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A Simple Method for Detection of Hemianopsia or Quadrantanopsia
432
AMERICAN JOURNAL OF OPHTHALMOLOGY
October, 1990
Fig. 2 (Miller). The housing and locking screw have been removed to show the bulb. Left, A normal filament. Right, A bent filament.
ment was swept across the pupil, I found it difficult to determine the axis of astigmatism, and I could produce scissors' reflexes or pseudo-irregular astigmatism at will. Bends in the filament did not affect the far-point determination. A problem with a streak retinoscope should be suspected if the intercept, the divergent beam of light emanating from the filament, is not straight. The sleeve of the retinoscope can be raised or lowered to focus the filament on a wall and confirm the suspicion (Fig. 1). If the image of the focused filament is bent, remove the housing and locking screw to determine the nature of the bend (Fig. 2). The straight filament of the retinoscope bends in response to sudden jolts while it is hot (Joseph F. Andera, personal communication, Stereo Optical, Chicago, Ill.; June 18, 1990). It does not bend if it simply has been left on in the supine position. Halogen bulbs heat to 4,000 F and are particularly prone to trauma. To reduce the likelihood of filament damage, turn the
retinoscope off and wait a few seconds before returning it to its receptacle. Should a bend occur, turn it on with the locking screw removed and tap it in the opposite direction of the bend. This simple maneuver will often correct the problem.
A Simple Method for Detection of Hemianopsia or Quadrantanopsia Rudolph Hahnenberger, M.D. Department of Ophthalmology, University Hospital.
Inquiries to Rudolph Hahnenberger, M.D., Department of Ophthalmology, University Hospital, 5-751 85 Uppsala, Sweden.
When a perimeter is not available, confrontation tests are usually used for testing visual fields. Most of these techniques are reliable if performed correctly. Testing is difficult to per-
Vol. 110, No.4
Letters to the Journal
form in patients who are in the supine position immobilized by monitoring, infusion systems, or both. For several years I have successfully tested visual fields using a prism between 30 and 60 diopters. When the patient fixates on an object with both eyes and a prism is placed in front of one eye, the image of that eye will be displaced from the fovea. The patient with two intact visual fields will thus experience diplopia, since the displaced image does not fall on a corresponding part of the retina. If this image, however, falls on a blind part of the visual field no diplopia will occur. The examination is done in a room with reduced illumination. The patient fixates a flash light, positioned at a distance of about 1 m. A prism is then placed in front of one eye and rotated around the visual axis. The patient reports diplopia as long as there is no visual field defect in the particular area tested, for example, 30 degrees from the fixation point if a 60-D prism is used. The contralateral eye is tested in the same manner. This method discloses only absolute defects. The results must be interpreted cautiously when the prism is positioned in the horizontal plane, since fusion is possible up to 20 P.D. base in. In any other position, however, fusion is impossible as long as high-power prisms are used. The test is useful in binocular, nonsquinting subjects, in whom conventional confrontation tests are difficult to perform.
Demographic Patterns and Academic Choices of Graduates of One Ophthalmology Training Program Robert A. Catalano, M.D., Mabel M. P. Cheng, M.D., and John M. Cutro, B.S. Department of Ophthalmology and Lions Eye Institute, Albany Medical College. This study was supported by an unrestricted grant from Research to Prevent Blindness, Inc.
Inquiries to Robert A. Catalano, M.D., Department of Ophthalmology, Albany Medical College, Albany, NY 12208.
To determine trends in resident profiles and practice choices over the past two decades, records of the 77 graduates of Albany Medical
433
College's ophthalmology training program from 1967 to 1987 were reviewed and validated through telephone interviews. Information regarding preresidency intentions, postresidency training, age, sex, hometown, educational and research background, publications before and during residency, practice location, and practice choice was collected. The National Board of Medical Examiners, Department of Psychometrics, provided confidential Part I scores for 57 of the 77 graduates and performed a discriminant analysis to identify factors related to postresidency practice. Individuals were categorized into four residency periods. The first period included resident graduates during the first six years of the program; the remaining graduates were divided into successive five-year blocks. A pooled, within-groups correlation matrix was generated and discriminant analysis, based on Bayes's theorem, was performed to determine the posterior probability that a given individual would enter academic medicine. Only individuals with a full-time, tenure-track appointment at a medical college with an accredited residency program were considered to be engaged in academic medicine. Increasing trends included the percentage of women (zero of 18 [0%] the first six years to five of 20 [25%] the final five years); individuals with additional training before residency (three of 18 [17%] to six of 20 [30%]); nonscience majors (two of 18 [11%] to 11 of 20 [55%]); number of graduates from the affiliated medical school (three of 18 [17%] to ten of 20 [50%]); and percentage with publications before (two of 18 [11%] to 12 of 20 [60%]) and during residency (six of 18 [33%] to 13 of 20 [65%]). The age of applicants and the number of graduates remaining within 50 miles of the residency program (seven of 18 [39%] to nine of 20 [45%]) stayed consistent. Similarly, a nearly constant approximately 30% of the individuals returned to their hometown, and over 70% of those who stated Albany as their hometown remained in the area. Expressed interest before residency in academic medicine increased steadily from four of 18 (22%) to 12 of 20 (60%), as did fellowships attained (two of 18 [11%] to 12 of 20 [60%]). There was, however, no appreciable increase in the number of individuals entering academic practice (one of 18 [6%] to three of 20 [15%]). Nine of 12 individuals who entered academic medicine have remained in an academic practice. The minimum period in academia was two
AMERICAN JOURNAL OF OPHTHALMOLOGY
October, 1990
Fig. 2 (Miller). The housing and locking screw have been removed to show the bulb. Left, A normal filament. Right, A bent filament.
