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Title

Diving and parafoveal scotoma.

Purpose	To describe parafoveal scotoma and color vision changes as long-term detrimental effects of diving.
Methods	A semi-professional diver with bilateral parafoveal scotoma underwent a full ophthalmic and general workup.
Results	A 55-year old male patient was referred because of a 4-year history of bilateral small parafoveal scotoma. BCVA was 10/10 in both eyes. Only detailed 10-2 automated perimetry showed small central defects where standard 30-2 perimetry failed. The lesions remained stable over a follow-up period of 15 months. Optic nerve function was normal. Consecutive fundoscopic evaluation transiently showed 1 cotton wool spot, discrete dot haemorrhages and a few small retinal nerve fibre bundle defects. The Farnsworth-Munsell 100 hue color vision test revealed a blue-yellow defect. High resolution macular OCT imaging, fluorescein angiography, blue-light autofluorescence imaging and a full-field ERG were otherwise unremarkable. Blood analysis, cardiovascular workup and brain imaging (MRI) were normal. Thorough questioning led to a history of over 2400 dives over the past 25 years explaining the presence of scotoma, transient retinal microvascular changes and color vision deficits.
Conclusion	Immediate risks of diving such as decompression sickness are well-known. But, because of extended exposure to increased pressure underwater, more subtle, long-term effects emerge including retinal damage parallel to the number and depth of dives. When confronted with parafoveal scotoma in the absence of other etiologic factors, patients should be questioned about diving. A reduction in the number and depth of dives should be discussed to prevent more serious damage. These observations should not be extrapolated to sportive divers.
Conflict of interest	No

Authors 1

Last name	VAN HOORDE
Initials	T
Department	UZ
City	Gent

Authors 2

Last name	VANMARCKE
Initials	A
City	Wevelgem

Authors 3

Last name	DE ZAEYTIJD
Initials	J
Department	UZ
City	Gent