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Ophthalmic Images
February 11, 2016

Legal Blindness From Severe Optic Nerve Head Drusen

Author Affiliations
  • 1Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
  • 2Cataract and Primary Eye Care Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
JAMA Ophthalmol. 2016;134(2):e153660. doi:10.1001/jamaophthalmol.2015.3660

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.

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