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JAMA Ophthalmology Clinical Challenge
September 10, 2020

Progressive Vision Loss in a 62-Year-Old Woman

Author Affiliations
  • 1University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Department of Ophthalmology, Miami, Florida
JAMA Ophthalmol. Published online September 10, 2020. doi:10.1001/jamaophthalmol.2020.1746

A 62-year-old woman with a history of chronic angle-closure glaucoma and bilateral peripheral iridotomies sought a second opinion for worsening visual acuity in the left eye for 2 months. She had been treated for glaucoma for approximately 1 year. Review of systems was negative for previous episodes of eye pain, redness, or emesis. Her medical history included hyperlipidemia, obesity, and prior cataract surgery in both eyes. On examination, best-corrected visual acuity was 20/20 OD and 20/80 OS. The patient’s pupils were equal, round, and reactive to light without a relative afferent pupillary defect. Intraocular pressure was 11 mm Hg bilaterally without medication. Slitlamp findings were notable for patent peripheral iridotomies, open angles on gonioscopy, and an asymmetrically enlarged cup-disc ratio with mild pallor of the left optic nerve. Color vision was decreased in the left eye. Visual field (VF) testing as well as ganglion cell layer (GCL) segmentation by optical coherence tomography (OCT) were obtained for both eyes (Figure 1).

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