What is the nature of a visual field failure?

A visual field loss is the weakening or even the loss of a part of the visual field. Visual perception is restricted or cancelled in this area. Possible forms of representation can be:

Flashes of light,
Small, dancing points (so-called Mouches volantes),
Color changes,
Dark spots or but
Total blindness.

What forms are there?

A scotoma can first be distinguished by the degree of its expression. For example, a complete loss of sensitivity, i.e. blindness, is called absolute scotoma, while a partial loss of sensitivity is called relative scotoma. In addition, scotomas can be differentiated according to their respective pattern of loss.

These special forms include:

Paracentral scotoma
Central scotoma
Pint scotoma
Bjerrum-Skotom
Centroececal scotoma
Fixation point scotoma
Flicker scotoma

Central scotoma is a form of visual field loss that affects the central visual field (in the area of the fovea centralis) without affecting the blind spot. If the latter is the case, it is called a centrocecal scotoma. A central scotoma occurs in the context of a macular lesion or optic nerve damage.

It occurs, for example, in the case of optic nerve damage in the form of papillitis or retrobulbar neuritis and can thus be an early sign of multiple sclerosis. The paracentral scotoma is an isolated visual field defect (scotoma) in the bjerrum area of the visual field (section of the visual field which – from the blind spot – surrounds the macula in an arc between 5° and 20° from the fixation point at the bottom and at the top). A paracentral scotoma with inclusion of the blind spot is called Seidel scotoma.

Diagnosis of the scotoma

If the visual field failures occur for the first time, it is urgently recommended that you consult your ophthalmologist as soon as possible. The longer the symptoms persist, the worse the prognosis. In the medical history, the patient explains his or her symptoms to the doctor and is asked about relevant concomitant diseases such as diabetes, high blood pressure or glaucoma.

Visual acuity is then checked and it is determined whether the patient has a distorted perception of his or her surroundings. Using a slit lamp (special microscope), the structures of the eye are examined, from the anterior part with cornea and lens to the back of the eye and the retina. During ophthalmoscopy, the point of sharpest vision, the fovea centralis, which is located in the center of the macula (yellow spot), is assessed.