A visual aura or scintillating scotoma is not blurry, it is a transient or longstanding visual perceptual disturbance experienced with a migraine or seizure.
Picture this.
A crescent of stimulating zigzags or other geometric patterns that slowly advances to the edge of a visual field. The scintillations melt into the background to the physiological blind spot.
That’s when you know that you might be experiencing scintillating scotoma.
Definition of Scintillating Scotoma
Scintillating scotoma is defined as the blurring of vision with the sensation of a luminous appearance before the eyes. As mentioned, it may appear to be a zigzag or wall-like outline. Scintillating scotoma is also referred as teichopsia or a visual migraine, and it is the most common visual aura prior to having a migraine.
It was first described by 19th-century physician Hubert Airy (1838–1903).
The slowly expanding area of visual loss with a stimulating, jagged border that can last up to 20 minutes and then goes back to a normal vision, can also occur acephalgically (which is a scintillating scotoma without a headache).
It is often confused with an ocular migraine, as the pain originates from the eyeball or socket. The aura may have one symptom or a succession of visual disturbances.
Varying Symptoms with Age
Scintillating scotomas without pain are most likely to occur at the age of 50. For younger people, their visual aura is followed by a headache.
In women, the transition is associated with their hormonal changes (or menopause). However, older men experience fewer headaches after auras.
Overall, triggers of the aura may vary from one individual to another.
Causes
A migraine is caused by abnormal brain activity, which can be triggered by a number of factors.
Common causes of scotomata include demyelinating disease such as multiple sclerosis (retrobulbar neuritis), damage to nerve fiber layer in the retina (seen as cotton wool spots) due to hypertension, toxic substances such as methyl alcohol, ethambutol and quinine, nutritional deficiencies and vascular blockages.
Cortical spreading depression, which is a wave of electrophysiological hyperactivity followed by a wave of inhibition, is a pattern of changes in the behavior of the nerves in the brain during a migraine, which is another cause.
A migraine is caused by hormones, the influence of the genes, stress, or from a variety of food. It can also be a result of a corrective surgical operation, or from an ocular infection that has left a scar.
Scotomas from tumors or problems from the pituitary gland are less common, and these can compress the optic nerve or impede the blood supply. However, they are curable or reversible by operations.
How long does it last?
Auras may be present without a headache, especially in older migraineurs, and rarely in non- migraine headache disorders. Although, the amount of time it takes for an aura to develop varies, the aura symptoms usually last from 5 minutes to 1 hour.
Is it serious?
Symptoms are temporary and an ocular migraine is not considered a serious condition. An ocular migraine is sometimes confused with a retinal migraine, but they are two distinct conditions.
A retinal migraine is rare and affects only one eye. Loss of vision in one eye can be a symptom of a more serious medical issue.
What does kaleidoscope vision mean?
It’s caused by the same changes in your brain chemistry, blood vessels or nerve excitability that cause regular migraines, only it’s taking place in your retina or in areas of your brain associated with eyesight.
You may experience flashing lights, wavy lines going through your vision or actual blind spots.
Understanding this Ailment
Physical examination is the initial assessment to diagnosis. The medical tests used to detect the disorder include the Amsler grid, perimetry and visual field test, as well as horizontal eccentricity.
The abnormal functioning of the occipital cortex is at the back of the brain, not in the eyes. Normal central vision may return several minutes before the scotoma disappears from peripheral vision.
Meaning of the term
In Greek, the word scotoma means “darkness”. Scotoma in the medical field refers to a concealed region in the field of vision. People who are suffering from it notices a dark spot or crescent of stimulating zigzags or geometric patterns that slowly advances to the edge of the visual field.
Scintillating scotomas can be characterized by one or more dark or light areas or blurred regions in the visual field. These people may also suffer from an increased requirement of greater illumination and contrast when reading and may experience difficulties in perceiving colors.
How does it start?
Scintillating scotoma begins as a spot of flickering light near or in the center of the visual field that can prevent vision within the scotoma area. The bright flickering light obstructs the normal vision, and one or more shimmering arcs of white or colored flashing lights can be seen.
It then gradually extends outward from the initial spot. The scotoma area may expand to completely occupy one half of the visual area, or it may be bilateral.
What does it involve?
The majority of people who suffer from scotoma experience persistent black spots or a dark region. The disorder may give the sufferers difficulty in identifying the people they know by their physical attributes.
In pregnant women, scintillating scotoma manifests or is an early symptom of severe preeclampsia. It can arise due to the elevated intracranial pressure that can lead to malignant hypertension.
Patients can keep a diary on which the episodes occur, and make a small sketch of the anomaly that may vary between episodes.
Pain
With scintillating scotoma, you experience at least 5 headaches in a span of 4 to 72 hours, and the headache must have at least two of the following characteristics:
- The headaches have a unilateral location
- Pulsating quality
- Moderate or severe pain intensity
- Aggravation by or causing avoidance of routine physical activity
And during a headache, you can experience one of these symptoms:
- Nausea and/or vomiting
- Photophobia and/or phonophobia
Your ability to do simple daily activities is compromised— your ability to read, mobilize, and watch the television becomes difficult. The pain intensity can range from moderate to severe and intensifies with movement or physical activities. Some scintillating scotoma sufferers lie quietly in a dark room, and it subsides gradually within a day or after sleep.
