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

Thanks in advance.


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Thank you for your reply. After reading about central serous
retinopathy (he is not diabetic nor does he have high BP), it sounds
like it describes his symptoms and situation very well.

Don Wwrote:
[quote:606e91159d]
Thank you for your reply. After reading about central serous
retinopathy (he is not diabetic nor does he have high BP), it
sounds
like it describes his symptoms and situation very well.

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.

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 wrote:


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.




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.

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.

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.

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".

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.

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.

kind of a wonder, because during the normal day, light rays will strike
this area around the vascular tree at various (mostly random) angles,

"Don W" <dwilgus@prodigy.net> wrote

kind of a wonder, because during the normal day, light rays will strike
this area around the vascular tree at various (mostly random) angles,

But it doesn't. Normally the shadow doesn't move and the retina loses all
perception of edges that do not move. Wiggle a light (slit lamp, penlight,
even through the sclera) and the shadows become perceptible.