Scotoma: Causes, Symptoms, Treatment and Cost

Scotoma is a medical term describing an area of decreased vision or blindness surrounded by normal vision.

There are three main types of scotoma:

• Central Scotoma: The most common type of scotoma, a central scotoma affects the centre of one’s vision and can lead to impaired reading ability and other visual disturbances.
• Peripheral Scotoma: A peripheral scotoma is an area on the far edge of one's field of vision where people may experience decreased visual acuity or visibility.
• Mixed Scotoma: Mixed scotoma is a type of visual field defect in which a combination of central and peripheral scotomas are present.

• Scotoma is usually caused by damage to the retina, optic nerve, or occipital lobe of the brain, although it can also be caused by migraines, brain tumours, multiple sclerosis, diabetes, and other neurological disorders.
• Damage to the visual pathways from the eyes to the brain, as a result of stroke or trauma, may also trigger scotomas.
• They can also be induced temporarily with eye drops or electrically applied stimuli such as galvanic vestibular stimulation (GVS).

Common symptoms of scotoma include:

• Areas of vision loss in the shape of a circle or arc
• Blurred or foggy vision
• Difficulty adapting to dim lighting or transitions between different lighting conditions.
• Other associated symptoms include double vision and headaches behind the eyes, as well as increased sensitivity to bright light and difficulty focusing on objects nearby or far away.

• Maintain a healthy lifestyle: Get adequate rest, exercise regularly, and follow a nutritious diet to keep your eyes healthy and reduce the risk of scotoma.
• Wear sunglasses when outdoors: UV protection for your eyes can help prevent symptoms related to photophobia, eye fatigue and scotoma.
• Take frequent breaks from screens: Rest your eyes from bright screens like televisions, phones and computers throughout the day to avoid extended exposure which can lead to scotoma.
• Visit an eye doctor regularly: Have regular checkups with an optometrist or ophthalmologist who can check for any signs of scotoma or eye pressure that could cause vision problems down the road.
• Use proper lighting: Adjust indoor lighting to avoid glare and use lamps with shades when needed, ambience lighting is better for eyes than direct lighting that can cause strain leading to scotoma.

• Visual Field Test: This test measures the peripheral vision and identifies blind spots (scotomas) in the visual field. It involves having the patient look at a central point while different lights are flashed in various parts of the visual field.
• Visual Acuity Test: This is a basic test that evaluates how well a person can see details from a distance. It uses an eye chart to measure how clearly a person can read letters of different sizes at various distances.
• Amsler Grid Test: This is a simple test that uses a grid pattern to assess a person's vision for changes or distortions. It helps to identify any scotomas in the central vision (macula).
• Ophthalmoscopy: This is an examination of the back of the eye (retina) using an ophthalmoscope, which is a lighted instrument. It helps to detect any abnormalities such as scotomas due to damage or disease of the retina.
• Fundus Photography: This is an imaging technique used to capture photographs of the entire fundus (back part) of the eye. The photographs can be used to detect any signs of retinal damage or disease, including scotomas.
• Optical Coherence Tomography (OCT): This imaging technology creates precise images of layers inside the eye, including the retina and macula, using light waves. It allows doctors to diagnose retinal diseases and detect irregularities.

• Loss of vision: Scotoma can lead to partial or complete blindness, depending on the extent and scope of the condition.
• Difficulty concentrating: Concentration problems due to loss of vision can occur as a result of Scotoma.
• Reduced sense of orientation: People suffering from Scotoma may find it difficult to locate objects around them due to their impaired vision.
• Social isolation: As one’s ability to process visual information is decreased, they may feel more isolated and without a social life due to the condition.
• Anxiety/Depression: People living with Scotoma may experience anxiety and depression related to their visual impairment caused by the scotoma condition in varying degrees depending on its severity.

• Taking herbs such as ashwagandha, brahmi, shatavari, and bhringaraj to support the nervous system.
• Consuming ghee or clarified butter to help nourish the eyes.
• Drinking an herbal tea made with licorice root, turmeric, honey, and ginger to help improve vision.
• Taking warm oil massages with sesame oil or almond oil to improve circulation in the eyes and promote healing of eye tissues.

• Foods high in beta carotenes such as sweet potatoes, carrots, spinach, kale, and other dark leafy greens.
• Foods rich in zinc such as oysters, beef, pumpkin seeds and lentils.
• Foods high in antioxidants such as blueberries and raspberries.
• Foods rich in Vitamin B12, like eggs, milk products, and fortified cereals.
• Foods like salmon, tuna, and sardines, which are high in omega-3 fatty acids.

