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<title>Angioscotoma</title>

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<span id="openzim-page-title" class="mw-page-title-main"><span class="mw-page-title-main">Angioscotoma</span></span>

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<p>An <b>angioscotoma</b> is a localized area of lower or absent visual sensitivity that follows the course of a retinal blood vessel. Because light‑sensitive <a href="Photoreceptor_cell" title="Photoreceptor cell">photoreceptors</a> lying beneath the retinal blood vessels receive less illumination, they send reduced or absent signals to the <a href="Brain" title="Brain">brain</a>, creating blind regions that normally goes unnoticed, since <a href="Neural_adaptation" title="Neural adaptation">retinal adaptation</a> suppresses awareness of this, similar to how the central <a href="Blind_spot_(vision)" title="Blind spot (vision)">blind spot</a> is invisible. Angioscotomas are best revealed with specialized forms of <a href="Perimetry" class="mw-redirect" title="Perimetry">perimetry</a> and <a href="Psychophysics" title="Psychophysics">psychophysical testing</a>. The magnitude of the defect depends on vessel calibre, eccentricity, and stimulus parameters. It has been shown in <a href="Squirrel_monkey" title="Squirrel monkey">squirrel monkeys</a> that angioscotoma casts a "shadow" on the <a href="Retinotopy" title="Retinotopy">retinotopic map</a> of the <a href="Visual_field" title="Visual field">visual field</a> in the <a href="Visual_cortex" title="Visual cortex">visual cortex</a>.

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<div class="mw-heading mw-heading2"><h2 id="History">History</h2></div>

<p>The <a href="Blind_spot_(vision)" title="Blind spot (vision)">blind spot</a> was discovered by <a href="Edme_Mariotte" title="Edme Mariotte">Edme Mariotte</a> in the 17th century, as a scotoma of the <a href="Optic_disc" title="Optic disc">optic disc</a>. It was understood and measured as a roughly elliptic region. <a href="Hermann_von_Helmholtz" title="Hermann von Helmholtz">Helmholtz</a> in the 19th century noted in his <i>Treatise on Physiological Optics</i> that there are some stump-like extensions to the blind spot.<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page: 43">: 43 </span></sup> However, they did not notice the scotoma due to retinal blood vessels.

</p><p>Angioscotomas were first discovered and mapped out by John Norris Evans (1891-02-28--1953-04-08)<sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> in 1926, who coined the term <b>angioscotometry</b> to describe the painstaking charting of the scotoma of the retinal blood vessels by manual <a href="Visual_field_test" title="Visual field test">perimetry</a>. He seated each subject in a seat in a dark setting, and tested whether they could see a tiny bright test object placed at various locations.<sup id="cite_ref-Evans1926_3-0" class="reference"><a href="#cite_note-Evans1926-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Using a 1.5 mm white disk, Evans reported intricate branch‑like scotomas that mirrored the arteries and veins emerging from the <a href="Optic_disc" title="Optic disc">optic disc</a>, with a full map requiring up to 2 hours to complete. He plotted this for subjects under various conditions, such as while holding breath, with glaucoma, etc. A year later, he confirmed that only short stump‑like scotomas had been noticed previously, some further data plotted with a smaller 1 mm stimuli, and under varying conditions on the subject.<sup id="cite_ref-Evans1927_4-0" class="reference"><a href="#cite_note-Evans1927-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> He published a monograph on this in 1938 in which he described its use in assisting diagnosis of various conditions, such as <a href="Retinal_edema" class="mw-redirect" title="Retinal edema">retinal edema</a>, <a href="Glaucoma" title="Glaucoma">glaucoma</a>, <a href="Optic_neuritis" title="Optic neuritis">optic neuritis</a>, etc.<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup>

</p><p>In the 1940s there were further developments. Evans reviewed the state of research in 1942.<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> In 1945, Welt designed a portable campimeter and linked the size of both the blind spot and the angioscotoma to retinal arterial pressure.<sup id="cite_ref-Welt1945_7-0" class="reference"><a href="#cite_note-Welt1945-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> In the same year, Weekers and Humblet published detailed tracings that overlaid vessel photographs onto Bjerrum screen plots, firmly establishing the one‑to‑one correspondence between vascular anatomy and scotoma shape.<sup id="cite_ref-WeekersHumblet1945_8-0" class="reference"><a href="#cite_note-WeekersHumblet1945-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup>

</p><p>With the advent of computer-automated perimetry in the 1970s, angioscotomas could be plotted with higher precision. More recently, <a href="Microperimetry" title="Microperimetry">microperimetry</a> by adaptive optics scanning laser ophthalmoscopy (AOSLO) has been applied to angioscotometry, and it was revealed that the average cone sensitivity can drop by 3–5 <a href="Decibel" title="Decibel">dB</a> directly over a parafoveal vessel only 21 μm wide, corresponding to 4.2<a href="Minute_and_second_of_arc" title="Minute and second of arc">′</a> in angle.<sup id="cite_ref-Tuten2012_9-0" class="reference"><a href="#cite_note-Tuten2012-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup>

