[White-noise field campimetry before and after artificial increase of intraocular pressure. Possible applications in diagnosis and evaluation of glaucoma]. / Rauschfeldkampimetrie vor und während künstlicher Augeninnendrucksteigerung. Einsatzmöglichkeiten in der Diagnostik und Bewertung des Glaukoms.

A total of 173 eyes (visual field defect stages O-V) of 99 glaucoma patients were investigated by means of conventional threshold-oriented suprathreshold automated test point perimetry using the Tübingen Automatic Perimeter (TAP) and by means of white-noise-field campimetry (flickering random dot pattern) using the Tübingen Electronic Campimeter (TEC). Most eyes were affected by primary open-angle glaucoma (119) or low tension glaucoma (35). The concordance between the two methods was good in 65 eyes (37.6%). Sufficient in 32 (18.5%) eyes, poor in 32 cases (18.5%) and inadequate in 44 eyes (25.4%). Among the last group of 44 eyes, 32 perceived a scotoma in the noise field (NF) but did not show any pathologic defect in conventional automated test point perimetry: the opposite constellation was found in only 12 eyes. In most cases, scotoma in the NF showed a change in both brightness and motion (noise) perception. No clear relationship between the type of glaucoma and a certain constellation of the aforementioned NF specifications could be found. Complete lack of noise perception in the scotoma occurred more frequently in advanced glaucoma (stage > or = IV). In 110 eyes of 63 of the glaucoma patients, white-noise-field campimetry was carried out during artificial IOP elevation achieved by suction-cup oculopression: during steplike increases of the negative pressure in the suction-cup up to maximum of 375 mmHg the following stages could be seen (the percentage of eyes that perceived each phenomena over the negative pressure range is shown in brackets): change in NF perception compared with initial findings (96.4%); impairment of central noise-field perception (78.2%); concentric constriction of NF (61.8%); complete breakdown of noise (field) perception (42.7%). A further, quantitative classification of these eyes was possible by evaluation of the negative pressure in the suction-cup that led to any one of these NF phenomena. The results demonstrate the usefulness of white-noise-field campimetry as a very fast screening method for detecting glaucomatous visual field defects. It can also be performed as a pressure tolerance test and thus be used to classify glaucomatous risk stages.

Ophthalmological features of pseudo-tumor cerebri. Report on 18 cases.

The aim of this paper is to point the attention of the ophthalmologist to the ophthalmic symptoms of pseudo-tumor cerebri. The ophthalmologist needs to control periodically patients with this condition in order to decide for an urgent necessary operative decompression in case of initial visual deficits.

[Field of vision established by perimetry in achromatopsia (author's transl)]. / Gesichtsfeldbefunde bei der Achromatopsie.

The results of perimetry especially of profile perimetry is in cases of achromatopsia so typical and unmistakable that it can be referred to for the differentia. l diagnosis of this disease. This follows from an examination of 33 cases with congenital achromatopsia. In all cases profile perimetry was flattened in the fixation area but not nearly as strong as it is usually the case if visual acuity is decreased to 0,1. 7 times there was found a small central scotoma at the margin of which it is fixated. The reason for the diverging of light difference sensitivity and visual acuity is discussed.

[Examination of stereoscopic vision with the phase-difference haloscope (author's transl)]. / Untersuchung des Steteosehens mit dem Phasendifferenzhaploskop

The authors report on the possibilities for examination of the stereoscopic vision at 2 or 4 meters by the phase-difference-haploscope. Besides a gross-qualitative test, methods of estmating realdepth acuity are described. There is a great variability of test-conditions for special scientific problems. During the routine examintion of disturbed binocular vision it is possible to test the stereo acuity, even if there is squint or aniseiconia.

[White noise field campimetry. A new form of perimetric examination]. / Rauschfeldkampimetrie. Eine neuartige perimetrische Untersuchungsweise.

