Darkened spot and blurriness

Discussion in 'Optometry Archives' started by ip1234, Jan 4, 2007.

  1. ip1234

    ip1234 Guest

    A couple days ago, my cousin (in his mid-thirties) noticed that he ha
    a well-defined, darker spot in the center of his field of vision fo
    one eye. His vision in that eye is also a little blurry. Thes
    things are noticable day and night. His mother has had cataracts
    his grandmother has macular degeneration. Is it likely he has one o
    those? (He has high cholesterol that is being controlled wit
    medication. His BP, cholesterol and weight are all good.) Who woul
    be the best person to see for a diagnosis? And, should he think abou
    getting disability insurance

    Thanks in advance

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    ip1234, Jan 4, 2007
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  2. Neither one of those, but it could be a retinopathy, unless it seems to
    "float" or move when his eye is stationary, which could mean just a
    floater. Needs to be seen by an eye doc, and insurance may be a good
    idea, but probably too late, unless he fudges the date of first onset
    (aka insurance fraud)...
    William Stacy, Jan 4, 2007
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  3. ip1234

    ip1234 Guest


    Thank you for your reply. After reading about central serou
    retinopathy (he is not diabetic nor does he have high BP), it sound
    like it describes his symptoms and situation very well. I am sure i
    will be reassuring to him (since it has a much better prognosis tha
    macular degeneration!) until he is able to see a doctor

    Thank you

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    ip1234, Jan 4, 2007
  4. ip1234

    Don W Guest

    Just curious, how does this all lead to this conclusion?

    Don W.
    Don W, Jan 4, 2007
  5. ip1234

    ip1234 Guest

    Don Wwrote
    Just curious, how does this all lead to this conclusion

    Don W.[/quote:606e91159d

    Which conclusion?

    If he has retinopathy, it is likely to be central serous retinopathy.
    From what I read, there are 4 types: retinopathy of prematurity
    diabetic retinopathy, hypertensive retinopathy, and central serou
    retinopathy. He's not an infant, nor diabetic, nor hypertensive.

    I am not sure how William came to the conclusion that it could b
    retinopathy, but the risk factors and symptoms I read about that see
    to apply to my cousin are

    Male between 20-4
    Reduced visual sharpness/blurrines
    Distortion (very very slight in my cousin's case
    Grey or blind spot

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    ip1234, Jan 4, 2007
  6. ip1234

    Don W Guest

    Excuse. I was impressed as to how fast macular degeneration was
    ruled out. But the odds are it would be age related and I did not note
    his age range. Hopefully it is not that.
    With this type of symptom occuring, I would be in the doctor's office
    as soon as possible. Good luck.

    Don W.
    Don W, Jan 4, 2007
  7. Mac. degen does not ordinarily cause a positive scotoma (one that the
    patient "sees" as a spot in the vision). I know some illustrators often
    simulate the disease using a dark or black spot in the center of the
    view. This is not what Mac Degen people see. It would better be
    portrayed with the detail in the scotoma area just having the same color
    as that surrounding the defect. (e.g. a face with missing eyes, nose and
    mouth shown with the featureless area the same skin tone as the rest of
    the face). Central serous retinopathy often does cause a positive dark
    scotoma such as is often erroneously depicted as macular degeneration.

    w.stacy, o.d.
    William Stacy, Jan 4, 2007
  8. ip1234

    Don W Guest

    Dear Dr. Stacy,

    That is completely untrue. The natural blind spot (optic nerve) may
    "fill in", but in "Mac Degen" the spot can be dark or black.

    Don W.

    PS. And the person experiencing this should see an ophthalmologist,
    very quickly.
    Don W, Jan 5, 2007
  9. I suppose it "can appear dark or black" but most patients I've run
    across with macular degeneration don't report that. Most mac. degen.
    occurs very slowly and the losses associated are usually "filled in" in
    a manner very similar to that of the normal blind spot, or indeed, of
    the Purkinje tree itself. I thinkd this is the very reason that most
    macular degeneration patients have the "dry" type and first complain
    more of a blur or an indistinctness of fine detail or of straight lines
    appearing wavy or bent. Now a sudden hemorrhage like one might get from
    the much rarer "wet" form probably would cause a dark positive scotoma,
    but I don't see many of those (thankfully). Other docs here might want
    to chime in on this, since many of them may see more of this than I do.
    My patient population is pretty young, average age is about 42.

    w.stacy, o.d.
    William Stacy, Jan 5, 2007
  10. ip1234

    Don W Guest

    The problem is with the symptom, one does not know how things will
    evolve (quickly or slowly) in time. I have one reference that shows
    "successful outcomes" depend on moving fast for treatment. They
    plotted a graph where the x-axis was calibrated in _days_. Which tells
    me you really have to move on this, insurance or not. Really, what do
    you have to lose??
    As to the Purkinje tree vascular event, that can be negated by moving
    the light source across the retina where the vascular shadows are then
    cast in a "slightly new (small offset) area". Where the brain is not
    prewired as in the old area to compensate for their presence in front
    of the retina.
    As far as scotomas being filled in. Not usually so. I think it is
    too new an event for the brain to adapt.

