Dark Spots in Vision: Insights on Macular Degeneration

Q: Dark Spots in Vision: Insights on Macular Degeneration

Hello, Little Orange： The black shadow around the pinhole is due to diffraction and some optical phenomena, which is normal and will disappear once removed. <br>In cases of pigmentary retinopathy, vision may be unclear at night; however, your condition may not necessarily indicat

The pinhole version has a shadow?

Hello Dr.
Gao,
I have noticed a significant decrease in vision in my left eye in dark or indoor environments, while my right eye remains clear under the same conditions.
Both eyes are clear during the day with good lighting.
Today, during a pinhole vision test, I observed a black spot in the center of my left eye that obstructs my field of vision, with a bright ring surrounding it, allowing me to see letters faintly from the bright ring.
My right eye also has a faint black ring in the center, but I can still see the letters clearly.
When the pinhole was removed, there was no black spot in either eye's field of vision, and I found no abnormalities during a self-check with the Amsler grid.
I have undergone OCT, visual field tests, dilated fundus examination, and glare contrast sensitivity tests at the hospital, all of which were normal.
However, during fundus photography, several doctors noted no issues, but recently one doctor observed that the macula in my left eye appears slightly lighter than in my right eye.
He advised me to return for a follow-up in three months, suspecting that the cause in my left eye may be macular degeneration.
Since I have been unable to identify the cause of my left eye's condition, I previously consulted with you (article number #153416) and followed your advice to schedule an appointment at a medical center to investigate potential pigmentary retinopathy.
Should I wait for three months for this follow-up, or proceed with the planned visit to the medical center? I found information online stating that early diagnosis of night blindness is crucial, and I am concerned that waiting three months may cause me to miss the critical window for treatment.
Additionally, I am puzzled as to why there is no visible black spot in my normal field of vision, yet it becomes so pronounced when using the pinhole test.
Given my situation, would it be more effective to undergo fluorescein angiography (FAG), electroretinography (ERG), or electrooculography (EOG) for a quicker diagnosis? Should I undergo all of these tests, or is there a specific order in which they should be performed?
I would appreciate your guidance and recommendations regarding the necessary examinations.
Thank you for your response!

Xiao Juzi, 30~39 year old female. Ask Date: 2020/03/12

Dr. Gao Pilin reply Ophthalmology

Hello, Little Orange: The black shadow around the pinhole is due to diffraction and some optical phenomena, which is normal and will disappear once removed.
In cases of pigmentary retinopathy, vision may be unclear at night; however, your condition may not necessarily indicate this disease, and some tests are needed to rule it out.
Therefore, waiting for three months should not affect your condition.
As for the order of examinations, it is best to discuss this with your attending physician.
After evaluation, the specialist may determine that it is not this disease and may arrange for other tests.
The Ophthalmology Department at Puzi Hospital in Taiwan is open: Monday, Tuesday, Thursday, and Friday from 8:00 AM to 12:00 PM, and Wednesday from 2:00 PM to 4:30 PM.
Online responses can only serve as a reference; it is essential to seek medical attention at a healthcare facility if necessary.
I hope to have the opportunity to assist you.
Gao Pilin

Reply Date: 2020/03/12

More Info

Understanding dark spots in vision, particularly in relation to macular degeneration, is crucial for maintaining eye health and ensuring timely intervention. Based on your description, it appears that you are experiencing significant visual disturbances in your left eye, especially in low-light conditions. The presence of a dark spot in your central vision, along with the observation that your right eye remains unaffected, raises important considerations regarding the health of your macula, which is the central part of the retina responsible for sharp, detailed vision.

Macular degeneration, particularly age-related macular degeneration (AMD), is a leading cause of vision loss in older adults. However, it can also occur in younger individuals due to various factors, including genetic predisposition, lifestyle choices, and other underlying health conditions. The symptoms you describe—such as the dark spot in your vision and the difference in clarity between your two eyes—are indeed consistent with potential macular issues. The fact that you notice a dark area surrounded by a bright ring when using a pinhole occluder suggests that there may be some distortion or damage to the retinal cells in your left eye.

The tests you have undergone, including Optical Coherence Tomography (OCT) and visual field assessments, are essential for evaluating the structural integrity of your retina and macula. The observation that your left macula appears slightly less pigmented than the right could indicate early changes associated with macular degeneration or other retinal conditions. The recommendation for follow-up in three months is standard practice, as it allows for monitoring any progression of symptoms or changes in the retina.

Regarding your concern about the urgency of diagnosis, it is understandable to feel anxious about potential vision loss. Early detection and intervention are indeed critical in managing conditions like macular degeneration. If you feel that your symptoms are worsening or if you experience new symptoms, it may be prudent to seek an earlier appointment at the medical center you have scheduled. Discussing your concerns with your ophthalmologist can help determine if additional testing is warranted sooner than the planned follow-up.

As for the pinhole occluder revealing a dark spot that is not apparent in your normal vision, this phenomenon can be explained by the way light enters the eye. Pinhole occlusion reduces the amount of light entering the eye and increases depth of field, which can sometimes make underlying issues more noticeable. It can also help to isolate visual disturbances that may not be as apparent under normal viewing conditions.

In terms of further diagnostic testing, the choice between fluorescein angiography (FAG), electroretinography (ERG), or electrooculography (EOG) depends on the specific concerns your eye care provider has regarding your condition. FAG is particularly useful for assessing blood flow in the retina and identifying any leakage or abnormal blood vessels, which are common in certain types of macular degeneration. ERG measures the electrical responses of the retina's light-sensitive cells, while EOG assesses the function of the retinal pigment epithelium. Your ophthalmologist will be able to guide you on the most appropriate tests based on your symptoms and previous findings.

In summary, while your symptoms may suggest potential macular degeneration, it is essential to continue monitoring your condition and follow up with your eye care provider. Early intervention can significantly impact the management of retinal diseases, and staying proactive about your eye health is crucial. If you have any further concerns or if your symptoms change, do not hesitate to seek immediate medical attention.

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