Neuro-Ophthalmology

Abstract

• 1. A 16-year-old boy is complaining of increasingly blurry vision for the past 8 weeks. His right eye was affected first, but was soon bilateral. He has no past medical history of eye or vision difficulty before. Family history is positive for a grandfather with macular degeneration, both paternal grandparents with cataracts, and an uncle who has had “poor vision” for most of his life. He occasionally smokes cigarettes, but does not drink alcohol or take recreational drugs. He is a high school student and is currently taking AP English and AP math. On examination, his vision is 20/400 OD and 20/200 OS, normal reactive pupils, extraocular motility, and intraocular pressure. Funduscopic examination is shown below:

  You ordered visual field testing. His visual field testing is below:

  You have never seen a central scotoma quite as large as his.

  His likely diagnosis is:

  • A. Leber’s hereditary optic neuropathy

  • B. Methanol toxicity

  • C. Pseudo tumor cerebri

  • D. Nicotine-induced visual loss

  • E. Neuromyelitis optica