Visual Fields and Ganglion Cell Analysis Predict Location of Intracranial Lesion

Abstract

A 44-year-old woman noticed blurry vision in her left eye. Vision was 20/20 and 20/30 with minimal left relative afferent pupillary defect and minimal pallor of left optic nerve head (Fig A). There was an incongruous right homonymous hemianopic defect on visual field testing (Humphrey 24-2 algorithm, Fig B). Ganglion cell analysis demonstrated generalized thinning on the left and thinning of nasal retina on the right, consistent with junctional scotoma (Fig C). These findings enabled exquisite localization of lesion to left pre-chiasmatic optic nerve and left optic tract.