Systemic disease: Heteronymous hemianopias

Lesions impacting upon the visual pathway around the chiasma characteristically lead to field loss in both eyes but on opposite sides – heteronymous loss. Here are three such cases that  have presented in my practice

Case 1

A 67-year-old female patient (ST) was recommended by her doctor to have a second opinion after being referred to an eye clinic by her longstanding optometrist for ‘suspicious visual fields.’ She was seen by the clinic where they assumed that she had been referred for glaucoma and discharged with a letter stating that the visual fields were ‘normal’, that there was no family history of glaucoma and no signs of glaucoma were detectable. Acuities had been recorded as 6/6 R and L, and intraocular pressures were 16 mmHg both eyes.