The Pulfrich effect in optometric practice

The Pulfrich effect can occur spontaneously, giving severe symptoms of changed visual perception in a variety of conditions in which an interocular latency difference has occurred. The symptoms principally involve misjudgements on the location of objects, especially when driving. Interocular latency differences can inadvertently be created in patients in practice and this study has investigated the Pulfrich effect in anisocoria, uniocular mydriasis, and with uniocular tint (X-chrom lens). In all cases a Pulfrich effect was consistently evident and compared to the size of the effect provoked by neutral density filters. The results show that with anisocoria, uniocular mydriasis and the X-chrom lens, the provoked Pulfrich effect is similar to that found reported previously in cases of trauma. These cases had severe visual symptoms so that care should be exercised in practice, where procedures likely to provoke the Pulfrich effect are contemplated. Specifically, patients who have received uniocular mydriasis in practice should be cautioned about the possible visual effects and advised not to drive until the effect of the mydriatic has finished and equal pupil sizes have been restored.

The fluctuations of accommodation and ageing

OBJECTIVE

The aim of this study was to investigate the influence of age on the fluctuations of accommodation.

METHOD

Fluctuations of accommodation were measured on six 'young' (16-25 years, mean age 22 years) observers and six 'older' (35-48 years, mean age 42 years) observers. Accommodation was continuously recorded using a SRI optometer whilst the observers steadily viewed a high contrast target at stimulus levels 0.25 D, 1.00 D and 2.00 D. Fluctuations were quantified using power spectrum analysis, and frequencies were grouped into bands: low (LFC 0.3-0.6 Hz and 0.3-0.9 Hz) and high (HFC 1.1-2.2 Hz).

RESULTS

Accommodation response levels for these stimuli for both groups of observers were quite similar. Fourier analysis was used to generate power spectra so that the fluctuations of accommodation for each observer group could be compared. In general power increased for increasing response levels for both groups of observers, although less power was evident for the older observers in both LFC and HFC bands. Differences in power were not significant at these frequency bands for the two observer groups. When the whole power spectrum is compared these differences became significant with more power evident in the younger cohort.

CONCLUSION

Reductions in both amplitude and speed of accommodation with age are well known, and the decline in magnitude of the fluctuations found here is consistent with a general diminution in accommodation dynamics as the accommodation mechanism ages. For the older group, some of who were near absolute presbyopia, there may be little contribution to power from changes in lens shape and it is possible that small changes in lens position in the eye contribute to the power spectrum.

Comparison of age-related changes in short-wavelength-sensitive cone thresholds between normals and patients with primary open-angle glaucoma

PURPOSE

To establish the effect of aging upon short-wavelength-sensitive cone (S-cone) sensitivity for both normals and patients with primary open-angle glaucoma (POAG).

METHODS

S-cone thresholds were established for the detection of blue test spots on a bright yellow adapting background. Detection thresholds for combined medium- and long-wavelength-sensitive cones (M/L-cones) were also established for a yellow test spot upon a yellow background. A group of 177 normal subjects (age range 20 to 80 years) and 46 glaucoma subjects were examined.

RESULTS

The rate of decline of S-cone sensitivity with increasing age was found to be similar in patients with POAG and age-matched normals (approximately 0.2 log units/decade), although S-cone sensitivity in the POAG population was significantly lower (p < 0.05) than that in age-matched normals by approximately 0.3 log units.

CONCLUSIONS

The results of the present investigation show an age-related decline in S-cone sensitivity for both normals and patients with POAG. The decline in S-cone sensitivity within the POAG population is similar to that occurring in normal subjects when the two populations are matched for age.

Relationship between visual acuity and observation distance

The visual acuities of 17 young emmetropes and corrected ametropes were measured over the range of 7.5-0.19 m using a Bailey-Lovie chart. Accommodation stimulus-response measures were also taken over this range using retinoscopy to establish whether variations in visual acuity with observation distance could be attributed to accommodation behaviour. Tonic accommodation was recorded using the Canon R1 autorefractor and was compared with visual acuity and stimulus-response results. In general, visual acuity was found to be dependent on stimulus distance, being significantly reduced for most observers for the closest targets. There were three categories of observer performance for visual acuity as a function of observation distance; one group showing no change in visual acuity with distance, a second showing a flat function for distances 7.55-0.5 m, and then a decrease in visual acuity for shorter distances; and a third category that showed a maximum visual acuity in the 1.2-1.6 m region. This behaviour was unrelated to individual stimulus-response characteristics and there was no significant relationship between tonic accommodation and the distance where acuity was best for the third category observers.

