A 63 year old woman has progressive decrease in her visiul acuity and peripheral visual field loss

A 63 year old woman has progressive decrease in her visiul acuity and peripheral visual field loss. She is shortsighted and needs to wear glasses. On examination, she has normal pupils on both eyes. What is the SINGLE most likely diagnosis?

A. Cataract
B. Glaucoma
C. Retinal detachment
D. Iritis
E. Giant cell arteritis

The symptoms and progressive decrease in vision and myopia point towards openangle glaucoma.

Simple (primary) open-angle glaucoma is present in around 2% of people older than 40 years. Other than age, risk factors that need to be known for PLAB include: - family history - black patients - myopia
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Note: The incidence increases with age, most commonly presenting after the age of 65 (and rarely before the age of 40).

Unfortunately, in the vast majority of cases, patients are asymptomatic. Because initial visual loss is to peripheral vision and the field of vision is covered by the other eye, patients do not notice visual loss until severe and permanent damage has occurred, often impacting on central (foveal) vision. By then, up to 90% of the optic nerve fibres may have been irreversibly damaged

Open-angle glaucoma may be detected on checking the IOPs and visual fields of those with affected relatives. Suspicion may arise during the course of a routine eye check by an optician or GP, where abnormal discs, IOPs or visual fields may be noted.

Features may include - peripheral visual field loss - nasal scotomas progressing to ‘tunnel vision’ - decreased visual acuity - optic disc cupping