Young woman experiences gradual vision loss

A 21-year-old African-American woman presented to our hospital with a gradual decline in vision in both eyes over the past 2.5 years. She had been lost to all medical and ophthalmic care during this period of time. We will initially withhold her medical history for the purposes of diagnostic discussion.On presentation, best corrected visual acuity was 20/100 in the right eye with pinhole to 20/40 and 20/50+ in the left eye with no improvement with pinhole. The patient’s current glasses prescription was –3.25, +0.75 @30 in the right eye and –3.25 sphere in the left eye. IOP was 28.5 mm Hg in the right eye and 24 mm Hg in the left eye. Pupils were symmetrically round and reactive to light with no relative afferent pupillary defect in either eye. She was able to see six out of six Ishihara color plates in the right eye and five out of six in the left eye. Confrontation to visual fields was full in the right eye, but she demonstrated generalized peripheral constriction in the left eye.