The patient, a 67 y/o female retired librarian, has not had an eye exam in 12 years

The patient, a 67 y/o female retired librarian, has not had an eye exam in 12 years

In the clinic she states no problems with driving short distances, reading or using the computer. She uses OTC readers for close work. She states mild eye burning especially after reading for long time. No

floaters or halos, pain, double visions or redness.

PMH/PSH- hypertension x 10 years; controlled; CS x 1

Meds: hydrochorothiazide

Allergies: NKDA

Ocular Hx- presbyopia, no eye surgeries, hx of eye trauma.

Ocular Family Hx- mother and father cataracts; neg- macular degeneration

ROS- denies any recent illness or any new CV, Resp, GI, CNS, Skin or musculoskeletal sx

Ocular Exam

Visual acuity OD (Right) 20/20 OS (Left) 20/20

IOP (PRESSURE) OD 21mm Hg OS 23 mmHg

Pupil- Equal, round and reactive to light (PERRL), no APD ( afferent pupillary defect)

Automated visual field test: superior arcuate defect in both eyes

No nastigmus

Questions:

1.What do you think this patient has?

2. What are the Differential Diagnosis?