ABSTRACT
A 69-year-old man presents to the local ophthalmologist with complaint of poor vision in the left eye. He does not know how long it has been present, but he noticed it upon covering the other eye about one week before. He does not believe the vision has gotten any worse since onset. His past medical history includes hypertension, for which he takes metoprolol, and dietcontrolled diabetes. On examination his visual acuity is 20/25 OD and 20/60 OS. There is a 1.5 log unit relative afferent pupillary defect (RAPD) on the left. The slit lamp examination reveals only mild nuclear sclerotic cataracts. His Humphrey visual fields testing shows marked field loss on the left, and a full field on the right (Figures 1.1 and 1.2). He has a pale optic disc nerve on the left compared to the right (Figures 1.3 and 1.4), which is confirmed on optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) shown in Figure 1.5.
