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JAMA Ophthalmology Clinical Challenge
November 2014

Sudden-Onset Paracentral Vision Loss

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
JAMA Ophthalmol. 2014;132(11):1367-1368. doi:10.1001/jamaophthalmol.2014.3347

An 84-year-old man with a history of diabetes mellitus type 2, hypertension, and a transient ischemic attack 4 years earlier presented to the University of Illinois at Chicago emergency department for evaluation of 1 day of decreased vision in his left eye. He described it as a central “band” of absent vision just below center. On examination, visual acuity measured 20/40 OD and 20/60 OS, improving to 20/40 with pinhole. A complete blood cell count, results of a comprehensive metabolic panel, erythrocyte sedimentation rate, C-reactive protein level, and computed tomography of the head without contrast were all normal. Review of systems was negative. Ocular history included penetrating keratoplasty with intraocular lens exchange and Descemet stripping automated endothelial keratoplasty in the right eye. Four days later in the Retina Clinic, visual acuity was unchanged. Slitlamp examination of the anterior segment was normal. Ophthalmoscopy revealed no vitreous cells, a posterior vitreous separation, cup-disc ratio of 0.3, normal retinal vessels, and a superior parafoveal crescent of translucent retina without associated edema or hemorrhage. The peripheral retina was normal. Fundus autofluorescence and fluorescein angiogram showed abnormalities in the superior macula (Figure 1).