Baker report, 1968 congressional hearings

1. A history of 6-8 weeks of tearing, misty vision, and photophobia.
2. A pale optic nerve with absent cupping; sluggishly reacting pupils; impaired red light reflex.
3. Confluent retinal mottling, obscured macula, mild red-green dyschromanopsia.
4. Bilateral centrocecal scotomata; bilateral superior temporal quadrantanopsia (for red stimulus
only. Vision in decreased light (10 foot-candles): grossly impaired to absent.
E. Discussion and Creditability Score
The definite retinitis, field defects for red vision, and red-green dyschromanopsia, along with a history of tearing, misty
vision, and photophobia are all consistent with the diagnosis of tobacco-alcohol amblyopia (Ref. 1). This condition is also
supported by the findings in the General Medicine Evaluation, where other effects of excessive smoking and alcoholism
are evident.
The subject's retinal pathology is severe; in terms of the specific event he claims he saw, it is extreme. His "sighting" is
highly unlikely because he attaches both color and shape to it in the face of specific deficiencies in each of these areas. His
attestation about seeing the object best when looking straight at it (see Psychiatric Anamnesis) is uncreditable because his
central macular vision has been so severely compromised by retinitis. It is conceivable that what actually happened is that
he 1) received a transient visual stimulus (i.e., car or airplane lights) which 2) set off some abnormal receptor firing in a
damaged retinal area and 3) in turn was misperceived.
Creditabillty score 5%.
Ref. 1 Walsh, P.B.: Clinical Neuro-ophthalmology, Williams & Wilklna, Baltimore 1957, p. 1182.
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IV. Neurologic Evaluation
A. Neurologic History:
Subject is right-handed and denies any degree of ambidextry. He denies periods of euphoria, uncontrolled behavior or
delirium. He denies recent changes or difficulty with dressing, eating, or writing. He states that he does not feel that he has
recently become clumsy or weak. He said he had never had the experience of deja-vu episodes or of performing acts over
which he had no control and no unpleasant tastes or odors that he couldn't explain. He states that he is not aware of any
increased difficulty in expressing himself or understanding the speech of others. He has no problem with calculation or
with seeing objects as smaller or larger than they really were. He is not aware of any difficulty with color vision, flashing
lights, or other forms of visual hallucinations.
He admits to headaches which occur after he has been drinking heavily; these have been decreasing in frequency. He states
that he has never lost consciousness (with associated tongue biting, incontinence, or period of confusion upon awaking).
He denies trauma or infections of his head, eyes, ears, or neck.
B. Neurologic Examination:
Mental Status: See Section V (Psychiatric Evaluation).
Cerebellar Function: Finger-to-nose and heel-to-shin intact; rapid alternating movements are rhythmical and coordinated;
no awkwardness or other abnormalities in any gross or fine movements. Foot dexterity and Figure eight test are performed
without difficulty. No broad-based gait or ataxia noted.
Cranial Nerves:
I Olfactory: Each nostril perceived cloves (stimulus was identified with patient's eyes closed).
II Optic Nerve: Reported in detail in Section III (Neuro-ophthalmology).