Scotoma or floater?

[WyoSue]

In December I suddenly developed a dark circular spot in my visual field. This spot was in a fixed point in my peripheral vision (not at the center) and did not move around or "float." I made an appt. with my opthalmologist who examined my eyes (without dilation) and gave me a visual field test. At this exam, the doctor said "I can't see anything. I think it's a floater." The doctor dismissed me and didn't recommend any follow-up care, examinations, or treatment.
When I examined my online personal health record that is provided for me by my insurance company, I saw that the doctor had diagnosed my condition as "Scotoma. Visual field defect, unspecified."
In the past 2 weeks, this spot has changed appearance though not location. It has changed from a very circular black spot with white halo to an irregularly-shaped area with white edges and opaque center. Today it has morphed into a couple thin wavy lines that are barely noticeable.
My background: 59-yr-old female with rheumatoid arthritis who has been on hydroxychloroquine therapy for 4 years (400 mg/day).). I also have had a chronic hepatitis C infection for about 35 years with chronic dry eye and mouth.
My questions:
Based on this limited information, do you think my eye problem is more likely a scotoma or a floater?
Would you recommend cessation of hydroxychloroquine therapy at this time?
Would you recommend additional examinations and visual tests at this time?
Thank you in advance for your help.

[Doreen Fazio, M.D.]

I am happy that your retinal tear was treated promptly and did not progress to a retinal detachment.  You need to be monitored regularly in the future, and should be seen immediately if the same symptoms ever develop again.  You also need to be monitored for the Plaquenil therapy, although you are on a safe dose.

[WyoSue]

When you say I need to be "monitored regularly," could you be more specific? How often, and with what particular tests?

[WyoSue]

Yes, I've learned from my internet research that PVD is not uncommon among older people (age 60+) and that people who are severely myopic are at higher risk. My doctor said this affects about 10% of the population. I have many relatives who lived to be in their 80s and 90s and none of them suffered from this. I guess that makes me special, haha!
Thanks for the information and the well wishes.

[flossy93]

Thanks so much for the detailed feedback, WyoSue.  It's great to hear that you got a prompt diagnosis and treatment for the detached area of retinal tissue, before it spread to a larger area that would have been worse.  

Did the doctor think your original visual symptom in December was related to the initial formation of the retinal tear or to the PVD?  It's sure seems like the two might be related.  

I think the vitreous detaching or peeling away slowly from the posterior eye happens over time to most people with age.  It can cause retinal tears as it pulls off the back of the eye over time; obviously tears can occur without this pulling too.  

Often people have PVD without a retinal tear or detachment, but do experience 'flashing' (like a black and white 'barber pole' at the side of one's vision) as the tension of the pulling causes photoreceptors to fire.  I've had a lot of that as I had PVD in both eyes by middle age due to high myopia.  

Unfortunately it sounds like you have more than the normal number of floaters and vitreous 'junk' due to the tear you experienced.  I sure hope your doctor is correct that the material will gradually be absorbed and stop annoying you.  

Good luck with your recovery - hope the floating debris dissipates soon!

[WyoSue]

It was a floater, but the doctor diagnosed it as scotoma so the insurance would pay for the visit. But, 2 days ago I suffered a posterior vitreous detachment and retinal tear. The tear was repaired with cryosurgery yesterday, but there is no fix for the vitreous detachment, so says my dr. He said the blood and vitreous matter floating around my eye would eventually be absorbed, but it could take months. It's so annoying.
In case you're wondering what the symptoms were of the detachment, I first noticed a weird arc-shaped flash in my peripheral vision, followed several hours later by a shower of floaters both large and small. Weirdest thing I've ever seen! The cryosurgery was quick and relatively painless, and dr. says if I hadn't gotten the surgery as soon as I did, I would have suffered a retinal detachment as well, resulting in blindness. Scary stuff!

[flossy93]

What was the answer?  I'd be interested to know what the doctor said if you don't mind posting it.

[WyoSue]

Never mind, my question was answered by my eye doctor.