A 69-year-old white man presents with a complaint of decreased vision that has been worsening over the past few years. He states that he has difficulty reading street signs and intermittently "bumps into things." He denies associated eye pain, redness, trauma, or other ocular symptoms. Prior to this, he has not had any ocular problems. He denies headache, neck pain, jaw claudication, myalgias, and weight loss.
Medical history includes:
Candesartan 16 mg orally daily;
Atorvastatin 5 mg orally daily;
Lansoprazole 30 mg orally daily; and
Ibandronate 150 mg orally monthly.
On ocular examination, his vision was 20/30 in the right eye and 20/25 in the left eye. Pupils were briskly reactive, and there was no relative afferent pupillary defect. Color vision with Ishihara pseudoisochromatic plates was normal. Confrontation visual fields suggested temporal defects in both eyes, and Amsler grid testing also demonstrated blurring of the lines temporally on each side. Extraocular motility was normal on each side.
External examination was normal, and slit lamp examination revealed nuclear sclerotic lenticular changes in both eyes. Intraocular pressure was normal, and the funduscopic examination demonstrated slight temporal optic disc pallor on each side. The remainder of the fundus was normal in both eyes.
What is your differential diagnosis at this juncture?
What studies might help determine the underlying pathology?
Medscape Ophthalmology © 2009
Cite this: Matthew A. Cunningham, Rod Foroozan. A 69-Year-Old Man With Decreased Vision and Abnormal Visual Field - Medscape - Jul 13, 2009.