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Medical Forum / General / Vision / August 2008Strange vision problem, desperately seeking answers
About 6 months ago I began to experience what can be best described as a persistant migraine aura, in which I get small colored or black/gray spots that appear suddenly then fade over several minutes. They occur in 1 eye at a time. I've been getting this every day, many times a day ever since. The trouble is, is that some of the spots have NEVER gone away, and since this all started, I've accumulated about 3 or 4 fixed spots in each eye, in random locations. The color the spots had when they originally appeared faded over a week or two, but it leaves a small blank or blind spot. Letters on pages I read that fall in range of these spots vanish. It's just a blank. In addition to having several of these permanant blind spots, when I look at lines, they look slightly wavy or blurry in isolated areas of my peripheral vision. I've been to 2 opthomologists, a retina specialist and a neuro- opthomologist and I've had general exams, an angiogram, an MRI, visual field tests, and a retina thickness test. None of these showed anything out of the ordinary. I'm rather alarmed at this, as my symptoms are progressing and I don't know what to do. I'm 28 yrs old, nearsighted, and I do a lot of computer work at my job. I have no known family history of such a vision problem. Any help, ideas, or advice would be deeply appreciated. Thank you. > In addition to having several of these permanant blind spots, when I > look at lines, they look slightly wavy or blurry in isolated areas of [quoted text clipped - 4 lines] > field tests, and a retina thickness test. None of these showed > anything out of the ordinary. How can you have the symptom of a "permanent blind spots" and not have these show up on a field test? Don W. PS. The retinal thickness test is an OCT? > How can you have the symptom of a "permanent blind spots" and not have these > show up on a field test? > > Don W. From my own experience, some of these aura spots can be very tiny. It would not surprise me that all the flashes in a field test can fall between these spots. To me, however, it is the wavyness that would attract my attention. That sure seems to be a sign of retinal problems. I am not a medical professional or tech, but I urge you to seek competent medical advice if you can find it. Bill To Don: I don't know why the spots couldn't be detected. It's very troubling to me. I had what I think is called the Humphry test(?) The test is the one where they flash little points of light and I clicked on a button indicating when I saw wach flash. Also when I look at the Amsler grid I can see missing areas and swirling/blurry areas. These blind spots and disturbances are very tiny I assume, but they are large enough from my perspective that I see gaps in lines and missing vision when looking at things that fall in range of these spots. I wonder if these spots are too tiny and scattered to be successfully detected? Are there other tests that could be done? There are a few other people I've found on various websites like this one who have reported nearly identical symptoms, but most of them have had little success in the way of getting any diagnosis or treatment. Thank you for responding. It would appear that the problem areas are able to respond to the bright light of the visual field test, but are not sensitive enough to provide normal vision. Glenn Hagele Executive Director USAEyes (R) Patient Advocacy Surgeon Certification "Consider and Choose With Confidence" (TM) Email to glenn dot hagele at usaeyes dot org http://www.USAEyes.org Lasik Bulletin Board http://www.USAEyes.org/Ask-Lasik-Expert/ I am not a doctor. Copyright 2008 All Rights Reserved My other question was did you have an OCT (optical coherence tomograph) also? Was that the "retinal thickness" measurement? Don W. > � My other question was did you have an OCT (optical coherence tomograph) > also? > Was that the "retinal thickness" measurement? > > Don W. Oops sorry about that. Yes it was an OCT. I think the gaps in the Amsler grid, undiagnosed, would bother me the most. After all of these tests, I would hate to suggest an nth opinion, but I would tend to lean that way. I would defer to professionals on this site for more advice. I think daily checking of the Amsler is important to see if there are "other" changes. Don W. Definitely what Don said, this is a problem you should keep investigating. At a big guess I wonder if you're suffering from transient ischemic attacks(momentary loss of blood supply) at the retina, optic nerve, LGN or V1. Given the apparent lack of retinal abnormalities that suggests the cause ïs "behind the eye". Too hard to know but if this is an ongoing deterioration of your sight you had better do something real quick. Hey Don, Did you ever get around to trying phototrop? > I think the gaps in the Amsler grid, undiagnosed, would bother me the > most. [quoted text clipped - 5 lines] > > Don W. > Definitely what Don said, this is a problem you should keep investigating. sorry. I don't have any suggestions. you are seeing the right people. this is an issue for a retina specialist and/or a neuroophthalmologist. > At a big guess I wonder if you're suffering from transient ischemic > attacks(momentary loss of blood supply) at the retina, optic nerve, LGN or > V1. if it happens in only one eye at a time, then it has to be either a problem at the level of the retina or at the optic nerve anterior to the chiasm. so it sounds like you are saying there is no objective confirmation of a visual field defect. if no defects show on a Humphries VF, retinal tomogram, or MRI you probably are having difficulty getting very far with the doctors you are seeing since they can't correlate your complaints with any measurable defect. are there any other non-visual neurological issues that you are experiencing? muscle weakness, paresthesia? > are there any other non-visual neurological issues that you are > experiencing? �muscle weakness, paresthesia? Nothing of that nature. I feel healthy otherwise and I exercise. Only other things that trouble me are bouts of depression and general anxiety. Only a couple of weeks prior to noticing this vision problem, I had a series of panic attacks and high anxiety. About 10 years ago I tested positive for anti-nuclear antibodies because I have rosacea and I was sent for some bloodwork at the time to check for signs of possible auto-immunie diseases. I