Is a star pattern of scotomas around fixation a characteristic feature of Acute Idiopathic Bilateral Simultaneous Exudative Sensory (AIBSES)?

Star Pattern of Scotomas in Acute Idiopathic Bilateral Simultaneous Exudative Sensory Retinopathy (AIBSES)

No, a star pattern of scotomas around fixation is not a characteristic feature of Acute Idiopathic Bilateral Simultaneous Exudative Sensory (AIBSES) retinopathy.

Scotoma Patterns in Various Retinal Conditions

While scotomas (blind spots in the visual field) are common in many retinal and optic nerve conditions, the pattern of these scotomas varies significantly depending on the underlying pathology. Based on the available evidence, AIBSES does not present with a characteristic star pattern of scotomas around fixation.

Scotoma Patterns in Related Conditions

Different retinal and optic nerve conditions present with distinct scotoma patterns:

• Acute Zonal Occult Outer Retinopathy (AZOOR): Presents with scotomas that may impact visual function, but these typically have an arcuate pattern rather than a star pattern 1

• Optic Neuritis: Often presents with a scotoma centered on the fixation point with sloping borders 2

• Anterior Ischemic Optic Neuropathy (AION): Typically presents with inferior altitudinal defects with sharp borders along the horizontal meridian 2

• Glaucoma: Initial parafoveal scotomas often progress in an arcuate pattern that later deepens approximately 3° to 5° above fixation 3

Diagnostic Approach for Scotomas

When evaluating scotomas, regardless of their pattern, the following diagnostic approach is recommended:

1. Comprehensive Visual Field Testing:

   • Standard automated perimetry
   • Microperimetry (gold standard for detecting scotomas and fixation patterns) 1

2. Advanced Imaging:

   • OCT to rule out macular pathology
   • Wide-field imaging technologies
   • OCT-A to detect perfusion loss in the outer retinal layer 1

3. Amsler Grid Testing:

   • For patients to periodically test their central vision monocularly
   • To detect changes in scotomas over time 1

Clinical Implications of Scotoma Patterns

The pattern of scotomas has significant implications for:

• Reading Ability: Scotomas that limit horizontal span reduce reading fluency and ability to use magnification 1

• Fixation Stability: Patients with central scotomas often develop eccentric fixation with a preferred retinal locus (PRL) 4, 5

• Visual Rehabilitation: Training interventions, including device training and structured reading practice, are essential for patients with central or paracentral scotomas 1

Differential Diagnosis Considerations

When evaluating unusual scotoma patterns, consider these conditions:

• Central Serous Chorioretinopathy: Can present with central scotomas 1

• Multiple Evanescent White Dot Syndrome: May present with scotomas that differ from AIBSES 1

• Epiretinal Membrane (ERM) and Vitreomacular Traction (VMT): Can cause shimmering scotomas due to traction on the retina 1

Management Implications

Understanding the correct pattern of scotomas is crucial for:

1. Accurate diagnosis of the underlying condition
2. Appropriate treatment planning based on the specific pathology
3. Visual rehabilitation strategies tailored to the specific scotoma pattern
4. Monitoring disease progression over time

Remember that perceptual filling-in of scotomas can occur, which may mask their true pattern and extent 6. This phenomenon should be considered during visual field assessment.