Neuro-Ophthalmology

Case 8

Patient Presentation: A 31-year-old male is referred to the ophthalmology clinic. He suddenly developed an inferior visual field defect in the left eye 9 months ago that persisted. He was unable to seek medical care at the time. On exam, BCVA is 20/20 OU and Humphrey visual field testing showed a left inferior central scotoma and is shown below.

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Question: What is the differential diagnosis of this visual field defect?

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Question: A fundus photo and OCT macula OS are shown above. What OCT protocol would be helpful in differentiating the cause?

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Question: OCT macula OS with vertically oriented line scans is performed and shown above. The retina highlighted in yellow is ________ in relation to the fovea.

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Question: What is the main abnormality seen on the OCT?

Question: Based on the OCT findings, clinical presentation, and fundus description, what is the diagnosis for this patient?

References:

1. Hayreh SS, Podhajsky PA, Zimmerman MB. Branch retinal artery occlusion: natural history of visual outcome. Ophthalmology. 2009;116(6):1188-94.e944.

2. Ghazi NG, Tilton EP, Patel B, Knape RM, Newman SA. Comparison of macular optical coherence tomography findings between postacute retinal artery occlusion and nonacute optic neuropathy. Retina. 2010;30(4):578-85

Learning Objectives:

1. To diagnose and classify chronic BRAO using OCT findings

2. To understand the management plan for patients with chronic BRAO