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Zusammenfassung Einführung Special Olympics Deutschland (SOD) ist die deutsche Organisation der weltweit größten Sportbewegung für Menschen mit geistiger und mehrfacher Behinderung: Viele Landesverbände von SOD bieten mittlerweile alle 4 Jahre Sommerspiele für diese Klientel an, an denen Kinder und Erwachsene aus dem jeweiligen Bundesland teilnehmen. Während der Landessommerspiele von SO Baden-Württemberg in Offenburg im Jahr 2017 konnten die Athletinnen und Athleten im Rahmen des Gesundheitsprogramms „Opening Eyes – Besser Sehen“ an einem augenärztlichen Screening teilnehmen. Methoden Optiker und Optometristen erhoben die Anamnese und Refraktion, prüften auf Farbfehlsichtigkeiten, Sehschärfe (Ferne und Nähe) sowie den orthoptischen Status. Insgesamt 4 erfahrene Ärzte in Weiterbildung und Fachärzte der Klinik für Augenheilkunde des Universitätsklinikums Freiburg führten Spaltlampenuntersuchungen, Funduskopie und Augendruckmessungen durch. Bei Bedarf wurde eine Funduskopie in Mydriase bzw. eine OCT-Untersuchung angeschlossen. Ergebnisse Insgesamt wurden 166 Personen untersucht (48% weiblich = 80; 52% männlich = 86). Der Abdecktest war in etwa 45% der Fälle in der Ferne und in 47% der Fälle in der Nähe auffällig. Sechs bzw. 11% der Patienten gaben Doppelbilder an (9/156; 17/156; jeweils Ferne und Nähe). Eine auffällige Farbsehprüfung mit weniger als 9 von 9 erkannten CVTM-Testtafeln (Color Vision Testing Made Easy nach Waggoner) wurde bei 8% (11/143) dokumentiert. Fundusauffälligkeiten sahen wir in 13% der Fälle (16/125). 41% (48/118) benötigten eine neue Brillenverschreibung. 29% (45/157) gaben eine Überempfindlichkeit gegenüber Licht an. Jeder 2. Teilnehmer hatte in den letzten 3 Jahren einen Augenarzttermin wahrgenommen; dennoch ergab die Erhebung in 10% (16/160), dass noch kein Augenarztbesuch stattgefunden hatte. In 4% der Fälle wurde eine notfallmäßige Vorstellung beim niedergelassenen Augenarzt empfohlen (z. B. im Falle eines akuten Keratokonus oder aufgrund eines erhöhten Augeninnendrucks). Eine optionale Behandlung (z. B. wegen eines Trockenen Auges) wurde in 40% der Fälle (66/166) empfohlen. Diskussion Menschen mit geistiger Behinderung beklagen allgemeine Probleme mit den Augen oder neu aufgetretene Sehprobleme nicht zwangsläufig und unmittelbar. Zusätzlich besteht möglicherweise ein eingeschränkter Zugang zur augenärztlichen Versorgung im Vergleich zu Menschen ohne geistige Behinderung. Aufgrund der 4% behandlungsbedürftiger Diagnosen sowie der 53% der Teilnehmer mit nicht optimalem Refraktionsausgleich erscheint eine augenärztliche Begleitung von Special Olympics sinnvoll, sollte verstetigt und mit öffentlichen Mitteln unterstützt werden.

Tests of contrast sensitivity (CS) are not routinely performed in the clinic, although CS is reduced in many conditions, such as amblyopia or glaucoma. This may be due to perceived time constraints or unaffordability of equipment.Monocular CS functions obtained with the FACT, CSV 1000E, and Lea Symbols were compared in 19 healthy subjects aged 24 - 78 years and 24 subjects aged 5 - 16 years, 9 of whom had amblyopia.CS functions could be obtained with all three tests. The tests were equally comfortable for young and adult patients, and took less than 5 minutes to perform (one eye). All measured CSs at 3, 6, 12, and 18 cycles per degree (cpd), but the FACT included 1.5 cpd. LINEAR MIXED EFFECT MODELS: were performed. While there was no significant difference at low spatial frequencies, the Lea CS test showed a ceiling effect in that range, while the FACT showed a floor effect at high spatial frequencies. CS in amblyopic children did not differ between the contralateral and the amblyopic eye. Overall, amblyopic eyes had lower CS values than the control eyes and CS did not correlate significantly to visual acuity at distance.All three CS tests could be usefully applied in the clinic in adults as well as children over the age of 4 years. Only the CSV 1000E exhibited neither a ceiling nor a floor effect. This was also the fastest test. In children with amblyopia, CS testing offers additional information on visual function. In contrast to previous reports, we did not find that the CSV and FACT are interchangeable.Obwohl Kontrastempfindlichkeit bei vielen Augenkrankheiten wie Amblyopie oder Glaukom vermindert ist, werden Kontrastempfindlichkeitstest nicht routinemäßig durchgeführt. Der Grund dafür liegt womöglich in der Zeitknappheit oder an mangelnder Ausrüstung.Kontrastempfindlichkeitsfunktionen wurden mit 3 verschiedenen Tests: FACT, CSV-1000E und Lea Symbolen monokular bei 19 gesunden Erwachsenen (24 – 78 J) und 15 gesunden und 9 amblyopen Kindern (5 – 16 J) gemessen und miteinander verglichen.Mit allen 3 Tests konnten Kontrastempfindlichkeitsfunktionen erhalten werden. Die Tests waren vergleichbar angenehm für Jung und Alt und dauerten alle weniger als 5 Minuten (1 Auge). Während alle Tests Kontrastempfindlichkeiten bei 3, 6, 12 und 8 Zyklen pro Grad messen, werden mit dem FACT auch Werte bei 1,5 Zyklen pro Grad gemessen. Lineare Mixed-Effect-Modelle wurden erstellt. In tiefen Ortsfrequenzen ergab sich keine signifikante Differenz. Lea zeigte einen Ceiling-Effekt in den tiefen und FACT ein Floor-Effekt in den hohen Ortsfrequenzen. Bei den amblyopen Kindern bestand kein signifikanter Unterschied zwischen dem amblyopen und dem Partnerauge. Insgesamt hatten die amblyopen Augen tiefere Kontrastempfindlichkeiten als die Kontrollen und korrelierten nicht signifikant mit dem Fernvisus.Alle Tests können sowohl bei Erwachsenen als auch bei Kindern über 4 Jahren sinnvoll in der Praxis eingesetzt werden. Für Kinder mit Amblyopie liefert die Kontrastempfindlichkeit zusätzliche Informationen über die visuelle Funktion. Im Gegensatz zur Literatur waren FACT und CSV nicht austauschbar. Der CSV ließ sich am schnellsten durchführen und zeigte als einziger Test weder einen Floor- noch einen Ceiling-Effekt.

