paracentral scotoma

Over the past five months, I've developed a paracentral scotoma.  Ut moves with my eye. I went to the retina specialist who said my macula and retina are normal.  He suggested that central scotoma may disappear over time.  My glaucoma specialist says he's 'only a plumber' and said his work to reduce pressures in that eye worked well.  Every time I see him, he compliments my work and ignores my comments about the growing scotoma.  Visual fields are stable but there are a few central blind spots.  After the filtration process, this central scotoma became more obvious, and now 'controls my vision'.  

My questions:

-Can such a scotoma that moves with the eye actually diminish with time?

-Or is the glaucoma the culprit here, and the scotoma is beyond the eye and the result of poor transmission of the visiual signals thru the optic nerve fibres?

-Or?  Is there an Or?

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

Russell you've ask this question in one form or another several times in the last months. The answer hasn't changed.

My recommendation is to see a neuroophthalmologist. Find one near you at www.aao.org or ask the glaucoma MD to refer your.

JCH MD

[walkietalkie]

Wow doc, you really have good memories! Considering the huge no. of posts here. Any patient will be glad to have you as their doc, who remembered all the details!

[russell903]

Yes, I have posted similar questions about the scotoma.   The magnitude is now such that it affects my ability to have a 'two eye function'.  I can look with the scotoma eye alone and it does not affect the view.  But trying to blend the two starts the chaos.  I'll see a neuroophthalmologist soon, and not ask for your comments on this increasing problem any longer.  

Thank you.  Russell903

[kg17]

If you could get the okay from the glaucoma specialist to get an multifocal ERG done, that would be most helpful.  It could let you know how your retinal function correlates with the scotoma.  I believe that would really help narrow down a diagnosis.

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

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[russell903]

thanks for the suggestion.  mERG was prescribed by a retina specialist, but the testing facility rejected me because I had a filtration procedure in that eye.  the glaucoma specialist has been okay with an ERG (also rejected at the test facility) but then not okay with the mERG.  Both use a special lens, and that is said to be the problem with the test.  It can damage the filtration surgery.  I sit as usual in a quandry due to conflicts between analytical procedures and existing eye conditions.  It's been the way of my visual conditions for the last three years.  Any other thoughts?  I'm open for just about anything at this point.  Dr. Hagan has suggested a neuroophthalmologist, and I'll be seeing him, but am concerned that he too will run into the 'opposing forces' as well.  Russell903

[kg17]

I would suggest that you (if you haven't already) visit the Prevent Blindness in America forum (just google it).  The doctor who moderates that forum is a highly regarded, world renowned glaucoma specialist from Bascom Palmer.  Not only is he "highly decorated" but he's got the most incredible bedside manner.  Perhaps you put together a well thought out, succinct description of your problem and seek his advice.

Good luck.  It's very difficult to have visual problems that go undiagnosed/unexplained.

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

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[russell903]

Thanks for the suggestion about the Prevent Blindness web site.  I registered today. Interesting that the first article I read happened to discuss one of my previous eye MD's!  The patient had similar experiences to mine.  While a world renowned glaucoma guy, he's also apparently world renowned for his patient abuse.
Was the Bascom Palmer MD you were commenting on a Dr. Anderson?  That's who is handling the forum answers right now.  Russell903  

[kg17]

Yes, I'm referring to Dr. Anderson