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Visual field constriction in a 42 year old woman

BMJ 2013; 347 doi: (Published 19 August 2013) Cite this as: BMJ 2013;347:f4927
  1. Ali S Hassan, specialist trainee year 2, ophthalmology,
  2. Pieter Gouws, consultant ophthalmologist
  1. 1Ophthalmology Department, Conquest Hospital, Hastings, East Sussex, TN37 7RD
  1. Correspondence to: A S Hassan alishassan{at}

A healthy 42 year old white woman was referred by her optician with subjective loss of visual field, particularly in her right eye. She had previously been functioning normally, but the notable deterioration in her visual field meant that she had recently lost the confidence to drive. Her central vision was unaffected. She had no family history of eye problems.

Best corrected distance visual acuity (Snellen) was 6/6 bilaterally and near acuity was N5 bilaterally. She had a mild relative afferent pupillary defect in the right eye. Examination of the anterior segment of each eye was normal and Goldmann applanation tonometry showed pressures of 12 mm Hg in each eye.

Dilated fundal examination showed bilaterally unremarkable maculas and retinas. Both optic discs had an irregular margin and confluent pale bumpy surface over the entire optic nerve head (fig 1). Goldmann visual field tests showed gross constriction bilaterally (fig 2). B-scan ultrasonography of both eyes showed highly echogenic bodies in both optic nerve heads.

Fig 1 Colour photographs of the right (A) and left (B) optic disc showing irregular disc margins and multiple excrescences over the entire optic nerve head. Autofluorescent emissions from the right (C) and left (D) optic discs

Fig 2 Goldmann visual field plots showing bilateral advanced constriction, which was worse on the right (A) than on the left (B)


  • 1 What is the diagnosis?

  • 2 How do patients with this condition present?

  • 3 How can the diagnosis be confirmed?

  • 4 How is this condition managed?


1 What is the diagnosis?

Short answer

Bilateral advanced optic disc …

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