Pediatric vision screening has been shown to reduce the prevalence of amblyopia. To assess the current local situation in the Canton of St. Gallen, a survey study was performed.A standardized questionnaire was sent to 191 general practitioners and school doctors to obtain information on the currently applied vision screening protocols for children. The questionnaire included 17 questions with multiple answers possible.Sixty-seven participants (35%) answered the survey. Overall, 61 (91%) of the repliers confirmed that some sort of vision screening exists. According to 45 (67%) repliers, a mandatory examination exists. As to the question about the person performing the examination, multiple answers were given; 39 (44%) answered that the secretary or the medical practical assistant performs the vision tests, 15 (17%) indicated the school doctor, and 25 (28%) indicated the general practitioner or the pediatrician. Most screening tests are performed in a general practitioner's practice (32; 40%), some are done in the kindergartens (17; 21%), and others are done in a pediatrician's practice (17; 21%). The majority of children are tested at the age of 5 - 6 years (58, 87%). Sixty-one (91%) of the repliers indicated that at least the children's visual acuity is measured. Acuity is assessed with different methods, mainly, with pictures (20; 30%), numbers (23; 34%), and Snellen optotypes (33; 49%).There are no consistent regulations regarding vision screening in the Canton of St. Gallen. Actually, rather different screening scenarios exist. Tests are performed by a variety of people in different locations with diverse testing procedures. A standardization of the applied screening procedures at cantonal and national levels seems reasonable.Sehscreening bei Kindern führt zu einer Reduktion der Amblyopieprävalenz. In der vorliegenden Studie wurden die lokalen Gegebenheiten mit einer Meinungsumfrage untersucht.Ein standardisierter Fragebogen mit 17 Fragen und möglichen Mehrfachantworten wurde an 191 Allgemeinmediziner und Schulärzte versandt, um die geübte Praxis des Sehscreenings bei Kindern zu erheben.Die Rücklaufquote betrug 35% (67 Teilnehmer). 61 befragte Personen (91%) bestätigten, dass ein Sehscreening durchgeführt wird. 45 der Befragten (67%) bestätigten verbindliche Richtlinien. Die Untersuchung wird von einem breiten Personenkreis durchgeführt: In 39 Fällen (44%) werden diese durch die Sekretärin oder durch medizinisches Assistenzpersonal ausgeführt, in 15 Fällen (17%) obliegt sie dem Schularzt und in 25 Fällen (28%) dem Hausarzt oder dem Pädiater. Die Untersuchung erfolgt zumeist in der Praxis des Hausarztes (32, 40%), aber auch im Kindergarten (17, 21%) und beim Kinderarzt (17, 21%). Die meisten Kinder werden im Alter von 5 – 6 Jahren getestet (58, 86%). Gemäß Umfrage wird in erster Linie der Visus erhoben (61, 91%). Die Visusprüfung erfolgt unterschiedlich; vor allem mit Snellen-Optotypen (33, 49%), Zahlen (23, 34%) und Kinderbildern (20, 30%).Einheitliche Richtlinien für das Sehscreening bei Kindern existieren im Kanton St. Gallen nicht. Das führt zu recht unterschiedlichen Szenarien bezüglich involvierter Personen, Untersuchungsorten und angewendeter Testverfahren. Die Untersuchung der Kinder erfolgt eher spät. Eine Vereinheitlichung der Screeningabläufe auf kantonaler und nationaler Ebene scheint sinnvoll.

Dieser Artikel gibt einen Überblick über die physiologischen Grundlagen der Sehschärfe und die Prinzipien für deren Bestimmung in der Praxis des Ophthalmologen oder Optometristen. Dabei werden die Sehschärfe als eine Funktion des menschlichen Auges im Zusammenhang mit anderen Sehfunktionen erläutert und ihre im normalen Auge zu erwartenden Werte angeführt. Die Bedingungen für eine normgerechte Sehschärfebestimmung werden mit Bezug auf die novellierte ISO/FDIS 8596 (2018) beschrieben.

Ist bei einem Patienten eine medizinische Versorgung zur Verbesserung des Sehvermogens nicht mehr moglich, dann sollte baldmoglichst eine optische Versorgung mit Sehhilfen stattfinden. In diesem Beitrag wird die Vorgehensweise der Versorgung sehbehinderter Patienten mit optischen und elektronischen Hilfsmitteln und die Beratung uber optimale Beleuchtung und Filterbrillen beschrieben. The numbers of low vision patients will steadily increase because of increasing longevity. It is important to be aware of those patients so that visual rehabilitation can be started as soon as possible and needed. Before the adjustment of low vision devices a diagnosis should be confirmed in order to check any therapeutic option and to ensure the best individual rehabilitation. If there is no further therapeutic option left a detailed anamnesis of the problems due to low vision should be made to ensure that every patient gets the optical or electronic device he really needs in his everyday life. The first step of the adjustment is to get the best subjective refraction for the far distance and the magnification needed for reading. Thereafter, the testing of different devices can start. It is important to know the advantages and disadvantages of the different devices. Besides the optical devices a counceling of the best light and of edge filters should be made. For the prescription of the devices certain criteria must be performed. That way it is possible to reach the main target namely to improve the quality of life of our low vision patients.

Background and Study Aims To report a case of late recovery of visual acuity after surgical removal of a sphenoorbital meningioma (SOM). Materials and Methods A 42-year-old woman was referred for progressive proptosis of the right eye for 5 years. Her best-corrected visual acuity (BCVA) was 10/10 in her right eye and 10/10 in her left eye, and thyroid function tests were negative. Ophthalmic examination showed slight exophthalmos of her right eye, but eye movements and pupillary light reflexes were normal. Intraocular pressure and fundus examination (FE) in both eyes were normal. Computed tomography scan of the orbits showed hyperostosis and an increase in the thickness of the lateral wall of the orbit, volume reduction of the right orbit, the optic canal, and the sphenoidal fissure, edema, and medial displacement of the lateral rectus muscle. We performed coronal orbitotomy and removed the tumor via a frontotemporal-orbitozygomatic approach and lateral orbitotomy. Results Three hours postoperatively, her right eye was blind with signs of orbital apex syndrome. A high dose of intravenous corticosteroid was then administered. Twenty-four hours postoperatively, BCVA of right eye was motu manu (hand motion), and pupillary light reflexes in the right eye were absent. Five days postoperatively, BCVA allowed counting fingers at 5 m, and ocular motility was partially recovered. Fifteen days postoperatively, BCVA was 1/15, and eye movements were totally recovered. Eight months postoperatively, BCVA was 3/10, pupillary light reflexes were still absent, and FE in the right eye showed a slightly pale temporal half of the optic disc. Twenty months postoperatively, BCVA in the right eye was 7/10. Conclusions Late recovery of visual acuity after sphenoorbital meningioma removal may be possible despite an initial decline.