Patients with circumscribed visual field defects can perceive them while looking at a surface with small black and white spots flickering randomly at high frequency (such as the white-noise field of a TV screen following the end of transmissions for the day). This autonomous perception of scotomata can be used as a screening method, to perform subsequent manual or automatic grid perimetry with the same TV monitor, concentrating on the defective part of the visual field alone. The results of white-noise scotometry used to examine the visual fields of 161 patients are presented. It appears that the test is capable of identifying suprageniculate homonymous hemianopias, since patients either do not observe them at all in the white-noise field or only to a far lesser degree. In addition, the blind spot and some congenital visual field defects are not observed as visual field defects at all in the white-noise field. However, all acquired circumscribed defects caused by lesions of the first, second, or third neuron are readily seen in the white-noise field if the patient is capable of stable fixation.

[Results of Rauschfeld examinations with the Tübingen electronic campimeter. A comparison with current perimetry procedures]. / Rauschfeld-Untersuchungsergebnisse mit dem Tübinger Elektronik Kampimeter (TEC). Ein Vergleich mit herkömmlichen perimetrischen Verfahren.

In a total of 121 patients scotomata, detected by white-noise campimetry, were presented graphically in a standardized manner. The intensity of brightness and strength of motion ("noise") perception within the scotoma, as well as the reliability of the patients' statements, were taken into consideration. The results of white-noise campimetry were compared with conventional raster perimetry using the Tübingen automatic perimeter. In each case the examiner was naive with respect to the result of the other method. In 77% of all comparisons, the correspondence between the results obtained with white-noise campimetry, on the one hand, and automatic perimetry on the other was sufficiently close, so that one method confirmed the other. However, when white-noise campimetry was used alone congenital visual field defects, long-standing retinal scotomata, and old suprageniculate lesions mostly could not be detected. When these defects were excluded from the analysis, the correspondence between the two methods increased to 85% (in the 89 remaining patients). Special applications of white-noise campimetry as a screening method or for the purpose of patient self-examination are discussed. Furthermore, it is suggested that this method could be used as a tolerance test for revealing expansion of the scotoma under short-term artificial elevation of the intraocular pressure.

[Perception of the blind spot with Rauschfeld campimetry. An additional diagnostic criterion in papillary changes]. / Die Wahrnehmung des Blinden Flecks bei der Rauschfeldkampimetrie. Ein zusätzliches diagnostisches Kriterium bei Papillenveränderungen.

In conventional test point perimetry the optic disc is detected as an absolute scotoma (blind spot). However, in white noise campimetry the blind spot usually cannot be perceived: the white noise is continuous over the whole field if presented to a normal eye. This is true not only for the blind spot but also for all scotomas caused by congenital damage to the retina or the visual pathway (e.g. colobomas). On the other hand, the blind spot is always perceived in white-noise campimetry if acquired damage to the peri-cecal region is present. In such cases this method can give important information concerning the etiology of an enlarged blind spot detected with conventional test point perimetry. In addition during the follow-up of a papilledema, fading of the perception of the blind spot in the white-noise field indicates when the edema is resolved. Results of white-noise campimetry in papilledema, glaucomatous atrophy of the optic disc and anterior ischemic optic neuropathy are presented and compared with findings of conventional test point perimentry.

[Disorders of function in pitting of the optic disk]. / Funktionsstörungen bei Grubenpapille.

Using 44 eyes with optic disk pits as reference material, these pits are described with particular attention to the functional disturbances which accompany them. Visual acuity is reduced in about 50% of eyes thus affected. In two-thirds of the cases the deterioration in visual acuity occurs suddenly and without warning, prompting the patient to see an ophthalmologist. The cause of the sudden disturbance of vision is the formation of subretinal fluid, which presumably originates in the vitreous and then passes through the pit into the subretinal space. In the present study it was demonstrated that pits in the optic disk are also accompanied by a defect in the nerve fiber layer. Under meticulous examination these scotomas can be identified both in static perimetry by their steep scotoma rims and ophthalmoscopically by the absence of the nerve fiber layer and of subretinal fluid. The nerve fiber defects often cause only small scotomas which go unnoticed by the patient. In some cases, when they affect the center, they can also result in reduced visual acuity and strabismus.

Influence of windshield tint and tilt on recognition distance under mesopic conditions.

