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Photo Essay |

Use of Blue-on-Yellow Perimetry to Demonstrate Quadrantanopia in Multiple Sclerosis

Naoya Fujimoto, MD; Emiko Adachi-Usami, MD
Arch Ophthalmol. 1998;116(6):828-829. doi:10.1001/archopht.116.6.828.
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A 25-YEAR-OLD woman woman with quadrantanopia in both eyes was examined using blue-on-yellow perimetry; the disorder corresponded with plaque detected on magnetic resonance imaging (MRI). She had had multiple sclerosis for 5 years. She had a visual acuity of 1.0 in both eyes. Goldmann perimetry showed normal visual fields in the right eye, but in the left eye abnormal points were sometimes found in the center within 30° with use of the Humphrey field analyzer. The patient was followed up 3 times a year using the white-on-white perimetry of the Humphrey field analyzer (model 750, Carl Zeiss, San Leandro, Calif). Perimetry revealed abnormal points in the left superior quadrant of both of her eyes (Figure 1). The patient showed left superior homonymous quadrantanopia on blue-on-yellow perimetry in both eyes (Figure 2). An MRI scan revealed plaque in the right temporal lobe (Figure 3). The patient's visual field defects corresponded with the lesion detected by MRI.

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Figure 1.

A 25-year-old woman had abnormal points in the left superior edge of both eyes revealed by white-on-white perimetry. The gray tone indicates the visual field in the left eye (left) and the right eye (right).

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Figure 2.

The same patient as in Figure 1 whose visual fields were examined by blue-on-yellow perimetry on the same day as depicted in Figure 1. The patient showed left superior homonymous quadrantanopia also known as "pie-in-the-sky defect."

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Figure 3.

Left, Magnetic resonance imaging (T2-weighted transverse image) demonstrated a large plaque (arrow) in the right temporal lobe. The left superior quadrantanopia corresponded with a lesion in the Meyer temporal loop. Right, Magnetic resonance imaging (T2-weighted coronal image) demonstrated a large plaque (arrow) in the right temporal lobe.

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