Interpretation of visual field defects respecting the vertical meridian and not related to distinct chiasmal or postchiasmal lesions

Hemianopia respecting the vertical meridian generally results from a disturbance in the optic chiasm or the postchiasmal visual pathway. We present five unusual patients with visual field defects respecting the vertical meridian that were not related to distinct chiasmal or postchiasmal lesions, as determined by magnetic resonance imaging (MRI). Optic neuritis, plus the influence of the testing algorithm for perimetry, was a possible cause in two cases. The symptoms of one patient with homonymous hemianopia were a functional deficit. In the two other cases, the visual field defects may have been caused by optic disc abnormalities. Although visual field defects respecting the vertical meridian, and without any evidence of distinct disease, are uncommon, neurologists and neuro-ophthalmologists should consider the differential diagnosis if MRI is negative for distinct lesions in the optic chiasm or the postchiasmal visual pathway.