• Foods high in sodium and sugar: Processed foods, fried foods, sugary snacks and sodas.
• Foods high in saturated fats and trans fats: Processed meats, dairy products prepared with whole milk, baked foods produced commercially, and deep-fried food items from restaurants.
• Highly refined grains: Refined wheat products like white bread, white rice, and pasta.
• High calorie foods with few nutrients: Sweets and candy, chips and other snack foods, alcoholic beverages.
• Food additives: artificial sweeteners, artificial colours or flavours, preservatives and MSG (monosodium glutamate).

• Visual field training: This therapy involves the use of computer-based tests and exercises designed to improve the patient's awareness of their scotoma and their ability to detect visual stimuli in the affected area.
• Low vision aids: These devices magnify images to help compensate for lost vision in a scotoma. Examples include hand-held telescopes and magnifiers, stand magnifiers, and illuminated magnifiers.
• Eye exercises: Certain eye exercises can help strengthen surrounding areas of vision, allowing a patient to better understand the environment around them despite a scotoma.
• Cognitive retraining therapy: This type of therapy teaches patients how to use non-visual cues to recognize objects or people within their scotoma. It also helps patients learn how to compensate for their blind spots by using techniques such as scanning and tracking with their eyes or head movements.
• Vision rehabilitation: Vision rehabilitation uses a variety of techniques including education, vision therapies, adaptive devices, and counselling to help patients adjust to life with a scotoma and manage activities of daily living more effectively.
• Laser Panretinal Photocoagulation: This procedure uses a laser to create tiny burns around the affected area of the retina, which can help improve vision by restoring some light sensitivity.
• Vitreous Surgery: This treatment involves removing the vitreous from the eye and replacing it with a salt solution or a gas bubble. This can reduce or eliminate blind spots caused by scotomas on the surface of your retina.
• Intraocular Lens Surgery: In this procedure, an artificial lens is placed in your eye to replace the cloudy natural lens that causes scotomas in many cases. This type of surgery may be used if laser treatment or vitrectomy are not successful in improving vision.
• Stereotactic Radiosurgery: A specialised device directs radiation beams at specific areas on your retina to create lesions that block signals from nerve endings and reduce scotomas caused by certain types of retinal degeneration diseases such as age related macular degeneration (AMD).

If you are experiencing symptoms of Scotoma, it is advisable to consult an ophthalmologist as soon as possible.

An ophthalmologist is a medical professional with special training in the diagnosis and treatment of eye diseases and conditions, such as Scotoma.

• Corticosteroids: These drugs reduce inflammation and lower pressure in the eye, helping relieve Scotoma symptoms.
• Anticholinergics: Drugs such as cyclopentolate can help inhibit pain signals in the brain associated with Scotoma.
• Sodium chloride: This electrolyte helps osmotically pull fluids away from tissue, reducing pressure in the head which relieves Scotoma symptoms.
• Beta-blockers: These drugs help lower blood pressure and thus reduce the risk of developing this vision problem.
• Antioxidants: Supplementation with these compounds helps protect eyes from free radicals which are thought to contribute to Scotoma development and progression of symptoms.

Generally, if the underlying condition is successfully treated, scotoma can resolve within days or weeks.

In some cases, however, recovery may take months or even years as neural pathways need to compensate for lost vision.

If a permanent damage to the retina had occurred there may not be any recovery.

Generally, treatment with medication, corrective lenses or surgery may provide temporary relief, but it is not usually expected to be permanent.

In some cases, laser treatments may offer longer term improvements, however more severe cases may require ongoing treatment to maintain vision.

• Practice regular safety precautions, such as using appropriate eye protection when outdoors.
• Perform any recommended physical activities or therapies that may help with Scotoma treatment.
• Adjust medications or dosages to reduce the severity of Scotoma symptoms, if needed.
• Use a low-vision aid or tool for enhanced sight in areas affected by scotoma spots or dim vision due to disruption in the normal visual field experienced by an individual with Scotoma.
• Regularly monitor progress from Scotoma treatments and inform your doctor of new symptoms as they arise, so adjustments can be made to effectively manage the condition if necessary.

The cost of Scotoma treatment in India typically depends on the type of treatment required and can vary from Rs. 10,000 to over Rs. 4 lakhs.

Common side effects of Scotoma treatments include:

• Headache
• Eye strain
• Increased sensitivity to light.
• Dizziness, blurred vision, trouble concentrating, exhaustion, and nausea/vomiting are some other, less common side effects that might occur.
• Serious complications from Scotoma treatments can include double vision, drooping eyelids and corneal abrasions or even retinal detachment in rare cases.

If you experience any scotoma symptoms, you should see a doctor in your area right away because they can lead to complications like 'Vision Loss, Reduced sense of orientation, Difficulty concentrating,' for which treatment regimens can last anywhere from a few months to years, depending on how severe the condition is.