FUNCTIONAL DEFICITS ASSOCIATED WITH DARK WITHOUT PRESSURE

Area of Science:

• Ophthalmology
• Retinal Imaging
• Visual Electrophysiology

Background:

• Dark without pressure (DWP) has been historically considered a benign retinal finding.
• Previous literature suggests DWP does not cause functional visual deficits.

Purpose of the Study:

• To describe a patient presenting with progressive visual symptoms.
• To correlate these symptoms with reduced retinal sensitivity in areas of DWP.
• To investigate the diagnostic capabilities of microperimetry versus standard visual field testing for DWP.

Main Methods:

• Retrospective chart review of a single patient with progressive visual complaints.
• Comprehensive ophthalmic examinations including multimodal imaging.
• Analysis of optical coherence tomography (OCT), OCT-angiography, and microperimetry data.

Main Results:

• A 23-year-old male reported progressive blurred vision in peripheral visual fields.
• Multimodal imaging revealed characteristic features of DWP in corresponding retinal areas.
• Microperimetry demonstrated significantly reduced retinal sensitivity in DWP areas, while Humphrey visual field (HVF) 24-2 testing remained normal.

Conclusions:

• DWP is not always a benign finding and can be associated with progressive visual complaints.
• Microperimetry is a more sensitive tool than HVF 24-2 testing for detecting functional deficits in DWP.
• This case challenges the established understanding of DWP as a functionally silent retinal anomaly.