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<div class="mw-heading mw-heading2"><h2 id="Cortical_map">Cortical map</h2></div>

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</style><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="Cortical_map" title="Cortical map">Cortical map</a></div>

<p>Angioscotomas have an effect beyond the <a href="Retina" title="Retina">retina</a>, affecting the <a href="Retinotopy" title="Retinotopy">retinotopic map</a> on the <a href="Visual_cortex" title="Visual cortex">visual cortex</a>. In <a href="Squirrel_monkey" title="Squirrel monkey">squirrel monkeys</a>, focal deprivation by vascular shadows causes a precise rerouting of <a href="Thalamocortical_radiations" title="Thalamocortical radiations">geniculocortical afferents</a> in layer 4C of <a href="Primary_visual_cortex" class="mw-redirect" title="Primary visual cortex">primary visual cortex</a>, producing dark, vessel‑shaped columns after <a href="Enucleation_of_the_eye" title="Enucleation of the eye">enucleation</a> of one of the eyes.<sup id="cite_ref-AdamsHorton2002_10-0" class="reference"><a href="#cite_note-AdamsHorton2002-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-AdamsHorton2003_11-0" class="reference"><a href="#cite_note-AdamsHorton2003-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> Where <a href="Ocular_dominance_column" title="Ocular dominance column">ocular dominance columns</a> are fine, each angioscotoma is flanked by pale zones mapped exclusively to the opposite eye, implying a reciprocal exchange of cortical territory during development. In <a href="Macaque" title="Macaque">macaques</a> and <a href="Human" title="Human">humans</a>, whose ocular dominance columns are broader relative to vessel size, such representations had not been detected visible, suggesting species differences in competitive plasticity.<sup id="cite_ref-HortonAdams2005_12-0" class="reference"><a href="#cite_note-HortonAdams2005-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup>

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<div class="mw-heading mw-heading2"><h2 id="Gallery">Gallery</h2></div>

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</style><div class="mod-gallery mod-gallery-default mod-gallery-center"><div class="title"><div>Angioscotomas plotted from normal subjects</div></div><div class="main"><div><ul class="nochecker bordered-images whitebg gallery mw-gallery-traditional">

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</ul></div></div></div><div class="mod-gallery mod-gallery-default mod-gallery-center"><div class="title"><div>Angioscotomas plotted under special conditions</div></div><div class="main"><div><ul class="nochecker bordered-images whitebg gallery mw-gallery-traditional">

<div class="gallerytext">Using eccentric fixation, the more nasal parts of the angioscotoma can be plotted.</div>

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<div class="gallerytext">1. Pressure on globe shows only stumps of large vessels. 2. Holding the breath causes similar effect; also 3. Holding the head low. 4. Pressure on opposite eye widens arteries and still more veins, 5. Pressure on the carotid produces no definite effect. 6. Looking thru red glass brings out finer vessels.</div>

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<div class="gallerytext">20. Venous engorgement. 21. After pressure over internal 22. Same case, normal. 23. Scotoma after ligation of common carotid. 24. Edematous swelling of nerve and retina. 25, Normal blind spot of other eye.</div>

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<div class="gallerytext">Widening of angioscotoma under various conditions (holding head lower than trunk; holding the breath; making digital pressure on the same eye; (a vein) on opposite eye; (an artery) on opposite eye).</div>

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<ul><li><a href="Blind_spot_(vision)" title="Blind spot (vision)">Blind spot</a></li>

<li><a href="Ocular_dominance_column" title="Ocular dominance column">Ocular dominance column</a></li>

<li><a href="Visual_field_test" title="Visual field test">Perimetry</a></li>

<li><a href="Purkinje_tree" class="mw-redirect" title="Purkinje tree">Purkinje tree</a></li></ul>

<div class="mw-heading mw-heading2"><h2 id="References">References</h2></div>

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</style><cite id="CITEREFHelmholtz1924" class="citation book cs1"><a href="Hermann_von_Helmholtz" title="Hermann von Helmholtz">Helmholtz, Hermann von</a> (1924). Southall, James Powell Cocke (ed.). <i>Helmholtz's treatise on physiological optics</i>. Rochester, N.Y.: <a href="Optical_Society_of_America" class="mw-redirect" title="Optical Society of America">Optical Society of America</a>.</cite></span>

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<li id="cite_note-2"><span class="mw-cite-backlink"><b><a href="#cite_ref-2">^</a></b></span> <span class="reference-text"><cite id="CITEREFOhly1953" class="citation journal cs1">Ohly, J. H. (1953). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312548">"John Norris Evans"</a>. <i>Transactions of the American Ophthalmological Society</i>. <b>51</b>: <span class="nowrap">6–</span>8. <a href="ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/0065-9533">0065-9533</a>. <a href="PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312548">1312548</a></span>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/13216767">13216767</a>.</cite></span>

