A man in his late 40s presented for evaluation of progressive visual acuity and visual field loss in both eyes over a 10-year period. Best-corrected visual acuity was 20/200 OD and counting fingers OS. No afferent pupillary defect was present. Goldmann perimetry revealed severe field constriction in each eye. A diagnosis of optic nerve head drusen was made based on clinical examination (Figure). Given a history of progressive visual loss, magnetic resonance imaging was completed to rule out compressive optic neuropathy. Low-vision aids were recommended to maximize visual potential. Two years after presentation, visual acuity and Goldmann perimetry remained stable.
Khan MA, Forman AR. Legal Blindness From Severe Optic Nerve Head Drusen. JAMA Ophthalmol. 2016;134(2):e153660. doi:10.1001/jamaophthalmol.2015.3660