unilateral quadrantanopia

(10) Upper altitudinal hemianopia as a result of bilateral destruction of the lingual gyri. Webfingers appropriately, this can be scored as normal. In (eds): Neurologic Complications of Cancer. J Am Optom Assoc 1995 Nov;66(11):675-80. The pupil. [21] Causes [ edit] E. Relative afferent (Marcus Gunn) pupil results from a lesion of the optic nerve, the afferent limb of the pupillary light reflex (e.g., retrobulbar neuritis seen in multiple sclerosis). WebDefinition (NCI_CTCAE) A disorder characterized by visual perception of unclear or fuzzy images. had been recorded at 20/25. (B) Horner's syndrome, left eye. WebQuadrantanopia also called quadrantanopsia, refers to a defect in the visual field affecting a quarter of the field of vision. Dalla Via P, Opocher E, Pinello ML, et al. A. Meschia JF, Bushnell C, Boden-Albala B, et al. WebConclusion : Unilateral quadrantanopia appears to have been caused by pituitary tumor with intratumor hemorrhage, or pituitary apoplexy, that compressed the posterior portion of optic chiasm upwards. Any complaint of a fixed missing spot in the visual field (monocular or binocular). Lindenmuth KA, Skuta GL, Rabbani R, et al. Occlude the abnormal eye and shine the light in the normal eye. Frequently seen in females with absent knee or or ankle jerks. The presence or absence of coincident flashing lights, floaters, dyschromatopsia, eye pain, headache, vertigo, diplopia, metamorphopsia or other seemingly unrelated symptoms will often direct your management. Complete hemianopia describes having no visual stimulus in half of their visual field. Prasad, Sashank. Clinicians should be aware of the localizing value of specific visual field defects and perform neuroimaging to exclude a structural lesion including mass lesions[15]. It projects through the geniculocalcarine tract to layer IV of the primary visual cortex (Brodmann's area 17). Time is critical! Occasionally, patients will spontaneously recover vision in the affected field within the first three months after the brain injury; however, vision loss remaining after this period of spontaneous recovery is traditionally thought to be permanent, certain companies now claim to be able to induce recovery of vision after this three-month period. Any complaint of headaches not explained by the exam. Visual field loss increases the risk of falls in older adults: the Salisbury Eye Evaluation. However, the etiology is less commonly from a congenital, traumatic, vascular, inflammatory, infectious, demyelinating, and infiltrative source[5]. American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, Council on Functional Genomics and Translational Biology, Council on Hypertension. A regular patient to the clinic, he had been seen six months ago for a comprehensive examination and diagnosed with moderate nonproliferative diabetic retinopathy (DR)in both eyes. His visual acuity recovered fully, but his visual fields only partially recovered. Note that the defect in the right (asymptomatic) eye strongly respects the vertical midline. It regulates voluntary (saccadic) eye movements. CN = cranial nerve. Imaging for neuro-ophthalmic and orbital disease - a review. When patients display other neurological symptoms, an immediate referral is required. Ask the patient to assign a brightness value of 100 points to that light. Visual field testing by confrontation demonstrated severe depression of the superior temporal quadrant of the left eye, but was also noted to affect the superior nasal quadrant of the right eye. Webunilateral blindness or enucleation, visual fields in the remaining eye are scored. WebThe bitemporal hemianopia field defect is the classic presentation of a chiasmal lesion. Complete homonymous hemianopias have no localizing value, except to say that they are post-chiasmal.1. Glaucoma is the leading cause of field loss across all adult age groups when tested using automated threshold or supra-threshold perimetry.8, Other leading causes of visual field loss in patients past age 55 are non-glaucomatous optic nerve disease, stroke, age-related macular degeneration (AMD) and retinal vascular occlusive disease.1,8 Stroke is the leading cause of homonymous hemianopias, followed by trauma, tumor, brain surgery and demyelination.10, In younger age groups, prevalence of visual field loss is much lower, and causes are more varied and may be functional or psychogenic in nature. Dont waste precious minutes before sending the patient for evaluation and care. To fully appreciate the potential underlying causes for various visual field defects, it is important to have a working knowledge of the anatomy of the visual system. Superiorquadrantanopia. For example, I have had patients require a repeat scan because I didnt specify thin enough sections through a particular region. Ultimately, this patient was diagnosed with neurosyphilis, and