Well, I'm sure that this is going to sound like a dumb question to all of you optho people, but I'd still like some help with it anyways. I had a patient c/o intermittent blurry vision for the past year. She had no real signficant PMHx, and upon further questioning, she stated that every time she went to an optometrist with this complaint, the optometrist would increase her prescription (she was now on bifocals, but claimed to be able to see better without them so she never wore them, didn't have them in the office). I was pressed for time because she had multiple other complaints, so I didn't do a complete optho exam, but I did try to do a fundoscopic exam (on undilated pupils) just for kicks. The odd part was that the bottom pupil was hazy b/l on fundoscopic exam. No matter how I tried to adjust my fundoscope, I couldn't see through the bottom half of the pupil; it was just a dark black shadow overlying it. Could this have been some real pathology, or was this just due to physical examiner incompetence? I kind of regret not checking visual fields, and I couldn't check acuity without her glasses; so we just referred her to outpatient optho.