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JAMA Ophthalmology Clinical Challenge
May 7, 2020

A Young Man With Peripheral Vision Loss

Author Affiliations
  • 1Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston
  • 2Harvard Medical School, Boston, Massachusetts
JAMA Ophthalmol. Published online May 7, 2020. doi:10.1001/jamaophthalmol.2020.0566

A man in his 30s with an unremarkable medical and ocular history presented to his optometrist with reduced peripheral vision. The patient reported slowly progressive difficulty with night driving as well as perceiving objects in the periphery over the past 5 years. The patient was an avid basketball player and was forced to quit recently when he was unable to locate his teammates during play. He denied changes in color vision. There was no history of trauma. He did not use tobacco, alcohol, or drugs. His parents and both siblings were reportedly healthy with no history of ocular disease. His visual acuity was 20/20 OU, with no afferent pupillary defect. The Farnsworth D-15 dichotomous test results were normal in the right eye and tritan deficient in the left eye. His intraocular pressure was normal in both eyes. Refraction revealed hyperopic astigmatism in both eyes. His anterior examination results were unremarkable with no evidence of intraocular inflammation. The dilated fundus examination results showed minimal optic nerve pallor, vascular attenuation in both eyes, and a subtle area of increased pigmentation in the superior retina of the right eye only (Figure 1A). The fundus autofluorescence results showed bilateral peripheral mottled hypoautofluorescence contrasting a ring of hyperautofluorescence around the macula (Figure 1B). Automated perimetry was reliable and showed symmetrical severe bilateral field constriction with a remaining island of 6° of central vision.

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