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<li id="cite_note-Evans1926-3"><span class="mw-cite-backlink"><b><a href="#cite_ref-Evans1926_3-0">^</a></b></span> <span class="reference-text"><cite id="CITEREFEvans1926" class="citation journal cs1">Evans, John N. (1926-07-01). <span class="id-lock-subscription" title="Paid subscription required"><a rel="nofollow" class="external text" href="https://www.sciencedirect.com/science/article/pii/S0002939426903450">"Angioscotometry"</a></span>. <i>American Journal of Ophthalmology</i>. <b>9</b> (7): <span class="nowrap">489–</span>506. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2FS0002-9394%2826%2990345-0">10.1016/S0002-9394(26)90345-0</a>. <a href="ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/0002-9394">0002-9394</a>.</cite></span>

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<li id="cite_note-Evans1927-4"><span class="mw-cite-backlink"><b><a href="#cite_ref-Evans1927_4-0">^</a></b></span> <span class="reference-text"><cite id="CITEREFEvans1927" class="citation journal cs1">Evans, John N. (1927-08-01). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC513211">"A contribution to the study of angioscotometry"</a>. <i>British Journal of Ophthalmology</i>. <b>11</b> (8): <span class="nowrap">369–</span>384. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1136%2Fbjo.11.8.369">10.1136/bjo.11.8.369</a>. <a href="ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/0007-1161">0007-1161</a>. <a href="PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC513211">513211</a></span>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/18168647">18168647</a>.</cite></span>

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<li id="cite_note-5"><span class="mw-cite-backlink"><b><a href="#cite_ref-5">^</a></b></span> <span class="reference-text"><cite id="CITEREFEvans1938" class="citation book cs1">Evans, John Norris (1938). <i>An introduction to clinical scotometry</i>. New Haven: Yale University Press. <a href="OCLC_(identifier)" class="mw-redirect" title="OCLC (identifier)">OCLC</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/oclc/11263704">11263704</a>.</cite></span>

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<li id="cite_note-6"><span class="mw-cite-backlink"><b><a href="#cite_ref-6">^</a></b></span> <span class="reference-text"><cite id="CITEREFEvans1942" class="citation journal cs1">Evans, John N. (1942-07-01). <span class="id-lock-subscription" title="Paid subscription required"><a rel="nofollow" class="external text" href="https://www.sciencedirect.com/science/article/pii/S0002939442910353">"The Present Status of Angioscotometry"</a></span>. <i>American Journal of Ophthalmology</i>. <b>25</b> (7): <span class="nowrap">861–</span>865. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2FS0002-9394%2842%2991035-3">10.1016/S0002-9394(42)91035-3</a>. <a href="ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/0002-9394">0002-9394</a>.</cite></span>

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<li id="cite_note-Welt1945-7"><span class="mw-cite-backlink"><b><a href="#cite_ref-Welt1945_7-0">^</a></b></span> <span class="reference-text"><cite id="CITEREFWelt1945" class="citation journal cs1 cs1-prop-foreign-lang-source">Welt, M (1945). <span class="id-lock-subscription" title="Paid subscription required"><a rel="nofollow" class="external text" href="https://karger.com/oph/article-abstract/110/1-2/43/247316/L-Angioscotome-physiologique">"Étude sur les rapports entre les dimensions de la tache aveugle de Mariotte et des angioscotomes, et la tension artérielle rétinienne"</a></span> [Study on the relationship between the dimensions of the blind spot of Mariotte and angioscotomas, and the retinal arterial tension]. <i>Ophthalmologica</i> (in French). <b>109</b> (<span class="nowrap">2–</span>3): <span class="nowrap">137–</span>158. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1159%2F000300229">10.1159/000300229</a>.</cite></span>

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<li id="cite_note-WeekersHumblet1945-8"><span class="mw-cite-backlink"><b><a href="#cite_ref-WeekersHumblet1945_8-0">^</a></b></span> <span class="reference-text"><cite id="CITEREFWeekersHumblet2010" class="citation journal cs1 cs1-prop-foreign-lang-source">Weekers, Roger; Humblet, Max (2010-03-17). <a rel="nofollow" class="external text" href="https://orbi.uliege.be/bitstream/2268/306134/1/000300258.pdf">"L'Angioscotome physiologique"</a> [Physiological Angioscotoma] <span class="cs1-format">(PDF)</span>. <i>Ophthalmologica</i> (in French). <b>110</b> (<span class="nowrap">1–</span>2): <span class="nowrap">43–</span>59. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1159%2F000300258">10.1159/000300258</a>. <a href="Hdl_(identifier)" class="mw-redirect" title="Hdl (identifier)">hdl</a>:<a rel="nofollow" class="external text" href="https://hdl.handle.net/2268%2F306134">2268/306134</a>. <a href="ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/0030-3755">0030-3755</a>.</cite></span>

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