A 45-year-old female patient presents with symptoms of tingling in the fingers, muscle cramps, and fatigue. Her laboratory results show low serum calcium, low parathyroid hormone (PTH) levels, and elevated serum phosphate levels. Based on these lab results, which of the following is the most likely diagnosis?

Choice A Reason:

Macular degeneration primarily affects central vision and is characterized by a gradual loss of vision rather than sudden symptoms. It does not typically cause flashes of light, shadows over the visual field, or floaters. These symptoms are more indicative of a retinal issue.

Choice B Reason:

Cataracts cause clouding of the lens, leading to blurred vision and difficulty seeing at night. However, they do not cause sudden flashes of light, shadows over the visual field, or floaters. Cataracts develop gradually and do not present with acute symptoms.

Choice C Reason:

Glaucoma is associated with increased intraocular pressure, which can lead to gradual loss of peripheral vision. While acute angle-closure glaucoma can cause sudden symptoms, it typically presents with severe eye pain, headache, and nausea, rather than flashes of light and floaters.

Choice D Reason:

Retinal detachment is characterized by the sudden onset of flashes of light, floaters, and a shadow or curtain over the visual field. These symptoms occur because the retina is pulling away from its normal position, which can lead to vision loss if not treated promptly. Immediate medical attention is required to prevent permanent vision loss.

Choice A Reason:

Tonometry is a diagnostic test that measures the intraocular pressure (IOP) inside the eye. This measurement is crucial for detecting and managing glaucoma, as elevated IOP is a significant risk factor for the disease. By measuring the pressure, healthcare providers can assess the risk of optic nerve damage and initiate appropriate treatments to prevent vision loss.

Choice B Reason:

Tonometry does not allow for the inspection of the optic disc for signs of degeneration. This function is typically performed using ophthalmoscopy or optical coherence tomography (OCT), which provide detailed images of the optic nerve and retina. These tests are essential for evaluating the structural damage caused by glaucoma but are not part of the tonometry procedure.

Choice C Reason:

Tonometry is not performed to evaluate peripheral vision. Peripheral vision is assessed using perimetry or visual field testing, which maps the field of vision and detects areas of vision loss. This test helps determine the extent of visual impairment caused by glaucoma but is separate from tonometry.

Choice D Reason:

Tonometry does not diagnose the type of glaucoma. While it measures intraocular pressure, diagnosing the specific type of glaucoma requires a comprehensive eye examination, including gonioscopy to examine the drainage angle of the eye and other tests to assess optic nerve health and visual field. Therefore, tonometry is just one component of the diagnostic process.