Glaucoma Quiz: Ace Your Exams

A 65-year-old woman presents to her opthamologist for vision changes. Over the past year, the patient has been involved in several low-speed motor vehicle accidents after failing to notice incoming traffic. She has not experienced any ocular pain or erythema. Past medical history is notable for Crohn disease, type II diabetes mellitus, hypertension, and atrial fibrillation. Current medications include infliximab, lisinopril, metformin, metoprolol, and warfarin. Vital signs are within normal limits, and ophthalmologic examination is notable for an intraocular pressure of 25 mmHg in the right eye and 27 mmHg in the left eye. Slit lamp examination reveals thinning of the outer rim of the bilateral optic nerve heads. The patient is also noted to have bilateral peripheral vision loss. Which of the following is the most likely cause of this patient’s clinical condition?