Today is the first of many Mystery Case Mondays here at The Atrium! We will be posting a hypothetical case every week to get our pre-health students thinking about various clinical issues and the anatomical/physiological causes that underlie them. Join us in the comments section to share your insights and tentative diagnoses, then check back on Friday to read about the diagnosis and recommended treatments of these cases.
This week, our hypothetical patient is a 65-year-old woman experiencing decreased bilateral vision over the past month. She was told by her doctors that this was secondary to early age-related macular degeneration. She reports difficulty reading, loss of depth perception, and dimness of her vision in addition to having dull headaches that began about 6 months ago. She did not have any ocular pain or new flashes, floaters, or diplopia. The patient denied the use of tobacco or alcohol and did not have any family history of ocular issues. She is currently being treated with Seroquel for her bipolar disorder. Upon examination the patient demonstrated an inability to see anything in the outer half of both her left and right visual fields. Slit lamp biomicroscopy demonstrated that the macular and retinal nerve fiber layer OCT were normal in both eyes. A Humphrey visual field (HVF) 30-2 was performed.
Thought Questions:
This week, our hypothetical patient is a 65-year-old woman experiencing decreased bilateral vision over the past month. She was told by her doctors that this was secondary to early age-related macular degeneration. She reports difficulty reading, loss of depth perception, and dimness of her vision in addition to having dull headaches that began about 6 months ago. She did not have any ocular pain or new flashes, floaters, or diplopia. The patient denied the use of tobacco or alcohol and did not have any family history of ocular issues. She is currently being treated with Seroquel for her bipolar disorder. Upon examination the patient demonstrated an inability to see anything in the outer half of both her left and right visual fields. Slit lamp biomicroscopy demonstrated that the macular and retinal nerve fiber layer OCT were normal in both eyes. A Humphrey visual field (HVF) 30-2 was performed.Thought Questions:
What is the most likely diagnosis for this patient?
Which additional diagnostic tests would confirm this diagnosis?
What are the anatomical structures involved in this clinical issue?
What are the potential underlying causes for this condition?
What is a good recommended course of treatment for our hypothetical patient?
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