Rapidly progressing glaucoma associated with monoclonal gammopathy

Area of Science:

• Ophthalmology
• Hematology
• Internal Medicine

Background:

• Primary open-angle glaucoma (POAG) is a common optic neuropathy.
• Glaucoma management typically focuses on intraocular pressure control.
• Sudden visual deterioration can occur but warrants thorough investigation.

Observation:

• A 63-year-old woman with surgically controlled POAG experienced acute visual field loss and subjective visual decline.
• Intraocular pressure remained stable in both eyes, inconsistent with typical glaucoma progression.
• Systemic evaluation was initiated due to the discrepancy between clinical presentation and known disease.

Findings:

• Extensive systemic workup identified monoclonal gammopathy of undetermined significance (MGUS).
• MGUS is a premalignant condition characterized by the presence of monoclonal proteins in the blood.
• This finding suggests a potential link between MGUS and unexplained visual changes.

Implications:

• Unexplained vision changes in patients with pre-existing ocular conditions necessitate comprehensive systemic assessment.
• Consideration of hematologic disorders like MGUS is crucial when vision loss exceeds expected disease progression.
• Early detection of systemic conditions can guide appropriate management and potentially prevent further visual morbidity.