- Email: [email protected]
Kindergarten Visual Acuity Chart*
NOTES, CASES, INSTRUMENTS KINDERGARTEN VISUAL ACUITY CHART* CONRAD BERENS,
M.D.
New York
Psychology is an important factor in testing the visual acuity of children under six years of age. To improve performance, interest must be stimulated, and thus a higher degree of visual acuity may be obtained. Some visual-acuity charts for examining young children lack interest for the modem child and are often inaccurate. Even the most scientific visual-acuity charts for children, for example, the Evans! charts and Inouye test types, probably are not so accurate as the E test, which has been so well systematized by the personnel of the National Society for the Prevention of Blindness." The purpose of the kindergarten chart described here is to stimulate interest by presenting figures with which the average child over three years of age is familiar. Furthermore, since the chart is colored, it tends to stimulate the child's interest. The figures have been drawn to conform as nearly as possible with one-minute and five-minute angles (fig. 1). The chart measures 10 inches by 28 inches and contains seven rows of figures by means of which visual acuity of 20/200, 20/100, 20/70, 20/50, 20/40, 20/30, and 20/20 may be tested. To enhance the value of the chart and in order to test visual acuity greater than 20/20, a row of block E's is included at the bottom of the chart. By means of this row • Presented before the American Ophthalmological Society, June 3, 4, and S, 1937, Hot Springs, Virginia. Aided by a grant from the Ophthalmological Foundation, Inc., and developed with the cooperation of the Department of Research at the New York Eye and Ear Infirmary.
667
Fig. 1 (Berens). Kindergarten visual-acuity chart.
of E's, visual acuity of 20/100, 20;70, 20/50, 20/40, 20/30, 20/20, 20/15, and 20/10 may be measured. The E's also permit a comparison of visual acuity obtained by means of the E test and that obtained employing the figure test. It has, moreover, been found that a single letter for each distance is less confusing when testing children. 35 East Seventieth Street.
NOTES, CASES, INSTRUMENTS
668
REFERENCES
Evans, ]. N. Optotype for young children. Amer. Jour. Ophth., 1919, v. 2, June, p. 425. • The vision of pre-school children. National Society for the Prevention of Blindness, New York. Publication 66, 1929, p. 18.
1
LOCAL RECURRENCE OF'MELANOMA OF CHOROID 13 YEARS AFTER ENUCLEATION F. H.
NEWTON,
M.D.
Dallas, Texas
S. G. W., a white man aged 34 years, examined on November 7, 1923, showed a tumor of the choroid in the outer portion of the right eye, situated just posterior to the ciliary body. After enucleation on November 9, 1923, the pathologist gave the following report: "Pathological study of the eye revealed a tumor mass measuring 5.2 X 3 mm., located just behind the temporal portion of the ciliary body. This tumor was solid, cellular, and brownish in color. The microscopical sections showed it to be composed of spindle-shaped cells arranged in wavy strands running in all directions; frequently in whorl formation. Melanin pigment, located both in these cells and extracellularly, was particularly prominent towards the periphery of the growth. The tumor mass merged gradually into the choroid at its margin. An occasional thinwalled blood vessel was seen in the tumor. The retina was detached and lay loosely over the tumor mass. The sclera was not invaded, but was thinner than normal. Pathologically this neoplasm was in the first or intraocular stage of growth. There was no gross nor microscopical evidence that the tumor had extended into or through the sclera. Diagnosis: Malignant intraocular melanoma, right eye." The patient was next seen on December 2, 1935, at which time there was no definite indication of local recurrence. His general health seemed excellent. In February, 1936, there appeared in the lower half of the socket a moderate-sized swelling which was firm and showed no
gross pigmentation. It appeared that the artificial eye had irritated the socket to some extent. The patient was advised to keep himself under close observation. On July 7, 1937, he again reported with a firm dark mass filling the apex of the right socket, the size and shape of a small pecan nut. Exenteration of the orbit was performed. The pathologist's report was as follows: "The specimen consisted of the right orbital contents, the eye having been enucleated some 14 years previously because of the presence of an intraocular melanoma. On sectioning through this mass of fatty and epidermal tissue, which included the eyelids, a tumor mass coalblack in color and measuring as much as 3 em, in diameter, was demonstrable. This tumor had invaded rather diffusely the orbital tissues. The picture grossly was characteristic of malignant melanoma. The sections showed a very cellular malignant neoplasm composed of elongated spindle-shaped cells. Many of these cells were packed with granular melanin pigment, and much extracellular pigment was noted. The tumor cells appeared to be proliferating at a relatively slow rate of speed yet they invaded the surrounding- orbital tissues with' ease. This tumor was appraised as being strongly radio resistant and was rated grade two malignancy." It was noted that the type of cells in the original growth and the recurrent mass were very similar, though the pigmentation in the latter was much more evident. This case is being reported because of the length of time between the primary enucleation and the local recurrence and because of the lack of evidence of any metastatic manifestation. Mercantile Bank Building.
