Testing Visual Fields in Children

Visual fields in the pediatric population are an essential part of the eye exam that remain challenging to even the most experienced clinicians. Becoming educated in the multiple ways a child's visual field can be tested regardless of age and cognitive and physical abilities will allow the clinician to gain better insight into the child's function and in some cases, allow the clinician to identify pathological or neurological anomalies in the visual pathway. Gross visual field or functional visual field extent can be estimated by tests such as confrontation visual field testing, finger counting field testing, and white sphere kinetic perimetry. For threshold measurements of a child's visual fields, the Goldmann perimeter, or the more advanced computerized tests such as the Humphrey perimeter, Octopus perimeter, or frequency doubling technology perimeter can be used. Modifications can be made to certain tests to better suit the child's cognitive and physical abilities. The chapter covers different methods of visual field testing specific for the pediatric population.

No fingers, no SNARC? Spatial-Numerical Associations and temporal stability of finger counting

The Spatial-Numerical Association of Response Codes (SNARC) effect (i.e., faster left/right side responses to small/large magnitude numbers, respectively) is considered as strong evidence for the link between numbers and space. The studies have shown considerable variation in this effect. Among the factors determining individual differences in the SNARC effect is the hand an individual uses to start the finger counting sequence. Left-starters show a stronger and less variable SNARC effect than right-starters. This observation has been used as an argument for the embodied nature of the SNARC effect. For this to be the case, one must assume that the finger counting sequence (especially the starting hand) is stable over time. Subsequent studies challenged the view that the SNARC differs depending on the finger counting starting hand. At the same time, it has been pointed out that the temporal stability of finger counting starting hand should not be taken for granted. Thus, in this preregistered study, we aimed to replicate the difference in the SNARC between left- and right-starters and explore the relationship between the temporal stability of finger counting starting hand and the SNARC effect. We expected that higher stability should be associated with a stronger SNARC effect. Results of the preregistered analysis did not show the difference between left- and right-starters. However, further exploratory analysis provided weak evidence that this might be the case. Lastly, we found no evidence for the relationship between finger counting starting hand stability and the SNARC effect. Overall, these results challenge the view on the embodied nature of the SNARC effect.

Universalities and cultural specificities of finger counting and montring: evidence from Amazon Tsimane’ people

Despite variety of cultures, our shared biology and the universality of finger counting suggests that numbers are embodied. Another lines of research show that numerical cognition might be bound to what our bodies are able to do. Differences in finger counting are apparent even within Western cultures. Relatively few indigenous cultures have been systematically analyzed in terms of traditional finger counting and montring (i.e., communicating numbers with fingers) routines. Even fewer studies used the same protocols across cultures, allowing for a systematic comparison of indigenous and Western finger counting routines. We analyze the finger counting and montring routines of Tsimane’ (N = 121), an indiginous people living in the Bolivian Amazon rainforest, depending on handedness, education level, and exposure to mainstream, industrialised Bolivian culture. Tsimane' routines are compared with those of German and British participants. Tsimane’ reveal a greater variation in finger counting and montring routines, which seems to be modified by their education level. We outline a framework on how different factors might affect cross-cultural and within-cultural variation in finger counting.

The role of materiality in numerical cognition

Numerical elaboration and the extension of numbers to non-tangible domains such as time have been linked to cultural complexity in several studies. However, the reasons for this phenomenon remain insufficiently explored. In the present analysis, Material Engagement Theory, an emerging perspective in cognitive archaeology, provides a new perspective from which to reinterpret the cultural nexus in which quantification develops. These insights are then applied to representative Neolithic, Upper Palaeolithic, and Middle Stone Age artifacts used for quantification: clay tokens from Neolithic Mesopotamia, notched tallies from the European Upper Palaeolithic, hand stencils with possible finger-counting patterns as documented at Cosquer and Gargas, and stringed beads from Blombos Cave in South Africa.

Finger-counting in the Upper Palaeolithic

Upper Palaeolithic hand stencils at Cosquer Cave have been interpreted as forming a numeric code. The present analysis examined ‘digits’ at Cosquer and Gargas from the perspectives of modern ethnography, shared cognitive functioning and human hand anatomy, concluding that correspondences between the 27,000-year-old hand stencils and modern finger-counting practices, including the use of so-called biomechanically infeasible hand positions, are unlikely due to chance; thus, the hand stencils may indeed represent integers. Images of finger-signs may provide an additional avenue for interpreting Palaeolithic quantification.

