Can scotomas develop around the central vision in Acute Idiopathic Bilateral Simultaneous Exudative Serosus (AIBSES)?

Scotomas in Acute Idiopathic Bilateral Simultaneous Exudative Serous (AIBSES)

Yes, scotomas can develop around the central vision in Acute Idiopathic Blind Spot Enlargement Syndrome (AIBSES), not just affecting the blind spot area. While AIBSES primarily causes enlargement of the physiologic blind spot, the condition can also lead to paracentral scotomas that affect vision around the central area.

Clinical Presentation of Scotomas in AIBSES

Characteristic Patterns

• Primary blind spot enlargement: The hallmark feature is enlargement of the physiologic blind spot 1
• Paracentral scotomas: Can develop in areas surrounding central vision 2, 3
• Dynamic visual disturbances: Patients may experience shimmering scotomas due to effects on photoreceptors 4
• Photopsia: Acute onset of light flashes often accompanies the scotomas 1

Diagnostic Features

• Visual field testing shows enlarged blind spots of variable sizes and densities 5
• OCT imaging reveals absence of the inner and outer segment (IS/OS) line in affected areas 5
• The condition primarily affects the outer retina, which explains the development of scotomas 1
• Scotomas can be detected through microperimetry, which is the preferred method for detecting scotomas in macular disease 4

Progression and Monitoring

Natural History

• AIBSES typically presents unilaterally but can affect the contralateral eye later 2
• The condition may initially be stable but can worsen over time with subsequent blind spot enlargement 2
• Scotomas may increase in size without treatment, as documented on Humphrey visual field testing 2

Monitoring Recommendations

• Regular monocular Amsler grid testing is important to detect changes in scotomas 4
• OCT is crucial for diagnosis and monitoring of outer retinal changes 1
• Patients should be educated about reporting any changes in vision, including new or expanding scotomas 4

Treatment Considerations

Response to Treatment

• Some cases have shown reduction in the size of scotomas with corticosteroid treatment 2, 3
• Without treatment, scotomas may increase to a larger size than at initial presentation 2
• Treatment of underlying retinal conditions may help manage scotomas 4

Differential Diagnosis

• Central serous chorioretinopathy can present with central scotomas 6
• Multiple evanescent white dot syndrome and acute zonal occult outer retinopathy need to be differentiated from AIBSES 1
• Optic neuritis is a common misdiagnosis when AIBSES presents with paracentral scotomas 1

Clinical Implications

Visual Function Impact

• If there is a blind spot (scotoma) in the center of vision, patients will need to use vision outside the center to see objects (the preferred retinal locus) 7
• Patients with central or paracentral scotomas will require magnification and vision rehabilitation to use remaining vision optimally 7

Management Approach

• Multimodal imaging with visual field assessment is essential for accurate diagnosis 3
• ICGA and fundus autofluorescence can determine the range of lesions earlier than other methods 5
• Regular monitoring is essential as the condition can progress over time 2

Understanding that AIBSES can cause scotomas around central vision, not just at the blind spot, is crucial for proper diagnosis and management of this rare condition. Early detection and appropriate monitoring can help preserve visual function and improve quality of life for affected patients.