Small blind spots without ON?

[goobybear22]

Does anyone here get smallish temporary scotomas in their central vision? They look like the after image of a camera flash, and happens in only one eye at a time lasting less than 5 minutes. I have been getting these a couple times a month for the past couple years, three of them have remained permanent and have turned into gray blind spots.
I have also been getting flashes or seeing a rolling ball of light in the peripheral vision of my left eye every night randomly or when I cough or laugh for about a year and a half. I've been to a retinal specialists and a couple ophthalmologists and they assured me it's not a retinal tear or even PVD.
Anyone?

[goobybear22]

I wanted to add that it's possible I do have ON but the eye doctor did not mention it and I don't have any of the other symptoms that go along with having it.

[jreagan70]

Hi goobybear:

First, it's great that you don't have any problems with your retina. But that's only part of an eye and vision exam. You know what it isn't, but you haven't said that anyone has probed for what the problem is.

It's hard to believe that none of the ophthalmologists has pursued visual field testing to quantify your blind spots or the neurological causes of your blind spots. Have you had an MRI of your optic nerves or a VEP?

Any visual disturbance that lasts for only about 5 minutes is not ON. Those short episodes are more typical of a blood vessel problem that deprives those areas of the retina (not in your case, apparently) or optic nerve (or brain, if more testing were to be done) of oxygen for short periods of time.

One of the incorrect things that people do is to continue to refer to ON in the active voice, as if it's an ongoing problem. ON is an episode that ends and should be referred to in past tense when it's over. The damage that's left over from an episode of ON is not ON. It's called optic neuropathy, not optic neuritis.

So you may not have an active case of ON, and your blind spots would not be referred to as ON. But they may be left over from a previous case of ON that was painless, so you didn't know what was going on.

Those blind spots that converged into permanent spots did not come from 5-minute episodes of ON, since ON doesn't present in 5-minute episodes. They might have come from longer episodes that actually were ON. They might have become permanent if there was blood vessel damage somewhere in your optic nerve.

Again, it's time to move beyond what didn't cause your blind spots. It's time to look at what might have or did cause them. And since your ophthalmologists don't seem to be pursuing that angle, it's time for a neuro-ophthalmologist to do that.

Previous episodes of ON might have caused your blind spots, but damage from migraines or tiny strokes might have caused them, too. The rolling balls of light when you cough or laugh might be phosphenes from optic nerve damage. It sounds like you'll need a neuro-ophthalmologist to continue the investigation. It isn't possible to know what the cause is without a neuro-ophthalmology evaluation. I hope you're able to get one scheduled.

[goobybear22]

Thank you for your reply,
I tried to keep my original post short, but by doing that I realize I left out some important information.
You mentioned that this sounds vascular, and it does to me too, but after about 20 different eye appointments with 9 doctors, the doctors can't even tell me this.

In the past 8 years, I have had three "episodes" of these blind spots that never go away. All three started out bright and obvious like an afterimage from the sun, remain like that for a few months and eventually dim down to a gray spot I can't see through. I have seen 9 eye doctors, including retina specialists, ophthalmologists, AND for the most recent episode - a neuro ophthalmologist. I had photos of my retina taken, SD OCTs, autoflorescence exams, (10-2) vision field tests (which show my blind spots), and also a mfERG (which is similar to VEP I think?), which shows areas of missing vision. So I've proven to them that I have this permanent missing vision, but none of these doctors can tell me why. All they are looking at is my eyes- none of them have listened to me about my other symptoms. Also, none of them have mentioned anything about my optic nerve.

I have leakage in the periphery of my retina of both eyes, also unexplained. Again, I know not an MS symptom, but I'm typing out the whole eye journey.

