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Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.
On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.
A dilated fundus examination was performed demonstrating the following:
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Neuro-Ophthalmology
Case 31
Patient Presentation: A 76-year-old woman was referred for constant blurry vision in both eyes over the last 6 years. Her past medical history was significant for mild hypertension and joint inflammation. Her medications included prednisone 10 mg PO and vitamin supplementation. On examination, her visual acuity was 20/20 OD and 20/20 OS. IOP was 12 OU. There was no RAPD. IOP was 12 OU. Dilated fundus examination was performed and was unremarkable.
Humphrey visual field testing (24-2) was performed and is shown below:
Question 1: What visual field defect(s) is/are present in this patient?
OCT RNFL and ganglion cell analysis (GCA) was performed and is shown below:
Question 2: What pattern of changes is demonstrated by the GCA?
Question 3: What was the most likely cause of this patient’s VF defect?
Learning Objectives:
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To understand the visual field and OCT findings of longstanding and bilateral retrochiasmal lesions.
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