M.D.
New York
Psychology is an important factor in testing the visual acuity of children under six years of age. To improve performance, interest must be stimulated, and thus a higher degree of visual acuity may be obtained. Some visual-acuity charts for examining young children lack interest for the modem child and are often inaccurate. Even the most scientific visual-acuity charts for children, for example, the Evans! charts and Inouye test types, probably are not so accurate as the E test, which has been so well systematized by the personnel of the National Society for the Prevention of Blindness." The purpose of the kindergarten chart described here is to stimulate interest by presenting figures with which the average child over three years of age is familiar. Furthermore, since the chart is colored, it tends to stimulate the child's interest. The figures have been drawn to conform as nearly as possible with one-minute and five-minute angles (fig. 1). The chart measures 10 inches by 28 inches and contains seven rows of figures by means of which visual acuity of 20/200, 20/100, 20/70, 20/50, 20/40, 20/30, and 20/20 may be tested. To enhance the value of the chart and in order to test visual acuity greater than 20/20, a row of block E's is included at the bottom of the chart. By means of this row • Presented before the American Ophthalmological Society, June 3, 4, and S, 1937, Hot Springs, Virginia. Aided by a grant from the Ophthalmological Foundation, Inc., and developed with the cooperation of the Department of Research at the New York Eye and Ear Infirmary.
667
Fig. 1 (Berens). Kindergarten visual-acuity chart.
of E's, visual acuity of 20/100, 20;70, 20/50, 20/40, 20/30, 20/20, 20/15, and 20/10 may be measured. The E's also permit a comparison of visual acuity obtained by means of the E test and that obtained employing the figure test. It has, moreover, been found that a single letter for each distance is less confusing when testing children. 35 East Seventieth Street.
NOTES, CASES, INSTRUMENTS
668
REFERENCES
Evans, ]. N. Optotype for young children. Amer. Jour. Ophth., 1919, v. 2, June, p. 425. • The vision of pre-school children. National Society for the Prevention of Blindness, New York. Publication 66, 1929, p. 18.
1
LOCAL RECURRENCE OF'MELANOMA OF CHOROID 13 YEARS AFTER ENUCLEATION F. H.
NEWTON,
M.D.
Dallas, Texas
S. G. W., a white man aged 34 years, examined on November 7, 1923, showed a tumor of the choroid in the outer portion of the right eye, situated just posterior to the ciliary body. After enucleation on November 9, 1923, the pathologist gave the following report: "Pathological study of the eye revealed a tumor mass measuring 5.2 X 3 mm., located just behind the temporal portion of the ciliary body. This tumor was solid, cellular, and brownish in color. The microscopical sections showed it to be composed of spindle-shaped cells arranged in wavy strands running in all directions; frequently in whorl formation. Melanin pigment, located both in these cells and extracellularly, was particularly prominent towards the periphery of the growth. The tumor mass merged gradually into the choroid at its margin. An occasional thinwalled blood vessel was seen in the tumor. The retina was detached and lay loosely over the tumor mass. The sclera was not invaded, but was thinner than normal. Pathologically this neoplasm was in the first or intraocular stage of growth. There was no gross nor microscopical evidence that the tumor had extended into or through the sclera. Diagnosis: Malignant intraocular melanoma, right eye." The patient was next seen on December 2, 1935, at which time there was no definite indication of local recurrence. His general health seemed excellent. In February, 1936, there appeared in the lower half of the socket a moderate-sized swelling which was firm and showed no
gross pigmentation. It appeared that the artificial eye had irritated the socket to some extent. The patient was advised to keep himself under close observation. On July 7, 1937, he again reported with a firm dark mass filling the apex of the right socket, the size and shape of a small pecan nut. Exenteration of the orbit was performed. The pathologist's report was as follows: "The specimen consisted of the right orbital contents, the eye having been enucleated some 14 years previously because of the presence of an intraocular melanoma. On sectioning through this mass of fatty and epidermal tissue, which included the eyelids, a tumor mass coalblack in color and measuring as much as 3 em, in diameter, was demonstrable. This tumor had invaded rather diffusely the orbital tissues. The picture grossly was characteristic of malignant melanoma. The sections showed a very cellular malignant neoplasm composed of elongated spindle-shaped cells. Many of these cells were packed with granular melanin pigment, and much extracellular pigment was noted. The tumor cells appeared to be proliferating at a relatively slow rate of speed yet they invaded the surrounding- orbital tissues with' ease. This tumor was appraised as being strongly radio resistant and was rated grade two malignancy." It was noted that the type of cells in the original growth and the recurrent mass were very similar, though the pigmentation in the latter was much more evident. This case is being reported because of the length of time between the primary enucleation and the local recurrence and because of the lack of evidence of any metastatic manifestation. Mercantile Bank Building.