Scotomatous

Scotomatous is an adjective used in ophthalmology to describe features related to scotomas, which are areas of impaired or absent vision within an otherwise intact field. A scotoma may be absolute, with no light perception in the affected area, or relative, where there is reduced sensitivity to light but some perception remains. Scotomas can be central, paracentral, or peripheral, and they may be static or progressive depending on the underlying disease.

Common causes include retinal disorders such as macular degeneration and diabetic retinopathy; optic nerve diseases such as glaucoma, optic neuritis, or ischemic optic neuropathy; and cerebral conditions affecting visual pathways, including stroke or tumors. Congenital scotomas can occur with developmental anomalies, though many scotomas are acquired later in life.

Diagnosis relies on visual field testing. Perimetry with Humphrey or Goldman machines, manual kinetic fields, and the Amsler grid can help map scotomas. Imaging such as optical coherence tomography (OCT), fundus photography, or MRI may aid in identifying retinal, optic nerve, or brain causes.

Management focuses on treating the underlying condition when possible; many scotomas, especially those due to advanced retinal or optic neuropathy, are permanent. Low-vision rehabilitation, including eccentric viewing techniques and assistive devices, can improve function. Ongoing monitoring with functional testing helps gauge progression.