Hintergrund: Trotz bereits umfangreich vorhandener Studien zur Frage eines fraglichen Zusammenhangs zwischen moglichen Seheinschrankungen und der Legasthenie, welcher von augenarztlicher Seite mehrheitlich verneint wird, propagieren einige Optiker weiterhin eine Behandlung der Legasthenie durch die Korrektur einer „Winkelfehlsichtigkeit” nach MKH. Unser Ziel war es, auch unter Einbeziehung des Pola-Tests, den Sinn einer solchen Behandlung zu uberprufen. Patienten und Methoden: In einer prospektiven Studie wurden uber 2 Jahrgange die Kinder der 4. Klassen der Grundschulen unserer Stadt untersucht, bei denen durch die ubliche Diagnostik eine Legasthenie gesichert wurde (n = 21). Verglichen wurden die Ergebnisse mit einer bezuglich der Lese-Rechtschreib-Fahigkeit unauffalligen gleichaltrigen Vergleichspopulation (n = 21). Untersucht wurden der Visus, die Stellung mittels Cover-Test, Maddox-Zylinder und Pola-Test fur die Nahe, das Binokularsehen (Bagolini- und Worth-Test, Langtest I und II, Titmus-Test, Fusionsbreite), die Akkommodationsbreite, die Refraktion in Zykloplegie und der organische Befund. Ergebnisse: Ein signifikanter Unterschied fand sich zwischen den Legasthenikern und der Vergleichsgruppe bezuglich der Divergenzbreite in Nahe (p = 0,009) und Ferne (p = 0,019) (bei Legasthenikern kleiner) und dem binokularen Nahvisus (p = 0,04). Mithilfe der SAS-Prozedur STEPDISC konnte mittels der Parameter Divergenzbreite in der Nahe, Nahvisus und alternierender Prismen-Cover-Test in der Nahe mit einer Sensitivitat von 81 % und einer Spezifitat von 75 % zwischen den Legasthenikern und der Vergleichsgruppe unterschieden werden. Die Ergebnisse des Pola-Tests zeigten keinen signifikanten Unterschied zwischen den beiden untersuchten Gruppen. Schlussfolgerungen: Zwischen beiden untersuchten Gruppen konnte kein Unterschied bezuglich der Augenstellung nachgewiesen werden, sodass eine Behandlung der Legasthenie mit Prismen nicht sinnvoll ist. Aufgrund der kleinen Patientenzahl ist die Aussagekraft der Ergebnisse allerdings eingeschrankt. Background: Despite numerous studies dealing with the question of a possible relation of visual problems and dyslexia, which is negated by most ophthalmologists, some opticians still favour the treatment of dyslexia by correction of the ”Winkelfehlsichtigkeit” following MCH. Our aim was by also including the Pola test to check the usefulness of this treatment. Patients and Methods: In a 2-year prospective study we examined the 4th grade elementary school students in our city who had dyslexia as an assured diagnosis (n = 21). The results were compared to those of an age-matched group without pathological findings regarding their reading and spelling ability (n = 21). Examinations included visual acuity, eye position by cover test, Maddox cylinder and Pola test for near distance, binocular vision (Bagolini and Worth test, Lang test I and II, Titmus test, amplitude of fusion), amplitude of accommodation, refraction in cycloplegia and organic status. Results: A significant difference was found between the two groups regarding the amplitude of divergence in near (p = 0.009) and far distance (p = 0.019) which were both smaller for the dyslexia group, as well as the binocular near visual acuity (p = 0.04). Using the SAS procedure STEPDISC we discriminated the normal and dyslexia group by amplitude of divergence, near visual acuity and alternating near prism cover test with a sensitivity of 81 % and a specifity of 75 %. The results of the Pola test did not show any significant difference between the groups. Conclusions: No differences were found between the groups regarding the eye position. Therefore a treatment of dyslexia using prisms does not appear reasonable. However because of the group sizes the significance of the results is limited.

Background Opinions differ on the course of the visual acuity in the amblyopic eye after cessation of occlusion therapy. This study evaluated visual acuity in a historical cohort treated for amblyopia with occlusion therapy 30-35 years ago. Materials and methods Between 1968 and 1975, 1250 patients had been treated by the orthoptist in the Waterland Hospital in Purmerend, The Netherlands. Of these, 471 received occlusion treatment for amblyopia (prevalence 5.0%, after comparison with the local birth rate). We were able to contact 203 of these patients, 137 were orthoptically re-examined in 2003. We correlated the current visual acuity with the cause of amblyopia, the age at start and end of treatment, the visual acuity at start and end of treatment, fixation, binocular vision and refractive errors. Results Mean age at the start of treatment was 5.4 +/- 1.9 years, 7.4 +/- 1.7 years at the end and 37 +/- 2.7 years at follow-up. Current visual acuity in the amblyopic eye was correlated with a low visual acuity at the start (p 1 D, n = 16) visual acuity had decreased from 0.17 +/- 0.23 logMAR to 0.21 logMAR +/- 0.23. In patients with both strabismic and anisometropic amblyopia (n = 23), visual acuity had decreased from 0.52 logMAR +/- 0.54 to 0.65 logMAR +/- 0.54. Overall, acuity had decreased in 54 patients (39%) after cessation of treatment. Of these, 18 patients had an acuity decrease to less than 50% of their acuity at the end of treatment. In 15 of these 18 patients anisohypermetropia had increased. Conclusions A decrease in visual acuity after cessation of occlusion therapy occurred in patients with a combined cause of amblyopia or with an increase in anisohypermetropia.

Background Assessment of visual acuity depends on the optotypes used for measurement. The ability to recognize different optotypes differs even if their critical details appear under the same visual angle. Since optotypes are evaluated on individuals with good visual acuity and without eye disorders, differences in the lower visual acuity range cannot be excluded. In this study, visual acuity measured with the Snellen E was compared to the Landolt C acuity. Patients and methods 100 patients (age 8 - 90 years, median 60.5 years) with various eye disorders, among them 39 with amblyopia due to strabismus, and 13 healthy volunteers were tested. Charts with the Snellen E and the Landolt C (Precision Vision) which mimic the ETDRS charts were used to assess visual acuity. Three out of 5 optotypes per line had to be correctly identified, while wrong answers were monitored. In the group of patients, the eyes with the lower visual acuity, and the right eyes of the healthy subjects, were evaluated. Results Differences between Landolt C acuity (LR) and Snellen E acuity (SE) were small. The mean decimal values for LR and SE were 0.25 and 0.29 in the entire group and 0.14 and 0.16 for the eyes with strabismus amblyopia. The mean difference between LR and SE was 0.55 lines in the entire group and 0.55 lines for the eyes with strabismus amblyopia, with higher values of SE in both groups. The results of the other groups were similar with only small differences between LR and SE. Conclusion Using the charts described, there was only a slight overestimation of visual acuity by the Snellen E compared to the Landolt C, even in strabismus amblyopia. Small differences in the lower visual acuity range have to be considered.

Background: Visual acuity measurements are used to determine the course of diseases, treatment outcomes, consequences of accidents, and the occupational ability of a patient. The fact, that visual acuity depends both on visual function as well as on the circumstances of examination, is often understood more intuitively than explicitly. Precision and accuracy of visual acuity measurements must be kept in mind, and occasionally need to be quantified and statistically evaluated, to avoid clinical errors. Methods: Factors influencing acuity measurements are analyzed. Using appropriate examples the precision of acuity measurements is evaluated and quantified with standard vision test charts and threshold or staircase procedures. Limits of confidence and limits of tolerance are described for the statistical evaluation of consecutive visual acuity measurements. Results and conclusions: The statistical evaluation of standard procedures is relatively time consuming, as 3 to 4 standardized measurements are needed on first examination and on follow-up. Threshold and staircase methods, however provide more feasible data, due to the examination technique. All evaluation procedures described here, can only be applied with logMAR acuity readings.

BACKGROUND: Optic neuropathies presenting as bilateral disc oedema lead to a vast field of differential diagnosis; a toxic aetiology should be taken into consideration. HISTORY AND SIGNS: A 55-year-old patient with a non-metastatic pleuramesothelioma received cisplatin as palliative chemotherapy. Due to a unilateral high myopia on the left eye the patient has a severe anisometropic amblyopia. The patient complained about visual loss and changed colour vision. Visual acuity was 0.1 on the right eye and counting fingers on the left eye. The anterior parts of the eyes were unremarkable, the optic nerve head showed bilateral disc oedema. The MRI was free of tumour or signs of elevated intracranial pressure. Colour vision test Panel D-15 revealed a pathologic colour perception affecting the tetartan-axis. Perimetry showed a cecocentral and superior bundle scotoma. THERAPY AND OUTCOME: The patient has been treated with methylprednisolone (Solu-Medrol) 500 mg i. v. 1 gr daily for three days, continued by 100 mg oral steroids successively reduced over a period of three weeks. After three weeks visual acuity increased to 0.3. CONCLUSIONS: Toxic neuropathies including disc oedema, retinal oedema and optic neuritis are rare, but have been described as occasional side effects of treatment with cisplatin.

