A man in his 80s presented with 3 months of painless progressive vision loss, followed by gait changes, memory loss, and 10-lb unintentional weight loss. Medical history was notable for coronary artery disease, hypothyroidism, and prostate cancer in remission.
On ophthalmic examination, visual acuity was hand motion OU (baseline from 9 months prior was 20/50 OD and 20/30 OS), with briskly reactive left pupil and trace right relative afferent pupillary defect. He could detect 2/4 gross colors in the right eye and 1/4 gross colors in the left eye. Confrontation visual fields revealed dense right homonymous hemianopia with additional asymmetric deficits on Goldmann perimetry (Figure 1). Extraocular movements were full with gaze-evoked nystagmus. Horizontal vestibulo-ocular reflex, assessed by head impulse testing, was normal. Slitlamp and dilated fundus examination revealed pseudophakia and mild epiretinal membrane in the right eye and mild nuclear sclerosis in the left eye.
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Cai S, Yordi SF, Henderson AD. Homonymous Hemianopia With Normal Magnetic Resonance Imaging. JAMA Ophthalmol. 2020;138(6):702–703. doi:10.1001/jamaophthalmol.2020.0447
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