By Alfred Kestenbaum
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Additional resources for Clinical Methods of Neuro-Ophthalmologic Examination
Differentiation between true field defects and spurious concentric con traction: 1. The spurious concentric contraction parallels a corresponding de crease of the central vision. 2. In spurious concentric contraction, the outline of the field becomes normal again if a large enough object is used; that means that the "con traction" disappears under proper conditions. If, for example, the cen tral visual acuity is VB (20/100), a 5 mm. object gives a contracted field, but a 25 mm. object would produce a normal outline.
The outline of the field in papillar diseases is, therefore, always rugged. Of course, at a later stage, the entire field is restricted to a small central or eccentric remnant, so that the rugged form can no longer be recognized. Then a kind of central or eccentric tubularfieldmay result. This rugged type of field defect may be called peripheral wedge-shaped type or papüfor type offielddefect (Figs. 20a, b). It is characteristic for all affections of the disk. This form of defect is found in papilledema, in intrabulbar optic neuritis, in secondary optic atrophy after papilledema or after neuritis, and in the first or typical form of primary luetic optic at rophy.
CHIASMAL TYPES (BITEMPORAL HEMIANOPIA) If a lesion involves the central part of the optic chiasma from any direc tion, whether from above, from below, from in front, or from behind, bitemporal hemianopia results (Fig. 22). A combination of an affection of the chiasma, and of a minor affection of one optic nerve, results in bitemporal hemianopia together with loss of macular vision in one eye (macular loss). Median lesion of the chiasma in combination with destruction of one optic nerve or one optic tract results in amaurosis of the homolateral eye and temporal hemianopia of the other eye.