I think you need to localize the lesion before performing a lab investigation, it is unclear if this is retina, optic nerve, or psychologic.
Some important history is missing:
Why does a healthy patient who is unaware of visual field loss go to see a neuro-ophthalmologist?
Any history of head trauma, meningitis?
Is the RNFL temporal thinning due to nasal shifted peaks or is it real?
What does the ganglion cell look like?
What does the outer retina look like on OCT, auto-fluorescence?
If both normal, consider full field ERG.
Is the MRI really normal? Is ther optic nerve T2-hyperintensity or atrophy?
Best,
Drew
Original Message:
Sent: 4/28/2026 9:05:00 AM
From: Sherif Ahmed Kamel Abdelbar
Subject: RE: patient whose help I need
I would do immunology labs to screen any background autoimmune disorders
Original Message:
Sent: 4/28/2026 8:37:00 AM
From: Scott Forman
Subject: RE: patient whose help I need
She has no atherosclerosis of her carotids and was completely unaware of her disability until I pointed it out to her. I have seen her twice and the field defect is real and documented; She has mild dyschromatopsia and some temporal RNFL thinning.
Scott Forman, MD
Original Message:
Sent: 4/28/2026 8:18:00 AM
From: Scott Forman
Subject: patient whose help I need
I have a 61 year old healthy female with Alopecia who has had at least a 2-3 year history of near complete binasal hemianopia with normal imaging (MRI) and autoimmune workup. She has not had an LP or CSF chemistries.
Anythoughts.
Scott Forman, MD