Background The hallmark of Wolfram syndrome -- an extremely rare autosomal recessive disorder -- is the association of juvenile onset diabetes mellitus with optic atrophy. Additional symptoms such as deafness and diabetes insipidus may develop. History and signs An 18-year-old man suffered progressive visual loss over the last seven years. Severe optic atrophy with extensive cupping and slightly elevated intraocular pressure in both eyes were found. Perimetry revealed peripheral defects with paracentral scotomas. ERG results excluded tapetoretinal degeneration; visual evoked responses were delayed. At the age of nine the patient had been diagnosed with diabetes mellitus type I and neurosensory deafness, seven years later a beginning hypogonadism was found. Therapy and outcome Wolfram syndrome is a progressive degenerative disorder with reduced life expectancy. Treatment is symptomatic. Conclusions Wolfram syndrome should be considered in every patient who presents with optic atrophy and juvenile onset diabetes mellitus.

BACKGROUND: In young patients with the clinical symptoms of a neuritis neuroradiological imaging is not always necessary. This case report describes a young patient who suffered from a recurrence after 5 years. Since all findings, particularly visual evoked potentials, were classic for neuritis, the patient was treated for neuritis although periocular pain was not present. CASE REPORT: Five years after a neuritis of the left eye (OS), the patient was again referred with a visual loss (VA 0.3 OS). In addition to an afferent pupillary defect OS and a constricted visual field OS, an inter-eye latency difference was demonstrated in the visually evoked potentials. The patient was treated with megadose steroid therapy. Although periocular pain as a classic symptom was absent, no neuroradiological imaging was performed. Six weeks later visual acuity and visual fields further worsened, such that a nuclear magnetic resonance imaging was indicated revealing a meningioma fronto-basally compressing the optic nerve. After neurosurgical intervention visual acuity and field stabilized. CONCLUSIONS: In rare cases, meningioma may mimic the symptoms of neuritis. Therefore, neuroradiological imaging is indicated in recurrences or complicated disease courses, particularly if classic symptoms such as periocular pain are missing.

Background The Melkersson-Rosenthal syndrome complex is characterised by asymmetric orofacial oedema, facial palsy, furrowed tongue (lingua plicata) and additional neurological symptoms. Patient A 21-year old man presented with a bilateral asymmetric oedema of the eyelids which increased during the follow-up period of 12 years. Intermittent swelling of the auditory channel occurred and resulted in hearing loss. Furthermore, the patient complained unspecific neurological symptoms as headache, tinnitus and subjective visual defects. The lid oedema did not only result in cosmetic problems but seriously restricted visual fields. Results Our patient showed the typical symptoms of the Melkersson-Rosenthal complex, lacking however facial palsy which is often caused by mechanical compression along the course of the facial nerve. The differential diagnosis of recurrent swelling of the lids was discussed on an interdisciplinary plane. The inflammatory activity could be reduced and the frequency of swelling episodes could be diminished by a treatment with hydroxychloroquine. The initially relapsing, then persistent swelling had led to severe restriction of the visual field and resulted in a severe social stigmatisation and psychic stress for the patient. The surgical resection of the granulomatous tissue was carried out under steroid treatment to prevent recurrence. Histochemical analysis showed inflammation of the lymphoid plasmacellular type with mucipolysaccharidoid deposition typical of Melkersson-Rosenthal syndrome. Blepharoplasty resulted in an improved cosmetic appearance. The patient remained symptom-free with an excellent functional result. Conclusions After persistence and constancy of the findings of a granulomatous blepharitis, surgical correction is a good opportunity to minimise the subjective complaints and neurological symptoms.

The neuro-ophthalmologic examination provides an enormous amount of information about the 40% of fibers that provide afferent and efferent limbs of the visual, pupillary, and ocular motor pathways. A few tools and the correct testing approach will maximize the value of this examination. This chapter provides step-by-step examination methods and points out some of the common errors that are made.

Background Endoscopic endonasal optic nerve decompression (EEOND) is indicated in traumatic and endocrine orbitopathies as well as in idiopathic intracranial hypertension. Case We present a patient with bilateral nonspecific inflammatory orbitopathy (NSIO) and optic nerve compression presenting with acute severe visual loss. Bilateral orbital and optic nerve decompression was performed as an emergency procedure with a favorable ophthalmological result. Conclusion EEOND is an effective and safe technique in acute orbitopathies and should be taken in consideration in atypical clinical settings causing severe acute visual loss.

The National Health Survey for Children and Adolescents intends a comprehensive description of the health status of children and adolescents. In this context physical examination of children and adolescents permits collection of objective data concerning physical development, certain body functions and selected performance parameters. Most important are indicators pointing towards increasing developmental and health problems in children and adolescents, which are partly predictive for the health status as an adult. Body measurements including stages of puberty will be taken, the blood pressure measured, vision tests carried out, coordination skills and endurance tested. Besides, if acute symptoms are detected, severity of atopic dermatitis is recorded. The methods and instruments have been tested in a pilot study over a period of one year and were optimised for the main study.

Purpose To classify dissociated horizontal deviations (DHD) based on the etiology of the vergence that causes the dissociation of the squint angle. Methods Dissociated strabismus can reliably be diagnosed by a change of the squint angle caused by an alternation in the fixation from one eye to the other, when all the other conditions (head posture, direction of gaze, fixation distance, accommodation) remain unchanged. The decisive diagnostic tool is the reversed fixation test: During monocular fixation with one eye, the squint angle of the other eye is neutralized using a synoptometer or a prism. Then, the fixation is changed to the other eye, which keeps its position behind the prism. If the change in fixation causes a change in the position of the previously fixating eye, the deviation is dissociated. If the position of the previously fixating eye does not change, the deviation is not dissociated. Results Dissociated strabismus can be detected and differentiated from both comitant and incomitant non dissociated strabismus by the reversed fixation test. The dark red glass test is less sensitive and less specific for dissociated strabismus than the reversed fixation test, if a difference in accommodative convergence is excluded, possible causes of DHD are nystagmus-attenuating convergence, substitution of version eye movement by convergence, and a horizontal side effect of the vertical eye muscles in asymmetric DVD. Conclusion Dissociated strabismus is an effect of vergence which is brought about by the change in the fixation or dominance from one eye to the other eye or in the interocular ratio of afferent input (luminance). Dissociated strabismus can be classified based on its direction or due to its etiology.

