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Hi. I'm online and happy to answer your question today.
Are you treating her? What is your training?
How is the color vision in the affected eye?
Hi- just wanted another pair of eyes on this unusual case. I am an optometrist She is my patient.
No- pupils were normally reactive
So. To review. Healthy, young female, no significant PMHx, No drug use, no trauma, no other physical findings/complaints, with completely normal eye exam. She has a history of mild amblyopia but there is a sudden decrease in vision as well as a global decrease in HVF indices ( what program did you use, 30-2?). Do I have it correct so far?
Yes the 30-2, I was careful in history she insists no trauma or drug use, and looks healthy
Did you check color vision? Perhaps with Ishihara plates?
No this was not done
Ok. Red/green is not the best test in these cases anyway.....
The first thing that comes to mind is retrobulbar optic neuropathy. This could also be caused by MS.
I do have the old farnsworth d-15
That would good.....
Other things in the DDx are toxic optic neuritis, posterior scleritis, rare rod/cone or cone/rod dystrophies, functional vision loss and then we get into just plain guessing.....
But that would be a reschedule- Curious about what options come to mind- Considering referral to neuroophthalmologist
Well we have no pain, sign of inflammation, monocular onset, etc, which makes it tough
I would consider an MRI with contrast of the brain and orbits and referral to an ophthalmologist. Neuro ophthalmologist is a good idea but it wouldn't hurt to get a second pair of eyes on the issue before trying to get into a busy neuro opth guy.....
There may be a mild RAPD present....they amblyopia alone should have caused at least one log unit of a defect.....
Possible, of course. We are in a small town, no ophthalmologist, and a 150 mile drive to one- either general or neuro-
I'm a retina doc so I get a lot of optic nerve stuff.....I like to think of myself as the "poor man's neuro-ophthalmologist :o)
With the brown vision- does that make you think of anything particular
I'm the only retina guy for an hour in any direction....so I know all about small towns ;)
Makes me think of optic nerve problems......
Well, since it appears pre-chiasmal, the options aren't that great for someone her age
I'd try to get a MRI and then take it from there. A FA would may also be of some help, although it likely will come back normal in this case.
Ok- makes since. Thanks
And stigmata of neurofibromatosis?
ok....just a thought.
The sudden onset has me worried, of course,
Sorry I couldn't be of more help in this very interesting case. If you have a chance drop me a note and let me know what you find.
I would like that- how would I do that?
Ya, me too. Try to get her in for another look see ASAP.
Just post to this thread, or if it has closed, just "ask" for me on the main page. There is no need to pay again to get back to me.
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What State are you in? I'm in Wisconsin
My sister lives in Santa Barbara.....
Pleasant there, I hear- I'm in the middle of the desert, nearest town palm springs
sounds hot.....take care. The lady is lucky to be treated by a concerned Optometrist like you :o)