Sadun A A
Doheny Eye Institute, Los Angeles, California.
Metab Pediatr Syst Ophthalmol (1985). 1990;13(2-4):79-84.
Many optic neuropathies and subtle maculopathies may have similar clinical presentations. This represents a challenge to the ophthalmologist to distinguish between the two on clinical grounds. These patients may not have obvious signs and their symptoms may be ambiguous. For example, a young man presenting with optic neuritis may have similar complaints to one suffering from central serous retinopathy. Several general principles can be used to distinguish between optic neuropathies and maculopathies. Additionally, specific psychophysical tests can be of help. The most important aspect of the history is in establishing the tempo of onset, duration and resolution of the symptoms. Optic nerve lesions often produce symptoms described as dimness or grayness, whereas macular lesions usually reduce visual acuity and produce metamorphopsia. The clinical examination requires comparing optic nerve function studies (afferent pupillary defects, color vision and brightness sense) to visual acuity. Additionally, assessing the central visual field especially through Amsler grid testing or threshold Amsler grid testing is very useful. Certain psychophysical tests can be performed in the office. Threshold amsler grid testing, photostress testing, contrast sensitivity, and the Pulfrich phenomena can all be put to advantage in distinguishing between optic neuropathies and maculopathies.
许多视神经病变和细微的黄斑病变可能有相似的临床表现。这给眼科医生在临床上区分两者带来了挑战。这些患者可能没有明显体征，其症状也可能不明确。例如，一名患有视神经炎的年轻男性可能与一名患有中心性浆液性视网膜病变的患者有相似的主诉。有几条通用原则可用于区分视神经病变和黄斑病变。此外，特定的心理物理学测试可能会有所帮助。病史中最重要的方面是确定症状的起病速度、持续时间和缓解情况。视神经病变常产生如视物模糊或灰暗等症状，而黄斑病变通常会降低视力并产生视物变形。临床检查需要将视神经功能检查（传入性瞳孔障碍、色觉和亮度感觉）与视力进行比较。此外，评估中心视野，尤其是通过阿姆斯勒方格表测试或阈值阿姆斯勒方格表测试非常有用。某些心理物理学测试可在诊室进行。阈值阿姆斯勒方格表测试、光应激测试、对比敏感度和普尔弗里希现象在区分视神经病变和黄斑病变方面都能发挥作用。
