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JAMA Ophthalmology Clinical Challenge
May 23, 2019

Visual Field Loss in a Patient With Optic Disc Cupping

Author Affiliations
  • 1Viterbi Department of Ophthalmology; University of California, San Diego
  • 2Ratner Children's Eye Center at the Shiley Eye Institute, University of California, San Diego
JAMA Ophthalmol. 2019;137(7):844-845. doi:10.1001/jamaophthalmol.2019.1173

A 52-year-old man was referred to the neuro-ophthalmology clinic for evaluation of visual field loss. He had exotropia and amblyopia of the left eye. He was diagnosed as having glaucoma 6 months prior to presentation owing to optic nerve cupping and visual field deficits on automated perimetry and was taking latanoprost. His medical history was significant for pyruvate dehydrogenase deficiency, and his family history was notable for glaucoma in his grandmother. He was being treated by the neurology department for his pyruvate dehydrogenase deficiency with thiamine, vitamin C, and oxaloacetate. His systemic symptoms included hyperhidrosis and episodes of hand tremors, ataxia, and dysarthria that occur every 2 to 3 years.