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ARTICLES
Year : 1971  |  Volume : 19  |  Issue : 2  |  Page : 55-60

Lack of retinal correspondence


Department of Ophthalmology Maulana Azad Medical College and Associated Hospitals, New Delhi, India

Correspondence Address:
D K Sen
Department of Ophthalmology Maulana Azad Medical College and Associated Hospitals, New Delhi
India
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Source of Support: None, Conflict of Interest: None


PMID: 15744970

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How to cite this article:
Sen D K, Sood G C. Lack of retinal correspondence. Indian J Ophthalmol 1971;19:55-60

How to cite this URL:
Sen D K, Sood G C. Lack of retinal correspondence. Indian J Ophthalmol [serial online] 1971 [cited 2020 Apr 1];19:55-60. Available from: http://www.ijo.in/text.asp?1971/19/2/55/34991

Table 5

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Table 5

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Table 4

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Table 4

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Table 3

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Table 3

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Table 2

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Table 2

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Table 1

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Table 1

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Lack of retinal correspondence (L.R.C.) is a distinct entity which should not be confused with Lack of normal retinal correspondence. In the latter event the patients while being tested on the major amblyoscope attempt to "put the lion into the cage" but are unable to do on account of suppression; they, however, can see the pictu­res crossing.

Lack of retinal correspondence (L.R.C.) is fairly common but sur­prisingly no detailed studies are available. As late as in 1954 Levinge[2] and in 1957 Lyle and Foley[3] studied the various anoma­lies of retinal correspondence in some details but did not also pay any attention to this condition. Lyle [5] briefly mentioned that a person should be diagnosed as having L.R.C. when he on the major amblyoscope cannot see the pictures crossing at any angle. While investigating the nature of retinal correspondence in our cases of squint with central fixa­tion this criterion of Lyle [5] for diagnosing L.R.C. appeared insuf­ficient to us as some of the cases with amblyopia diagnosed on major amblyoscope as having L. R.C. were found to be actually having normal or abnormal reti­nal correspondence by the after­image test.

We, therefore, undertook a sys­tematic study of this condition.

The preliminary observations have been reported earlier Sood, Sen and Jain[6]. The present report analyses all available data in de­tail in a series of 102 cases.


  Methods and Materials Top


Three hundred and fifty cases of various types of horizontal comitant squint [Table - 1] with normal fundi and central fixation (as determined by projectoscopy using the Linksz star graticule) were thoroughly studied and fully investigated in our Orthoptic and Pleoptic Clinic. Visual acuity was recorded with the correcting glasses by means of Snellen's test types using the full line. Retinal correspondence was determined in all the cases by the Synopto­phore method (Lyle [5] ) and after­ image method as described in our preliminary report (Sood, et al [6] ). In the latter method all the pati­ents who failed to perceive both the horizontal and vertical after­images at the same time were put under the category of L.R.C. All the cases of L.R.C. were given Orthoptic exercises for atleast a period of six weeks to note the response.


  Observations Top


Of the 350 cases studied 120 were found to have L.R.C. by the Synoptophore method and 102 cases by the after-image method, which make an over-all incidence of 34.3% and 29.1% respectively. As the cases diagnosed by the preliminary observations by after-image method are the true cases of L.R.C. only they are con­sidered in this study in detail.

Of the 102 cases diagnosed by the after-image method the maxi­mum number (45 constituting 44.1%) were in the age group of 10 to 20 years. There were only 12 patients below the age of 10 years and 3 patients over the age of 40 years. The condition occu­red in exotropia in 22.8% cases and in esotropia in 38.5% cases. Of the unilateral exotropias the condition was present in 31.7 cases and of the alternating exo­tropias the condition was present in 19.0% cases. Again, of the uni­lateral esotropias the condition was present in 41.7% cases and of the alternating esotropias the condition was present in 24.0% cases. The over all incidence in unilateral squint was 38.2% and in alternating squint was 19.7% [Table - 2]. In 54 cases (52.9%) the onset of squint was before 3 years of age and in 91 cases (89.2%) the onset of squint was before 6 years of age. There was only 1 case where the onset of squint was after 10 years of age [Table - 3]. In the majority of the cases (75, 73.5%) the degree of squint was between 10° and 25° [Table - 4]. Visual acuity in the affected eye in unilateral cases was 6/60 or less. In alternating squints the visual acuity was 6/9 or more in the majority of the cases (28 out of 34) [Table - 5].

Response to orthoptic exercises was very poor in all the cases.

None of them showed any im­provement.


