I’ve had a few patients referred to me for subjective complaints of visual field constriction, worse temporally, which progressively worsens over time. The complaint is often expressed as a comparison between the excellent vision they had in their youth compared to where it is now. It is painless and is often described as progressive.

The concern with bitemporal visual field constriction, of course, often results in neuroimaging to look for a pituitary tumor or some other lesion that affects the optic chiasm, even if the automated perimetry appears to be normal. But what happens if the MRI or CT is normal?