A 45-Year-Old Man With Progressive Vision Loss in One Eye

Carlo R. Bernardino, MD


February 19, 2014

Clinical Presentation

A 45-year-old Hispanic man presented to the clinic because of 4 months of progressive vision loss in the left eye. He also noted decreased peripheral vision in the right eye. The patient had no significant medical history.

On ocular examination, his best corrected visual acuity was 20/20 in the right eye and 20/60 in the left eye. Pupils were normally reactive to light, with no afferent pupillary defect. Visual fields were decreased temporally in both eyes. Ocular motility was full.

Intraocular pressures were 15 mm Hg in the right eye and 13 mm Hg in the left. Examination of the anterior segment was unremarkable, and fundus examination was normal. The cup-to-disc ratios of the optic nerves were 0.3 in the right eye and 0.5 in the left eye. A bitemporal visual field defect was diagnosed, and follow-up with automated visual field testing was arranged.

On follow-up 2 days later, automated visual field testing revealed a temporal defect in the left eye that crossed over the midline into fixation (Figure 1). The right visual field demonstrated a temporal defect that respected the vertical midline (Figure 2).

Figure 1. Humphrey 24-2 visual field test of the left eye, demonstrating a temporal visual field defect that crosses the midline into fixation.

Figure 2. Humphrey 24-2 visual field test of the right eye, demonstrating a temporal visual field defect that does not cross the vertical midline.

The results of color vision testing with Ishihara plates were 13/17 plates for the right eye and 8/17 plates for the left eye.

Of note, blood pressure was elevated at 159/103 mm Hg, with a pulse of 57 beats/min.


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