Electroretinographic assessment and diagnostic reappraisal of children with visual dysfunction: a prospective study.

PURPOSE: To assess the presence or absence of a retinal cause of visual impairment using electroretinography (ERG) in children with no obvious discernable cause on ocular examination. DESIGN: Prospective observational case series. MATERIALS AND METHODS: A prospective study was carried out involving 120 children with the mean age 4.4+/-3.2 years with visual dysfunction. All children underwent ERG under general anesthesia using a special handheld mini-Ganzfeld (Kurbisfeld) dome. RESULTS: Fifty-two (43.3%) children were male and 68 (56.7%) were female. The clinical diagnosis was as follows: Leber's congenital amaurosis (LCA) (n=47), achromatopsia (n=25), congenital stationary night blindness (CSNB) (n=9) and others (unclassifiable, n=39). The visual acuity ranged from perception of light (PL) to PL with projection in children with LCA. In the rest (n=73), some sort of visually guided behavior was discernable. Following ERG, a diagnostic reappraisal resulted as follows: LCA (n=49), achromatopsia (n=28), CSNB (n=4), cone-rod dystrophy (n=22), rod-cone degeneration (n=7), normal (n=8) and others (unclassifiable, n=2). Except for the two unclassifiable cases, ERG was successful in the diagnosis or exclusion of retinal dysfunction in the rest. By Pearson Chi-square test, there was a statistically significant association between the clinical and ERG diagnosis (P < 0.001). CONCLUSION: LCA was the commonest cause of visual dysfunction in our series. A statistically significant correlation between clinical and electrophysiological diagnosis was seen. ERG helped in firmly establishing the presence or absence of global retinal dysfunction in the majority (118/120) of pediatric patients with visual dysfunction.

[Traffic ophthalmology. Assessment of ability to drive in road traffic]. / Verkehrsophthalmologie. Fahreignungsbegutachtung im Strassenverkehr.

Assessment of an individual's ability to drive in road traffic is an important part of the ophthalmologist's work. It fulfils the ophthalmologist's duty to care for the patient and increases general road traffic safety. This assessment requires testing of visual acuity, visual field, mesopic vision and glare, motility, binocular vision and colour vision. Also the optical media and the fundus have to be examined. If an optical aid is necessary, it should be suitable for use in road traffic. In some cases restrictions are necessary, which should be noted in the driver's licence. Testing of visual function has to be performed with standardised procedures according to the recommendations of DOG and BVA. This article will provide readers with an overview of current practices in assessing the ability to drive in road traffic and enable them to render an accurate professional opinion regarding driver's licences.