    Don W.
    Don W, Jan 5, 2007
  11. Ok it seems that you must be talking about the wet or proliferative type
    of macular degeneration, where things can indeed happen fast and early
    intervention is necessary. Certainly moving fast is not an issue with
    the common dry type of macular degeneration, as it is an exceedingly
    slow process.

    I do recognize the importance of early intervention in such a case. But
    I also know that this is by far the rarer situation. The more common
    type takes years to develop and that this the type that I was talking
    about, where positive scotomata would be the exception.
    More a phenomenon than an event, any localized deficit of retinal
    function can be visualized by strongly illuminating an adjacent normal
    retinal area.

    Where the brain is not
    I think it's more a retinal level (ganglion cell, etc.) phenomenon than
    a cortical one. The recovery times for such things as the Purkinje tree
    is so fast as to be hardly considered a "prewired" situation.

    Like I said, the Purkinje phenomenon is a great example of such
    relatively instantaneous adaptation. Shift the shadow a bit with a
    strong oblique light source, and what is at first a dramatic
    visualzation disappears within a second or so. Too fast for any
    rewiring to take place higher up, that's for sure. It's all at the
    ganglion level, right down in the retina itself.
    William Stacy, O.D., Jan 5, 2007
  12. ip1234

    gudrun17 Guest

    My husband was first diagnosed with central serous retinopathy, and
    then sent to another specialist who diagnosed a choroidal hemangioma
    which was treated with PDT. In either case, it seems to me the chance
    of recovering full vision diminishes the longer a person waits to see a
    doctor. As it was explained to me, the longer the retina is elevated,
    the greater the chance it will not flatten again completely. My husband
    wishes he had seen the retina specialist much sooner than he did.
    gudrun17, Jan 5, 2007
  13. ip1234

    Don W Guest

    When the spot occurs, such as the case here, I would not consider
    this ("well defined dark spot") a possible manifestation of dry MD.
    But the possibility of wet MD would bother me. Agreed, moving fast is
    not necessary with dry MD. But it is not sure here how this symptom
    evolved in time.

    You comments on the Purkinje effect are interesting. I agree the
    effect is transitory, lasting for a fraction of a second or so, at
    least how I have noticed it. Then the incoming light is compensated
    for, that is, one does not see the vascular tree. That to me seems
    kind of a wonder, because during the normal day, light rays will strike
    this area around the vascular tree at various (mostly random) angles,
    and yet no image of the tree is produced ("seen"). But move a
    light from a slit lamp across it and there it is produced.

    But as far as scotoma is concerned, there is no compensation for the
    missing field. I hope you agree.

    Don W.
    Don W, Jan 6, 2007
  14. ip1234

    Don W Guest

    So what you are saying is that if one modulates the shadows edge, (that
    is, turn the edge on and off) the vasculature will appear?

    Don W.
    Don W, Jan 6, 2007
  15. True, or move the edge a bit as he said. The most dramatic display of
    this is when you manage to hold the eye perfectly still, all detail
    vision fades away. The vision system depends on a moving image for
    vision to occur. That's the reason we have what's called micronystagmus
    or physiologic nystagmus.

    w.stacy, o.d.
    William Stacy, Jan 6, 2007
  16. to be more correct, I should have said vision requires a changing image,
    either in intensity (on/off) or in position (motion). And that fade out
    with the still eye only takes a second or so.
    William Stacy, Jan 6, 2007
  17. ip1234

    Don W Guest

    Getting back as to what constitutes seeing or not seeing the retinal
    vascular. If modulation of the edges (on - off) is the same as moving
    the edges, then the eye going from a dark environment to bright light
    should produce at least a brief flash of these trees.

    I've never noticed this although it seems that should happen.

    Don W.

    PS. Yes I have read that fixing the retinal image makes the image
    disappear. I think also that direct retinal displays need built in
    jitter. There has been a paper (Deruaz) that discusses fixation
    instability to improve the vision (letters) of people with central
    scotomas. I think I know someone that has "improved" their vision from
    20/200 to 20/100 by this kind of "trick".
    Don W, Jan 6, 2007
  18. absolutely it happens. if you haven't seen it, you don't have the light
    at the right angle. It is only momentary, which is why moving the light
    helps the visualization since a single presentation is not as good as
    many in rapid succession, just like in the movies.
    William Stacy, Jan 6, 2007
  19. btw the conditions that I have experienced it is wearing very dark
    sunglasses (too dark, really) and catching a ray of sunlight from beyond
    the edge of the sun lens. Flashes a very bright P. tree on the darkness
    of the sun lens. Don't try this while driving....
    William Stacy, Jan 6, 2007
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