was treated with penicillin. Color vision, visual fields and extraocular motilities were normal in both eyes. (Reprinted with permission from Fix JD: BRS Neuroanatomy. Damage to the right parietal lobe can produce contralateral neglect. Definition (NCI) Blurred vision is the loss of visual acuity (sharpness of vision) resulting in a loss of ability to see small details. Arch Ophthalmol 2001 Dec;119(12):1788-94. The incidence of visual field loss increases with age. 3. Knowledge of the functional anatomy of neurological pathways is essential in the interpretation of examination results. Webhomonymous lower quadrantanopia with macular sparing Vison abnormalities other than visual field deficits can also help localize lesions 1: retina, optic nerve, optic chiasm, or Contralateral homonymous superior quadrantanopia often called pie in the sky is seen when a mass lesion is in the temporal lobe. 3. The retrochiasmal afferent pathway extends posteriorly past the chiasm and includes the optic tract, lateral geniculate body, optic radiations, and the striate cortex[8]. 1. THE and 20/200 O.S. On attempted lateral conjugate gaze, the only muscle that functions is the intact lateral rectus. It is often asymmetric and is greater on the side of the supratentorial lesion. For pathology affecting the post-chiasmal pathways, the accepted convention is that greater congruity is associated with more posteriorly located lesions.1 However, this is not an absolute rule. The amount of compensatory movements and the frequency with which they are employed is believed to be dependent on the cognitive demands of the task; when the task is so difficult that the subject's spatial memory is no longer sufficient to keep track of everything, patients are more likely to employ compensatory behavior of biasing their gaze to the afflicted side. Unexplained visual acuity loss. Edgar DF, Crabb DP, Rudnicka AR, et al. The tips of the occipital cortices are supplied by both the MCA and posterior cerebral artery (PCA). Biomicroscopy revealed healthy anterior segment structures; dilated funduscopy showed moderate nonproliferative DR, but no evidence of neovascular scaffolding, vitreous hemorrhage or retinal detachment in either eye. In essence, the more the field loss in one eye appears to be a carbon copy of the other, the greater the level of congruity. Ophthalmology 2007 Dec;114(12):2232-7. 1. Ophthalmology 1990 Mar;97(3):367-70. WebQuadrantanopia is a condition associated with the temporal and parietal region of brain. (D) Third-nerve palsy, left eye. Philadelphia: Mosby, 1998. These fibers innervate the sphincter muscle of the iris. Depending upon your level of comfort, you may also want to perform a cranial nerve screening, or even a gait, balance and symmetry screening. Partial vs. complete hemianopia. The visual cortex has a retinotopic organization: 1. right. Vision flickering off and on is a common symptom of patients with giant cell arteritis. It occurs in syphilis and diabetes. WebPost-chiasmal lesions result in homonymous field defects, i.e., affecting the same side (right or left) of the visual field and respecting the vertical midline. Lesions of the occipital lobe result in homonymous hemianopias, contralateral to the side of the lesion (i.e., a right-sided field defect with a left-sided lesion and vice-versa). O.S. WebA visual world of someone with normal vision. Traumatic chiasmal syndrome: A meta-analysis. Light shincd into one eye causes both pupils to constrict. Clin Exp Ophthalmol. Once confirmed, treatment goals for isolated stroke are aimed at controlling modifiable risk factors that could predispose to subsequent CVAs. If patient is blind from any cause, score 3. It may have a Mass effect is the compression of nearby structures by a mass (aneurysm, tumor, hematoma, abscess). Lesions of the Optic Chiasm, Parasellar Region, and Pituitary Fossa. Bitemporal field loss. Unfortunately, during resection of the tumor, the right optic nerve was damaged, and the patient was left with partial visual field loss in both eyes. 3. Post-geniculate fibers split into superior and inferior pathways, traveling through the parietal and temporal lobes, respectively, as they course posteriorly in the brain. (C) Internuclear ophthalmoplegia, right eye. The areas of the field lost in each eye are shown as black areas. When a patient presents complaining of loss of some or all of the vision in one eye or in a particular part of the field of vision, the most critical step is to determine if this is a neurological emergency. The History Makes the Diagnosis A trace relative afferent pupillary defect was seen O.S., but both pupils were of normal size. The diagnosis can be made with the swinging flashlight test (see Figure 17-4A). Right homonymous superior quadrantanopia. *Images generated. Optometric management depends on the extent of field loss and the