Tilted disc syndrome may mimic false visual field deterioration

Abstract

. Purpose: Tilted disc syndrome is a congenital anomaly of the eye characterized by mostly upper temporal visual field defects. The aim of the present study was to evaluate the effect of gradual myopic correction in the improvement of visual field defects associated with tilted disc syndrome. Methods: The visual field was examined in 38 eyes of 24 patients using standard Goldmann perimetry. The isoptres IV‐4e, I‐4e, I‐3e and I‐2e were plotted. The defective isoptres were tested again with gradually increasing myopic correction until no further change was noted. Results: The most common type of defect was a relative upper temporal defect (19 eyes). Temporal relative defects were found in five eyes, upper altitudinal field defects in six eyes, an enlarged blind spot in four eyes, and an inferior field defect in one eye. The visual field defect partly or totally disappeared with increased myopic correction in 18 (50%) eyes. The mean improvement was 17.0 ± 6.2 degrees and the mean additional myopic correction was 3.1 ± 1.5 D. Conclusions: Even a small change in near correction during visual field examination may imply worsened or improved visual field defects in tilted disc syndrome. To prevent a false interpretation of field deterioration in a patient with tilted disc syndrome and glaucoma, visual field assessment should include examination with the myopic correction that provides the maximal improvement of the defective visual field.

Analyses of shape of eyes and structure of optic nerves in eyes with tilted disc syndrome by swept-source optical coherence tomography and three-dimensional magnetic resonance imaging

“…25,28 However, it has also been reported that some visual field defects were not improved by an increase in the myopic correction. 28 Although the mechanism causing the visual field defects that were not improved by increased myopic correction has not been determined, it is possible that it is due to the severe bending of the retinal nerve fiber tissue, which would impair axonal flow. We did not thoroughly analyze the visual field in this study, so more comprehensive studies are necessary to determine this hypothesis.…”

Clinical Features in High Myopia: a Danish cohort study of unselected high myopia cases followed from age 14 to age 60

“…Further, kinetic Goldmann perimetry with the largest and brightest object was included. This test strategy reflects the requirement that holders of a driving licence should be able to perceive finger movements in the VF periphery, but does not aim to map more central and subtle sensitivity losses (Carta et al 2005;Vuori & Ma¨ntyja¨rvi 2008 Results: An irregular posterior pole contour was observed in 15 eyes, unilaterally in 11 eyes and bilaterally in four (two subjects). Nasal fundus ectasia was suggested in six and other deviations from the sphere in seven subjects.…”

Evaluation of peripapillary choroidal and retinal nerve fiber layer thickness in eyes with tilted optic disc

“…A commonly observed problem with tilted disc is the detection of early glaucomatous damage. Both are associated with visual field defects, and tilted disc morphology is a finding in optic disc rim eva luation; its presence makes identification of the usual signs of glaucomatous damage, such as pathological cupping, difficult to detect (23,24) . We may say that the presence of a small visual field defect in a patient with an inferior tilted disc and superior RNFL loss is most probably related to tilted disc morphology instead of glaucomatous optic neuropathy; however, this argument needs to be proven by large-scale studies comparing visual fields in both glaucoma and tilted disc groups.…”