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

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When it comes to experiencing fixed black spots in your vision, particularly in the context of your existing condition of floaters (known as "myodesopsia"), there are several potential explanations and steps you can take to address your concerns.

Firstly, it is important to understand that floaters are typically caused by changes in the vitreous gel of the eye, which can become more liquid and less gel-like as we age. This process can lead to the formation of clumps or strands within the vitreous, which cast shadows on the retina and appear as floaters. While floaters are common and often benign, any new or unusual visual symptoms warrant careful evaluation.

In your case, the presence of a fixed black spot that appears under specific lighting conditions, such as when looking at distant light sources, could be indicative of several possibilities:
1. Persistent Floaters: While most floaters move with eye movement, some can appear more fixed, especially if they are larger or denser. This might explain why you see a black circle that does not change position significantly. However, this is less common, as most floaters tend to drift with eye movements.

2. Weiss Ring: This is a specific type of floater that can appear as a ring or circle in the vision, typically resulting from posterior vitreous detachment. It can appear more fixed compared to other types of floaters.

3. Retinal Issues: Although your previous examinations indicated no significant retinal problems, the presence of a fixed black spot could raise concerns about potential retinal tears or detachment, especially if accompanied by other symptoms like flashes of light or a sudden increase in floaters.
4. Macular Issues: The macula is responsible for central vision, and any issues here can lead to visual distortions or fixed spots. While your previous tests may not have indicated problems, conditions like macular degeneration or macular holes can sometimes develop without immediate symptoms.

5. Optical Illusions or Visual Phenomena: Sometimes, visual disturbances can be attributed to neurological factors or visual processing issues rather than direct ocular pathology.

Given your history of floaters and the recent emergence of this fixed black spot, it is crucial to follow up with an eye care professional. Here are some recommended steps:
- Comprehensive Eye Examination: Ensure that you have a thorough examination, including dilated fundus examination and possibly optical coherence tomography (OCT) to assess the retina and macula in detail.

- Monitor Symptoms: Keep a log of when the black spot appears, its duration, and any associated symptoms (e.g., flashes of light, changes in vision). This information can be valuable for your eye care provider.

- Seek a Second Opinion: If your current eye care provider is unable to provide clarity on your symptoms, consider seeking a second opinion from a retinal specialist who can offer more specialized insights.

- Stay Informed: Educate yourself about potential eye conditions, but avoid self-diagnosis. Reliable sources include the American Academy of Ophthalmology and other reputable medical organizations.

In conclusion, while your symptoms may relate to your existing floaters, the fixed nature of the black spot and its specific triggers warrant further investigation to rule out any serious underlying conditions. Regular monitoring and communication with your eye care provider are essential to ensure your eye health remains a priority.