Background The theory of the "Measuring and Correction Methods of H.-J. Haase" (MCH) states that a small misalignment of one eye, called fixation disparity, indicates a difficulty in overcoming a "vergence position of rest" that is different from ortho position. This difficulty, so the theory, can cause asthenopic complaints, such as headaches, and these complaints can be relieved by prisms. The theory further claims that fixation disparity can be ascertained by a series of tests which depend on the subject's perception. The tests most decisive for the diagnosis of a so-called fixation disparity type 2 consist of stereo displays. The magnitude of the prism that allows the subject to see the test configurations in symmetry is thought to be the one that corrects the "vergence position of rest". Methods Nine subjects with healthy eyes in whom a "fixation disparity type 2" had been diagnosed were selected for the study. Misalignment of the eyes was determined according to the principle of the unilateral cover test. Targets identical for both eyes were presented on the screen of the Polatest E. Then, the target was deleted for one eye and the ensuing position change of the other eye was measured, using the search coil technique. This test was performed both with and without the MCH prism. Results In all 9 subjects the misalignment was less than 10 minutes of arc, i.e. in the range of normal fixation instability. Averaging across the 9 subjects, the deviation of the eye (misaligned according to MCH) was 0.79 +/- 3.45 minutes of arc in the direction opposed to that predicted by the MCH, a value not significantly different from zero. The MCH prism elicited a fusional vergence movement the magnitude of which corresponded to the magnitude of the MCH prism. Conclusion Ascertaining fixation disparity with the MCH is unreliable. Accordingly, it appears dubious to correct a "vergence position of rest" on the basis of the MCH.

Purpose Lea (LH) symbols seem to be favourable for visual acuity assessment in childhood. The symbols of the LH test are well standardized and applicable to preschool children. We compared the visual acuity determined by LH single symbols (LH) and the acuity measured with the Landolt-C (LC). Patients and methods 138 cooperative subjects aged 7 to 91 years were examined. Their visual acuity was either normal or reduced due to various etiologies. Their refractive error was corrected. The monocular LH and LC were determined by a 3/4 criterion (study 1). In 19 healthy subjects aged 21 to 58 years, acuity was reduced stepwise by 5 different calibrated occlusives (study 2). A Lighthouse single symbol book (LH symbols) was used at a distance of 3 m. LC was determined at a distance of 5 m. The luminance of the test field was 180-200 cd/m2. The right eye of each patient and the amblyopic eye of the squinting patients was taken for statistical evaluation. The strabismic patients' interocular differences of LC and LH were compared. Results Within study 1, LC ranged from 0.02 to 2.0 and LH from 0.03 to 2.5. LH overestimated LC by 1.4 lines on an average (t-test p 1 line, 85.7% resp. 90% of the strabismic amblyopic patients with an interocular LC difference > 1 resp > 2 lines were detected. In study 2, LC ranged from 0.1 to 1.6, LH from 0.12 to 2.0. The mean difference LH-LC was 1.3 lines. The regression equation was lgLH = 0.91 lgLC + 0.08 (r = 0.95). Conclusion LH symbols allow a reliable measurement of recognition acuity. Due to the design of the symbols, they are excellently suitable for application to preschool children. Age related normal values should be established. The systematic difference between the LC acuity and the LH acuity measured with the Lighthouse LH single symbol book by 1.4 lines has to be considered.

Background This overview gives a rough frame how to proceed to a quick diagnosis and possible differential diagnosis in patients with diplopia. Method A thorough interview concerning the onset of symptoms, invariability, and subjective perception is mandatory. The first step before examining ocular motility is to verify monocular or binocular double vision. When the reported diplopia is binocular, the examiner can carry out the red-glass test to determine the site of the double image. In a next step monocular range of movement in the 9 directions of gaze is evaluated to search for incomitance. Results The main causes of diplopia are palsies of the oculomotor nerves, mechanical restriction--posttraumatic or inflammatory--, supranuclear lesions and disturbed neuromuscular junction. Conclusion With a simple and clear diagnostic diagram ist is easy to work out the underlying cause of diplopia.

Purpose To show how to progress from the deviation of the visual axis (provided the diagnosis of concomitant strabismus is certain) to the classification of the squint in one out of the different squint syndromes and consequently to adopt the appropriate therapeutic strategy. Method Every sign correlated with the deviation contributes to progress step by step to the diagnosis of a given squint syndrome. The age on onset of strabismus, either convergent or divergent, and its characteristic, intermittent or constant, allow in a first step to evaluate the potential binocularity, as well in early as late (acquired) strabismus. The first group of early strabismus includes manifest infantile strabismus and microstrabismus. Both have abnormal binocularity. The possibility of functional amblyopia, angle variability and additional incomitances have to be investigated. Early intermittent strabismus keeping a potential normal binocularity are seldom. In the second group of late onset strabismus, retinal correspondence has to be investigated by correspondence tests and prism or bifocus compensation to distinguish between the two possible types (including the accommodative forms of strabismus), i.e. decompensated microstrabismus with abnormal binocularity or normosensorial strabismus with potential normal binocularity. In some cases potential binocularity may be initially uncertain and/or remain later on subnormal. Results As the result of this systematic approach, every cases of squint can be classified in one out of the different squint syndromes. Based on the precise diagnosis, the appropriate treatment can be carried out. The goals of treatment which can be reached in every syndrome are indicated. Discussion For an overall view of the squint syndromes a classification with two entrances are necessary, on the one hand early or late onset, on the other hand normal or abnormal binocular conditions. Conclusion This approach of concomitant strabismus should serve as guide lines for clinical practice.

BACKGROUND Partially sighted often experience problems in orientation in public areas. Individual visual aids can only be used with limitations. Improving light intensity and colour contrasts of timetables, information signs, direction symbols, etc. can provide remedies. Experimentally substantiated directives do not yet exist. PATIENTS AND METHODS Experiments were conducted in 231 partially sighted subjects (binocular vision < 0.3) diagnosed as experiencing dullness when watching the media, having maculopathies, glaucomas, or dystrophic alterations of the retina or choroid, and in 43 normal subjects to determine the subjective assessment of colour and light-intensity contrasts. The presented contrast patterns were Hartmann-characters as infield (3.3 degrees) with a rectangular surround (19.5 degrees x 14.3 degrees). Three experimental series were carried out in which subjects assigned 14 non-coloured/non-coloured contrasts, 35 non-coloured/colour contrasts and 30 colour/colour contrasts to any of the five assessment classes of extremely poor, poor, optimal, sharp, extremely sharp. The colour contrasts consisted of combinations of yellow, green, red, purple, blue, and non-coloured. RESULTS For non-coloured/non-coloured, the subjects preferred positive contrasts (bright infield, dark surround). Preferred contrast levels were 0.91 to 0.99 for positive contrasts and -0.96 to -0.99 for negative contrasts. For colour/non-coloured contrasts, 90% of the partially sighted preferred yellow as the foreground colour with a contrast level above 0.89. For colour/colour contrasts, optimal assessments of 90% of all partially sighted were yellow/purple and yellow/blue with contrast levels above 0.90. The determined results are applicable for the exact experimental contrast settings only. A field manual was prepared for planning and design of contrasts suited for the partially sighted in public areas. CONCLUSIONS Partially sighted, in subjective contrasts assessment, prefer bright characters of signs on a dark background for both non-coloured and colour contrasts with contrast levels above 0.9. Yellow was the preferred infield colour.

