Vision Loss and Eye Fatigue: When to Seek Further Evaluation

Vision loss and eye fatigue?

I would like to ask the doctor, three years ago I experienced eye discomfort and a stinging sensation, along with a phenomenon of white fog that would resolve with blinking.
A few days later, I noticed that my peripheral vision in the area near the blind spot of my left eye (approximately the location, as I have never seen my own fundus) disappeared beyond two centimeters.
Although it does not affect my central vision, I occasionally feel anxious about losing my vision when my eyes are fatigued.
I have visited many ophthalmologists, and each time after the examination, no issues were found.
My intraocular pressure is normal, and there is no retinal detachment or tears.
I have been told it is likely floaters and eye strain, but it is not just shadows; I genuinely cannot see anything.
I would like to know if a past retinal stroke can be detected through examination.
I also once suspected that I might have an enlarged physiological blind spot, but since I am not a professional, I am unsure and do not want to question the doctors.
Additionally, if glaucoma is present without elevated intraocular pressure, how would a doctor determine that? Should I see a neurologist or a specialist in brain disorders?

Shan Shan, 10~19 year old female. Ask Date: 2021/06/01

Dr. He Jianxian reply Ophthalmology

Temporary visual field loss that recovers must consider several conditions.
The first is thrombosis, where a blood vessel in the retina suddenly gets blocked by a thrombus, leading to a sudden loss of vision or visual field defect, which may recover suddenly after a few seconds (indicating that the thrombus has been pushed through the vessel).
Clinically, we refer to this phenomenon as "amaurosis fugax," and it typically lasts for a very short duration, usually just a few seconds.
The second condition is a migraine aura, which usually lasts for several minutes before recovery.
Some individuals may experience accompanying headaches, while others may not.
Typically, there are no abnormalities after recovery.
Based on your description, it is difficult to determine the exact condition, and further follow-up may be necessary.
This information is provided for your reference.
Dr.
He Jianxian, Ophthalmology, Nantou Hospital.

Reply Date: 2021/06/01

More Info

It sounds like you are experiencing a complex set of visual symptoms that are understandably concerning. Based on your description, you have had episodes of eye pain, temporary visual disturbances, and a persistent fear of vision loss, despite multiple evaluations showing normal eye pressure and no retinal detachment or holes. Let's break down your concerns and explore the potential underlying issues, as well as when to seek further evaluation.

Firstly, the symptoms you described, such as the transient loss of peripheral vision and the white fog that resolves with blinking, could be indicative of several conditions. One possibility is that you are experiencing a form of visual migraine or ocular migraine, which can cause temporary visual disturbances, including blind spots or "scotomas." These episodes can occur without a headache and may be related to stress or fatigue.
Another consideration is the possibility of vitreous detachment or changes in the vitreous gel within the eye, which can lead to symptoms like floaters or flashes of light. While you mentioned being told that you have "floaters" and eye fatigue, it is crucial to differentiate between benign floaters and more serious conditions that could affect your vision.

Regarding your concern about a past retinal vascular event, such as a retinal vein or artery occlusion, these conditions can sometimes leave residual effects that may not be easily detectable on routine examinations. If you suspect that you may have had a retinal event in the past, it would be prudent to discuss this with your eye care provider. They may recommend advanced imaging techniques, such as Optical Coherence Tomography (OCT) or fluorescein angiography, to assess the health of your retina more thoroughly.

As for your question about glaucoma, it is important to note that glaucoma can occur even when intraocular pressure (IOP) is within the normal range. This is known as normal-tension glaucoma. Diagnosis typically involves a comprehensive evaluation that includes assessing the optic nerve head, visual field testing, and sometimes additional imaging. If you have concerns about glaucoma, it may be beneficial to consult with a glaucoma specialist who can provide a more detailed assessment.

Given your ongoing symptoms and the impact they have on your daily life, it may be worthwhile to seek a second opinion or further evaluation from a neuro-ophthalmologist. This specialist can help determine if there are any neurological factors contributing to your visual symptoms, especially if you have concerns about potential neurological conditions.

In summary, while your symptoms may be related to benign conditions such as eye strain or migraines, it is essential to continue advocating for your health. If your symptoms persist or worsen, or if you experience new symptoms such as significant vision loss, it is crucial to seek immediate medical attention. Keeping a detailed log of your symptoms, including when they occur and any potential triggers, can also be helpful for your healthcare provider in diagnosing and managing your condition. Remember, your vision is vital, and it is always better to err on the side of caution when it comes to eye health.

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