2020–2021 BCSC Basic and Clinical Science Course™
Chapter 3: The Patient With Decreased Vision: Evaluation
This chapter includes a related video, which can be accessed by scanning the QR code provided in the text or going to www.aao.org/bcscvideo_section05.
In cases of decreased vision, 3 aspects of the patient’s history—in addition to the age of the patient—are crucial in determining the etiology:
laterality of the vision loss
time course of the vision loss
symptoms associated with the vision loss
Unilateral Versus Bilateral Involvement
Establishing the laterality of the vision loss is essential to localization of the lesion. Unilateral vision loss typically indicates a lesion anterior to the chiasm, whereas bilateral vision loss may reflect a bilateral ocular, chiasmal, or retrochiasmal lesion or a systemic process. Patients reporting vision loss should be asked whether they have checked each eye individually. A patient with a right homonymous hemianopia may mistake the temporal visual field defect as a problem with the vision of the right eye only. Binocular involvement might not be appreciated until the patient is examined.
Excerpted from BCSC 2020-2021 series: Section 5 - Neuro-Ophthalmology. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.