom. In this series of 10 patients with an age range from 25 to 72 years, there were 7 female and 3 male patients. With an average follow-up of 1 1/2 years there was no patient who subsequently developed migraine headaches or any persisting neurologic sequelae.
This paper examines the contribution of the macular region to visual function. Several test targets were used to measure visual performance within 10 deg of the center of the fovea for normal observers and for an observer with a uniocular central 6-deg scotoma. We conclude that the nature of the test target is more important in the measurement of parafoveal than central vision and that the macular region contributes significantly to the visibility of objects as large as 2.5 deg.
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When tested by Goldmann kinetic perimetry ten patients with glaucomatous optic disc cupping had no visual field defects, but visual field defects were detected when tested by threshold static perimetry on the Tubingen perimeter. To improve the detection ability of kinetic perimetry, we suggest placing the interisopter spot-checks close together or expanding the central 30 degrees plotting area.
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