Coffee and doughnut maculopathy: a cause of acute central ring scotomas

Aims-To report the clinical features of five patients with non-progressive central ring scotomas of acute onset associated with excellent retained vis ual acuity. Methods-Complete neuro-ophthalmological examinations were performed. Visual fields were performed by tangent screen, Goldmann, or Humphrey perimetry. In some cases further testing was carried out including fundus photography, fluorescein angiography, ERG, VEP, and neuroimaging. Results-The patients were three women and two men whose ages ranged from 25 to 57 years. Four patients were heavy caffeine consumers while the fifth p atient experienced an episode of hypotension. Vision loss was acute in all cases. The onset of vision loss was bilateral/simultaneous in three cases, bilateral/sequential in one case, and unilateral In one case. All affected eyes retained visual acuities of 20/25 or better. Colour vision was subnorm al in three of four cases. Visual field defects were characterised by a cen tral ring scotoma having an outer diameter less than 10 degrees. Fundus exa mination demonstrated temporal optic nerve pallor in three patients (five o f 10 affected eyes) and reddish, petaloid macular lesions in one patient. G ood visual acuity was maintained for the duration of follow up in all five patients. Conclusion-Central ring scotomas excellent retained visual acuity may prese nt as an acute, bilateral syndrome in patients who are heavy caffeine consu mers. The configuration of visual field loss and its location, combined wit h the presence of temporal pallor in five eyes, suggest that the defect loc alises to the inner layers of the macula. While these cases could be consid ered an expansion of the clinical spectrum of acute macular neuroretinopath y, some may represent a distinct entity.