A man in his 60s with a history of untreated, indolent B-cell lymphoma diagnosed 8 years ago noted acute-onset blurred vision in both eyes. His vision progressively worsened over 2 months before he sought care. In addition to his visual symptoms, he reported an episode of shortness of breath several weeks prior to presentation, ongoing fatigue, and headaches. He had no relevant ophthalmic history. His uncorrected visual acuity was 20/80 OD and 20/50 OS without pinhole improvement. Pupils, intraocular pressure, motility, confrontation visual fields, and slitlamp examination of the anterior segment were unremarkable. Dilated examination of both eyes revealed the findings seen in Figure 1.
Aderman CM, Schwartz DM. Acute Bilateral Vision Loss. JAMA Ophthalmol. 2016;134(2):235-236. doi:10.1001/jamaophthalmol.2015.3572