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Metamorphopsia (Visual Distortion)

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globe anatomy
anatomy of the eye (click on image to enlarge).
Image courtesy of Caitlin Albritton.

What is metamorphopsia?

Metamorphopsia (“meta-more-FOP-see-ya”) is a medical term used to describe an abnormal visual perception in which images appear distorted. For example, straight lines appear curved or jagged. It is an important symptom of retinal disease. Metamorphopsia is not caused by the need for new glasses, cataract, glaucoma, or optic nerve damage. Metamorphopsia is a sign of a retinal problem. It is detected and monitored with an Amsler grid.

Distortion
Distortion of lines on Amsler Grid in right eye (click on image to enlarge)

What causes metamorphopsia?

The retina is a thin layer of nerve tissue that acts like film inside a camera. The retina “takes a picture” and sends the image to the brain. The root cause of distortion in vision is a retina that is not smooth and flat against the eye wall. This distortion of the retina may be caused by many different conditions. Sometimes, problems under the retina cause fluid leakage resulting in metamorphopsia. Such conditions include macular degeneration, central serous retinopathy, histoplasmosis, high myopia, angioid streaks, and inflammation. In other situations, distortion may be caused by scar tissue under the retina from inflammation, trauma, bleeding, or chronic leakage of fluid under the retina. Distortion of the retina may also be caused by vitreomacular traction, macular hole, or macular pucker. The ophthalmologist (retinal specialist) will undertake examination and testing to determine the cause.

Is metamorphopsia an urgent situation?

Metamorphopsia may be an urgent situation if it is new in onset or has significantly increased recently. If the cause of distortion is inflammation or bleeding, prompt treatment is needed to prevent further loss of vision and worsening of symptoms. Longstanding distortion is less likely an emergency but merits an eye examination to determine the cause.

What is the treatment?

Metamorphopsia is a symptom rather than a diagnosis, so the treatment depends on the underlying cause of the distortion of vision. This is the reason why it is important to have an eye examination in order to determine the best course of action. Contact your eye doctor or retinal specialist if you have this important symptom.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright © 2016-2022 Designs Unlimited of Florida. All Rights Reserved.

Central Serous Retinopathy

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central serous retinopathy
anatomy of the eye (click on image to enlarge)

 

What is central serous retinopathy (CSR)?

Central serous retinopathy (also known as central serous chorioretinopathy) is an abnormal leakage of clear fluid under the retina, which causes symptoms of blurred vision often associated with a round or oval dark spot in the central vision. The retina is a thin layer of delicate tissue in the back of your eye, which lines the inside wall like the film in a camera. The retina “takes a picture” of objects you look at and sends the message to the brain.

What causes central serous retinopathy (CSR)?

The exact cause of CSR has not been well-defined. Classically, it occurs in middle-aged people with type-A personality and who are often under stress at home or work.  However, anyone may be affected regardless of age, personality type, and level of stress. Individuals with type-A personality are perfectionists who often feel pressured by time constraints. Research suggests that hormones released under stress can affect the blood vessels beneath the retina (in the choroid). These vessels may leak an abnormal amount of fluid, which then works its way under the center of the retina. Far-sighted eyes are more commonly affected than near-sighted eyes.  

What other things can aggravate central serous retinopathy (CSR)?

A host of factors may aggravate CSR. Sometimes, medical conditions (Cushing’s Syndrome, systemic lupus erythematosus, polycystic ovary disease, sleep apnea), medications (pseudephedrine, prednisone/cortisone/steroid by mouth/cream/injection/spray, OTC medication for the common “cold”, OTC nasal sprays, diet pills, muscle relaxants, and medications for erectile dysfunction), and other agents (testosterone, cocaine, caffeine, niacin, amphetamines, estrogen blockers, etc.) may contribute to the development of CSC. Rarely, CSC may be triggered by pregnancy, or by a viral infection or bacterial infection. Intense exercise has been implicated, as well. Indeed, anything that causes emotional or physiological stress in the body, including intense fasting, may contribute to the development of CSC.

What are non-medical treatments of CSC?

In many cases, the symptoms will disappear with time. Over a period of weeks to months, the abnormal leakage may stop with normal healing. Importantly, avoiding known triggers (listed above) may help. Other helpful measures include stress management, getting 8 hours of sleep per night, and treatment of sleep apnea.  

What are medical treatments of CSC?

The doctor can recommend the best course of action by taking special pictures of the eye called a fluorescein angiogram. The fluorescein angiogram shows where the leak is coming from and how active the leak is. Prescription medication may be helpful if fluid leakage does not go away with time alone. Patients with high blood pressure may benefit from beta-blocker medications. Thermal laser photocoagulation may be helpful if the site of leakage is not close to the center of vision. Side-effects are rare, but may include the appearance of a small, permanent blind spot in the vision. Another laser called Visudyne photodynamic therapy (PDT) may successfully avoid blind spots in the vision in eyes with areas of leakage close to the center of vision. Medicine injections may also be used to treat this condition.

What will happen to the vision?

Usually the vision returns to normal or near normal. Rarely, central serous chorioretinopathy will cause permanently limited central vision with distortion. In about a third of cases, CSC will return at a later date in the same or other eye. Repeated episodes of leakage may result in a build-up of permanent damage to the retina. Therefore, any future decrease in vision should be promptly reported to the doctor. The vision may be monitored with the Amsler grid test.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2013-2023 Designs Unlimited of Florida.  All Rights Reserved.