NOTES, CASES, INSTRUMENTS

KINDERGARTEN VISUALACUITY CHART*

CONRAD BERENS, M.D.New York

Psychology is an important factor intesting the visual acuity of children undersix years of age. To improve perform­ance, interest must be stimulated, andthus a higher degree of visual acuity maybe obtained. Some visual-acuity chartsfor examining young children lack inter­est for the modem child and are ofteninaccurate. Even the most scientificvisual-acuity charts for children, for ex­ample, the Evans! charts and Inouye testtypes, probably are not so accurate as theE test, which has been so well systema­tized by the personnel of the NationalSociety for the Prevention of Blindness."

The purpose of the kindergarten chartdescribed here is to stimulate interest bypresenting figures with which the averagechild 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 conformas nearly as possible with one-minuteand five-minute angles (fig. 1).

The chart measures 10 inches by 28inches and contains seven rows of figuresby means of which visual acuity of20/200, 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 orderto 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, HotSprings, Virginia.

Aided by a grant from the Ophthalmologi­cal Foundation, Inc., and developed with thecooperation of the Department of Research atthe New York Eye and Ear Infirmary.

667

Fig. 1 (Berens). Kindergarten visual-acuitychart.

of E's, visual acuity of 20/100, 20;70,20/50, 20/40, 20/30, 20/20, 20/15, and20/10 may be measured. The E's alsopermit a comparison of visual acuity ob­tained by means of the E test and thatobtained employing the figure test. It has,moreover, been found that a single letterfor each distance is less confusing whentesting children.

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668 NOTES, CASES, INSTRUMENTS

REFERENCES

1 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.

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, showeda tumor of the choroid in the outer por­tion of the right eye, situated justposterior to the ciliary body. After enucle­ation on November 9, 1923, the patholo­gist gave the following report: "Patho­logical study of the eye revealed a tumormass measuring 5.2 X 3 mm., located justbehind the temporal portion of the ciliarybody. This tumor was solid, cellular, andbrownish in color. The microscopicalsections showed it to be composed ofspindle-shaped cells arranged in wavystrands running in all directions; fre­quently in whorl formation. Melanin pig­ment, located both in these cells and extra­cellularly, was particularly prominenttowards the periphery of the growth. Thetumor mass merged gradually into thechoroid at its margin. An occasional thin­walled blood vessel was seen in the tumor.The retina was detached and lay looselyover the tumor mass. The sclera was notinvaded, but was thinner than normal.Pathologically this neoplasm was in thefirst or intraocular stage of growth. Therewas no gross nor microscopical evidencethat the tumor had extended into orthrough the sclera. Diagnosis: Malignantintraocular melanoma, right eye."

The patient was next seen on Decem­ber 2, 1935, at which time there was nodefinite indication of local recurrence.His general health seemed excellent. InFebruary, 1936, there appeared in thelower half of the socket a moderate-sizedswelling which was firm and showed no

gross pigmentation. It appeared thatthe artificial eye had irritated the socketto some extent. The patient was advisedto keep himself under close observa­tion.

On July 7, 1937,he again reported witha firm dark mass filling the apex of theright socket, the size and shape of a smallpecan nut. Exenteration of the orbit wasperformed. The pathologist's report wasas follows: "The specimen consisted ofthe right orbital contents, the eye havingbeen enucleated some 14 years previouslybecause of the presence of an intraocularmelanoma. On sectioning through thismass of fatty and epidermal tissue, whichincluded the eyelids, a tumor mass coal­black in color and measuring as much as3 em, in diameter, was demonstrable.This tumor had invaded rather diffuselythe orbital tissues. The picture grosslywas characteristic of malignant mela­noma. The sections showed a very cellu­lar malignant neoplasm composed ofelongated spindle-shaped cells. Many ofthese cells were packed with granularmelanin pigment, and much extracellularpigment was noted. The tumor cells ap­peared to be proliferating at a relativelyslow rate of speed yet they invaded thesurrounding- orbital tissues with' ease.This tumor was appraised as beingstrongly radio resistant and was ratedgrade two malignancy." It was noted thatthe type of cells in the original growth andthe recurrent mass were very similar,though the pigmentation in the latter wasmuch more evident.

This case is being reported because ofthe length of time between the primaryenucleation and the local recurrence andbecause of the lack of evidence of anymetastatic manifestation.

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