Pulfrich's phenonenon in a case of optic nerve hypoplasia

Introduction:  Optic nerve hypoplasia (ONH) is a congenital deficiency of retinal ganglion cells and their axons that form the optic nerve. This condition is associated with visual deficits ranging from no light perception in severe cases to vision within normal ranges in mild cases of ONH. In mild cases, deficits can be limited to sectoral anomalies in the visual field and normal vision with colour vision anomalies have been reported. We report here a case of mild ONH with visual symptoms relating to Pulfrich phenomenon (PP) occurring spontaneously. Methods:  A 12 year girl presented with typical visual symptoms (bumping into objects when walking, poor object location at tennis) associated with the spontaneous PP. A simple pendulum revealed a perceived anticlockwise ellipse indicative of a left eye defect. This was neutralised by an 85% transmission filter placed before the right eye. The inter-ocular latency difference was calculated to be 0.88 (S.D., 0.55) ms. Results:  Fundus biometry showed an asymmetry in optic nerve size, the left being smaller than the right. Visual fields, anomaloscope and other colour vision tests, and both flash and pattern-reversal stimuli Visually Evoked Potentials showed no difference in visual function between the right and left eyes. Conclusions:  A case of very mild ONH gives inter-ocular normal vision and visual function and yet a subtle inter-ocular delay occurs resulting in visual symptoms associated with PP. These were completely removed with tinted spectacles.