Page 26 - BOAF Journal 1 2012:2707

Behavioral Optometry
BOAF
Volume1 Number1 2012
lous fixation, false macula, or the like.
Irregularities in the shape of the plotting frequently indicate inaccurate charting. Some are, however, verified on subsequent chartings but these are rare and the plotted nerve-head is usu- ally elliptical or oval shape. It has been found that as little as a half diopter of astigmatism will create a narrowed or angled plotting of the nerve head. Thus, the patient must wear his distance prescription when nerve-heads are being plotted.
Figure No.2 shows a flatten- ing of the superior or inferior portion of the plotted nerve- head and is found in approxi- mately 80% of severe tonsil involvements. This flattening may be straight across or tilted. The greater the constriction in the vertical, the more apparent is the flattening. When the verti- cal constriction is less or there is a corresponding constriction in the horizontal, the flattening is less obvious as a flattening and may give the plotted nerve- head a distorted appearance. When the latter condition exists, there is usually a considerable difference in the shape of the two charted nerve-heads. Oc- casionally, but rarely, the flatten- ing may appear on one side. The absence of the flattening is not absolute evidence that there is no involvement of the tonsils. Generally, the side of the throat coinciding with the eye display- ing the greater nerve-head con- striction will be found to have the greater infection. The shape
and amount of constriction tend to remain fairly constant during the day where the tonsil in- volvement is the primary or only source of focal infection.
Fig.2
Figure No.2 shows a flattening of the superior or inferior portion of the plotted nerve-head and is found in approximately 80% of severe tonsil involvements.
When there is a greater constriction of one plotted nerve-head than the other, a dental involvement should be suspected. Sinus involvements will also create differences, however, usually not as great. The diagnosis of dental in- volvements can be made with greater certainty by a second plotting later in the day or on the following day. The compari- son of a non-basal and a basal charting will find a dental case changed very little, while the case which is principally sinusi- tis will usually have 8 to 25% greater restriction on a basal charting. (See Figure 3a & 3b.) According to Davidsen, the rea- son for this is that the cells of the sinuses are like a honey- comb and collect their puru- lence in the night. As soon as the patient arises in the morn- ing, this begins to drain into the system and the toxic effects are at their greatest then to thirty minutes after rising.
Sinus involvements, unless they are very severe, are re- flected by considerable change during the day and day to day
as the bacterial activity and the movement of the patient and their reparation or defense powers change. Constrictions reflecting sinus involvements are also more subject to change as the result of exercise and may improve from 20 to 25% following exercise. (see Figure 3c.)
Fig.3a
Fig.3b
Fig.3c
Figure No.3a is a caecanometric plotting of a typical low-grade sinusitis late in the day (a non- basal charting).
Figure No.3b is a caecanometric plotting of the same patient un- der basal conditions showing an increased restriction.
Figure No.3c shows the same patient after hyperventilation. This can be accomplished by having the patient walk or mark time for five minutes while doing forced breathing - then rest for 3 minutes and retake the charting. You should, especially in of si- nusitis, measure a 5 to 10% larger physiological blind spot. This is due to the anti-toxic ac- tion of the oxygen intake.
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