Homonymous hemianopia detected by short wavelength automated perimetry in a patient with normal standard perimetry and MRI

Purpose: To report a case of homonymous hemianopia detected by short wavelength automated perimetry (SWAP) in a patient with normal standard automated perimetry (SAP) and magnetic resonance imaging (MRI) of the brain and orbits. Methods: A 61-year-old woman with a history of motor vehicle accident with head injury nearly 50 years before presentation was referred for further evaluation as a glaucoma suspect. Complete ophthalmic examination, corneal pachymetry, SAP, SWAP, retinal nerve fiber layer analysis by ocular coherence tomography, and brain and orbital MRI were done. Results: The patient had intraocular pressure (IOP) of 18-mm Hg and vertical cup-to-disc ratios of 0.8 in each eye. Superior neuroretinal rim pallor was detected in both optic discs on dilated optic nerve examination, and corresponding retinal nerve fiber layer thinning was detected with ocular coherence tomography. SAP indicated minimal nonspecific changes in the right eye, whereas the left eye had a normal visual field. SWAP revealed a left homonymous hemianopia. Neurologic examinations and MRI of the brain and orbits were found to be normal. CONCLUSIONS: SWAP can detect subtle hemianopic field defects in patients with normal standard perimetry.