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temporal vision loss

  • 1.  temporal vision loss

    Posted 01-28-2026 12:15
    In the last 3 months I have seen 3 men, ages 49-67 reporting temporal vision loss in one eye. In all 3 cases, extensive neuro and retina evaluations have been unrevealing. The symptoms seem to wax and wane. There are no positive phenomena like you'd expect with an inflammatory retinopathy. The symptoms do not occur in "spells" like you'd expect if was vascular.
    I'm not overly worried that any of them have some sinister illness, but also at a loss for an explanation. Has anyone else seen anything similar or is this epidemic isolated to Utah?
    Bradley J Katz, MD, PhD
    Professor of Ophthalmology and Visual Sciences
    John A Moran Eye Center
    he/him/his


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  • 2.  RE: temporal vision loss

    Posted 01-28-2026 12:17
    Sir are they taking any drugs ?







  • 3.  RE: temporal vision loss

    Posted 01-28-2026 12:26
    They're all pretty healthy and are not taking any drugs or supplements that are common to all three men. Thank you!

    Bradley J Katz, MD, PhD
    Professor of Ophthalmology and Visual Sciences
    John A Moran Eye Center
    he/him/his



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  • 4.  RE: temporal vision loss

    Posted 01-28-2026 21:55
    Are the visual fields normal? Were they post cataract sx with negative dysphotopsia syndrome?

    Matt

    Sent via the Samsung Galaxy S21 5G, an AT&T 5G smartphone




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  • 5.  RE: temporal vision loss

    Posted 01-29-2026 07:54

    Hi

    If I understand well  the patient claimed transitory temporal visual field  loss in one eye ?

    Usually when there is a homonymous hemianopia the patient is usually  complaining only of the field defect temporal and the presence of nasal field loss we found  is a surprise for the patient.

    In this case can it be that there was a transitory ischemic event: a transitory homonymous hemianopia?and during the event the patient was aware only about the temporal field loss?




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  • 6.  RE: temporal vision loss

    Posted 01-29-2026 08:01
    My first impression is that those cases may be silent migrain or vascular migrainous attacks without headache 



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  • 7.  RE: temporal vision loss

    Posted 01-28-2026 12:18
    Brad,

    I have not but I will keep an "eye" out.  

    Robert





  • 8.  RE: temporal vision loss

    Posted 01-28-2026 12:34
    Actually I do have a patient.  He is a chronic 10/10 headache patient who looks completely comfortable in clinic and complains of temporal vision loss in the right eye.  He has a temporal hemianopia by confrontation OD, normal OS, and right hemianopia OU.  Formal fields show functional changes OU.  

    Does your patient complain of persistent vision loss? What do formal fields show?  Do they have a hemianopia with both eyes open?

    Robert




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  • 9.  RE: temporal vision loss

    Posted 01-28-2026 12:59

    Hello Dr Katz!

    Greetings from India! I remember you from the last years NANOS, we were "poster neighbours" :)

    If you are suspecting an impending epidemic in Utah of temporal field loss, then we know that epidemics are caused by infections, and viral infections can cause AZOOR which can actually be missed by many unless looked for specifically ( You did mention no photopsias etc but not every AZOOR presents with photopsia)Please share the retinal OCT/ HVF and the mfERG of any or all of these patients , maybe we can all try and help you.

    Looking forward to meet you in Boston poster session again!

    Regards

    shikha



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    Shikha
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  • 10.  RE: temporal vision loss

    Posted 01-28-2026 13:00
    How were the fields done?
    The best field study would be unilateral Goldman-type perimetry in each eye, testing with a peripheral program and a central program in each eye. That could pick up a temporal crescent field defect in one eye or a homonymous defect in each eye that may not be recognized in the dominant eye with both eyes open.
    Mickey Rosenberg


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  • 11.  RE: temporal vision loss

    Posted 01-29-2026 01:37
    I would agree that monocular temporal vision loss is usually functional.



    Bart K. Chwalisz, M.D.

    Neuro-ophthalmology, Headache Unit, and  Skull Base Neurology Clinic. Division of Neuroimmunology, Massachusetts General Hospital

    Skull Base Clinic: https://www.massgeneral.org/neurology/services/treatmentprograms.aspx?id=2070

    Neuro-ophthalmology, Massachusetts Eye & Ear Infirmary

     




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  • 12.  RE: temporal vision loss

    Posted 01-29-2026 01:42
    Maybe this needs to be another report for FVD.

    In my patient I found it interesting that he had normal visual behavior in clinic but had a temporal hemianopia OD and normal visual fields OS but then had a right hemianopia with confrontation with both eyes open.  And then with formal visual fields he had functional changes in each eye tested alone!

    With forced choice testing you can confirm malingering with functional vision loss.  Can you confirm it when a patient has normal visual field in the good eye which then changes to a hemianopia when the bad eye is uncovered?

    Let's keep this discussion going...

    Robert



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  • 13.  RE: temporal vision loss

    Posted 01-29-2026 08:13
    Edited by Michel Van Lint 01-29-2026 08:25

    I have around 10 patients with unexplained monocular temporal hemianopia. A few years ago, I presented this at a local meeting, but I was met with skepticism. One of the attendees did not believe me and became rather annoyed. In two patients I believe there was a possible explanation: a prechiasmal meningioma in one, and an optic neuritis in the other. The weird thing is, most patients are willing to do all sorts of tests, but then never return after saying we don't understand. Actually, there was a third patient where we found a cause: instead of the right eye the monocular loss was suddenly in the left eye after some delayed follow-up :)

    Edit to add: Some of the patients I asked to look nasally with the affected eye and when I presented a small light at the slitlamp at the nasal retina, they would not always be able to see the light

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  • 14.  RE: temporal vision loss

    Posted 01-29-2026 20:48

    I am certain that the group is familiar with this study by Seymour Hershenfeld and Jim Sharpe regarding monocular temporal hemianopsia that showed a surprising number of lesions in the region of the chiasm. 

     

    Monocular temporal hemianopia

    Seymour A Hershenfeld, James A Sharpe

    British Journal of Ophthalmology 1993; 77:424-427

     

    Abstract

    Monocular temporal hemianopia was identified in 24 patients. The field of the fellow eye was normal. Computed tomography or magnetic resonance imaging showed juxtasellar lesions in 19 patients. Fifteen had pituitary adenomas, two had tuberculum sella meningiomas, one a craniopharyngioma, and one an astrocytoma. One patient had optic neuritis. A relative afferent pupillary defect (RAPD) was detected in most patients. Field loss was functional in two. Two had congenital optic disc dysversion with hemianopia which did not respect the vertical meridian. Monocular temporal hemianopia is attributed to involvement of the ipsilateral optic nerve close enough to the chiasm to selectively impair conduction in
    crossing nasal retinal fibres from the ipsilateral eye, but too anterior to affect crossing nasal retinal fibres from the contralateral eye. The combination of an RAPD, with or without optic disc pallor, on the side of monocular temporal field loss implicates compression of the optic nerve at its junction with the chiasm.

    Janine

    _________________________________________

    Janine L. Johnston BScPharm., MD FRCPC FAAN

    Neuro-ophthalmology and Neuro-otology
    Thomson House Medical Consultants

    Professor

    Section of Neurology

    Departments of Medicine and Ophthalmology

    University of Manitoba

     




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