Migraine Aura
The migraine aura is a complex neurologic symptom that follows or accompanies the headache phase. It can be a combination of visual, sensory, or motor symptoms.
Negative visual phenomena or negative scotoma is common during an aura, and the sufferer may experience homonymous hemianopia or quadrantic field of defects; central scotomas; tunnel vision; altitudinal visual defects; and complete blindness. Scintillating scotoma is the most common positive visual phenomena.
Prevention
In order to prevent scintillating scotoma, proper medical treatment is needed to prevent the enlargement of the dark spot in the eye, and address the underlying cause of the development of scotoma.
Scintillating scotoma may also be a result of stress and fatigue. Help yourself by:
- Managing your stress levels. Meditate, go for long walks, do yoga or whatever relaxation technique suits you.
- Eating a balanced diet and nutritious meals. Monitor your consumption of coffee, caffeinated drinks, alcohol, and food high in preservatives. It is recommended to have a balanced diet that can supply essential nutrients, such as carotenoid oxidants, vitamins A and C, and dietary minerals.
- Avoiding long hours facing the computer, and taking frequent breaks. Do the 20-20 rule, every 20 minutes, look away from the computer and focus on something 20 feet away from you.
- Doing regular exercises three times a week. Exercise can reduce the amount of pain from migraines, although it can never directly hinder a migraine.
- Paying attention to your food consumption. There are foods that can trigger migraines.
- Get adequate sleep, and religiously follow a sleep routine. Wake up early at the same time each morning. Enough sleep can relieve strain in the eye and restore good vision.
- Staying away from loud environments, and using hearing protection.
However, if auras are an effect of an underlying condition, it is best to consult a physician to better determine the prevention and cure of the condition.
Treatment
A scintillating scotoma can trigger pain within the eyeball, and causes flickering of lights and spots.
Headaches will then be experienced, and it can cause discomfort, nausea, and vomiting. The headache episode after can be eased with medications. Without any doubt, migraines are debilitating, that is why the right treatment options for this condition should be found.
In the past there has been little that could be done by way of treatment, however, research into the plasticity connections of the brain and how they can be renewed is showing great promise.
Advanced research in neuroplasticity and the ability of the brain to develop and heal has led to effective means of the rehabilitation and treatment of vision. New research includes drug trials and both radiation therapy or radiosurgery.
Diagnosis
After diagnosis, the underlying cause is determined by the physician. By this time, the physician has developed proper treatment options.
These include options like vision restoration therapy, which works by stimulating the brain in precise and consistent ways. Quality of life is improved with this therapy, and there are significant improvements in vision.
NeuroEyeCoach is a therapy designed to re-train the ability of the person to scan the environment, re-integrate the left and right vision and improve the visual field.
Vision restoration therapy(1) focuses on the restoration of lost vision, while NeuroEyeCoach tries to make the most out of the remaining vision.
Eye exercises can also help to cope with the condition, and can help compensate for the loss of vision.
There is also equipment being manufactured and distributed that can promote vision treatment systems that can treat scintillating scotoma. However, the credibility of the equipment has not been properly evaluated and established.
Unfortunately, most cases of scintillating scotoma are not curable. However, it is still a need to seek treatment from an ophthalmologist if you are struggling with this ailment.
Rehabilitation
Scotoma is located at the outer edges of the vision does not cause severe vision problems. If the scotoma is located at the central vision, it cannot be treated or corrected with glasses, contact lenses, or 
surgery.
However, there are aids you can use depending on the extent of your condition. These tools are:
- Phone keypads and watch faces are in a large-font mode.
- Filters to reduce glare on the computer screens.
- Talking clock or scales.
- Audio books, magazines, newspapers, or machines that read the printed material aloud in a computer voice.
- Using a large-type printed books, or changing the font size in an eReader
- Personal computer hardware, such as lighted keyboards, large type, and software that magnifies screens and converts text to speech for both computers and phones.
- Magnifying eyeglasses, handheld magnifiers, or stand magnifiers to enlarge objects or reading materials.
- Regular checkups from an ophthalmologist are important.
Conclusion
Scintillating scotoma usually presents as a migraine with aura. The condition is usually caused by stress.
Suitable rehabilitative measures, treatments, and prevention should be chosen after a thorough assessment of the visual impairment. The length of how long you go between visual examinations can detect visual problems with no symptoms.
Indeed, scintillating scotoma is very difficult to live with. It is a result of lesions that greatly affect the pathway of the visual tract. People may need to be informed of the condition’s devastating effects, and a prompt assessment and treatment should be done to preserve eyesight.
If you suspect that you or a friend are exhibiting the symptoms, consult an ophthalmologist. Seek optical care to give you an immediate and preventive measure to help you find help for the condition and it’s symptoms.
If you’re interested in this, you might also like this information about: concussion headaches.
Article Resources:
(1) http://www.novavision.com/vision-restoration-therapy-vrt/