degree of recovery following the stroke. Sparing or involvement of the monocular temporal crescent localizes to the occipital lobe[13]. One exception to neurology referral is a patient with visual field loss that you suspect is psychogenic in origin. Douglas VP, Douglas KAA, Cestari DM. The posterior area receives macular input (central vision). To fully appreciate the potential underlying causes for various visual field defects, it is important to have a working knowledge of the anatomy of the visual system (figure 1). Visual field testing provides insight into the integrity of the visual pathway. Visual neglect (also called hemispatial neglect or unilateral Behav Brain Res. If the patient displays disturbances in speech, gait, memory, facial symmetry or behavior, an immediate referral to the ER is essential. A 55-year-old black male with a history of Type 2 diabetes and hypertension presented urgently for evaluation. Orbital masses. It usually affects a (/) Destructive lesion of the right frontal eye field. In Ophthalmology (Fifth Edition, pp. (1) Ipsilateral blindness. Glaucoma is the leading cause of visual field loss across all age groups.1 However, glaucoma patients often dont present with an initial chief complaint of visual field loss, unless the disease is quite advanced. Optom Vis Sci 2004 May;81(5):298-307. These fibers exit the midbrain with CN III and synapse with postganglionic parasympathetic neurons of the ciliary ganglion. Temporal defect in one eye, central defect inthe fellow eye. If there is extinction, patient receives a 1, and the results are used to respond to If you can confirm that the visual field is not organic in nature, careful consideration for a referral to a psychologist or psychiatrist is indicated. Field defects from damage to the optic nerve tend to be central, asymmetrical and unilateral; visual acuity is An anisocoria produces a small relative afferent pupillary defect in the eye with the smaller pupil. Double simultaneous stimulation is performed at this point. Walsh & Hoyt's Clinical Neuro-Ophthalmology. You can enhance the reliability of standard finger-counting testing by adding a facial Amsler test (have the patient fixate on your eyes and ask him or her if your other facial features appear distorted or are missing) and by performing double simultaneous stimulation confrontation fields. and 20/80 O.S. 909917.e1). Once confirmed, treatment goals for isolated stroke are aimed at controlling modifiable risk factors that could predispose to subsequent CVAs. Dr. Reed is an associate professor at Nova Southeastern University, where she teaches ocular disease and primary clinical care. Graefes Arch Clin Exp Ophthalmol 1999 Feb;237(2):117-24. The use of aspirin as a platelet anti-aggregant may be advisable in those with significant intracranial arterial stenosis. Fishman GA, Bozbeyoglu S, Massof RW, et al. Transection causes contralateral hemianopia. Such changes, among others, may indicate a cerebrovascular accident (stroke). On this Wikipedia the language links are at the top of the page across from the article title. These field defects will cross neither the vertical midline nor the horizontal midline. 13. Wise clinicians analyze patients complaints within the context of the ocular and medical history to arrive at a logical presumptive diagnosis. After the patient has a chance to recover from the transilluminators bleaching effects, do a white light comparison test. White light comparison testing showed a 25% sensitivity in the left eye as compared to the right. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. This visual field defect is characteristic of damage to Meyer's loop on the left side of the brain. One study found a five-fold increase of visual field loss between ages 55 and 80.8, An even more surprising finding: In one study of 61 post-stroke patients suffering from homonymous visual field loss (as determined by Humphrey visual field analysis), none were aware of the visual field loss.9 Also, only two of those 61 patients were identified as having field loss using the National Institutes of Health Stroke Scale (NIHSS) technique, which is a finger-counting confrontation visual field screening. The associated features like aphasia and hallucinations will help to further localize lesions to the temporal lobe[13]. Vision was 20/20 O.D. N Engl J Med 2008; 359: pp. Lesion A of visual radiations to sup. Note that half of the optic nerves cross at the optic chiasm, causing vision loss on one side to be quite different than that in one eye. Suprasellar and sellar lesions can produce optic neuropathies in one or both eyes; a junctional scotoma (ipsilateral visual loss and contralateral superotemporal visual field loss) or the junctional scotoma of Traquair (monocular hemianopic visual field loss); or chiasmal bitemporal hemianopsia (including paracentral bitemporal