Objective tests for blind spot?

[dazedmom]

My 14 year old daughter, who is suffering from some as-yet undiagnosed neurological problems, is also complaining about a blind spot in her left eye.  What she describes is a large central area that simply "isn't there"... as if somebody cut a hole in a piece of fabric and then seamed it together.   She has no color vision loss. The retinal specialist wants to send her to a neuropthalmologist across the state.  I'm a little uncomfortable with this because he has done no "objective" tests on her--not even a field of vision test.  He's just asked her to describe ws'hen/where his fingers disappear.  And, as nearly as I can tell, he's not finding anything much when he examines her actual eye.  Isn't there some way to verify her description before we chase off to further specialists?  

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

-

[dazedmom]

OK, thanks for the info!

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

Almost all tests done are subjective including a visual field tests. Objective tests such as VER are generally not the first line. The Eye MDs exam of the eye is the best objective test.

JCJH MD

[dazedmom]

Can you suggest a particular test or two that would be best beginning place?  Something that would be "objective" and not so easily manipulated or misunderstood?

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

I no longer do pediatric ophthalmology but at one time I did a great deal. I think that evaluating symptoms in children and young people is very very difficult. Many symptoms can come from a vivid imagination, a wish to manimpulate, get attention, explain away bad grades, punish the parent etc etc.

The evaluation of reduced vision in young people and children is very time consuming, very expensive and involves lots of tests and procedures.

The Eye MD walks a line between not wishing to miss anything but not wishing to put the child and family through a work-up that can cost many thousands of dollars.

JCH MD

[dazedmom]

OK.   Since the general opthalmologist is one who sent her to retinal guy, I guess we'll stick with the program and go to NO.  I've just been frustrated because every single test she's had for EVERYTHING has come out normal, despite some pretty obvious symptoms.  Some drs are beginning to think she's making it all up.  If we go to NO and he can't find anything either, we're just going to shoot her and put her out of her misery.  It's not that we want her to be sick; we just want to be able to stick tongue out at folks and say, "SEE!  There really is something wrong!"    It just has to be something little and very curable!

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

1. A complaint such as this requires a general ophthalmologist or a neuro-ophthalmologist. Most retina surgeons don't do visual fields or interpret them.
2. there are some very serious things that cause these blind spots "Scotomas" and proceeding with a work up is VIP.

JCH MD