The influence of the angle of inclination and tint of windshields on recognition distance was tested in 94 subjects aged 20-83 years. Both clear and tinted (heat-absorbing) windshields were tested. Light transmission (in the vertical position) was 90.3% for the clear windshield and 81.0% for the tinted windshield. The windshields could be set at angles of 0 degree (vertical), 30 degrees, 50 degrees and 70 degrees of inclination. The tests were performed at night with low-beam headlights (mesopic conditions). A Landolt ring (diameter 43.5 cm; contrast 1:1.5) served as a test stimulus; it was painted on a disc 87 cm in diameter that could be rotated in steps of 45 degrees. The mean recognition distance without the windshield was 32.2 m +/- 5.5 m (mean +/- SD). It decreased to 31.0 m +/- 5.6 m (29.0 m +/- 5.3 m) by using a clear windshield in the vertical position (values for the tinted windshield are shown in parentheses): 30.1 m +/- 5.6 m (27.9 m +/- 5.3 m) with a 50 degrees angle of tilt, and 28.5 m +/- 5.4 m (26.9 m +/- 5.1 m) with a 70 degrees angle. The differences between the recognition distances obtained using the various tilts and tints were small but statistically significant (P < 0.01 in all cases: Student's paired t-test). Since the performance of the human eye is stressed to its limits during nighttime driving, our study suggests that extreme tilt of the windshield should be avoided and that the option of delivering cars equipped with a heat-absorbing but clear front windshield should be provided.

[Modification of refraction and visual noise perception by suction cup oculocompression]. / Beeinflussung von Refraktion und Rauschfeldwahrnehmung durch Saugnapfokulokompression.

In 17 ocularly healthy persons the IOP was artificially raised by suction cup oculopression (negative pressure: 65 mmHg [8.67 kPa]) from initially 15.5 +/- 2.2 mmHg (2.07 +/- 0.29 kPa) to 25.2 +/- 4.0 mm Hg (3.36 +/- 0.53 kPa) (mean +/- SD). Continuing the initial refractive correction, visual acuity (Landolt's rings) decreased from initially 1.06 +/- 0.13 to 0.39 +/- 0.22 (P less than 0.001* [*t-test, paired ties each]). A new optical refraction with suction cup in position significantly raised the visual acuity to 0.64 +/- 0.24 (P less than 0.002*). The suction cup itself induced astigmatism of 2.15 +/- 1.46 dpt (Canon Auto-Refractometer RK-1), which significantly differed from the initial astigmatism (0.32 +/- 0.23 dpt) (P less than 0.001*). The minus cylinder axis initially showed no preferential position. During artificial IOP elevation it shifted to 90 degrees...125 degrees (referred to the right eye) and thus ran about perpendicular to the meridian the suction cup was positioned on the eyeball. Effects of such refractive changes on differential light threshold and VEP amplitude are demonstrated. The results presented allow critical interpretation of previous IOP tolerance tests. The influence of suction cup oculopression on the perception of the white-noise field is shown in some glaucoma patients: the speed of the white-noise campimetry allows the increase in field defects during artificial IOP elevation to be followed up directly.

Correlations between electroretinography, morphology and function in retinitis pigmentosa.

In a retrospective study, data from 116 patients suffering from different forms of retinitis pigmentosa were analysed, and 15 categories comprising altogether 34 symptoms or clinical signs were tabulated from each patient's record. The 15 categories evaluated were: visual acuity, visual field diameter, ring or central scotoma, nyctalopia, susceptibility to glare, refraction, cataract, electroretinography, colour of the optic disc, bone-spicule pigmentation of the retina, retinal vessel diameters, tapetoretinal reflex, sex, heredity, and age. Correlations between the tabulated 34 subcategories or symptoms were calculated. The results of a factorial analysis of the data showed a high number of highly significant correlations between the different categories. It seemed possible to discriminate between two groups of categories, with the members of each group being closely correlated but correlations with members of the other group being much smaller, if not nonexistent. We tentatively associated the first group with the functional state of the central retina and the second group with the state of the peripheral retina.

Standardization of the Tübingen flicker test.

In the Tübingen flicker test, the subjective brightness of a steady field is adjusted to that of a flickering test field at 50-0 Hz. This test has proven itself as a valuable and highly specific method in the diagnosis of optic neuritis (ON). This paper reports on the development of new judgement criteria and their standardization, based on a new cohort of 527 eyes, 138 of them with florid ON. After improving the conditions of examination and evaluation the optimal criteria for the definition of a pathological result were determined in an explorative manner that is described in detail. The criteria finally chosen are defined such that they preserve the high specificity (98%) of the test, while also retaining a high sensitivity (85.5%).

