A 48-year-old Hispanic man presented to the University of New Mexico Eye Clinic with progressively worsening vision in both eyes over many years. He denied diplopia, painful eye movements, flashes, floaters, nausea or recent weight loss.
Medical history was notable for benign prostate hyperplasia, fecal incontinence, gout, dyslipidemia, hypertension, and 20 years of heavy alcohol and tobacco use (sober since age 40). He was seen regularly by the neurology service for peripheral neuropathy and ataxia, which began at age 39 and slowly progressed until he was unable to ambulate without a walker.