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ARTICLE
Year : 1969  |  Volume : 17  |  Issue : 6  |  Page : 242-244
 

Abnormal retinal correspondence, evaluation of the diagnostic procedures


Department of Ophthalmology, Postgraduate Institute of Medical Education & Research, Chandigarh, India

Correspondence Address:
M K Garg
Department of Ophthalmology, Postgraduate Institute of Medical Education & Research, Chandigarh
India
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How to cite this article:
Garg M K, Jain I S, Gupta S D. Abnormal retinal correspondence, evaluation of the diagnostic procedures. Indian J Ophthalmol 1969;17:242-4

How to cite this URL:
Garg M K, Jain I S, Gupta S D. Abnormal retinal correspondence, evaluation of the diagnostic procedures. Indian J Ophthalmol [serial online] 1969 [cited 2014 Nov 26];17:242-4. Available from: http://www.ijo.in/text.asp?1969/17/6/242/38547


Abnormal retinal correspondence (A.R.C.) is a condition where the two fovea, which are normally corresponding points, lose their common vi­sual directions and acquire different ones---an extramacular element of one eye adopts the visual direction of the fovea of the other eye. Although much work has been done on the diagnosis of this condition, there is a lot of con­troversy on the importance of the va­rious diagnostic procedures. Smith [6] stated that the best method for the de­termination of false projection is the use of amblyoscope. Burian [2] also ag­reed with her but he suggested the use of more than one test for diagnosis of ARC. Bagolini and Capobianco [1] on the other hand had shown that the pre­sence of A.R.C. can be easily detected and thus more frequently diagnosed by the use of Bagolini's striated glasses than with the major amblyoscope or by the after-image test. According to Flom and Kerr [3] diagnostic disagree­ment between tests for retinal corres­pondence can be explained by measure­ment error, unsteady eccentric fixation and relative change in the position of eyes.

The present study has been conduct­ed to resolve the above controversy.


   Material and Methods Top


All the cases who were co-operative and intelligent, and showed A.R.C. on any of the three following tests were included in the series comprising of 80 patients.

i) Synoptophore test-The objec­tive and subjective angles were found on the synoptophore. Patients having unequal angles were labelled as cases of A.R.C. Where the angle of ano­maly (difference between objective and subjective angle) is equal to the ob­jective angle, A.R.C. is of harmonious type and if the angle of anomaly is less it is unharmonious. Cases where subjective angle could not be accurately recorded because of suppression, but the objects at the objective angle were not superimposed were also labelled as having A.R.C.

ii) After image test-This test was done on Synoptophore (Clement Clarke Model 2052). First, the right eye was exposed to a vertical slit with a red central fixation point for 10 seconds, and then the left eye was similarly ex­posed to a horizontal slit for 10 se­conds. The automatic flashing unit was then switched on. In N.R.C. the patient sees an after image in the form of a cross (+) and with A.R.C. the patient sees lines crossing each other away from the centre.

iii) Bagolini's striated glasses test Bagolini's striated glasses, which leave the transparency of the glass and the visual acuity of the patient unaltered are used. A normal subject wearing a pair of striated glasses at right angles, sees a light crossed by two luminous stripes, each ray being perceived only by one eye. If the stripes do not bi­sect at the light but cut each other to one side it shows the patient has A.R.C. A cross (+) through the light source in the presence of squint indi­cates harmonious A.R.C.

These three tests were performed on every patient and the presence or ab­sence of A.R.C. and the type of A.R.C. where possible, were noted.


   Observations Top


These eighty cases included 50 pa­tients of concomitant squint and 30 of straight amblyopia. The following observations were made.

Striated glasses test was positive for A.R.C. in 94% and was of the harmo­nious type in 84% of the cases. On major amblyoscope corresponding figures were 84% and 40%. With af­ter image test, only the harmonious type of A.R.C. could be diagnosed with certainty and the test was positive in only 62% of cases.

All the patients in this group had eccentric fixation. Seeing a cross (+) on after image test in the presence of eccentric fixation indicated a harmonious type of A.R.C. Bagolini's test also showed harmonious type of A.R.C. in all these cases. Cover test did not show any squint. Even on major amblyoscope no deviation of the eye and A.R.C. could he demon­strated. All the cases had binocular vision.


   Discussion Top


The above study comprising of 80 cases of A.R.C. was designed to know the utility of different diagnostic pro­cedures. The after image test is posi­tive for A.R.C. in only 62% of cases and the unharmonious type cannot be diagnosed with certainty. In many pa­tients the test cannot be performed be­cause of suppression of the squinting eye. Major amblyoscope test is posi­tive in a greater number (84%) of cases but the harmonious type is detected less often. Suppression of the squint­ing eye was again a hinderance in the test in many cases. Striated glasses test gives positive results in maxi­mum number (94%) of cases and 84% of these are of harmonious type.

Looking at these figures one would imagine that just the striated glasses test is enough for the diagnosis of A.R.C. This probably is true for the cases of harmonious A.R.C. but the unharmonious type of A.R.C. cannot be diagnosed with certainty unless the angle of squint and the shift of the line from the centre can be measured ac­curately for the same distance. Maxi­mum positive results for A.R.C. with Bagolini's striated glasses is probably due to the test being performed under natural test conditions. (Bagolini et al [1] ).

In a given case, we therefore feel that any one test is not enough. To get full information about the retinal cor­respondence more than one test re­peated on 2-3 occasions would be more helpful.

All our cases of straight amblyopia with A.R.C. fall into the group of microtropia-described by Helveston and von-Noorden [4] . Only the after image test and the Bagolini striated glasses are helpful in the diagnosis of A.R.C. in these cases.

Our observations are in agreement with those of Pasino and Maraini [5] and Bagolini et al [1] . We do not agree with Smith [6] that the best method for deter­mination of A.R.C. is the use of the major amblyoscope, nor do we agree with Flom et al [3] that the diagnostic disagreement can be explained by measurement error, unsteady eccentric fixation and relative change in the posi­tion of eyes. Striated glasses test has the added advantage of being simple, non time consuming and of being done under natural and non-dissociating test conditions of the eye without impairing visual acuity of the patients.


   Summary Top


Eighty cases of A.R.C. are examined by the amblyoscope test, the after im­age test and striated glasses test.

Striated glasses test gives the maxi­mum number of positive results for A.R.C. but no on esingle test is com­plete.

Importance of multiple tests in a given case is stressed.

 
   References Top

1.Bagolini, B. and Capobianco, N. M.: Subjective space in comitant squint, Amer. J. Ophthal. 59, 430-442 (1965).  Back to cited text no. 1    
2.Burian, H. M.: Sensorial retinal rela­tionship in concomitant strabismus. Arch. of Ophthal. (Chicgao) 37, 336­368, 504-533, 618-648, (1947).  Back to cited text no. 2    
3.Flom, M.C. and Kerr, K. E.: Deter­mination of retinal correspondence. Arch. of Ophthal. (Chicago), 77, 200­213 (1967).  Back to cited text no. 3    
4.Helveston, E. M. and von-Noorden. G. K.: Microtropia (A newly defined entity). Arch. Ophthal. (Chicago). 78. 272-281 (1967).  Back to cited text no. 4    
5.Pasino. J. and Maraini. G.: Importance of natural test conditions in assessing sensory state of squinting subject. Brit. J. Ophth.. 48. 30-34. (1964).  Back to cited text no. 5    
6.Smith, M. I.: Significance of false pro­jection in the treatment of squint. Arch. Ophthal. (Chicago). 21, 990-998 (1939).  Back to cited text no. 6    



 
 
    Tables

  [Table - 1], [Table - 2]



 

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