Coexistence of localized scotomata and neovascularizations in proliferative diabetic retinopathy

Abstract

Fifteen eyes of 15 patients with proliferative diabetic retinopathy within the central 60 degrees of the eye fundus were examined with computerized perimetry, and the visual field data were accurately correlated with the corresponding morphology as seen on fundus photographs and fluorescein angiograms. In 12 out of 13 eyes with neovascularizations outside the optic disc area an absolute scotoma could be correlated with a retinal area distal from the neocascularization, and in one case no scotoma was found in this area. The localized scotomata corresponded in 8 cases to non-perfusion areas as seen on fluorescein angiograms, whereas in 5 cases no pathological morphology was detected in these areas. Seven eyes which had neovascularizations at the optic disc showed the same pattern, but with visual field loss of more pronounced degree. Furthermore, other scotomata which not corresponded to any pathological fundus morphology occurred at approx. 30 degrees eccentricity in the visual field. The findings are discussed in relation to the current hypothesis about the initiation and development of neovascularizations in proliferative diabetic retinopathy.

Visual fields at different stages of diabetic retinopathy

“…This is in accordance with previous observations. Visual field defects corresponding to nonperfused areas have earlier been documented in advanced diabetic retinopathy using different examination techniques (Bell & Feldon 1984;Bresnick et al 1975;Federman & Lloyd 1984;Bek 1990;Chee & Flanagan 1993). Non-perfusion is due to capillary destruction and to changes in and sometimes occlusion of small arteriolar branches (Bresnick et al 1976).…”

“…Bek & Lund-Andersen have previously found incomplete correlation between haemorrhages, exudates and scotomas even when using painstaking automated static technique with small (Goldmann size I) stimuli and tight grids (Bek & Lund-Andersen 1989, 1990. One may also wonder why there was reproducible paracentral field loss in the absence of corresponding demonstrable fundus lesions.…”

“…Non-perfusion is due to capillary destruction and to changes in and sometimes occlusion of small arteriolar branches (Bresnick et al 1976). Visual field defects corresponding to nonperfused areas have earlier been documented in advanced diabetic retinopathy using different examination techniques (Bell & Feldon 1984;Bresnick et al 1975;Federman & Lloyd 1984;Bek 1990;Chee & Flanagan 1993).…”

“…Several studies have shown that diabetic retinopathy (DR) may influence the visual field; such changes are clear at advanced stages of the disease (Greite et al 1980;Bresnick et al 1976;Bek 1990;560 Chee & Flanagan 1993). It has also been suggested that visual field defects may appear even early in diabetic disease as paracentral and arcuate scotomas (Trick et al 1990; Greite et al 1980).…”

The effect of panretinal laser photocoagulation on visual acuity, visual fields and on subjective visual impairment in preproliferative and early proliferative diabetic retinopathy

“…Encountered sensitivity depressions have been registered mostly in the periphery, and more extensive treatment has been associated with greater field loss (ETDRS 1991;DRS 1981;Frank 1975). Computerized perimetry has shown, however, that visual field defects exist in diabetic retinopathy also before scatter treatment (Bell & Feldon 1984;Bek 1990Bek , 1991Trick et al 1990;Chee & Flanagan 1993;Henricsson & Heel 1994). Such depressions of sensitivity seem to be related mainly to retinal non-perfusion.…”