Decreased vision on the left side leads to hemianopia diagnosis
A 39-year-old African-American female presented to The Eye Center at Southern College of Optometry with complaints of blurred vision, loss of side vision to the left, and trouble with mobility. S
A 39-year-old African-American female presented to The Eye Center at Southern College of Optometry with complaints of blurred vision, loss of side vision to the left, and trouble with mobility. She was diagnosed with hypertension, hypercholesterolemia, and type II diabetes mellitus in 2007 when she was admitted to the hospital for a stroke. The stroke left her with left-side weakness, and she occasionally suffered seizures.
More recently, she had also reported being diagnosed with systemic lupus erythematosus. Her family ocular history was unremarkable-her paternal grandmother had diabetes, and her mother had hypertension. She smoked several times a week and reported no alcohol or recreational drug use.
Her medications included prednisone, levetiracetum (Keppra, UCB), amitriptyline (Elavil, AstraZeneca), metformin, and simvastatin (Zocor, Merck). She reported an allergy to sulfa antibiotics. Blood pressure was measured manually in-office at 111/76 mm Hg.
Case presentation
Entering visual acuities were 20/70 OD and 20/400 OS, which improved with pinhole to 20/30 OD and 20/50 OS.
Confrontation visual fields were restricted nasally OD and restricted in all gazes OS. Extraocular motilities were full in all gazes; cover test showed orthophoria at distance and near; and pupils were equal, round, reactive to light and accommodation with a positive afferent pupillary defect (APD) OS. Goldmann applanation tonometry was 19 mm Hg OD and 20 mm Hg OS.
A new subjective refraction improved vision to a slow 20/20 in OU. Biomicroscopy was unremarkable OU. Examination of the posterior segment showed optic nerve pallor, more severe temporally OS compared to OD (see Figures 1 and 2). There was also lattice degeneration in the periphery OU but no signs of retinal breaks present. No diabetic retinopathy was noted OU.