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Ask Dr. A.S. Desai Your Own Question

Dr. A.S. Desai
Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2071
Experience:  MS Ophthalmology with 11 years of surgical expereince
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For about the past month, when I wake up I see a large dark

Resolved Question:

For about the past month, when I wake up I see a large dark circle in the center of my field of vision. It will last for 5 to 10 minutes, if I lay there, or until I turn on the light. The spot doesn't move. If I close my right eye the spot appears in the same location in my left eye's field of vision. If I close my left eye, the spot appears in the same location in my right eye's field of vision. Very rarely will the spot be bright white, almost like the after-image of a flash bulb.

I have had migraines with visual auras since I was 4 and epilepsy since about the same time. Is this something to talk to my neurologist about?
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. A.S. Desai replied 1 year ago.

Dr. A.S. Desai :

Hello, Welcome to Pearl.com

Dr. A.S. Desai :

Are you available for chat now?

Customer:

Yes


 

Dr. A.S. Desai :

You said you have had visual auras with migraine in the past. What kind of visual aura have you experienced so far?

Customer:

I have had them in both eyes

Customer:

bright white lights in a crescent shape

Dr. A.S. Desai :

The fact that the dark circles last only for 5-10 minutes shows that it is definitely not neurological in nature. since you have a known history of migraine and visual aura, it looks more like another form of visual aura probably without the headache ( acephalic migraine). For a neurological cause, the scotomas( parts of visual field which are not seen) are more or less constantly present and do not disappear.

Customer:

consistent only with waking up though?

Dr. A.S. Desai :

The description which you have given looks more like a fortification spectrum or scintillating scotoma. Here the visual field is affected such that the scotoma begins in one part or entirely.

Dr. A.S. Desai :

Yes, still likely to be due to migraine.

Customer:

my mother (82yoa) has macular degeration (wet) in both eyes and my sister died from lupus. any chance it could be related to those?

Dr. A.S. Desai :

The other condition which can cause such a dark circle in the visual field is posterior vitreous detachment(PVD).

Dr. A.S. Desai :

Yes macular degeneration (wet) can result in different types of visual symptoms but then these would not disappear after 5-10 minutes.

Customer:

what other symptoms would I have / should I have during the day for PVD ? I'm not aware of any

Dr. A.S. Desai :

In case of PVD, the thick gel at the back of the eye( called vitreous) gets detached from its surrounding retina . This results in retinal traction which results in the symptom of flashes of light and includes color distortion.Flashes of light may not be prominent in some individuals. Once the vitreous gets detached completely , it may form clumps or strands and cause symptom of floaters such as dark spots, cobweb or thread like strands in the visual field.

More often it is not a serious issue and does not require any specific treatment. A routine retina examination needs to be done by an ophthalmologist just to check for the intactness of the retina and to look for any peripheral retinal tears or holes, which if found, can be sealed by lasers.


Customer:

I've had dark floaters and flashes since I was a child


 

Customer:

Is this something maybe an optometrist can do an initial check on?


 

Customer:

my health insurance is not the greatest and it won't cover an opthamologist


 

Dr. A.S. Desai :

But childhood flashes of light and floaters is more likely to be due to migraine rather than PVD as the latter is more of an age related change seen in adults.

Customer:

I guess what I meant to say is that, other than the spot when I wake up, I have had no change in my vision that I have noticed


 

Dr. A.S. Desai :

Well if you have a problem with consulting an ophthalmologist, you can consider an initial check up by an optometrist who can record the vision in both eyes and have a look at the back of the eye too.

Customer:

so your best diagnosis, without being able to see me face to face and run tests, is that these are migraine related?


 

Dr. A.S. Desai :

Do you have a known history of hypertension or diabetes?

Customer:

both run in my family but I do not have either


 

Dr. A.S. Desai :

That is good. Because transient obscuration of vision ( very brief loss of vision) is more often seen in those with hypertension and diabetes. But I guess your symptom is different in that there is no loss of vision but only a dark circle. So Yes the most probable diagnosis seems to be migraine.

Customer:

I think I was most worried about the macular degeneration


 

Dr. A.S. Desai :

I understand your concern but the most striking thing about your symptom is the nature of it ( dark circle) and the duration for which it lasts ( 5-10 minutes) which are more likely to be due to migraine than macular degeneration.

Customer:

And the fact that it will go away faster if I turn on the light? Does that mean anything?


 

Dr. A.S. Desai :

But nevertheless it is better to keep a record of your symptoms and take note of any change in symptoms especially when they begin to last longer or remain constant.

Customer:

I will do that.

Dr. A.S. Desai :

PVD is known to have symptoms which disappear in bright light sometimes.

Dr. A.S. Desai :

You may find this article interesting to read- http://en.wikipedia.org/wiki/Posterior_vitreous_detachment

Customer:

I will see if my neuro can get me a referral to an opthalmologist. That way my insurance will pay for it : )


 

Dr. A.S. Desai :

All the best and hope you get the referral.

Customer:

Thank you. I appreciate the help and the info.


 

Dr. A.S. Desai :

You are most welcome.

Customer:

Have a good day


 

Dr. A.S. Desai :

You too.


Thank you and best wishes.

It was a pleasure to have answered this question.

A positive rating is what I aim for and we can continue to interact till you get a satisfactory response.A positive feedback and /or bonus are most welcome and appreciated.

Views expressed are for information purpose only and cannot substitute a visit to an ophthalmologist


 


 

Customer:

You have given me what I need and you have been most helpful. Thank you

Dr. A.S. Desai :

Glad to have assisted you today. Have a good day!

Customer:

You too. Bye bye


 

Dr. A.S. Desai :

Bye

Customer:
Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2071
Experience: MS Ophthalmology with 11 years of surgical expereince
Dr. A.S. Desai and 2 other Eye Specialists are ready to help you

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