10 months of visual field distortion + extras.

Hi there.

I'm a 34  year old, diabetic male with a number of eye symptoms which first began in July last year.

I initially noticed a sudden bilateral increase in floaters, an intense visual snow in normal lighting conditions, strange spots of light in the centre of my vision which would appear for minute or two then vanish, and increased awareness of the prominence of the veins in my eyes when waking and blinking.

In addition to these symptoms, a couple of weeks later I noticed curvature - horizontal and vertical - of my visual field with the left eye seemingly affected with a worse vertical curve than the right. On closer examination, I also noticed an upwards, anti-clockwise rotation of the vision in my right eye, with vertical surfaces rotated somewhere between 2-4 degrees. The combined effect was an overall, mild warping of geometrically accurate shapes such as windows, blinds, doors, internet pages, etc.

In response I had a diabetic retinopathy screening last October, and a full eye examination at a Hospital in November. There were no signs of problems with the retina or optic nerve in both instances, nor any signs of raised intraocular pressure. Both maculae were flat and healthy with no retinal tearing and normal retinal vasculature.

During the following months, little changed, other than the development of an almost fluid-like effect to the visual snow in bright light conditions, and an occasional, slow, meandering phosphene, which would crawl up the centre of my vision. With this in mind, I attended another eye clinic in March with the same outcome, that my eyes were healthy. The doctor did suggest it may be a type of ocular migraine and referred me back to my general practitioner.

Given this strange diagnosis, and the fact the symptoms had remained fairly stable and permanent, I questioned this suggestion when I saw my regular doctor. He agreed that it did not sound much like migraine, and told me that he would not be taking any further action as long as the symptoms remained stable. He cited a perfectly normal MRI head I had at the end of 2009 as evidence that it was unlikely to be a neurological issue, and probably something idiopathic.

However, in the last 2 weeks there have further changes. Some of the distortion has improved noticeably, as has the visual snow, but there are 2 new symptoms: I am getting an occasional, strobe-like, dark flash when I look upwards or to the side. This happens maybe 2-3 times per day. I can only describe it as being like an inverse camera flash. It's not a blink because I have seen it more than once with my eyes closed in well-lit conditions. The other symptom is a small rotation of my field of view from right to left to left to right when I stare at anything for more than a couple of seconds, as if I'm on a small boat on a calm sea. The effect cannot be noticed if I cover each eye, and therefore only affects stereo vision.

Is there anyone out there who might know what this could be? I'm feeling so low because of all of this.

[John C Hagan III, MD, FACS, FAAO]

I believe you need to step up to a neuroophthalmologist. They are the Sherlock Holmes of eye diagnosis. Ask your present Eye MD to refer you or go to www.aao.org to find one near you.

JCH MD