onstrated a bilateral temporal retinal disturbance charac- terized by increased inner-retinal reflectivity without a significant increase in retinal thickness (Figure 2). Multi- focal electroretinography (mfERG) revealed evidence of bitemporal retinal cone-mediated pathway dysfunction (Figure 2), whereas full-field electroretinography and vi- sual evoked responses were normal in both eyes. Magnetic resonance imaging and magnetic resonance angiography were normal. Over the next six weeks, although the patient’s complaints of binasal field defects remained unchanged, funduscopy demonstrated narrowing and whitening of the arterioles in the temporal macula of both eyes associated with a few, small intraretinal hemorrhages, without retinal thickening or edema. Repeat fluorescein angiography continued to demonstrate normal foveal avascular zones in both fundi, although in the far temporal macula, there were large areas of arteriolar occlusion with capillary dropout (Figure 3). Repeat OCT demonstrated bilateral temporal retinal thinning in the parafoveal retina without visible retinal changes on ophthalmoscopy or angiography (Figure 3). Because our patient presented seven days after on- set of symptoms, we did not recommend any spe- cific therapy and instead advised follow-up with a hematologist regarding potential prophylactic systemic therapy. Macular occlusive disease occurs more commonly in SS disease than SC disease 1–4 ; however, our patient developed bilateral macular ischemic and frank retinal arteriolar occlusive disease in the setting of SC disease. Equally of interest is that the manifestation of this patient’s retinal dysfunction was that of bilateral nasal field defects that, in the presence of a normal retinal examination and normal fluorescein angiography, raised the suspicion of bilateral optic nerve dysfunction. Although retinal lesions uncommonly cause binasal field defects, the OCT in our patient revealed early retinal abnormalities and the mfERG confirmed a bitemporal retinopathy. Although the patient had symmetrically large optic nerve cups, in the setting of low intraocular pressures and healthy appearing peripapillary nerve fiber layer, the cupping is believed to be physiologic, and the sudden onset and spacial pattern of the visual field defects are consistent with the retinal lesions noted on OCT and mfERG. This case demonstrates that OCT and mfERG may be useful adjuncts in distinguishing optic nerve dysfunction from early ischemic retinal disease in the absence of ophthal- moscopic or fluorescein angiographic evidence of such disease. THE AUTHORS INDICATE NO FINANCIAL SUPPORT OR FI- nancial conflict of interest. Involved in concept and design; analysis and interpretation; writing and revising manuscript (M.C., H.T., T.H., J.B., N.M., N.A.); and data collection (M.C., H.T., N.A.). REFERENCES 1. Downes SM, Hambleton IR, Chuang EL, et al. Incidence and natural history of proliferative sickle cell retinopathy: observa- tions from a cohort study. Ophthalmology 2005;112:1869 –1875. 2. Weissman H, Nadel AJ, Dunn M. Simultaneous bilateral retinal arterial occlusions treated by exchange transfusion. Arch Ophthalmol 1979;97:2151–2153. 3. Merritt JC, Risco JM, Pantell JP. Bilateral macular infarction in SS disease. J Pediatr Ophthalmol Strabismus 1982;19:275–278. 4. Kabakow B, Van Weimokly SS, Lyons HA. Bilateral central retinal artery occlusion. AMA Arch Ophthalmol 1955;54: 670 – 676. Diagnostic Ability of Optical Coherence Tomography with a Normative Database to Detect Band Atrophy of the Optic Nerve Mário L. R. Monteiro, Frederico C. Moura, and Felipe A. Medeiros PURPOSE: To evaluate the diagnostic ability of stratus optical coherence tomography (OCT) with a normative database to detect band atrophy (BA) of the optic nerve. DESIGN: Cross-sectional study. METHODS: StratusOCT retinal nerve fiber layer thickness scans were obtained in 37 eyes with BA and permanent temporal visual field defect and 37 healthy eyes. The categorization of eyes according to the normative data- base of the instrument and sensitivity and specificity values were reported. RESULTS: The average thickness parameter demonstrated the highest sensitivity for detection of abnormalities in eyes with BA, followed by the parameters related to the temporal and nasal quadrants. Values of sensitivity were relatively lower for the 30 degree segments. CONCLUSION: StratusOCT with a normative database performed well in detecting retinal nerve fiber layer (RNFL) loss in eyes with BA. Clinicians should be aware of possible detection failure in the 30 degree segmental analysis, particularly at the 3 o’clock meridian. (Am J Ophthalmol 2007;143:896 – 899. © 2007 by Elsevier Inc. All rights reserved.) P ATIENTS WITH CHIASMAL COMPRESSION AND TEM- poral visual field (VF) loss often develop retinal nerve fiber layer (RNFL) loss in the nasal and temporal sectors of the optic nerve with relative preservation of Accepted for publication Nov 22, 2006. From the Division of Ophthalmology, Hospital das Clínicas of the University of São Paulo Medical School, São Paulo, Brazil (M.L.R.M., F.C.M.); and Hamilton Glaucoma Center and Department of Ophthal- mology, University of California, San Diego, California (F.A.M.). Inquiries to Mário L. R. Monteiro, Av. Angélica 1757 conj. 61, 01227-200, São Paulo, SP, Brazil; e-mail: mlrmonteiro@terra.com.br AMERICAN JOURNAL OF OPHTHALMOLOGY 896 MAY 2007