A 34 year-old African American female reports a two-week history of intermittent visual blurring, worse with bending over. She reports an associated bilateral, frontal headache which lasts a few hours but improves with lying down. She denies tinnitus, loss of sensory or motor function. Her blood pressure, when checked twice daily, is never more than 140/80. Past medical history is significant for stage V chronic kidney disease on peritoneal dialysis, hypertension, acne, and hyperlipidemia. She takes the following medications: aspirin 325mg, docusate, doxazosin, doxycycline 100mg BID, metoprolol, simvastatin, omeprazole.
Exam: BP 128/78, Weight 130 kg
Best corrected visual acuity 20/20 each eye. IOP 17mmHg in each eye by tonometry. No strabismus or restricted motility. Confrontational visual fields full to finger counting bilaterally. Color plates: 12/15 right eye, 11/15 left eye. Anterior segment slit lamp exam within normal limits. Dilated fundus exam is as follows (right and left):