Black Shadows in Vision: Is It Macular Degeneration? - Ophthalmology

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Seeing shadows in the vision could indicate a problem with the macula, or it may be related to other issues?


Thank you for the prompt response, Doctor! Your question: Hello Doctor, my son is eight years old and has over 200 degrees of astigmatism in both eyes, with myopia of +25 in the right eye and -25 in the left eye.
He has been using a 0.125% cycloplegic agent every night for control (for a year and a half).
Recently, he noticed that when he focuses on distant objects (like buildings or clouds), he sees a transparent black shadow (circular) surrounding the buildings.
When I asked him if he experiences this while writing or looking at nearby objects, he said he does not.
He mentioned that this occurs only with objects more than ten meters away and only when he is concentrating on them; if he does not focus intentionally, he does not see it.
Could you please explain what might be causing this? Could it be macular degeneration? He has been under ophthalmological follow-up for a year and a half, and the clinic doctors have examined his eyes with an ophthalmoscope without mentioning any issues with the macula.
However, this situation he described is recent, and he has not yet returned for a check-up (the last visit was in August).
I would like to know why this is happening and if it indicates a problem with the macula.
What examinations would be advisable? Thank you for your response.
Doctor: Ophthalmologist, Dr.
Gao Pilin suggests: Hello, the phenomenon of seeing it far away but not up close does not seem to indicate macular degeneration.
It could be a result of astigmatism or cycloplegia.
If he is not wearing glasses, you might want to try having him wear them to see if the situation improves.
You can discuss this with the doctor at the next follow-up.
--------------------------------------------
Hello Doctor, thank you very much for your quick response last night! I would like to ask you a few more questions! Today, I had my child take off his glasses (which he has been wearing all the time), and he still sees the transparent black shadow (a uniformly transparent, perfectly round black shadow).
When he looks with each eye separately, he sees the shadow in both eyes, and the size, shape, and color are the same for both, occurring at a distance of over 11 meters.
He only sees the shadow after staring for 1-2 seconds.
Additionally, I had him perform the Amsler grid test online at a distance of 30 cm for both eyes, and there were no shadows or distorted lines.
1.
Could this situation be an early symptom of macular degeneration? If it is an early symptom, can OCT detect the lesions, or would fluorescein angiography be better? Or should both tests be done together for a clearer picture?
2.
If this does not seem to be a macular issue, what other areas could potentially be affected? I have asked several friends with high astigmatism, and none have experienced this situation.
As for cycloplegia, I am not sure since he has been using it for a year and a half, and I have not heard of anyone else having this issue.
3.
Does the result of the Amsler grid test indicate that there are no problems with the macula, or can early changes not necessarily be detected?
Thank you, Doctor, for your assistance!

Xiao Wu, 0~9 year old female. Ask Date: 2021/09/28

Dr. Gao Pilin reply Ophthalmology


Hello, Xiaowu: 1.
It is likely not a macular issue.
We should first rule out the optical effects caused by dilation; let the pupils constrict and see if the symptoms persist.
2.
The observation of very round black circular shadows does not sound like a pathological finding; it seems more like an optical effect.
Moreover, since both eyes are affected similarly, it is unlikely to be a pathological phenomenon.
3.
The symptoms of macular degeneration do not present this way.
If the pupils constrict and the symptoms remain, I recommend a detailed examination by a retina specialist.

Reply Date: 2021/09/28

More Info


Thank you for your detailed inquiry regarding your son's vision issues. Based on the symptoms you've described, it appears that your son is experiencing a phenomenon that is not uncommon, especially in children with refractive errors such as myopia and astigmatism. The presence of a transparent black shadow or circular shadow when looking at distant objects could be attributed to several factors, but it does not necessarily indicate macular degeneration, especially given his young age.


Understanding the Symptoms
1. Visual Phenomena: The transparent black shadow your son sees when focusing on distant objects may be related to the way light is refracted through his eyes, particularly due to his astigmatism. Astigmatism causes light to focus on multiple points in the eye, leading to distorted or shadowy images. This can be more pronounced when looking at high-contrast objects against a bright background, such as buildings or clouds.

2. Eye Fatigue and Focus: Since your son only notices this phenomenon when he is concentrating on distant objects, it could also be a result of visual fatigue or strain. Children often do not realize they are straining their eyes, especially when focusing on distant objects for extended periods.

3. Ocular Health: Given that your son has been under regular eye care and has not shown any signs of macular degeneration during examinations, it is less likely that this symptom is related to the macula. Macular degeneration typically presents with more pronounced symptoms, such as distortion in central vision or difficulty recognizing faces, which do not align with your son's experience.


Recommended Actions
1. Follow-Up with an Eye Specialist: It is essential to discuss these new symptoms with your eye care provider during the next visit. They may recommend additional tests, such as Optical Coherence Tomography (OCT) or fluorescein angiography, to assess the health of the retina and macula more thoroughly. OCT is particularly useful for detecting early changes in the retina, while fluorescein angiography can help visualize blood flow in the retina.

2. Consideration of Glasses: Since your son has been wearing glasses, it might be beneficial to ensure that his prescription is up to date. Sometimes, an incorrect prescription can lead to visual disturbances. If he is not wearing his glasses when he notices the shadow, it could also indicate that his vision is not adequately corrected for distance.

3. Monitoring Symptoms: Keep a close eye on any changes in his vision. If the shadows become more pronounced, or if he begins to experience other symptoms such as flashes of light, increased floaters, or changes in his central vision, it is crucial to seek immediate medical attention.


Conclusion
In summary, while the symptoms your son is experiencing are concerning, they are not necessarily indicative of macular degeneration, especially given his age and the context of his existing refractive errors. The phenomenon could be linked to astigmatism or visual strain. Regular follow-ups with an eye care professional will be vital in monitoring his condition and ensuring that any potential issues are addressed promptly. Always feel free to ask your eye doctor any questions you may have during your visits, as they can provide the most personalized and accurate information regarding your son's eye health.

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