Gradual Painless 10 Year Visual Loss then Sudden Painful Loss in 80 Year Old Man

An 80 year old man experienced gradual painless visual loss starting at age 70, was diagnosed with 'retinitis pigmentosa sine pigmentosa' based on normal-appearing anatomy, 20/20 acuity, enlarging ring scotomas, reduced amplitudes on ERG. He was not; treated. He continued working and driving. At 80 years of age he was awakened at 5AM one morning with a sudden bilateral decline in his vision accompanied by headache, retrobulbar pain and pressure. He was taken to the emergency room, then referred to a neuro-ophthalmologist.