History / Objective Data
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This case was donated by Michael D. Gerstner, O.D. of the Southern College of Optometry. A thirty-seven year old white male presented to the clinic for a glaucoma evaluation. He described a decrease in side vision that was more significant in the right eye. The peripheral vision reduction was estimated to be present for approximately 5-10 years, and was reported to be stable without change over that time period. Previous head or ocular trauma was not noted.
Best corrected visual acuity was 20/20 in both eyes. He did not report systemic disease, but was using albuterol sulfate for asthma. Initial examination procedures included detailed color vision testing and pupil evaluation which were both normal.
Confrontation fields were markedly constricted and Amsler grid demonstrated significant defects in both eyes.
Biomicroscopy was unremarkable with Goldmann tonometry measuring intraocular pressure at 18mmHg in the right eye and 17mmHg in the left eye.
Gonioscopy showed ciliary body and 2+ pigment 360 degrees in both eyes.
Humphrey 30-2 full threshold visual field revealed extensive constriction of the peripheral fields, with the right field more constricted then the left field.
Optic nerve head analysis demonstrated bilateral, 2+ raised optic nerves. Margins appeared distinct with no pallor or hyperemia, distinct vasculature was observed, and a positive spontaneous venous pulsation was noted. The fundus periphery and macula were unremarkable in both eyes.
Orbit, retrobulbar, and brain imaging (MRI) with and without contrast found signal intensities and images to be with in normal limits. ERG and EOG studies were normal.
What is this condition and how should it be managed?
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Walt Mayo, OD
Technology Director
Southern Council of Optometry
PO Drawer L / 400 Marina Drive
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