A Shot in the Dark

Abstract

A 74 year-old man with a chief complaint of difficulty with night time driving for several years as well as difficulty going from a lighted room to a dark room. PMH of high cholesterol, BPH, hypothyroidism, GERD, glottic squamous cell cancer without recurrence, and a prior history of alcoholism. POHx: cataract extraction right eye and AMD. Medications include Multivitamin, Aspirin, Synthroid, Tamsulosin, Omeprazole, Crestor. Drinks wine intermittently and stopped drinking after possible DT's. He owns a bar. His initial exam VA: 20/25 OU, normal IHCP, CFVF: OD constricted, OS normal. Pupils with no APD but were sluggish. IOP's 13 mm Hg OU. Motility showed some slight decreased abduction OU: 5ET primary, 10ET left, 5ET right gazes. SLE: PCIOL OD, NS cataract OS. Optic nerves had 0.7 cups with difficulty in appreciating any pallor. He had a few RPE macular changes OU. The HVF appeared reliable with severe constriction OD>OS (MD -29 and -17 respectively). RNFL OCT showed a mean thickness of 69 and 61 microns respectively. Testing was later done

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