Impaired perception of moving objects after minor injuries to the eye and midface: the Pulfrich phenomenon

Delayed conduction along one optic nerve can result in an incorrect appreciation of moving objects. The temporal mismatch between the two different pathways results in altered perception of the vector of a moving target and is known as 'the Pulfrich phenomenon'. This is a well-recognised handicap in patients with multiple sclerosis, but has not previously been reported as a consequence of injury. All 187 patients who presented during 1991 with reduced visual acuity as a result of midfacial injuries were examined with a pendulum. Six had the defect and five of these had symptoms. In each case the patients were disturbed by car travel, because they perceived oncoming traffic moving in a hyperbolic curve towards them. These patients have been examined in detail and given a tinted lens for the normal eye to eliminate the illusion by delaying the input from the normal side to equal that on the damaged side. We recommend that this phenomenon is sought in all patients with mid-facial injuries or with later evidence of mild traumatic optic neuropathy, particularly if they are disturbed by car travel.

The simultaneous interocular brightness sense test. A test of optic nerve function

OBJECTIVE

To describe and establish control data from controls for a simultaneous interocular brightness sense test in which the apparent brightness of two independently viewed light patches was compared.

DESIGN

Dichoptic viewing was achieved by dissociation of right and left eyes using a septum and cross-polarization. Brightness matches were obtained by using adjustments to the illumination of the left retina while the illumination of the right retina was kept constant. OBSERVERS: Ninety-one control observers (age range, 20 to 91 years) participated in the study to provide normal brightness-matching data.

RESULTS

Effects from ocular dominance, age, and long- and short-term adaptation were negligible, but the test was sensitive to anisocoria. Just noticeable differences in dichoptic brightness matching were proportional to retinal illuminance; this finding was consistent with the Weber-Fechner law.

CONCLUSION

The test is quick and simple to complete and appears to offer considerable scope for the assessment of visual function when differences in the functional integrity of the optic nerves of the right and left eyes are suspected.

Simultaneous interocular brightness sense testing in ocular hypertension and glaucoma

OBJECTIVE

To investigate the performance of the simultaneous interocular brightness sense test in patients with ocular hypertension and primary open angle glaucoma (POAG).

DESIGN

Brightness matches were obtained for an age-matched control sample and for patients with ocular hypertension and POAG. In addition, for the patients with POAG, visual field defects were quantified and a risk factor count was established for those with ocular hypertension.

PATIENTS

Nineteen patients with ocular hypertension, 20 patients with POAG, and 61 age-matched controls participated in the study.

RESULTS

Seven patients with ocular hypertension exhibited brightness perception asymmetry outside normal limits for age-matched controls. Of these, six were at high risk of having glaucoma develop and only one of the remaining 12 was found to be at similar risk. All 20 patients with established POAG had results outside the normal limits for a test sensitivity of 100%. Three control observers had abnormal results, giving a test specificity of 95%.

CONCLUSION

The simultaneous interocular brightness sense test is quick and simple to perform and is suitable for a wide age range of patients. It warrants further assessment as a means of screening for ocular hypertension and glaucoma.

Colour vision screening in glaucoma: the Tritan Album and other simple tests

Results from simple colour vision tests used for the detection of the Type III colour vision deficiency in glaucoma and ocular hypertension are presented. We assessed 49 patients with primary open angle glaucoma, 16 ocular hypertensives, 54 age matched normals and 50 young normal observers using six established tests and the recently introduced Tritan Album. This test was introduced specifically for acquired colour vision deficiencies. Results show in general that individual tests have low sensitivity and poor screening efficiency. The best screening efficiency was achieved by the City University Colour Vision Test and the AO HRR plate test, no acquired tritan defects were identified by the Farnsworth F2 plate, and the Tritan Album had very low sensitivity (the lowest excluding the F2 plate). Best results were obtained from a combination of City University and HRR test scores and this combination could provide useful additional data on colour vision in a glaucoma screening programme.

Location of nonlinear processes within the pupillary pathway

The pupil oscillates in synchrony with a slow beat produced by adding two lights flickering at slightly different frequencies. This behavior shows that nonlinear processes are present within the pathway. To localize these processes, a light of one frequency was presented to one eye, while a light of a different frequency was presented to the other. No pupil oscillations were seen in response to the beat in these dichoptic conditions, but when both lights were superimposed and presented to the same eye a powerful pupillary response was produced. We conclude that the nonlinearity giving rise to the pupil's beat response occurs before the pathways from the two eyes join and hence is neural rather than muscular in origin. Furthermore, the lack of a pupil response in the dichoptic conditions suggests that the signals from the two eyes may combine linearly.

The Pulfrich phenomenon and its alleviation with a neutral density filter

A case is described in which a presumed vascular accident resulted in long-standing visual difficulties in both reading and the analysis of vectors of moving objects. Clinical examination revealed minimal right optic atrophy with a relative superior altitudinal visual field defect associated with a positive Pulfrich effect. A partial head turn to the right in association with paresis of saccades and pursuit eye movements to the right was also evident. Spectacles for distance which incorporated a neutral density filter before the left eye were prescribed. These practically eliminated the Pulfrich effect and alleviated the problems of vector analysis. A near correction was provided which incorporated prisms with bases to the right. This eliminated the reading difficulties. The visual problems experienced by patients suffering from a positive Pulfrich effect are described and discussed.

