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Good Hope Hospital Eye Clinic
Is the arcuate scotoma or the cupping due to Glaucoma?
notes from lectures made by 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.

arcuate scotoma: www.aafp.org

 

Is the disc cupping glaucoma?

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)

 

 

The address of this site ('org' changing to 'nhs') is changing from http://www.goodhope.org.uk/departments/eyedept/ to http://www.goodhope.nhs.uk/departments/eyedept/
Eye website feedback -- Heartlands -- page edited October 2011 -- Public transport to Good Hope --