Background There are controversies concerning the necessity of pre-school vision screening. Aim of the study evaluation of the prevalence of pathologic ophthalmologic findings in kindergarten children. Materials and methods 1030 families were offered a vision screening. Of these, a total of 948 children, aged 3 to 6 years, voluntarily underwent a screening for strabismus, amblyopia and refractive anomalies. The examination was performed in the kindergarten in the absence of the parents. METHODS OF EXAMINATION: A questionnaire concerning general and ophthalmologic history of the child and of the family was evaluated. Visual acuity, cover-uncover-test, Lang-stereotest, retinoscopy, ophthalmoscopy (undilated pupils) were performed and the glasses were evaluated. Results The screening was highly accepted by the parents and 92% of the families (n = 948) took part. The compliance of the children was very good. A total of 38.7% (n = 381) of the children showed one or more abnormal parameters. 21.4% (n = 229) showed a reduced visual acuity. Strabismus was found in 3.7%. Half of the children with abnormal findings already had had a vision screening, but only 25% had received ophthalmologic treatment. Of those who possessed glasses, 25% came without them, and another 25% had a reduced visual acuity even with their glasses. The main problems were many false-positive results and high costs. Conclusions Ophthalmologic and orthoptic screening in kindergarten is technically easy and conclusive in experienced hands. Ideas to reduce costs and to avoid overreferrals are an age-related lowering of the visual acuity limit and a rescreening of suspected children in a screening-setting a second time before sending them to an ophthalmologist. Another possibility to reduce costs would be to perform examinations not by ophthalmologists but by "screening-orthoptists" who should be trained in retinoscopy and ophthalmoscopy.

Background Reading acuity as well as reading speed are good predictors of everyday visual function. As visual acuity tests are poor predictors of the real-world function, performance-based tests, e.g., reading speed measurements, can be used for the determination of visual function. Thus, a German reading chart was developed in order to evaluate reading acuity as well as reading speed. Methods Print size is defined as the height of a lower case x and progresses logarithmically from one phrase to another (factor: 1.25). Reading acuity is determined in LogRAD (Reading Acuity Determination). 32 short German phrases were created, comparable concerning grammatical difficulty as well as in number (n = 14), length and position of words. The reading speed parameters measured with a stop-watch in 160 persons (aged: Phi = 21a +/- 3.8a) were calculated in words per minute (w/min). Out of the 32 phrases the 24 most similar ones were selected statistically and used for the reading charts (Radner Reading Charts). With these reading charts a reading acuity score (LogRAD-score) can be calculated considering reading errors in words of different length. Reading speed can be determined at the same time. Reading acuity (LogRAD-Score) was measured in 32 normal eyes of 16 students and compared to the angular visual acuity (LogMAR). Results The mean reading speed of the test persons was 211.8 +/- 34.1 w/min. 24 phrases fulfilled the test item criteria for the reading chart: mean +/- 0.25 x SD. The reliability analyses yielded an overall Cronbach's alpha coefficient of 0.98! The mean visual acuity measured in 32 eyes was -0.115 +/- 0.097 LogMAR and the mean reading acuity score was +0.026 +/- 0.091 LogRAD. The mean difference was +0.104 +/- 0.066 and the correlation between LogMAR and LogRAD was good (r = 0.59). Conclusions With these reading charts it is for the first time possible to simultaneously determine reading acuity as well as reading speed in German. The high reliability of the 24 phrases and the high correlation between LogMAR and LogRAD leads us to expect a good reproducibility of the reading acuity evaluations. For the "Radner Reading Charts" we have shown that print size is the main reason for changes of reading speed.

Background According to certain findings obtained with the Zeiss Polatest®, H. J. Haase defined a Fixation Disparity Type One. In this diagnosis, the Zeigertest is particularly important. The Zeigertest consists of a central ring presented to both eyes for fixation, a vertical clock hand presented to the right eye and two markings at the six and twelve o'clock positions presented to the left eye. All parts are surrounded by a binocularly visible frame. Subjects with a Fixation Disparity Type One see a misalignment between the clock hand and the peripheral markings. We investigated (1) whether the perceived misalignment correlated with an objective deviation of the eyes from orthovergence and (2) whether subjects with a Fixation Disparity Type One had a deviation of the eyes from orthovergence when looking at a natural, i.e., fully fusionable object. Subjects and methods Out of 303 medical students, 10 subjects with a Fixation Disparity Type One were selected and asked to indicate the perceived alignment or misalignment in the Zeigertest with a laser pointer. Two subjects without fixation disparity served as controls. The position of both eyes was recorded using the search coil technique. One of the 10 subjects with Fixation Disparity Type One had to be excluded due to excessive blinking. Experiment 1: In the beginning all parts of the Zeigertest were presented to both eyes (natural viewing condition). Then, the object for one of the eyes was switched off leaving the frame as the only fusional stimulus. The outcome variable was a refixation movement of the other eye. This experiment is similar to the unilateral cover test. Experiment 2: In the beginning all parts of the Zeigertest were presented to both eyes (natural viewing condition). Then, the original Zeigertest was switched on (clock hand presented only to the right eye, peripheral markings only to the left eye). The outcome variable was a change ofvergence. Results Experiment 1: A significant refixation movement did not occur in any of the subjects. Experiment 2: In all 9 subjects with Fixation Disparity Type One the vergence changed significantly between 2.4 and 14.9 arcmin. The change of vergence correlated significantly with the angle of the perceived misalignment between clock hand and peripheral markings. Conclusion A fixation disparity ascertained at the Zeigertest does not indicate a fixation disparity under natural viewing conditions.

Background In Germany the paediatricians use three different visual acuity tests (Pictures, Rodenstock-Test, H-Test). We investigated the effectiveness of these procedures. Subjects In this study 303 children were referred by paediatricians to the study group in the Cologne Augenklinik. They were fully examined by an orthoptist and an ophthalmologist (gold standard). Results From these data the sensitivity and specificity of the tests used by the paediatricians were calculated. Only the H-Test proved to be satisfactory. Conclusion The actual situation of screening for amblyopia by paediatricians in children aged 3 1/2 to 4 is unsatisfactory in Germany. Paediatricians and ophthalmologists should use a similar test for visual acuity. Continuing education of medical personnel is desirable to ensure an adequate quality of screening.

Background Stereotests based on random distribution pattern (global stereopsis) show disadvantages when giving larger disparation, because subjects with limited fusion-ability do not recognize them, while realistic shapes of objects (contour stereopsis) are usually fused. Because of this random dot tests can not always be utilized to verify subnormal stereo-ability. Subjects and Methods This paper describes a way of testing stereo-ability not by approaching stereo-angle-thresholds but by presenting supra-threshold stimuli and evaluating the emphasized subjective elevation level readings. With this method I examined normosensoric healthy subjects and compared them to subjects with different binocular defects. Results and Conclusions The subjective sensations correlate well with the clinical impression of what those patients, known at the department for long periods, should be able to differentiate. There is no evidence that healthy people are fully competent while cured strabismus cases should be incompetent. Indeed a gradual decrease of stereo-ability is seen. We strive for a really simple finger test in terms of subjective deDth perception as a quick halfprecise office check.

