Neutralizing Peripheral Refraction Eliminates Refractive Scotomata in Tilted Disc Syndrome

Abstract

SIGNIFICANCEWe demonstrate that the visual field defects in patients with tilted disc syndrome can be reduced or eliminated by neutralizing the peripheral scotoma in the area of posterior retinal bowing, which may allow differentiation between a congenital anomaly and acquired pathology.PURPOSETilted disc syndrome is a congenital and unchanging condition that may present with visual field defects mimicking loss seen in neurological diseases, such as transsynaptic retrograde degeneration. Our purpose was to systematically investigate the ability of a neutralized peripheral refraction to eliminate refractive visual field defects seen in tilted disc syndrome. This was compared with the same technique performed on patients with neurological deficits.METHODSThe Humphrey Field Analyzer was used to measure sensitivities across the 30-2 test grid in 14 patients with tilted disc syndrome using four refractive corrections: habitual near correction and with an additional −1.00, −2.00 or −3.00 D negative lens added as correction lenses. Peripheral refractive errors along the horizontal meridian were determined using peripheral retinoscopy and thus allowed calculation of residual peripheral refraction with different levels of refractive correction. Visual field defects were assessed qualitatively and quantitatively using sensitivities and probability scores in both patient groups.RESULTSA smaller residual refractive error after the application of negative addition lenses correlated with improvement in visual field defects in terms of sensitivity and probability scores in patients with tilted disc syndrome. Patients with established neurological deficits (retrograde degeneration) showed improvement in sensitivities but not in probability scores.CONCLUSIONSNeutralizing the refractive error at the region of posterior retinal bowing due to tilted disc syndrome reduces the apparent visual field defect. This may be a useful and rapid test to help differentiate between tilted disc syndrome and other pathological causes of visual field defects such as neurological deficits.

An evidence‐based approach to the routine use of optical coherence tomography

“…This further reinforces the idea of glaucoma as a disease of statistical abnormality (for example, statistically depressed visual field or OCT results) . As alluded to above, other optic nerve head appearances or variations may mimic glaucomatous damage, and provide a false impression of pathological changes that may be better assessed using alternative clinical techniques (for example, tilted disc syndrome or myopic optic discs) . OCT in isolation, therefore, does not clearly provide a conclusive diagnosis of glaucoma.…”