hemianopsia from crossing macular fiber in posterior chiasm). Vision was 20/30 O.D. To further complicate matters, 30% of those subjects with significant visual field loss were still driving.9, Red Eye, Red Herring WebThis loss is unilateral and homonymous: this implies that the visual deficit affects the same region of the visual field in both eyes; this is due to the fact that fibers from the nasal hemi-retinas (representing the lateral or temporal visual field) from each eye cross in the optic chiasm, while fibers from the temporal hemi-retina (representing The medial rectus subnucleus of CN III, which mediates convergence, VI. Score 1 only if a clear-cut asymmetry, including quadrantanopia, is found. How the actual referral is carried out will vary based on the patients insurance, availability of neurologists in your area and other factors. It is most often associated with stroke and is more severe and persistent following right hemisphere damage, with reported frequencies in the acute stage of up to 80%. Lesions of the occipital lobe will result in contralateral congruous homonymous hemianopia. This is considered a bitemporal visual field defect despite the extension into the superior nasal quadrant in the left field. So, if the patient says, I cant see on the left side, you need more clarification before you develop a short list of differential diagnoses. Ultimately, this patient was diagnosed with neurosyphilis, and was treated with penicillin. Its not uncommon during pregnancy and puberty for patients to experience transient scotomas of this sort. 2005 Mar 31.;352(13):1305-16. THE PUPILLARY DILATION PATHWAY (Figure 17 4) is mediated by the sympathetic division of the autonomic nervous system. Pupils were normally reactive and ocular motilities were unrestricted. Visual radiation to lingual gyrus Visual radiation to cuneus. It contains noncrossing fibers from the two temporal hemiretinas and projects fibers to the suprachiasmatic nucleus of the hypothalamus. The same is true for the superior and inferior visual fields - the inferior retina processes the superior visual field, and the superior retina processes the inferior visual field[6]. bank of calcarine sulcus, Lesion B of visual radiations to inf. A referral to a retinologist, neurologist or internist may be required. J Clin Neurosci 2007 Aug;14(8):754-6. left, O.D. C. The Edinger-Westphal nucleus of CN III, which gives rise to preganglionic parasympathetic fibers. Although it may present as a complete bitemporal hemianopia, most patients will have an asymmetric presentation on visual field testing[4]. A significant visual field defect was present in not only the left eye, consistent with the patients case history, but also in the right eye. 1. 2014 Dec;45(12):3754-832. The etiologies of retrochiasmal lesions are different between adults and children. Premature Ejaculation Causes and Treatment, Anxiety and Panic Disorders Holistic Cure, Electromagnetic Radiation and Human Health, How to Improve Your Sex Life With Your Partner. All rights reserved. Homonymous hemianopias: Clinical-anatomic correlations in 904 cases. This visual defect is caused by damage to superior fibers of the optic radiations. Sign or Symptom ( T184 ) SnomedCT. C. The superior colliculus and pretectal nucleus project to the oculomotor complex of the midbrain. If both divisions on one side of the brain are affected, the result is a contralateral homonymous hemianopsia. (CN II) and an efferent limb (CN III). Kardon RH, Thompson HS. Pupillary dilation and its effects on automated perimetry results. Patients with residual field deficit following stroke may benefit from vision rehabilitation, including such elements as prismatic correction and compensatory training to improve visual search abilities. 1. This is considered a bitemporal visual field defect despite the extension into the superior nasal quadrant in the left field.How quickly does the referral need to be made? Double simultaneous stimulation is performed at this point. The bitemporal hemianopia field defect is the classic presentation of a chiasmal lesion. Most commonly, the nasal crossing fibers are affected, manifesting with a monocular temporal field defect in the ipsilateral eye. When to do Automated Field Testing: (2018). Bitemporal (either inferior or superior) quadrantanopia affects either the upper or lower outer visual quadrants in both eyes. Consultation with the appropriate medical caregiver is prudent. Vision was 20/30 O.D. All rights reserved. Congruency in homonymous hemianopia. The pattern of the visual field defect is also more indicative of stroke than other intracranial abnormalities, such as traumatic brain injury, cerebral hemorrhage or compressive tumor. Examining visual field defects in the paedriatric population exposed to vigabatrin. The bottom line: From a clinical standpoint, a right positive RAPD means that you should be looking for a problem in the right retina and/or optic nerve. 