A 39-Year-Old Man's Contact Lens Exam Reveals Abnormalities

Rod Foroozan, MD

Disclosures

May 20, 2019

Clinical Presentation

A 39-year-old man without any visual complaints underwent an eye examination for contact lenses, during which screening perimetry showed abnormalities in each eye.

The patient has a history of hypertension, for which he takes lisinopril; he is not taking any other prescription medications. He occasionally drinks alcohol and does not use tobacco. There is no family history of vision loss.

Visual acuity was 20/20 in both eyes. Color vision with Ishihara pseudoisochromatic plates was 10/10 in both eyes. Pupils were briskly reactive, with no relative afferent pupillary defect.

Automated perimetry (Figure 1) showed temporal defects in each eye.

Figure 1. Automated perimetry showing superior and inferior arcuate defects, worse temporally, and enlargement of the blind spot in each eye.

Intraocular pressure was 15 mm Hg in the right eye and 13 mm Hg in the left eye.

Slit-lamp examination of the anterior segment was normal in each eye.

Funduscopic examination (Figure 2) showed no optic disc cup and normal color of the neuroretinal rims.

Figure 2. Funduscopy showing optic disc hypoplasia with no central cup in each eye.

Optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) showed decreased measures in each eye, particularly inferiorly, and OCT of the macula showed no evidence of retinopathy (Figure 3).

An MRI of the brain was normal.

Figure 3. OCT of the RNFL showed decreased measures in each eye.

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