Scotoma is described as an island-like, blind space in the visual field. Central scotomas are seen in lesions of the macula of the eye.

The two most common causes of scotoma are: atrophic and exudative (hemorrhagic), age-related, macular degeneration. Other causes include: optic nerve disease, macular holes, and myopic macular degeneration.

Common complaints associated with the condition include: difficulty in reading and inability to visualize facial features. Central vision is blurred and distorted; however, peripheral vision is clear unless cataracts are present.

Tests that are useful include: visual acuity, and the Amsler grid.

In order to place images on healthier retinal areas, patients are taught to use eccentric head positions. Magnifying lenses may be of benefit. Some macular degenerative conditions may be treated using laser therapy.

Alone, macular degeneration will not result in total blindness. A condition of legal blindness may exist, but good peripheral vision and color vision may remain. Most patients learn to use low-vision aids successfully.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• Consider entitlement to specially adapted housing under 38 U.S.C. 2101(a)(2)(A)(i) if there is visual impairment to the degree specified in 38 CFR 3.809(b)(2).

• The veteran, spouse, surviving spouse or parent will be considered in need of regular aid and attendance if he or she is blind or so nearly blind as to have corrected visual acuity of 5/200 or less, in both eyes, or concentric contraction of the visual field to 5 degrees or less (38 CFR 3.351(c)(1)).

• Consider entitlement to automobile allowance and/or automobile adaptive equipment if there is visual impairment to the degree specified in 38 CFR 3.808(b)(3).

• Review for entitlement to special monthly compensation under 38 CFR 3.350.

• To determine the evaluation for visual impairment when both decreased visual acuity and visual field defect are present in one or both eyes and are service connected, separately evaluate the visual acuity and visual field defect (expressed as a level of visual acuity), and combine them under the provisions of 38 CFR 4.25. (38 CFR 4.77)