Not Seeing the Whole Picture

A 65-year-old woman presented to the neurology clinic with reduced vision in her right eye. She had visited an optician to obtain a new prescription. Routine examination that followed revealed a slight cataract and minimal retinal pigment epithelial changes. Visual field testing demonstrated a bi-temporal defect, more pronounced in the right eye. Interestingly, the patient herself had not noticed any subjective change to her visual fields. Overall, she reported feeling generally well but experienced intermittent headaches. The patient had been on anti-platelet treatment for 5 years as a stroke prevention (she never suffered from stroke). Additionally, she was a smoker, smoking 15 cigarettes per day.