By Alfred Kestenbaum
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Vertex Sign Observation of the location of the geometric vertex of the absent quad rant, the vertex sign, often facilitates differentiation between a lesion of the optic pathway and occlusion of a branch of the central artery. In poor visibility of the fundus or in questionable changes of the retinal vessels, this vertex sign alone may substantiate the diagnosis. 3. ENLARGED BLIND SPOT An enlarged blind spot is found in diverse conditions which involve the area surrounding the disk: (a) in glaucoma: either general increase of the blind spot because of a halo glaucomatosus or increase upwards or downwards (Seidel's sign); (b) in old age, because of a halo senilis; (c) in myopia, be cause of atrophy of the chorioid around the disk; (d) in papilledema: the retina around the disk is screened or compressed by the swollen papillar tissue; (e) Behr describes an enlarged blind spot in retrobulbar neuritis (this occurrence is still controversial).
The examiner brings his face into the visual field of the patient from diverse directions and observes whether and when the patient looks at him. Systematic and repeated observation of the eye movements in the different directions of the field permits a definite, although rough, examination of the field in these absolutely uncooperative patients. The highly attractive force of the human face found with aphasic pa- FIELD OF VISION 39 tients has its analogue in the behavior of infants. A study of the eye movements of infants made by Eestenbaum, revealed that no other ob ject was as attractive for the gaze of infants as the face of the observer or his assistant appearing in the visual field.
Object on the screen is easier to handle than a y 3 mm. object on the perimeter. The tangent screen is provided with lines indicating 12 meridians and a number of concentric circles around the center indicating every 10 degrees. The outline points, found on the screen, are transferred to the perimeter chart. The measurement of distances is, however, difficult when the points are not directly located on the marked meridians or on the marked circles. The lines fail particularly in measuring relative distance between the points at a scotoma's edge, so that special devices are required.
Clinical Methods of Neuro-Ophthalmologic Examination by Alfred Kestenbaum