ment was swept across the pupil, I found it difficult to determine the axis of astigmatism, and I could produce scissors' reflexes or pseudo-irregular astigmatism at will. Bends in the filament did not affect the far-point determination. A problem with a streak retinoscope should be suspected if the intercept, the divergent beam of light emanating from the filament, is not straight. The sleeve of the retinoscope can be raised or lowered to focus the filament on a wall and confirm the suspicion (Fig. 1). If the image of the focused filament is bent, remove the housing and locking screw to determine the nature of the bend (Fig. 2). The straight filament of the retinoscope bends in response to sudden jolts while it is hot (Joseph F. Andera, personal communication, Stereo Optical, Chicago, Ill.; June 18, 1990). It does not bend if it simply has been left on in the supine position. Halogen bulbs heat to 4,000 F and are particularly prone to trauma. To reduce the likelihood of filament damage, turn the
retinoscope off and wait a few seconds before returning it to its receptacle. Should a bend occur, turn it on with the locking screw removed and tap it in the opposite direction of the bend. This simple maneuver will often correct the problem.
A Simple Method for Detection of Hemianopsia or Quadrantanopsia Rudolph Hahnenberger, M.D. Department of Ophthalmology, University Hospital.
Inquiries to Rudolph Hahnenberger, M.D., Department of Ophthalmology, University Hospital, 5-751 85 Uppsala, Sweden.
When a perimeter is not available, confrontation tests are usually used for testing visual fields. Most of these techniques are reliable if performed correctly. Testing is difficult to per-
Vol. 110, No.4
Letters to the Journal
form in patients who are in the supine position immobilized by monitoring, infusion systems, or both. For several years I have successfully tested visual fields using a prism between 30 and 60 diopters. When the patient fixates on an object with both eyes and a prism is placed in front of one eye, the image of that eye will be displaced from the fovea. The patient with two intact visual fields will thus experience diplopia, since the displaced image does not fall on a corresponding part of the retina. If this image, however, falls on a blind part of the visual field no diplopia will occur. The examination is done in a room with reduced illumination. The patient fixates a flash light, positioned at a distance of about 1 m. A prism is then placed in front of one eye and rotated around the visual axis. The patient reports diplopia as long as there is no visual field defect in the particular area tested, for example, 30 degrees from the fixation point if a 60-D prism is used. The contralateral eye is tested in the same manner. This method discloses only absolute defects. The results must be interpreted cautiously when the prism is positioned in the horizontal plane, since fusion is possible up to 20 P.D. base in. In any other position, however, fusion is impossible as long as high-power prisms are used. The test is useful in binocular, nonsquinting subjects, in whom conventional confrontation tests are difficult to perform.
Demographic Patterns and Academic Choices of Graduates of One Ophthalmology Training Program Robert A. Catalano, M.D., Mabel M. P. Cheng, M.D., and John M. Cutro, B.S. Department of Ophthalmology and Lions Eye Institute, Albany Medical College. This study was supported by an unrestricted grant from Research to Prevent Blindness, Inc.
Inquiries to Robert A. Catalano, M.D., Department of Ophthalmology, Albany Medical College, Albany, NY 12208.
To determine trends in resident profiles and practice choices over the past two decades, records of the 77 graduates of Albany Medical
433
College's ophthalmology training program from 1967 to 1987 were reviewed and validated through telephone interviews. Information regarding preresidency intentions, postresidency training, age, sex, hometown, educational and research background, publications before and during residency, practice location, and practice choice was collected. The National Board of Medical Examiners, Department of Psychometrics, provided confidential Part I scores for 57 of the 77 graduates and performed a discriminant analysis to identify factors related to postresidency practice. Individuals were categorized into four residency periods. The first period included resident graduates during the first six years of the program; the remaining graduates were divided into successive five-year blocks. A pooled, within-groups correlation matrix was generated and discriminant analysis, based on Bayes's theorem, was performed to determine the posterior probability that a given individual would enter academic medicine. Only individuals with a full-time, tenure-track appointment at a medical college with an accredited residency program were considered to be engaged in academic medicine. Increasing trends included the percentage of women (zero of 18 [0%] the first six years to five of 20 [25%] the final five years); individuals with additional training before residency (three of 18 [17%] to six of 20 [30%]); nonscience majors (two of 18 [11%] to 11 of 20 [55%]); number of graduates from the affiliated medical school (three of 18 [17%] to ten of 20 [50%]); and percentage with publications before (two of 18 [11%] to 12 of 20 [60%]) and during residency (six of 18 [33%] to 13 of 20 [65%]). The age of applicants and the number of graduates remaining within 50 miles of the residency program (seven of 18 [39%] to nine of 20 [45%]) stayed consistent. Similarly, a nearly constant approximately 30% of the individuals returned to their hometown, and over 70% of those who stated Albany as their hometown remained in the area. Expressed interest before residency in academic medicine increased steadily from four of 18 (22%) to 12 of 20 (60%), as did fellowships attained (two of 18 [11%] to 12 of 20 [60%]). There was, however, no appreciable increase in the number of individuals entering academic practice (one of 18 [6%] to three of 20 [15%]). Nine of 12 individuals who entered academic medicine have remained in an academic practice. The minimum period in academia was two