A 35-Year-Old Man With Long-standing Decreased Vision

Rod Foroozan, MD


February 11, 2016

Clinical Presentation

A 35-year-old man was evaluated for decreased vision in both eyes. He stated that he never had what he considered to be normal vision. He felt that his vision had worsened in each eye over the past several years. The vision loss was painless, and he was no longer able to see road signs while driving.

The patient had a history of depression and was taking bupropion. He had 5 lb of weight loss in the prior year, which he attributed to depression. He drank alcohol occasionally and did not use illicit drugs.

He had a motorcycle accident 2 years ago with loss of consciousness. He was evaluated in the emergency department, and CT of the head showed no abnormalities.

Visual acuity was 20/60 in the right eye and 20/80 in the left eye. The patient was able to see the test plate of the Ishihara pseudoisochromatic plates with each eye. Pupils were brisk, with no anisocoria and no relative afferent pupillary defect. Intraocular pressures were 15 mm Hg in each eye. Visual fields to confrontation were full in the periphery in each eye.

Slit-lamp examination of the anterior segment was normal for both eyes. Funduscopic examination showed temporal optic disc pallor in each eye without evidence of optic disc cupping. No evidence of intraocular inflammation was observed.

Automated perimetry showed cecocentral defects in each eye (Figure 1).

Figure 1. Automated perimetry showing cecocentral defects.

Optical coherence tomography showed decreased measures of the retinal nerve fiber layer in each eye (Figure 2).

Figure 2. Optical coherence tomography showing a decreased retinal nerve fiber layer in each eye.


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