4. Bilateral lesions can cause complete cortical blindness and can sometimes be accompanied by a condition called Anton-Babinski syndrome. Findings of ocular disease will dictate appropriate management strategies based upon the condition. The patient was referred to his primary care physician with a request for an MRI with contrast of the area in question, to be performed within 24 to 48 hours. Vision restorative training (VRT) may provide a mechanism to regain visual function at the border of the visual field defect, although studies with this system have yielded conflicting and inconclusive results. This occurs from a lesion where the optic nerve and chiasm meet and can present with varying field defects in the monocular, ipsilateral eye[14]. C. The superior cervical ganglion projects postganglionic sympathetic fibers through rhe perivascular plexus of the carotid system to the dilator muscle of the iris. WebUnilateral cortical lesions involving the occipital lobe will usually produce a hemi-field cut contralateral to the site of the lesions. The most common cause of an optic chiasm lesion is from a compressive source, and this is often neoplastic in nature[4]. WebSudden unilateral quadrantanopia caused by retinal diseases often has characteristic presentations, such as acute onset and severe visual acuity defect. Our case is a peculiar case of ECD initially presented with unilateral homonymous superior quadrantanopia due to involvement of the visual apparatus in the mesial temporal lobe which progressed to unilateral ophthalmoplegia and total visual loss secondary to involvement of the cavernous sinus. FindingsOur patient was found to have an incomplete, moderately congruous, left homonymous hemianopia, denser above than below the horizontal midline. II. Chiasmal syndromes. INTRODUCTION. The retina processes the opposite side of the visual field. Quadrantanopia - this is an incomplete hemianopia referring to a quarter of the schematic 'pie' of visual field loss. Temporal lobe lesion (infarct, hemorrhagic stroke, trauma) on the side oppositethe visual field defect. Origin of the relative afferent pupillary defect in optic tract lesions. As the corticospinal motor tracts are often involved as well causing contralateral hemiparesis[13]. Superior right quadrantanopia. Such knowledge will enhance proper triage of these often-critical patients. Retina 2007 Jun;27(5):601-8. Spencer EL, Harding GF. Binocular visual-field loss increases the risk of future falls in older white women. WebIf a lesion only exists in one unilateral division of the optic radiation, the consequence is called quadrantanopia, which implies that only the respective superior or inferior quadrant of the visual field is affected. Severity of visual field loss and health-related quality of life. Skenduli-Bala E, de Voogd S, Wolfs RC, et al. The chiasm lies in the suprasellar cistern above the sella turcica, and is surrounded by the hypothalamus superiorly and the infundibulum and pituitary gland inferiorly[3]. The lateral geniculate body receives input from layer VI of the striate cortex (Brodmann's area 17). Neurology 2006; 66: pp. Recovery from poststroke visual impairment: evidence from a clinical trials resource. (9) Left central scotoma as seen in optic (retrobulbar) neuritis in multiple sclerosis. Optic radiations exit dorsally from the LGN into two separate fascicles: Inferior (known as Meyers loop) and Superior (known as the parietal fascicles). a. Transection causes a contralateral lower quadrantanopia. [2], An interesting aspect of quadrantanopia is that there exists a distinct and sharp border between the intact and damaged visual fields, due to an anatomical separation of the quadrants of the visual field. https://doi.org/10.1097/00055735-200312000-00002, Lee AG, Johnson MC, Policeni BA, Smoker WR. Layers 1, 4, and 6 receive crossed fibers; layers 2, 3, and 5 receive uncrossed fibers. Another way to help confirm subtle RAPDs is to purchase an inexpensive 0.3 log unit neutral density (ND) filter. The caudal Edinger-Westphal nucleus, which mediates contraction of the ciliary muscle. (J) Third-nerve palsy with ptosis, right eye. J Amer Geriatr Soc 2007 Mar;55(3):357-64. Does the missing area or spot remain the same size, or does it change? It is most commonly caused by brain tumors, subdural hematoma, or hydrocephalus. [7] Drivers with quadrantanopia, who were rated as safe to drive, drive slower, utilize more shoulder movements and, generally, corner and accelerate less drastically than typical individuals or individuals with quadrantanopia who were rated as unsafe to drive. [1] While quadrantanopia can be caused by lesions in the temporal and parietal lobes of the brain, it Post-chiasmal lesions result in homonymous field defects, i.e., affecting the same side (right or left) of the visual field and respecting the vertical midline. Sudden unilateral quadrantanopia caused by retinal diseases often has characteristic presentations, such as acute onset and severe visual acuity defect. Perimetric homonymous visual field loss post-stroke. 