A 78-Year-Old Man With Sudden Central Vision Loss

Yasmin Qaseem; Rod Foroozan, MD


December 17, 2013

Clinical Presentation

A 78-year-old man was referred for evaluation of a 1-week history of hazy central vision in his left eye that started as a web.

He has a history of retinal detachment in his right eye, high cholesterol, hypertension, and anxiety disorder. His hypertension was well-controlled with medication. Additionally, he has atrial fibrillation and had coronary artery bypass surgery as well as a history of prostate cancer, basal cell skin cancer, diverticulitis, and tonsillectomy. He does not currently use tobacco but was a former smoker. He denied symptoms of giant cell arteritis, including jaw claudication, headache, and scalp tenderness. His current medications are clopidogrel and dabigatran.

Ocular examination 1 week after the onset of hazy central vision revealed visual acuity of 20/25 in the right eye and 20/100 in the left eye. Color vision with Ishihara pseudoisochromatic plates was 10/10 for the right eye and 3/10 for the left eye. Pupils were sluggishly reactive to light with no relative afferent pupillary defect. Amsler grid testing was normal in the right eye, but the patient reported seeing "wigglies" on the grid with the left eye. Intraocular pressures were 16 mm Hg in the right eye and 15 mm Hg in the left eye. Slit lamp examination was normal. Automated perimetry showed decreased sensitivity in the right eye superonasally and decreased sensitivity in the left eye superiorly around fixation (Figure 1).

Figure 1.

Automated perimetry shows decreased sensitivity around fixation in the left eye.


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