Background Although tenotomy of the medial rectus (MR) is generally regarded to be obsolete, consecutive exotropia after this procedure, requiring a reoperation, still occurs. Patients and Methods In 143 patients a reoperation after tenotomy of the MR had to be performed because of consecutive exotropia. Either only the MR was sutured at the original insertion (advancement ; this constitutes group 1, n = 101) or the lateral rectus (LR) was recessed in addition (group 2, n = 12). The recession of the LR was only added if the adduction was not distinctly limited and if the distance of the MR from the limbus was less than 16 mm. We wanted to find out whether the procedure in group 1 or 2 gave the better results. Results In group 1 the muscle sheath of the MR was found at a distance of 7 mm (median), the muscle itself at a distance of 18 mm from the limbus (confidence interval 13.5-25 mm). In group 2 the distance of the muscle sheath from the limbus was similar to group 1, the muscle itself was found already at a distance of 12 mm from the limbus (confidence interval 6-18 mm). After reinsertion of the muscle at the original insertion without recession of the LR, a distinct limitation of abduction combined with a globe retraction was seen immediately after surgery. A spontaneous release of the old contracture reduced these troublesome side effects. Three months postoperatively the initial surgical effect had diminished to 83%. The average postoperative squint angle was - 3° at 5 m and -4° at 0.33 m with a high scatter. In group 1 [group 2 in brackets], the range of the horizontal motility was improved by 15 [10°] (median) and the incomitance, i.e. the difference between the angle of squint at 25° gaze to the right and to the left, by 4° [0°, i.e. no improvement]. Thus, this postoperative improvement was smaller in cases of simultaneous recession of the LR (group 2). Discussion The most important aim in a reoperation after tenotomy of the MR is to find the muscle itself and to suture it to the original insertion. It can be expected that the contracture of the MR will loosen when the muscle is put under increased tension. This effect will be less if the LR is recessed in addition to the advancement of the MR. Consistent with this assumption, our not randomized, retrospective study revealed a better horizontal motility after advancement of the MR alone. Because of the difficulties in revising a tenotomy, we strongly advise a graded recession rather than any form of tenotomy.

Aim of the study This study investigates the sensitivity of a computerised videorefractor (VRB 200) for refractive errors, especially amblyopiogenic, in babies and infants. Patients and methods Videopictures from 312 eyes of 156 babies and infants were taken, evaluated and compared with the current measurements (skiaskopy or refractometry) of the university eye hospital Erlangen-Nurnberg. Results 255 (81.7%) of 312 eyes were evaluable. The VRB 200 achieves a sensitivity of 96.1% in hyperopic eyes (219 of 228 eyes) and 94.7% in myopic eyes respectively (18 of 19 eyes). Of 8 emmetropic eyes 6 were recognized correctly negative. Astigmatism could be estimated coarsely quantitatively in power and qualitativ in the axis with a sensitivity of 80% (92 of 115 eyes) and a specificity of 86% (121 of 140). Anisometropia over 2 dpt was recogniced in 5 of 6 patients. A general statement concerning the specificity is not possible with this study, because it is not a mass screening procedure. Conclusion This videorefractor is able to recognize semi-quantitatively amblyopiogenic refractive errors with high sensitivity.

BACKGROUND: Postoperative bacterial endophthalmitis are caused in 80 % of the cases by the patient's own flora. Most of the time, bacterial agents are Gram-positive ((2/3) of cases) and more rarely Gram-negative ((1/3) of cases). Usually, Pseudomonas sp, Proteus sp or Klebsiella sp are isolated, but very rarely Morganella morganii. HISTORY AND SIGNS: We describe a case of a Morganella morganii endophthalmitis which occurred after a vitrectomy. THERAPY AND OUTCOME: Bacterial examinations disclosed the presence of Morganella morganii in the vitreous. An aggressive treatment (intravitreous [ceftazidim, vancomycin], topical [gentamycin, chloramphenicol] and intravenous [imipenem, ofloxacin] antibiotics) was introduced. In spite of this treatment, the outcome was not favorable. CONCLUSIONS: Post-vitrectomy endophthalmitis is very rare and the isolation of a Gram-negative bacteria, in this case Morganella morganii, is infrequent. The outcome of these infections is often poor despite the introduction of a rapid, specific and aggressive treatment.

Background In case of visual loss without morphologic pathology differentiation between a functional visual loss and a retinal disorder may be difficult. Patients and methods We report on two women, aged 33 and 44, who were complaining of a progressive visual loss occurring over the past several weeks to months. They were referred to our department with the presumed diagnosis of functional visual loss. Biomicroscopy of the anterior and posterior segments, perimetry (Goldmann), colour (FM-100-Hue-Test) and stereopsis testing (Lang-Stereotest), fluorescein angiography (FLAG) and electrophysiological testing (P-ERG, VECP, EOG, multifocal electroretinography [mfERG]) were performed. Results Visual acuity was 0.16 OU and 0.25 OU respectively. A small relative central scotoma (I/1) was detected by dynamic perimetry. Colour vision, random-dot stereopsis and the results of electrophysiological testing except multifocal electroretinography (mfERG) were normal. The mfERG was able to detect a cone dysfunction which was related to the fovea. Conclusion In case of visual loss of unknown etiology electrophysiological testing is indicated. The mfERG as an objective diagnostic method is able to detect a foveal cone dystrophy.

Pilots so far are required to have a good quality of stereopsis. Many people do not meet this requirement. But is this requirement justified by research in aviation medicine and psychology of perception? This question is discussed on the basis of the theoretical and empirical literature. The answer is: No.

PURPOSE: We present a visual acuity test for proof of malingering and psychogenic impairment of visual acuity. METHOD: The book contains 36 plates. On 32 plates, a Landolt-C is shown with a gap of 10 minutes of arc, thus corresponding to a visual acuity of 0.1, when applied at a distance of 1 metre. Each of the 4 alternatives of the Landolt-C occurs eight times in random order. Starting at position 21, four plates are interspersed showing a closed circle of the same size. The test is used at a distance corresponding to an acuity level of maximum 50% of the presumed factual acuity. Following a four alternative forced choice paradigm, the tested person is requested to call the direction of the Landolt-C within about 2 seconds, when the plates of the book are turned over. The responses and their latency are recorded using a digital electronic system which allows later audiovisual analysis. The response on the first closed circle and its latency is compared to the previous responses. Two subjects were tested who tried to pretend a reduction of their visual acuity. RESULTS: Malingering was proved by the verbal response of the first subject and by the long latency of the response of the second subject (4.0 s vs. 1.2 s-2.7 s for the previous responses). The entire test, explanation included, took less than 5 minutes. CONCLUSION: This handy test can be a useful tool in cases suspect of malingering or psychogenic impairment of visual acuity.

The aim of the following study was 1) to show the incidence of ophthalmic disorders in severely visually and mentally handicapped children retrospectively 2) to follow up the change in visual acuity over at least 2 years prospectively 3) to look at the effect of therapeutic concepts. 270 children of the "Blindeninstituts-stiftung Wurzburg" were followed up between 1960 and 1987. ad 1) Optic atrophy was the leading cause of visual impairment (24%) followed by cataract and retinopathy of prematurity (both found in 17%), malformations of the anterior segment (12%), cortical amblyopia (8%) and refractive error (6%). Strabismus was an additional finding in 38% of the children often associated with nystagmus. Convergent and divergent strabismus had the same incidence. ad 2) Visual acuity improved in 30% of cases of cortical amblyopia, in 40% of refractive errors and in 30% of optic atrophy. In cases of cataract there was a slight improvement in 20%. In 24% of aphakia a secondary glaucoma was observed. In cases of malformations of the anterior segment and ROP the visual acuity remained stable on a low level. The cases of ROP were advanced and had not received any surgical treatment. A deterioration in vision as often seen after surgical intervention was observed in 20% of ROP. In respect of the high incidence of refractive errors and orthoptic problems in multiple handicapped children they should be seen as early as possible by an ophthalmologist. Detection of a congenital cataract soon after birth as well as complications of other disorders should help to prevent blindness. The remaining visual perception is especially important for the handicapped child to communicate and move about.

A 45-year-old man with Fabry's disease is presented. 27 relatives are examined. Among the different examinations (serum activity of alpha-galactosidase, urinary excretion of trihexosyl ceramide, renal function, ocular examination) ocular examination remains the easiest and cheapest test for detection of heterozygotes. The ocular manifestations of this enzymatic defect are reviewed.