1. 2. Recurrent and transient holes in the visual field may indicate a vascular perfusion deficit. He said he experienced unusual flashes of light, followed by a sudden darkening affecting his left eye. Looking right Looking left Eyes converged. Ocular motor palsies and pupillary syndromes. However, the nasal retinal fibers decussate to the contralateral side for processing by the contralateral hemisphere of the brain[6]. O.S. 2 The condition may be If patient is blind from any cause, score 3. Am J Ophthalmol. Other localizing signs were Kedar S, Zhang X, Lynn MJ, et al. The defect is usually bilateral as it is typically caused by a lesion past the optic chiasma. Sometimes, however, the most obvious diagnosis is not the correct one. 2. A 46-year-old white male complained of blurry vision and a missing spot of vision in his left eye for approximately eight months. Unfortunately, during resection of the tumor, the right optic nerve was damaged, and the patient was left with partial visual field loss in both eyes. Natural course of visual field loss in patients with type 2 Usher syndrome. Patients who present with an awareness of a loss of visual field need prompt and accurate diagnosis, as management often involves immediate further evaluation and intervention. The visual field defect from a chiasmal lesion thus depends on which fibers are compressed. This page was last edited on August 29, 2022, at 13:24. Fixed scotomas usually signal retinal, optic nerve, or neurological involvement.16. He later revealed hed been suffering from a headache on the right side, behind his ear (the occipital region). WebThe location (and frequency) of lesions causing superior quadrantanopias was occipital lobe (83%), parietal lobe (3%), and temporal lobe (13%). Additionally, a comprehensive neurological evaluation was requested to rule out any additional compromise. Neurorehabil Neural Repair. Zhang X, Kedar S, Lynn MJ, et al. Identification of field loss using screening techniques. The decision to order radiological testing or wait for the neurologist to do it will also vary, depending upon your working relationship with the neurologist and the imaging centers in your area. A value of 80% or less is considered clinically significant. Due to the abrupt onset of symptoms, we suspected a cerebrovascular accident affecting the posterior optic radiations or anterior occipital cortex. right. Visual field recovery after vision restoration therapy (VRT) is independent of eye movements: an eye tracker study. Doc Ophthalmol 2003 Nov;107(3):281-7. THE PUPILLARY LIGHT REFLEX PATHWAY (Figure 17-3) has an afferent limb. Chimowitz MI, Lynn MJ, Howlett-Smith H, et al. [6], Binasal (either inferior or superior) quadrantanopia affects either the upper or lower inner visual quadrants closer to the nasal cavity in both eyes. The response in the stimulated eye is called the direct pupillary light reflex. Retinitis pigmentosa. Copyright 2023 Jobson Medical Information LLC unless otherwise noted. D. The optic tract contains fibers from the ipsilateral temporal hemiretina and the contralateral nasal hemiretina. (8) Left constricted field as a result of end-stage glaucoma. Vascular and ischemic etiologies (i.e hemorrhage, aneurysm) are more frequent for adults, whereas neoplasms are more common for children[9][10]. As they reach the occipital lobe (the primary visual cortex), the superior and inferior fibers are reunited. Damage to the optic radiations Total monocular field loss. 22. An 9nNa6>yKEV Are there other neurological signs? Causes of incident visual field loss in a general elderly population: the Rotterdam Study. Lesions cause contralateral hemianopia with macular sparing. WebLoss of vision in a quarter section of the visual field of one or both eyes; if bilateral, it may be homonymous or heteronymous, binasal or bitemporal, or crossed, for example, involving Townend BS, Sturm JW, Petsoglou C, et al. b. Lesions that involve both cunei cause a lower altitudinal hemianopia (altitud inopia). Hold the ND filter over the normal eye, and shine the light through the filter. In homonymous hemianopsia, an injury to the left part of the brain results in the loss of the right half of the visual world of each eye. Neuro-Ophthalmology (Amsterdam: Aeolus Press. Visual outcome of a cohort of children with neurofibromatosis type 1 and optic pathway glioma followed by a pediatric neuron-oncology program. The patient underwent neuroradiological evaluation, and a craniopharyngioma was found. 5. So macular vision can be spared when only one of the major cerebral vessel distributions is affected.