Pathologic processes involving the retina or choroid can present with a wide variety of visual field defects. Usually visual field defects of retinal diseases directly correlate with the fundus findings. Visual field changes are often the result of damage to the retina or scarring but, in conjunction with other clinical findings, they may help narrow the differential diagnosis. Most of the macular lesions result in visual field defects that do not respect the vertical or horizontal midline. Occasionally inflammatory disorders result in visual field defects that do not directly correlate with the retinal findings. For example, patients with multiple evanescent white dot syndrome (MEWDS) may have an enlarged blind spot. Macular disorders can cause central or paracentral scotomas depending on the location of the lesion. Causes of macular pathology include drusen, atrophy from dry age-related macular degeneration (AMD), retinal hemorrhage, choroidal neovascular membrane, macular edema, macular hole, macular scar, pathologic myopia, and macular dystrophies of the retina or choroid. Central serous chorioretinopathy (CSCR) can show a relative defect that is anatomically correlated with the area of subretinal or sub RPE (retinal pigment epithelium) fluid accumulation. Residual pigmentary changes in inactive CSCR can also cause a relative depression in the corresponding visual field. Pathologic myopia can present with a variety of visual field defects depending on the retinal findings, such as posterior staphyloma or choroidal neovascular membrane. AMD may show nonspecific changes in the central or paracentral visual field that correlate with the structural damage to the retina and choroid. Geographic atrophy in dry AMD can cause a dense scotoma correlated with the pattern of the atrophy. Choroidal neovascular membranes can cause a depression in the correlating visual field due to edema or hemorrhage. Disciform scars in endstage AMD can also cause a dense scotoma. Macular holes may cause a small central scotoma. Pattern dystrophies are a family of disorders with a common pathology at the level of the RPE. Butterfly dystrophy, an autosomal dominant disorder, and Sjögren reticular dystrophy, an autosomal recessive disorder, are two examples of pattern dystrophies.
Properties of Visual Field Defects Around the Monocular Preferred Retinal Locus in Age-Related Macular Degeneration