  Comments Top


The term "Non Retinal Corres­pondence" introduced by us (Sood, Sen and Jain [6] ). should be preferr­ed to "Lack of Retinal Correspon­dence" as the latter term may be easily confused with the term "Lack of Normal Retinal Corres­pondence" which is not necessari­ly a serious condition from the point of view of restoration of binocular function. The incidence of "Lack of Retinal Correspon­dence" is fairly high in this country (29.1%). That is because a large number of patients suffer­ing from squint in this country report very late for treatment by which time dense amblyopia has usually set in. The condition is present in almost all types of squint, though its incidence varies with the type of squint. The con­dition is commoner in esotropia especially in unilateral cases. That is because dense amblyopia is more common in these types of squint. Incidence also varies with the age of onset of squint and the age at which treatment is started. The earlier the onset of a constant squint and the longer the treatment is delayed, the greater the likelyhood of the development of dense amblyopia with consequent loss of retinal correspondence in some cases. In the present series in 89.2% cases the onset of squint was before 6 years of age. Incidence is depen­dent also on the type of test em­ployed for diagnosing the condi­tion. Synoptophore test as advocated by Lyle records more number of cases as some cases of marked amblyopia with normal or abnormal retinal correspon­dence are misdiagnosed as being cases of Non-Retinal Correspon­dence. However, the incidence is not dependent on the degree of ocular deviation. That the degree of squint in the majority of the cases was between 10° and 25° is because most of the patients at­tending the clinic had squint between 10° and 25° .

There are probably two groups of cases of Non-Retinal Corres­pondence. In one, it is suggested, retinal correspondence never had a chance to develop. Binocular vision, in its development, depends upon certain physiological proce­sses - the binocular reflexes. According to the theory put for­ward by Chavasse[1], the binocular reflexes will develop normally in a child under normal conditions, and will only fail to develop normally if prevented from doing so by some obstacle. Onset of squint at a very early age is one such obstacle which may not permit the development of binocular vision. That is the reason why L.R.C. is a constant finding in es­sential alternators.

In the other group the condi­tion follows intense suppression. When a squint is constant, sup­pression occurs, either uniocular­ly or alternating, and normal re­tinal correspondence may after a short period be lost. The patients when being tested on the Synop­tophore fail "to put the lion into the cage" but can see the pictures crossing indicating that simulta­neous perception is still present ("Lack of Normal Retinal Corres­pondence"). From that stage on­wards one of two things may happen (Lyle and Bridgeman[4]). Either simultaneous perception is lost (Non Retinal Correspondence) or else the patient develops a method whereby the two eyes may be used together inspite of the incorrect alignment (Abnor­mal Retinal Correspondence).

Chances of restoring binocular function in both the categories of cases of L.R.C. are practically nil as orthopitc exercises proved val­ueless in all the cases. Therefore, it is imperative to recognise this condition early so that a child having the condition is spared the regime of unnecessary orthoptic treatment.


  Summary Top


Non Retinal Correspondence was found to be present in 29.1% of cases of concomitant horizontal squint with normal fundi and central fixation by the after-image method which was found to be more reliable than the Synoptop­hore method for diagnosing the condition. A person having the condition sees only one after­image at a time in the after-image method.

The condition was commoner in esotropia and in unilateral cases. Incidence was dependant more on the age of onset of squint and the age at which treatment was started than on the degree of squint. Prognosis for binocular vision was found to be poor in all such cases. Orthoptic treatment was of no value.

It is stressed that the term "Non Retinal Correspondence" should be preferred to "Lack of Retinal Correspondence as the lat­ter may be easily confused with the term "Lack of Normal Retinal Correspondence" which is altoge­ther a different entity.


  Acknowledgement Top


We acknowledge our thanks to the Director, Indian Council of Medical Research for the grant sanctioned for carrying out the study.

 
  References Top

1.
CHAVASSE, F. B.: Cited in 4, P.1.  Back to cited text no. 1
    
2.
LEVINGE, M.: Value of abnormal retinal correspondence in binocu­lar vision. Brit. J. Ophth. 38, 332 (1954).  Back to cited text no. 2
    
3.
LYLE, T. K. and FOLEY, J.: Prog­nosis in cases of strabismus with special reference to Orthoptic treatment. Brit. J. Oph. 41, 139 (1957).  Back to cited text no. 3
    
4.
LYLE T. K. and BRIDGEMAN, G, J. O.: Worth and Chavasee's squint, ed. 9th, Bailliere, Tindall & Cox, London (1959).  Back to cited text no. 4
    
5.
LYLE, T. K. and WALKER, M. P.: Lyle and Jackson's Practical Ortho­ptics, ed. 4th, p. 54. Lewis, London (1953).  Back to cited text no. 5
    
6.
SOOD, G. C.: SEN, D. K. and JAIN, D. K.: Non Retinal Corres­pondence. Orient. Arch. Ophth. 7, 340 (1969).  Back to cited text no. 6
    



 
 
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