Now I am 76 years old and retired from work years ago and
at present I am forgetting not only English but also Japanese,
therefore, I am very much curious and unbelievable why nowadays
I receive letters of invitation for writing papers. To those invitations
from journals, I have declined the offers because of lack of my
ability. However, I have moved the letter from Ms. Patricia David
just beginning “start each day with grateful heart”. I am aged
therefore; each day is very precious, and I am very much thankful
for that I was happened to be born not ant nor cockroach but one of
the human beings in this beautiful earth.
My Childhood and Youth
When I was a child I enjoyed watching a group of ants working
busily to send food to their small house which was just a hole in
my garden. At that time, I thought that I was watching them closely
however, they could not recognize me as a whole being. I realized
functions of eyes are different among creatures. I heard dogs do not
have colour vision. When I graduated from university (it is shameful
to tell; I graduated from English Literature Department) in 1966, I
found the job offer for orthoptists on the bulletin of my university.
At that time, there was no occupation named as “orthoptist” in
Japan and in 1972, I got a national licence as a certified orthoptist.
Working Days in Nagoya University
I worked as an orthoptist mainly at the Department
Ophthalmology Nagoya University School of Medicine for 25 years.
I worked under the late Professor Hiroshi Ichikawa (specialty:
colour vision) Professor Shinobu Awaya (speciality: strabismus
and amblyopia) Professor Yozo Miyake, at present the Director of
Aichi Medical University, (specialty: retinal diseases and electro
retinogram) The all professors were not only splendid scholars
but also very impartial and liberal to the all staffs. I worked under
Professor Miyake for the longest. He encouraged us to write papers
in English and to apply them to western journals.
Measuring Binocular Visual Field of Patients by
Handmade Perimeter Named “Starlight Test”
After busy outpatients’ clinic which usually postponed to
around 2 o’clock or later, I used to examine visual acuity and visual
field of in patients of the Department of Brain Surgery. Measuring
their visual field with Goldman or Humphrey perimeter, I was
really surprised that patients of complete hemianopia were not
conscious of their visual field loss. I have examined plenty of visual
fields of patients; not only intracranial diseases but also glaucoma,
retinitis pigmentosa, functional visual field loss of children and I
have come to have strong wish to know how they were seeing
their surroundings [1-6]. This curiosity induced me to make
“starlight test (Figure 1). We also examined strabismus patients
whose amblyopia and strabismus had been treated yet still have
some residual deviation . The visual field of Figure 2 showed
discrepancy in among instruments but the result of starlight test
which showed the complete bitemporal hemianopia which was
coincided with the result of 10-2 of Humphrey . The reason why
they show bitemporal hemianopia at fixation point is in binocular
condition, patients with lesions of the optic chiasm is caused by the
compression of the decussating optic nerve fibers resulting in the
loss of overlapping visual field at fixation point.
Figure 1: Method and a view of normal subject of the “starlight test”.
Figure 2: Results of VF tests in case 6 after coil embolization of unruptured internal carotid aneurysm.
Working as a Teacher
After retirement from Nagoya University at age of 60, I was
offered from Department of Orthoptics and Vision Science, Aichi
Shukutoku University in Nagoya city as a teacher and worked
there until 70. As I got research expenditure from the University,
I acquired the copyright for “30 cm Visual Filed Card ”which was
supplement of the book entitled “Neurological Ophthalmology
for clinical use (309 pages) written by Fujino Tei published by
Igaku shoin Tokyo, 2001 and distributed all students and let them
examine their visual fields by themselves, I made not only white
cards, but also, red, green, yellow, blue cards too (Figure 3).
Figure 3: 30° visual field card.
My Message to Readers
VISION 2020 is the worldwide campaign of the WHO started
in 1999. The aim of campaign is to eliminate the main causes of
all preventable and treatable blindness by the year 2020. For this
purpose, I would like to suggest using stereo tests for screening.
Stereo tests are easy, cost effective tests which able to examine
from 3 years old to the aged. Among the stereo tests I recommend
the Lang stereo test I, or II which need not to use glasses and less
of false positive (Figure 4). The tests define the examinees have
normal binocular vision or not. In my study , in patients from
optic chiasmal lesions, before surgery, 3 out of 13 patients (23.0
%) passed the Lang and after surgery, 9 out of 13 (69.2%) patients
passed the Lang. I believe simple Lang tests are able to save people
not only from blindness but also their lives.