Finger-Counting and Numerical Structure

Number systems differ cross-culturally in characteristics like how high counting extends and which number is used as a productive base. Some of this variability can be linked to the way the hand is used in counting. The linkage shows that devices like the hand used as external representations of number have the potential to influence numerical structure and organization, as well as aspects of numerical language. These matters suggest that cross-cultural variability may be, at least in part, a matter of whether devices are used in counting, which ones are used, and how they are used.

Retrobulbar neuritis associated with empty sella syndrome: A diagnostic challenge

A 35-year-old female presented with sudden diminution of vision to finger counting at half meters in right eye (RE) since 15 days. RE showed grade III RAPD. Rest of the ocular examination was normal. She had no significant past medical history. Neuroimaging showed empty sella. We suspected retrobulbar neuritis (RBN) as a cause of loss of vision since there was no evidence of acute change in morphology of sella turcica like hemorrhage, trauma or ischemia, furthermore there were no pathological findings in RE and visual cortex to explain acute visual loss. Therefore, we prescribed intravenous steroids followed by oral steroids. Vision in RE improved to 6/12 after 15 days. We found that RBN can be a cause of sudden vision loss in cases with empty sella syndrome (ESS) and can pose diagnostic challenge that whether the vision loss is due to ESS or RBN. RBN can be a cause of acute vision loss in patients with ESS and can create diagnostic confusion.

The unexplored role of handshape similarity in processing numbers on the hands

With two simple experiments we investigate the overlooked influence of handshape similarity for processing numerical information conveyed on the hands. In most finger-counting sequences there is a tight relationship between the number of fingers raised and the numerical value represented. This creates a possible confound where numbers closer to each other are also represented by handshapes that are more similar. By using the American Sign Language (ASL) number signs we are able to dissociate between the two variables orthogonally. First, we test the effect of handshape similarity in a same/different judgment task in a group of hearing non-signers and then test the interference of handshape in a number judgment task in a group of native ASL signers. Our results show an effect of handshape similarity and its interaction with numerical value even in the group of native signers for whom these handshapes are linguistic symbols and not a learning tool for acquiring numerical concepts. Because prior studies have never considered handshape similarity, these results open new directions for understanding the relationship between finger-based counting, internal hand representations and numerical proficiency.

Central retinal artery occlusion in a patient who contracted COVID-19 and review of similar cases

A 54-year-old male patient applied to our clinic with a sudden and painless loss of vision in his right eye. He was suffering from COVID-19. His best-corrected visual acuity of the right eye was finger counting from 30 cm. The fundus examination revealed the presence of a ‘cherry-red spot’ appearance in the right eye. In optical coherence tomography imaging, hyper-reflectivity was observed in the inner retinal layers as well as increased retinal thickness in the right eye. In fundus fluorescein angiography, delayed arterial filling and prolonged arteriovenous transit time were observed in the right eye. The patient was diagnosed with central retinal artery occlusion after the COVID-19 infection. In this study, we report this case and its management.

Vitrectomy in stage 5 ROP – surgical and functional results of 1000 vitrectomies

Despite improvements in neonatal care, retinopathy of prematurity is still leading cause of blindness in the world. The most treatment problems pose stage 4 and 5 of this disease. Performing vitrectomy in stage 5 is a subject of controversy among ophthalmologists due to unsatisfactory functional results after the surgery. Therefore, our aim was to present the results of 1000 vitrectomies performed by the author in years 1994–2019 in 1018 eyes of 692 children with stage 5 retinopathy of prematurity. In these children lens sparing vitrectomies and lensectomy-vitrectomy with limbal approach were performed. The results were compared with visual function of 127 untreated children with stage 5 retinopathy of prematurity. Visual acuity of treated patients ranged from 0.05 to no light perception in stage 5 and from no light perception to finger counting in the untreated group. Comparing the functional results of treated and untreated patients, it can be concluded that vitrectomy gives a better chance of gaining useful vision.