A patient is admitted with progressive visual impairment and loss of peripheral vision. Which diagnosis is most consistent?

• A. Open-angle glaucoma
• B. Closed-angle glaucoma
• C. Cataracts
• D. Retinal detachment

Answer: (B)

Progressive peripheral vision loss points to glaucoma affecting the optic nerve from high intraocular pressure. In the common, chronic form, this loss is usually gradual and painless, with central vision remaining intact until later stages. That pattern fits open-angle glaucoma best: it slowly narrows the visual field, often without other early symptoms.

In contrast, closed-angle (angle-closure) glaucoma presents as an emergency: sudden, severe eye pain, headache, halos around lights, red eye, nausea, and a mid-dilated pupil, with rapid vision decline. Cataracts blur vision in general but don’t typically cause a gradual loss of peripheral vision, and retinal detachment usually presents with a sudden curtain-like loss of vision or flashes and floaters.

So, the described gradual peripheral field loss is most consistent with open-angle glaucoma. If you see a choice labeled as closed-angle in this vignette, remember that acute symptoms don’t match the gradual, peripheral vision loss described.