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Rapid diagnosis of patients with acute visual loss is critical1 but is difficult if the retina appears normal ophthalmoscopically. We report the case of a patient who presented with acute unilateral visual loss and a central scotoma.
A 75-year-old man complained of a sudden and painless decrease of vision in his left eye. He had undergone surgery for an unruptured intracranial aneurysm 20 years earlier and was taking 7 mg/day of systemic prednisolone for rheumatoid arthritis. He had also had diabetic mellitus without retinopathy for 5 years. He was being followed for a left hemianopsia and normal tension glaucoma for the previous 3 years.
On examination, a left relative afferent papillary defect (RAPD) was observed, and visual acuity (VA) was 20/30 OD and 20/2000 OS. All …