Good Hope, Heartlands, and Solihull Eye Clinics

Is the arcuate scotoma or the cupping due to Glaucoma?

David Kinshuck

 


Arcuate scotoma.....disc and field must match

If there is an arcuate scotoma there must be a notch. No notch, suspect not glaucoma. Here are the other causes of an arcuate scotomas.

  • Prelaminar
    • optic disc drusen
    • papilloedema (eg BIH/IIH)
  • laminar
    • ION..ischaemic optic neuropathy, +/- artereritic
  • optic canal
    • infiltrative, meningioma, demyelination, inflammatory mass
  • intracanalicular
    • carotid... ectatic or aneurysm

Generally an MRI will be helpful....contrast, fat suppression, T1.  This is well reviewed by Trobe.

  • if there is a notch...87% chance glaucoma
  • if the rim is pale.....90% NOT glaucoma

To assess

  1. Vision reduced ...not glaucoma. In glaucoma..vision good until late
  2. Colour vision reduced... not glaucoma. Test wish Ischiara or a simple red target.
  3. RAPD  test...if there is a defect, glaucoma unlikely
  4. pale disc...not glaucoma as above
  5. symptoms..not glaucoma. Generally glaucoma is assymptomatic.
  6. field and discs correspond...= glaucoma (as above)