[Comparison of the Kolling distance vision stereo-test with current stereo-test procedures]. / Vergleich des Stereo-Ferntests nach Kolling mit herkömmlichen Stereotest-Verfahren.

A new type of stereotest for distant vision (after Kolling) is compared with established stereotests for distant (different types of Zeiss Polatest) and near vision (Titmus, TNO, Lang tests) in a total of 203 patients. The Kolling test is based on the three-rod method in accordance with Helmholtz. The apparatus does not require separation of the visual input of the two eyes. This new stereotest is practice-oriented, quick, easy to understand and gives reliable and reproducible results. The test cannot be completed successfully with monocular viewing, if the head is fixed. The results show a good correspondence between the Kolling test and the Zeiss Polatest using disparate outlined figures. The Zeiss Polatest using random-dot patterns turned out to have the strictest criteria for this purpose of all stereotests. Interestingly enough, subjects performed much better in stereotests for near vision (Titmus, TNO tests) than in those for distant vision (Kolling test, different types of Zeiss Polatest). The widespread use of stereotests of near vision in driving tests is therefore problematic.

[Effect of prednisolone on the course of optic neuritis. Results of a double-blind study]. / Der Einfluss von Prednisolon auf den Verlauf der Neuritis nervi optici. Ergebnisse einer Doppelblindstudie.

The treatment of optic neuritis (ON) with corticosteroids has been controversial for many years. None of the previous studies with the usual dosage of steroids or ACTH has proven that this therapy is beneficial. However, these studies did not apply sensitive parameters for assessing the course of ON. The aim of this study was to examine the effect of corticosteroids using subtle parameters. The study design emphasized: 1. strict criteria for patient selection; 2. frequent controls during the initial period of the disease, follow-up for 1 year; 3. double-blind conditions with randomized groups; 4. assessment of the course with sensitive parameters, including visual acuity, visual evoked potentials (VEP) and the Tübingen Flikker Test, also called the Aulhorn Flicker Test, which monitors the activity of the ON. These last two tests were used for the first time in a controlled treatment study in ON. Thirty-eight patients with acute ON were treated orally in a double-blind procedure with either methylprednisolone (initially 100 mg daily, reduction every 3 days) or with vitamin B1 (100 mg thiamin daily) in the control group. The results of the Flicker Test and VEP showed a trend toward faster recovery under prednisolone within the first few weeks after onset of the disease. After 1 year none of the parameters examined showed any difference between the two groups. Thus, although prednisolone treatment in the dosage mentioned above seems to speed up recovery in the initial phase in some patients, no long-term benefit could be demonstrated.

[Visual compromise of automobile drivers by frontal photo-flash in mesoptic conditions]. / Visuelle Beeinträchtigung von Fahrzeugführern durch einen Front-Fotoblitz unter mesopischen Bedingungen.

The time for recovery of recognition of an optotype presented at a distance of 40 m subsequent to exposure to a flash gun (Eso company, Tettnang; flash energy 200 Ws, duration 1/1000 s; distance 10 m) was studied on 97 subjects aged 20 to 83 years. A Landolt-ring (contrast 1:5, diameter 29 cm), mounted on a disk (diameter 58 cm) which could be rotated in steps of 45 degrees served as a test target. The flash gun could be dimmed down by a red filter (Schott RG 665). The tests were performed at night without additional illumination except the low beam of the car. The flash gun was foveally fixated. After a white flash, a period of 93.1 s +/- 48.6 s (MEAN +/- SD) passed before the optotype could be recognized correctly again. By adding the red filter in front of the flash gun the recovery time could be shortened significantly (p < 0.0001; Wilcoxon signed-rank test) to 4.9 s +/- 1.7 s. "Time for re-adaptation" after dazzling by red flash is comparatively short and therefore strongly influenced by many variables (e.g. time for recognition and for verbalization). Because of that a final evaluation of dazzling by red flash seems to be impossible with this method. Subjects of advanced age and opacities of the ocular media showed an increase in the "time for re-adaptation" for the white as well as the red flash. In conclusion, a speed control using white flash guns at night can be considered as critical.