That the Pola test figures of heterophoric subjects with fixation disparities are described as deformed at times, was published by H. J. Haase two decades ago. The main subject in this publication is a 13-year-old boy with early childhood convergent strabismus, in which the "squint therapy" which was used at that time, did not change the angle of squint and the anomalous correspondence to any extent. The corrected visual acuity was the same bilaterally, 1.0 to 1.1. If the esotropic eye position was corrected as well as possible with prisms to the objective angle, a change between diplopia and binocular fusion occurred; occasionally even to "normal corresponding" fusion with correct stereopsis. In the transition phases the test level appeared to be more or less drawn out in width, and the half figures underwent all kinds of "somersaults". Binocular macropsia and monocular micropsia and macropsia, and also polyopia and unusual depth effects were described. Confusion did not occur; all pictures had form. These rare phenomena were interpreted as a competition between established anomalous and latent normal correspondence. This communication should stimulate further observations of this type and, should the occasion arise, lead to experimental research.

In 10 cases, aphakia after silicone oil surgery was corrected as follows: after completion of all retinal interventions, but not less than 3 months after silicone oil removal, an anterior chamber lens (Kelman Multiflex) was implanted. Binocular vision was interrupted for periods ranging from 4 months to 4.6 years (mean 2 years). Tests of the recovered binocular vision, on average 13 months after implantation of the lens, revealed simultaneous vision in 7 cases and exclusion in 2 (primary amblyopia; secondary divergent squint). Stereoscopic vision of 3800" was achieved in 4 cases, and of 200" in one. Four patients regained measurable fusion, between 6 and 29 diopters.

Background Strabismus with unilateral elevation in adduction is an upward deviation of the adducting eye of unknown, not necessarily paretic origin. The term old trochlear palsy may be erroneous since the hypertropia is not necessarily larger in downward gaze and a causative lesion can usually not be identified. We describe here a marked voluntary influence on unilateral elevation in adduction, in situations that exclude binocular fusion. Patients Two patients with an elevation in adduction of the right eye and a positive head-tilt phenomenon, a 21-year-old and a 28-year-old man, were able to vary their vertical angle of squint at will. Even under artificial conditions that exclude binocular fusion (alternate cover test, dark-red glass test) could they change their right-over-left deviation, Patient 1 between 4 and 20 degrees and Patient 2 between 0 and 15 degrees. Under natural viewing conditions both patients had binocular vision with stereopsis that decompensated only when they looked to the left. Conclusions We assume that our two patients had a motor memory that stores the muscle innervation for parallel eyes, i.e. the innervation suitable for binocular vision, and that the patients made use of or neglected this memory at will. In general, our observations suggest that a variable recourse to such a motor memory explains why, in patients with unilateral elevation in adduction, the angle of squint often changes. A voluntary access to this memory may, however, be exceptional.

Background Especially in aged patients testing the visual acuity can be most time consuming. An automatic test could therefore be of great help. The recently introduced "Freiburg Visual Acuity Test' (FVT) using a forced-choice determination of Landolt orientation has proved a reliable method of automatic visual acuity testing in younger patients. Patients To learn about practicability and ease of this self-administered test, we tried this test in 87 patients (mean age 73) before and after cataract surgery. The Landolt ring was presented in 8 different positions on a monitor. A keyboard of 8 buttons, depicting the possible orientation of the Landolt C, allowed the patients to run through the test by themselves. With each patient's correct response, the size of the Landolt ring decreased accordingly. Results Although near vision of all patients was grossly impaired and accommodation power zero, handling of the keyboard for the subject's response was generally reported as easy. The reliability and reproducibility of the obtained values were good and close to acuity values obtained using projected test figures according to DIN. Prior to cataract surgery we found DIN values statistically significantly lower than FVT values. This difference did not persist after surgery. Conclusion Although the tested patients were definitely no computer freaks, the procedure of the test was rapidly understood. The average testing time was 4.5 min, thus prolonged by 40% in comparison to assisted DIN testing, however consuming only 1.0 min of personnel's time. The test proved to be equally reliable in the elderly patient.

The retinal coding system for visual information comprises three important steps: 1) hyper- and depolarization of the sensory cells as the active basis for perception of light and dark; 2) reaction solely to changes in the bipolar cell on/off system, as a consequence of the action of the horizontal cells with the receptive fields, as a basis for adaptation to brightness and glare; and 3), under the influence of the amacrine cells, important time-space functions as a basis for visual perception of movement. The signal form, which changes over from analog to digital in the ganglion cell system, also results from this last step. therefore, both latencies and amplitudes (VEP) are important criteria for long signal response paths. Taking the examples of "statistical perimetry", visual acuity testing, and examination of contrast sensitivity, clinically relevant methodological problems from signal detection theory are illustrated: there are no "certain" measured values. This uncertainty and the age-dependence of normal values make it difficult to identify pathologic conditions, though trend analyses can help. As the sizes of the retinal areas examined by these methods differ so widely, correlations between the various examination methods are theoretically possible; but one method can never be substituted by another. In routine practice, to detect pathology early, one will sometimes deviate from the prescribed examination method (vision tests with low contrast for visual acuity).

A microcomputer program for the Apple II family of computers on a monochrome and a color screen is described. The program draws most of the tests used by ophthalmologists, and is offered as an alternative to a projector system. One advantage of the electronic generation of drawings is that true random orientation of Pflueger's E is possible. Tests are included for visual acuity (Pflueger's E, Landolt rings, numbers and children's drawings). Colored tests include a duochrome test, simple color vision tests, a fixation help with a musical background, a cobalt blue test and a Worth figure. In the astigmatic dial a mobile pointer helps to determine the axis. New tests can be programmed by the user and exchanged on disks among collageues.

Stereoacuity can be measured accurately in 6-year-old (pre-school age) children using a specially designed test. The values obtained, measured with stereo testers for long-range and close-range vision, do not differ significantly from those obtained in adults. Hence, it appears that the development of binocular vision must be terminated earlier than hitherto assumed. The limiting factor in stereo measurements at this age and with these methods is the degree of maturity of the children's mental and motor capabilities.

Visual acuity, contrast sensitivity, and visual fields were examined with and without occluders both in a group of healthy subjects and in a group of patients with field defects (mostly caused by glaucoma). The various results were compared with one another as well as with the results obtained from a group of cataract patients examined before and after surgery. The results confirm clinical experience: visual acuity enables some conclusions to be drawn on the degree and progression of opacity of a lens. The changes in contrast sensitivity and in the visual field, however, represent rather the quality of the visual degradation. Contrast sensitivity and diffuse alterations in the visual field have similar progression patterns. The alterations in contrast sensitivity are more pronounced at higher frequency levels. The contrast sensitivity test can be recommended as a simple and complementary functional test, particularly on cataract patients with severe complaints and relatively good visual acuity. The results of occlusive experiments afford some practical conclusions which enhance knowledge and differentiation of visual field changes induced by cataract and glaucoma. These conclusions can provide a basis for further and more detailed investigations.

A new acuity test was developed with a defined space between symbols to determine the effect of crowding on visual line acuity. Landolt-C was used as a symbol and the space between symbols (either 2 to 3 min. of arc or 17 to 18 min. of arc) was kept constant for all acuity values. The test permits a quantitative examination of crowding phenomena. The experimental results obtained in measurements of visual line acuity in normal-sighted, amblyopic and ametropic subjects are presented. The results of treatment for amblyopia had evidently been interpreted too optimistically in many patients hitherto.