Adam T. Chin, MD

A 68-year-old Cantonese-speaking woman was seen for an inpatient consultation by the retina service at the New England Eye Center for profound vision loss in both eyes.

A 65-year-old retired grocery store clerk was referred to the New England Eye Center with more than a year of progressive vision loss in the right eye. Two and a half years before presentation, she underwent uncomplicated cataract surgery on the right eye. Her vision was excellent immediately after the surgery. However, 1 year after the surgery, a “smudge” began obscuring the central vision in the right eye. Over the subsequent year, exams by outside providers revealed only scattered drusen. Yet, the vision continued to decline to the point that she felt that she was “looking through a dense film.” In addition to the declining acuity, the patient also noticed new floaters. She denied any flashes or photophobia.

A 26-year-old man was referred to the neuro-ophthalmology clinic at the New England Eye Center for evaluation of diplopia and ptosis of the left upper eyelid. For 1 month, he had persistent binocular vertical diplopia. The diplopia resolved when either eye was closed or when he looked down. As such, he found himself tilting his chin upward to see clearly. Upgaze seemed to worsen the diplopia. In addition, he had persistent left upper lid ptosis. Neither the eyelid position nor the double vision had changed over the month. Furthermore, these symptoms did not seem to worsen over the course of the day. Otherwise, he felt well with no recent illnesses, headaches, weakness, numbness, fevers, chills, sweating, palpitations, nausea or vomiting.

A 23-year-old female preschool teacher was referred to the New England Eye Center by an outside ophthalmologist for evaluation of a new inferior visual field defect of the left eye. Over the preceding week, the patient noticed waxing and waning blurring of the inferior portion of the visual field in her left eye that became persistent upon waking 4 days before her presentation. She also reported a throbbing bifrontal headache and bilateral eye strain for 2 weeks.

A 25-year-old woman was referred to the New England Eye Center by an outside ophthalmologist for evaluation of a new visual field deficit of the left eye. Approximately 1 week before presentation, the patient noticed an area of blurred vision in the temporal aspect of the left visual field. She felt that her central vision was spared and that the other eye was unaffected. She denied any other visual or neurologic symptoms.