The neuro ophthalmologist sent me to a Rheumatologist because the 25 vials of blood work came back as normal but showed a slightly positive ANA and he and the ophthalmologist at Bascom Palmer think the cause of the blind spots and leakage could be autoimmune, but after meeting with the Rheumatologist and him actually being the first doctor to put all my symptoms together, (toe that's been extremely itchy for a year with numbness spreading, tremors that come and go, severe headaches, etc) and he believes that this could be something neurological. Then he asked me if anyone in my family had MS, I told him my grandfather had MS, and he said I need an MRI. He is having me do more blood work for autoimmune diseases, but also referred me to a neurologist that I see in two weeks and will finally get a brain MRI (with orbits).

Jreagan70 - honestly, you seem to be more knowledgeable about vascular eye issues than all these doctors I've been going to, what would cause something like that to occur? Vascular and neurological are not in the same family so I'm wondering if I'm just being passed around from one doctor to another because they don't know what to do with me. I'm 32, in shape, eat healthily; I'm getting really sick of feeling like this and losing pieces of my vision and no one telling me what's going on has been frustrating to say the least.

I have a patient at work who has MS and a few months ago I was talking to him about his vision, and he said he has small permanent blind spots. So I thought I would ask all of you if this was another symptom that you have with MS. When I looked up ON online, it showed large areas of blindness... My spots are "small", they would cover a coin about the size of a quarter at about 18 inches away, and I have two in my left eye and one in my right, and again, no physical damage showing on my retina.

Thank you for your time.

[aytpicalsymptom]

goobybear22,

I know that this thread is somewhat old, but in case you come back to read, I wanted to let you know that I experience something very similar. I am a "limbo-lander" and just created a post about this very issue. To make a long story short, I have visited eye doctor after eye doctor (two "regular" optometrists, two ophthalmologists/retinal specialists) trying to get to the bottom of this phenomenon, and so far I don't have an answer. I have had fundus photos, visual field testing, OCT - no closer to getting a diagnosis.

I recently was referred for MRI regarding this issue, and that's where my demyelinating lesions were found, somewhat unexpectedly I think.

However, my current neurologist doesn't think that MS is the cause of these particular symptoms.

If I ever find out anything, I'll let you know. I'm trying to get an appointment with a neuro-ophthalmologist at the moment.

By the way, did any of these spots begin shortly after the onset of a viral illness?

[aytpicalsymptom]

In case anyone else ever reads this looking for answers, I got a diagnosis today from a retinal specialist of either Acute Macular Neuroretinopathy (AMN) or Acute Zonal Occult Outer Retinopathy (AZOOR). He wants to do an ERG to distinguish the two but says the diseases are quite similar.

He said that AZOOR is possibly linked in some way to MS.

They found my disease by looking very carefully at OCT images for an area of retinal thickening in a certain layer. I had to have OCT done twice to detect this. Hope this helps someone.

[Welshey50000]

vision issues

Hi, im an 18 year old male and have been experiencing similar eye issues for about 1 year. I get every day bright spots in my vision, some are dark purple afterimage like when lookinh at a camera flash. Some flash when i blink, and some dissappear. I have 1 that has remained permanent from last year in the lower right of my vision. I have been to retina specialists, neuroopthalmologists, had an MRI etc and nothing out of the ordinary has been found. I get migraines sometimes, for me this involves a circular blind spot in both eyes that moves around my vision.

Other symptoms i notice are enhanced 'blue field entoptic phenomena' which is when you can see your white blood cells flowing through your veins in your vision. This has become hard to ignore for me and some almost 'slow down' then crawl, and speed back up.

I have researched extensively on AZOOR and the symptoms seem different, they complain of photopsias which is constant bright flashes. I dont have this, i have monocular blobs which occur in each eye at different times, they are not flashes. Also, my visual field didnt pick up on any missing vision.

Atypicalsymptom, what did you end up getting diagnosed with? Azoor?

** Moderator's note - Post broken into paragraphs for easier reading. Many people with MS have visual difficulties that prevent them from reading large blocks of print. **

[Poppy7402]

Another problem that can cause the types of issues you describe is Susac's syndrome. It's apparently misdiagnosed as MS in some people.

Fluorescin (sp?) angiography of the eyes is one of the ways they diagnose this so if someone is having trouble finding out what is going on with their eyes, this may be something else to pursue.

