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Diagnostics in Psychic Visual Disorders with Fundus-controlled Examination Techniques using the Scanning Laser Ophthalmoscope
Bültmann S., Rohrschneider K.,
Ruprecht-Karls-Universität Heidelberg, Universitäts-Augenklinik (Heidelberg)
Background: Diagnostics in psychic visual disorders may prove challenging as well as time consuming and expensive. Multiple examination techniques have been introduced into diagnostics to objectively assess subjective statements and to discover aggravation or simulation as to prevent errors in diagnosis of curable diseases.
Methods: 10 females 12 to 58 years of age, who presented with unclear visual deterioration, metamorphopsia or visual field defects were examined with the scanning laser ophthalmoscope as well as regular diagnostics and electrophysiology For the former we used static as well as kinetic fundus perimetry, reading tests and mfERG stimulation (RETIscan) with the SLO.
Results: In all patients stable central fixation was observed. In cases with concentric visual field reduction observed in Goldmann perimetry, we found even further reduced visual fields for kinetic fundus perimetry as well as fixation to various grades inside the scotomata. Reading was only possible for large optotypes while for smaller letters we observed clear fixation towards the beginning of the text. In two cases, a pathologic mfERG (SLO) could be explained by grossly instable fixation during recording. Ganzfeld-ERG was normal in all patients, in 4 cases, mfERG and VECP was of no use due to lacking cooperation.
Conclusions: Besides the discrepancy of stable foveal fixation and the subjective reduction of visual acuity, the VCR-based observation of fixation movement during perimetry is very helpful in diagnostics of simulation or aggravation. The different size of the residual visual field in dependence from the examined retinal area appears striking. The option of assessing the locus and stability of fixation as well as the possibility of comparing the results with fundus perimetry makes mfERG with the SLO a precise and objective diagnostic technique.