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JAMA Ophthalmology Clinical Challenge
November 2017

A Man With Bilateral Peripheral Visual Field Loss

Author Affiliations
  • 1Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
JAMA Ophthalmol. 2017;135(11):1274-1275. doi:10.1001/jamaophthalmol.2017.2308

A 64-year-old man presented to the Department of Ophthalmology for evaluation of bilateral visual field (VF) loss. His VF loss was recognized on automated Humphrey VF screening and had remained unchanged during the subsequent 5 years (Figure, A). His ocular history was significant for mild nuclear sclerosis. His current medications included multivitamins and fish oil.

Neuro-ophthalmic examination revealed visual acuities of 20/30 OD and 20/25 OS that matched with the density of his cataracts. Color vision was within normal limits bilaterally. Pupils were symmetric without afferent defects. Applanation tonometry pressures were 18 mm Hg OD and 17 mm Hg OS. Slitlamp examination revealed mild nuclear sclerosis in each eye. Repeated automated Humphrey VF testing revealed bilateral inferior arcuate defects (mean deviation, −4.80 dB OD and −2.6 dB OS). Examination of his fundus revealed bilateral tilted optic nerves with peripapillary atrophy (Figure, B).

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