The scotoma results in the presence of one or more spots in the visual field. We can distinguish several forms of which the most described are the central scotoma with the presence of a black spot and the scintillating scotoma with several luminous spots in the visual field.

Definition of scotoma

The scotoma is a gap in the visual field. This is characterized by:

• the presence of one or more spots;
• regular or irregular;
• black or bright;
• in the center of the visual field, and sometimes at the periphery;
• at the level of one eye, but sometimes at the level of both eyes.

Types de scotome

Many types of scotoma have been described. The most documented are:

• the central scotoma which results in the appearance of a black spot in the center of the visual field;
• the scintillating scotome which results in the appearance of glittering spots that may be reminiscent of those caused by a flash of light.

Causes du scotome

This visual field gap can have very different causes:

• macular degeneration, a deterioration of the macula (specific area of ​​the retina) that is most often related to age (age-related macular degeneration, also simplified as AMD);
• damage to the optic nerve which may be due to various conditions such as a viral infection, inflammatory disease or multiple sclerosis;
• pressure on the optic chiasm (the point where the optic nerves meet) which can occur with stroke, bleeding or tumor in the brain;
• a vitreous detachment (gelatinous mass filling the eye) which manifests itself by floaters (condensations) and which may in particular be due to aging, trauma or surgery;
• an ophthalmic migraine, or migraine with visual aura, which is characterized by a scintillating scotoma before the migraine attack.

Diagnostic of the scotome

Confirmation of a scotoma is performed by an ophthalmologist. The eye care professional checks visual acuity and analyzes the internal and external appearance of the eye. He rules out other possible explanations to confirm the diagnosis of scotoma.

As part of his analysis, the ophthalmologist may use drops that dilate the pupils. These make it possible to observe the retina and the optic nerve, but have the disadvantage of blurring the vision for several hours. It is strongly recommended to be accompanied during this type of consultation.

The diagnosis can also be based on the results of an angiogram, a method that allows you to visualize the blood vessels.

Stain (s) in the visual field

The scotoma results in the presence of one or more spots in the visual field. It can be a single stain or several small stains. One distinguishes in particular the central scotoma with the presence of a black spot in the center of the visual field and the scintillating scotoma with several luminous spots in the visual field.

Possible decrease in visual acuity

In some cases, scotoma can affect visual acuity. In particular, a person with a central scotoma may have difficulty performing precision activities such as reading or sewing.

Possible pain

Scintillating scotoma is a typical symptom of ophthalmic migraine. It often precedes a migraine attack.

If there is no discomfort or complications, scotoma may not be treated.

When treatment is possible and / or necessary, management may be based in particular on:

• analgesic treatment;
• the use of antiplatelet drugs;
• laser surgery.

Some cases of scotoma can be prevented by adopting a healthy lifestyle and some preventative measures. In particular, it may be advisable to:

• maintain a healthy, balanced diet that is a source of antioxidants (mainly fruits and vegetables) in order to strengthen eye protection;
• wear sunglasses with a suitable and effective protective screen;
• avoid smoking;
• carry out a regular sight check-up.