A 50-year-old patient with POAG undergoes Humphrey visual field testing. The report shows an arcuate scotoma extending from the blind spot and respecting the horizontal midline. This pattern of visual field defect corresponds to damage to which part of the optic nerve?
- A Superior and inferior poles of the optic disc, with nerve fibre bundles arching around the fovea ✓
- B Nasal pole of the optic disc, causing temporal field loss
- C Central macula, causing central scotoma
- D Optic chiasm, causing bitemporal hemianopia
Correct answer: A. Superior and inferior poles of the optic disc, with nerve fibre bundles arching around the fovea
Explanation
Arcuate scotomas in glaucoma follow the pattern of retinal nerve fibre bundles, which arc above and below the macula. Damage to the superior and inferior poles of the optic disc produces arcuate field defects that respect the horizontal midline. This is because the nerve fibre layer does not cross the horizontal raphe. Central scotoma and bitemporal hemianopia are not glaucomatous patterns.
Reference: Shields' Textbook of Glaucoma, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.