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Dr.S Riaz
Dr.S Riaz, Ophthalmologist
Category: Eye
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I am a 33 year old, healthy male, with no history of (afaik)

Customer Question

Good day,
I am a 33 year old, healthy male, with no history of (afaik) related diseases.
Since approx. 2.5 years ago I have started to develop scotoma's in both eyes. There is a clear loss of vision in the affected areas. Some are merely less light sensitive whilst others no longer 'see' anything anymore. The shape and size vary also. Some are quite round whilst others are elongated. They are most certainly not 'floaters', as I have these also and am not concerned about them.
I've consulted two eye-specialist about a year ago, but they could see no irregularities of the retina. They used lamp examination, an automated perimetry exam, and fluorescein angiography to come to this conclusion.
Meanwhile, the condition is still progressively getting worse, with yet another new deep scotoma since yesterday, and I now have a real fear of going slowly blind over the coming years.
What would be your advise at this stage?
Thank you for you time.
CV, The Netherlands
Submitted: 7 years ago.
Category: Eye
Expert:  Dr.S Riaz replied 7 years ago.


Did the ophthalmologists you saw said that the eyes were normal?

Were the scotomas confirmed by the perimetry test?

Are you having flashes of light as well?

Customer: replied 7 years ago.
Hello Dr. Shariq Riaz,
The ophthalmologists could find no defects during their examinations, so yes, they concluded a normal situation.
At the time of the test, the scotoma's were fewer than they are now and did not show up on the test.
This may be because the test is too coarse?
The largest scotoma is about the size of my indexfinger's nail at arms-length.
By now there are several of these scotoma and more various in size and shape.
Also, when I look at a bright area and then immediately at a dark area, the scotoma's appear to remain bright for a brief period.
Like an after image. The same happens when I blink at the sky.
Much like the afterimages when someone takes a picture with flash.
I don't experience flashes of light outside of the 'afterimages' I descibe above.
Those would be indicative of retinal tearing or detachment, correct?
That doesn't seem to be the case in my laymans opinion..
Expert:  Dr.S Riaz replied 7 years ago.

You need to see a retina specialist. Flashes of ligh may be seen in retinal tear or detachment but can be seen in other conditions like posterior vitreous detachment which is a normal ageing change in which the vitreous gel in the back part of the liquifies and may cause floaters and sometimes flashes of light. That is one possibility. Other possibilities include asteroid hyalosis, synchysis scintillans etc. Your ophthalmologists may have missed it since it was an early stage. If this is the diagnosis, it is likely to be picked up at this time. If perimetry test failed to identify any scotomas then you do not have them. You are probably having floaters only. However, a fundus examination by a retina specialist is important. Thanks and best wishes.

Customer: replied 7 years ago.
Thank you for your educated opinion, I'll try to get hold of a retinal specialist (you wouldn't know of any in Holland I suppose, haha).
One more thing I forgot to mention that I do not know is of relevance; sometimes the edges of my blind-spot (the normal blind spot) seem to pulsate. This is predominantly the case in my left eye. It doesn't seem related to strenuous activity (which I believed to be the case the first time it happened).
Also, the blind spot seems larger that it used to be, but I could be mistaken as I have no reliable way of measuring it. If it's worth anything: at it's widest, it appears about 7/8 cm wide (or 4 fingers) at arms length.
Again thank you for your advice.
Expert:  Dr.S Riaz replied 7 years ago.

You're most welcome. You can find a retina specialist in Holland on any search engine like google. It's important to get a dilated eye examination to find the cause for these symptoms. Pre-senile cataract (lenticular opacities)is another possibility but in this case the floaters would be fixed and not mobile. The floater could grow in this case as the opacity enlarges. Seeing a retina specialist should help. Thanks and best wishes.

Expert:  Dr.S Riaz replied 7 years ago.

Do you have any more questions?

Dr.S Riaz and other Eye Specialists are ready to help you
Customer: replied 7 years ago.
No more questions, thank you.
I'll arange for a new dilated examination to see if this time any more can be seen.
Good Day!
Chris Vendel
Expert:  Dr.S Riaz replied 7 years ago.
You're most welcome.