A 66 year old woman presented to an optometrist in May of 2006 with the complaint of blurred left vision. Her visual acuity was 20/30 in the right eye and 20/70 in the left. He found no pathology and recommended glasses, with only minimal improvement in visual acuity in the left eye. He explained the decreased visual acuity in the left eye as amblyopia, with no history of long-term visual acuity loss in that eye and no explanation as to why.
She was not satisfied with the answers the optometrist gave her. She saw another optometrist at Cosco who agreed with her that something wasn't right, and he referred her to a retinal specialist.
She presented to the retinal specialist on June 9th, 2006. He mentioned that she was less light sensitive in the left eye than the right and he noted very minimal optic nerve pallor in the left eye. He diagnosed possible optic neuropathy and ordered a VF 30-2, color vision, and an MRI with contrast.
The visual field confirmed a significant junctional scotoma in the left eye. The patient missed plates 10 and 13-16 on the Ishihara color vision test, and the MRI demonstrated a sellar/suprasellar mass lesion. The patient was referred to neurosurgery for urgent consulation.
The patient underwent trans-sphenoidal resection of the confirmed pituitary adenoma and a repeat visual field test in August demonstrated some improvement in the visual field but great improvement in visual acuity to 20/25.
This case is a reminder of the importance of good history, good investigation as to the cause of vision loss, and further testing and referral in the presence of unexplained vision loss.