Idiopathic Acquired Temporal Wedge Visual Field Defects

ABSTRACT

Our aim is to report 13 unusual cases of acquired, temporal sectoral scotomas. Such stationary “wedge” field defects have been reported previously in cases of presumed congenital nasal hypoplasia of the optic disc and as a complication of vitreoretinal surgery. To our knowledge, the literature provides no reports of similar defects occurring spontaneously. This is a descriptive clinical case series of 13 patients presenting with sub-acute monocular temporal visual field loss. All were clinically assessed and investigated with Goldmann perimetry, automated Humphrey visual fields, retinal optical coherence tomography, orbital ultrasound, and standard and multi-focal electroretinography. Cases were followed with serial perimetry for a mean of 3.9 years (range: 6 months to 10 years). Goldmann and Humphrey perimetry both demonstrated “wedge”-shaped defects extending temporally from an apex contiguous with, or lateral to, the blind spot. There was no evidence of optic disc drusen, glaucoma, disc hypoplasia, or focal retinitis. Sectoral optic disc swelling was not present in any patient at presentation. In all cases, the visual field defect remained stable. One patient developed a similar defect in the fellow eye after an interval of 5 years. Here we describe 13 cases of acquired, stationary temporal wedge scotomas, novel in the literature. Although the aetiology is uncertain, we propose damage to the nasal rim of the optic disc as a likely mechanism.

KEYWORDS:

• Temporal
• wedge
• scotomas
• field
• defects

Acknowledgment

Preliminary results of this work were presented at the European Neuro-Ophthalmological Society (EUNOS) congress, June 2015, at Ljubljana, Slovenia.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Funding

C.L.F. was generously supported by the Sydney Eye Hospital Alumni Travelling Fellowship and the RANZCO Eye Foundation scholarship. However, neither organization had a role in the design or conduct of this research.

Additional information

Funding

C.L.F. was generously supported by the Sydney Eye Hospital Alumni Travelling Fellowship and the RANZCO Eye Foundation scholarship. However, neither organization had a role in the design or conduct of this research.