I have a 76 year old retired school principal and college educator who was diagnosed with Stargardts disease at the age of 40. Eight years ago she developed acephalgic migraine which usually consists of a bitemporal fortification spectrum in white that is quite annoyingly flashing and lasts for 10-15 minutes without headache.
She is horribly distraught by the interaction of these two disorders. She describes the visual aura causing "an utter visual cacophony" for three to four days after the visual aura subsides in which she has a "honeycomb" panoply of bright lights in her central vision wrecking any possible reading or visual task.
Has anyone seen this unusual combination before and does anyone have any ideas to soften the visual nightmare for her?
A neurologist years ago tried a number of anti seizure and psych meds like lamotrigine which made things maddeningly worse. Any thought are appreciated.
Her visual acuity is 20/25 OD and 20/40+ OS best corrected. Her color vision is shot in both eyes and she has central scotomata occupying most of the central 10 degrees. I do want to review her MRI scans from 2017 and 2022 as white matter lesions are described in both parietal and occipital lobes as "lacunar". Her fields show a central scotoma respecting the horizontal meridian curiously in both eyes that is almost identical in both eyes.
Thank you
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Scott Forman, MD
Senior Fellow North American Neuro-ophthalmology Society
Adult and Pediatric Neuro-ophthalmology
Comprehensive Ophthalmology
Functional Medicine