Black Spots in Vision: Possible Causes and Next Steps - Ophthalmology

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Hello, and thank you for sharing your symptoms. Based on your description, it seems you are experiencing some complex visual phenomena that could be concerning. Let's break down your symptoms and explore possible causes and next steps.


Symptom Analysis
1. Black Spots After Closing Eyes: The occurrence of black spots that appear when you open your eyes after closing them for a few seconds could be related to several factors. Given that you have high myopia and a history of floaters (known as "myodesopsia"), it is important to consider that these symptoms might not be directly linked to your existing conditions. The fact that these spots disappear quickly suggests a transient phenomenon, possibly related to the way your retina or visual pathways are responding after a period of darkness.
2. Visual Arc or Light Phenomena: The appearance of an electric arc or bright light before sleep, which persists for a few seconds after opening your eyes, may indicate a form of visual disturbance. This could be related to visual migraines or a phenomenon known as "phosphenes," which are sensations of light that occur without light actually entering the eye.

Possible Causes
- Retinal Issues: While your OCT and dilated eye exams did not reveal abnormalities, it’s still essential to consider that some retinal conditions may not be easily detectable without specialized imaging or tests. Conditions like retinal tears or detachment can sometimes present with transient visual disturbances.

- Neurological Factors: Given that your symptoms include visual disturbances that may be linked to brain function, it would be prudent to consider a neurological evaluation. Conditions affecting the brain, such as migraines or even transient ischemic attacks (TIAs), can manifest as visual symptoms.

- Circulatory Issues: Your doctor's suggestion regarding blood circulation problems could be relevant, especially if you have risk factors such as hypertension or diabetes. Poor circulation can affect the retina and lead to transient visual disturbances.


Next Steps
1. Consult a Neurologist: Since your symptoms may have a neurological component, it would be wise to consult a neurologist. They can perform a thorough evaluation, including imaging studies like an MRI, to rule out any neurological conditions that could be causing your symptoms.

2. Further Eye Examination: Although your initial eye exams were normal, consider seeking a second opinion from a retina specialist. They may have more advanced diagnostic tools to evaluate the health of your retina and vitreous more thoroughly.

3. Lifestyle and Health Monitoring: Monitor your overall health, including blood pressure, blood sugar levels, and any other cardiovascular risk factors. If you suspect circulation issues, discussing this with your primary care physician may lead to further evaluations or lifestyle modifications.

4. Medication Consideration: Regarding the use of blood-thinning medications, it is crucial to consult with a healthcare provider before starting any new medication. They can assess whether this is appropriate based on your overall health and specific symptoms.


Conclusion
Your symptoms warrant a comprehensive approach that includes both ophthalmological and neurological evaluations. While transient visual disturbances can sometimes be benign, they can also indicate underlying issues that require attention. It’s essential to advocate for your health and seek the appropriate specialists to ensure a thorough investigation of your symptoms. Please keep a detailed record of your symptoms, including their frequency and any triggers, as this information can be invaluable for your healthcare providers. Wishing you the best in your pursuit of answers and health!