Binocular accommodation reaction and response times for normal observers

Accommodation was recorded from right and left eyes of visually normal observers in both binocular and monocular viewing. Reaction and response times were similar in monocular and binocular viewing and are not influenced by eye dominance. Far-to-near responses were significantly quicker than near-to-far responses. The origin of this difference may be a feature of the elastic properties of the accommodation mechanism. Limited data are presented that indicate that the slowing of accommodation speed with age affects the near-to-far response disproportionally. Errors in the initial direction of response were fewer in binocular viewing in comparison with monocular viewing.

Twin channel infrared optometer for recording binocular accommodation

A twin channel infrared (IR) optometer for recording accommodation from each eye is described. Some modifications to a conventional single channel optometer design are necessary to facilitate binocular recording. The optometer incorporates an on-line microcomputer for data acquisition and processing. Processing includes power spectrum and correlation analysis, and a facility for performing cursor controlled measurement of time delays. Accommodation responses recorded are shown to be independent of horizontal eye movements, and little affected by the drug used for mydriasis.

Fluctuations in accommodation: a review

When a young observer attempts to accommodate steadily on a fixed stimulus, the nominally steady-state response shows small instabilities or fluctuations (sometimes termed microfluctuations or oscillations). These fluctuations typically have an amplitude of a few tenths of a dioptre and a frequency spectrum extending up to a few Hertz. The properties of these fluctuations are described for various viewing conditions: pupil diameter, target vergence, target form, target contrast, and target luminance all influence the frequency spectra of the oscillations, as may anomalies of vision such as amblyopia. The possible roles that the fluctuations might play in the function of the accommodative system are discussed. It is suggested that the higher frequency components around 2 Hz may arise from the mechanical and elastic characteristics of the lens, zonule and ciliary body. Components at lower frequencies (less than 0.5 Hz) may be of more significance in the function of the accommodative control system.

Central visual fields for short wavelength sensitive pathways in glaucoma and ocular hypertension

While conventional clinical visual acuity and kinetic visual fields may be essentially normal in ocular hypertension and early stages of glaucoma, other foveal aspects of vision (eg color, spatial and temporal contrast sensitivity) may be quite abnormal. Specifically, a selective vulnerability of the short wavelength sensitive (SWS) visual pathways in these conditions has previously been noted. Here we studied the central visual fields of 33 primary open angle glaucoma (POAG) patients, 32 ocular hypertensives (OHT), and 24 age-matched normal controls using blue and yellow test flashes on bright yellow backgrounds. SWS cone and MWS and/or LWS cone pathway sensitivities were measured at the fovea and at 2.5 degrees, 5 degrees, 10 degrees and 15 degrees eccentricities, in either the inferior temporal (for OHT) or horizontal nasal retina (for POAG). As expected, all groups had normal sensitivity to yellow flashes--detected by LWS and/or MWS cones--in these meridians. By comparison, for the blue flashes--detected by the SWS cones--the POAG and OHT groups had sensitivity deficits, uniformly across the central visual field, of about 6X and 1.8X, respectively, compared to normals. While six of 31 (19%) OHT subjects had localized glaucomatous field defects (greater than 0.4 log units) in the non-foveal inferior temporal retina, none of the 12 OHT subjects who were also tested in the horizontal nasal retina showed loss in this meridian. Finally, while no POAG subjects had localized sensitivity loss for yellow flashes in the horizontal nasal retina, four did show local field defects with blue test flashes.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical measures of central vision function in glaucoma and ocular hypertension

A generalized loss of visual sensitivity, even for foveal targets, has been reported as an early sign of glaucoma. In the present study of central vision, we used relatively simple and rapid clinical tests of color thresholds, color discrimination, and spatial contrast sensitivity to compare the vision of three age-matched groups of patients who had primary open angle glaucoma (n = 33) or ocular hypertension (n = 32) as well as normal subjects (n = 24). The largest sensitivity losses for both glaucoma and ocular hypertensive groups were disclosed by a color threshold test with blue lights designed to isolate the blue-sensitive pathways of the visual system. The loss of sensitivity for both the glaucoma group and the ocular hypertensive group is consistent with recent reports (from postmortem studies of human eyes) of extensive axon death even in the absence of glaucomatous field defects.

Stereoscopic threshold in children and adults

The threshold of stereoacuity is reported as measured on 369 normal children aged 3 to 7 years, and on 51 normal adults. Four standard clinical stereotests were used and two different testing procedures adopted. The results show that both threshold and variability decrease with age, and performance becomes adult-like at different ages for different tests. Interest correlations are poor, and in cases where the correlation is significant, no identifiable pattern emerges between testing procedures, age, and stereotests. The procedures themselves gave no significant difference in stereoacuity values between all four tests.