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JAMA Ophthalmology Clinical Challenge
August 2016

Unexplained Homonymous Hemianopia

Author Affiliations
  • 1Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
JAMA Ophthalmol. 2016;134(8):935-936. doi:10.1001/jamaophthalmol.2015.6112

A woman in her 60s was referred for a chronic progressive left homonymous visual field defect. Three years prior to presentation, she reported difficulties with her vision. She had difficulty comprehending some words while reading and also reported the feeling of a “blind spot” in her vision and a “part of her vision” that she could not see. She was found to have a left homonymous visual field defect. She underwent repeated visual field examination every 6 months, showing progression of the visual field defect along with an increase in false-negative results. She underwent 3 magnetic resonance imaging (MRI) scans of the brain, showing no neoplasm or stroke, and also underwent a stroke workup with negative results. Review of the most recent MRI showed profound cortical atrophy of the parieto-occipital lobes with a slight predilection to the right side compared with the left. On further questioning, she had developed some recent difficulties with short-term memory and reported easily getting lost when driving. Her best-corrected visual acuity was 20/20 OU, and color plate results were severely reduced in both eyes. Dilated fundus examination findings were unremarkable. Automated visual fields again showed a left homonymous visual field defect with high false-negative results (Figure, A). She was unable to draw a clock and had simultanagnosia (Figure, B).

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