saw a Rhumatologist for awhile but was never diagnosed as having anything. The rosacea was affecting my eyes at that time, I was told I had a 'nodule' on or in my right eye for about a year, it constantly felt like a grit. I was given eyedrops that contained a steroid ingrediant and it helped and the problem subsided. I don't take any medications at this time. Still have the rosacea on my skin but it seems stable. I truly appreciate all of the responses. > are there any other non-visual neurological issues that you are > experiencing? ?muscle weakness, paresthesia? Nothing of that nature. I feel healthy otherwise and I exercise. Only other things that trouble me are bouts of depression and general anxiety. Only a couple of weeks prior to noticing this vision problem, I had a series of panic attacks and high anxiety. That type of stress can trigger autoimmune attacks, I'm wondering if perhaps a sign of optic neuritis but I suspect that would have been picked up. Lupus, a diffuse autoimmune disease, can trigger optic neuritis and other neurological complaints. In Multiple Sclerosis optic neuritis is often the first symptom. The ongoing presence of rosacea needs to be dealt with, it could be helping to drive autoimmunity, perhaps, maybe ... About 10 years ago I tested positive for anti-nuclear antibodies because I have rosacea and I was sent for some bloodwork at the time to check for signs of possible auto-immunie diseases. I saw a Rhumatologist for awhile but was never diagnosed as having anything. The rosacea was affecting my eyes at that time, I was told I had a 'nodule' on or in my right eye for about a year, it constantly felt like a grit. I was given eyedrops that contained a steroid ingrediant and it helped and the problem subsided. I don't take any medications at this time. Still have the rosacea on my skin but it seems stable. I truly appreciate all of the responses. John, Too bad we're not in the "Dear" era, I would write you a "Dear John" letter! All I can say is Q10 is IN my medicine cabinet. I tried to write your email but got a "Retun to Sender" message, at that time. How are you doing? And What are you doing? Reminds me, got some _positive_ zinc papers to (hmmm) digest. Don > Definitely what Don said, this is a problem you should keep investigating. > At a big guess I wonder if you're suffering from transient ischemic [quoted text clipped - 17 lines] >> >> Don W. Don, Email: Jhasenkam@gmail.com I'm not sure, never really was, that zinc is a problem. The RPE is very high in zinc so high zinc levels in drusen and lipofuscin are to be expected. There is evidence that slowing of the visual cycle by retinol absorption antagonists can impede degeneration. In fact I saw a study of a mouse model for Stargardt where adding vitamin A accelerated the rate of deposition. Stargardt patients should not be taking vitamin A or beta carotene supplements. There are currently a few clinical trials on the way in relation to the retinol antagonists. Expect a positive but not glowing result. The q10 is okay but in phototrop they use carnitine and omega 3's. The latter is easily covered by good oily fish but the acetyl l carnitine will require supplementation. All three clinical trials of phototrop showed very promising results and there was even regression of drusen in some cases. There is some theoretical basis for phototrop regime, it wasn't just dreamed up by mixing supplements. I would add lipoic acid to the mix, it has demonstrated good retinal protection in a number of paradigms, particulary diabetic retinopathy. Make sure you buy supplements of a good type, most are bloody useless. A friend of mine who lives in New York and really does his homework on this stuff recommends the Vitamin Shoppe. They have a website, you can order online. > John, Too bad we're not in the "Dear" era, I would write you a "Dear John" > letter! [quoted text clipped - 31 lines] >>> >>> Don W. John, That one zinc paper by Lengyel, ("High concentration of zinc in sub-retinal pigment epithelial", Exp Eye Res. 2007 ) where the concluding line, "Based on the evidence provided here we suggest that zinc plays a role in sub-RPE deposit formation in the aging eye and possibly also in the development and/or progression of AMD" This was the paper that (far as I know) had everyone backing off of the 80mg of AREDS zinc Rx. Beta carotene is a definite no according to Dr. Folk in his latest Medrounds. For ARMD. I don't see lutein or zeaxanthine anywhere mentioned in your write-up. ???? In the phototrop references by Feher, they mention improvements, but issue no numbers. (But in those papers I only have the abstract). So.....???? What are the studies that you are referring to? Don > Don, > [quoted text clipped - 61 lines] >>>> >>>> Don W. Hey Don, Yes, L and Z are a given, I was specifically addressing the supplement issue of phototrop but in relation to AMD generally there are a quite a number of things the individual can do that *might* help delay progression. Good to see others going against beta carotene, I was going to suggest that even those with AMD, despite the epidemiological findings, should be wary of too much vit A(the enzyme that converts BA to Vit A is in the retina) because it appears that anything which slows the visual cycle will help in a great many retinal conditions. This is because the RPE is the most metabolically busy region in the body, giving it a break seems to help. However I felt it inappropriate to express that idea on an open forum but if a professional is asserting the same hey I'll go there ... . I suspect chronically low vitamin A will increase risk but chronically high vitamin A and\or BC can increase the risk. Hence the conflicting data in the epidemiological studies, where some seem to suggest that a high beta carotene intake either conferred no protection or worse ... . I'll have to dig up those other trials Don, but have this one on hand: Ophthalmologica. 2005 May-Jun;219(3):154-66.Click here to read Links Improvement of visual functions and fundus alterations in early age-related macular degeneration treated with a combination of acetyl-L-carnitine, n-3 fatty acids, and coenzyme Q10. PMID: 15947501 [PubMed - indexed for MEDLINE] I'd be more worried about excess free iron in the RPE than zinc. With age iron accumulation can be a problem. Excess iron is a very strong driver of oxidative events. > John, > [quoted text clipped - 84 lines] >>>>> >>>>> Don W. Alrighty then... |
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