[Welshey50000]

vision issues

In case anyone else ever reads this looking for answers, I got a diagnosis today from a retinal specialist of either Acute Macular Neuroretinopathy (AMN) or Acute Zonal Occult Outer Retinopathy (AZOOR). He wants to do an ERG to distinguish the two but says the diseases are quite similar.

He said that AZOOR is possibly linked in some way to MS.

They found my disease by looking very carefully at OCT images for an area of retinal thickening in a certain layer. I had to have OCT done twice to detect this. Hope this helps someone.

Did you get diagnosed with azoor or the other one in the end?

[aytpicalsymptom]

Did you get diagnosed with azoor or the other one in the end?

Since I had that appointment, I have been referred to another retinal specialist, had the full field ERG and had OCT twice, as well as other tests.

To make a long story short, I have been "undiagnosed" with AMN/AZOOR because the abnormalities on the OCT did not show up on the more recent OCTs, which couldn't have been performed more than a month later.

So the retinal specialist who made that diagnosis isn't confident in it anymore - he thinks there may have been something "transient" or an "imaging fluke." His colleague that he referred me to agrees. I am back in vision limbo.

He suggested that I may have autoimmune retinopathy (based on symptoms) but couldn't find any objective findings to indicate it, so he was pretty doubtful that this was the correct diagnosis either.

Sorry I can't provide any clarity.

[Welshey50000]

vision issues

Since I had that appointment, I have been referred to another retinal specialist, had the full field ERG and had OCT twice, as well as other tests.

To make a long story short, I have been "undiagnosed" with AMN/AZOOR because the abnormalities on the OCT did not show up on the more recent OCTs, which couldn't have been performed more than a month later.

So the retinal specialist who made that diagnosis isn't confident in it anymore - he thinks there may have been something "transient" or an "imaging fluke." His colleague that he referred me to agrees. I am back in vision limbo.

He suggested that I may have autoimmune retinopathy (based on symptoms) but couldn't find any objective findings to indicate it, so he was pretty doubtful that this was the correct diagnosis either.

Sorry I can't provide any clarity.

Thanks for the reply, have you posted on the medhelp 'bright spot when blinking symptom' ? Hundreds of us have this very symptom and no diagnosis. The autoimmune retinopathy is unlikely, as people who have this symptom on the other forum have been blood tested for antibodies and come back clear. Also, this causes massive visual loss ive heard.
What other visual phenomena/ symptoms do you get?

[aytpicalsymptom]

Thanks for the reply, have you posted on the medhelp 'bright spot when blinking symptom' ? Hundreds of us have this very symptom and no diagnosis. The autoimmune retinopathy is unlikely, as people who have this symptom on the other forum have been blood tested for antibodies and come back clear. Also, this causes massive visual loss ive heard.
What other visual phenomena/ symptoms do you get?

Yes, I posted there under the same name about my diagnosis but haven't written about my "undiagosis" yet.

These are my only symptoms - the small, focal bright spots that can last seconds, minutes, days, or indefinitely, fading to small scotomas.

They are about the size of a single letter if I hold a page of size 12 or so font at reading distance.

My scotomas are "paracentral" and monocular.

Have you had multifocal ERG? I only had full field ERG and was told that multifocal would be much better for detecting these small spots, but it doesn't exist where I live.

[Welshey50000]

vision issues

Yes, I posted there under the same name about my diagnosis but haven't written about my "undiagosis" yet.

These are my only symptoms - the small, focal bright spots that can last seconds, minutes, days, or indefinitely, fading to small scotomas.

They are about the size of a single letter if I hold a page of size 12 or so font at reading distance.

My scotomas are "paracentral" and monocular.

Have you had multifocal ERG? I only had full field ERG and was told that multifocal would be much better for detecting these small spots, but it doesn't exist where I live.

When did you post on the other forum? And yes i have these too, but only 1 has remained permanent. I also get increased blue field entoptic phenomena and many other weird visuals