III.5 Glaucoma Example

A patient was presented with normal visual acuity OU (both eyes), intraocular pressures (IOP) of 18 mm Hg OU (both eyes), and 0.7 C/D OD (right eye) and 0.6 C/D ratio OS (left eye). Corneal pachymetry showed slight thinning in both eyes at 523µ OD (right eye) and 530µ OS (left eye). Static threshold perimetry testing showed nonspecific defects OU (both eyes) and was unreliable due to multiple fixation losses. Confocal scanning laser ophthalmoscopy produced OPM topographic representations of both optic nerves suggestive of glaucoma. The contouring of the optic nerve head (ONH) in the left eye showed a slightly enlarged cup with diffuse thinning of the superior neural rim. In the right eye, there was greater enlargement of the cup and sloping of the cup superior-temporally with a clear notch of the neural rim at the 12:30 position. Corneal compensated scanning laser polarimetry was performed bilaterally. Analysis of the OPM representation of the retinal nerve fiber layer (RNFL) thickness map showed moderate retinal nerve fiber loss with accentuation at the superior pole bilaterally. The patient was diagnosed with normal tension glaucoma and started on a glaucoma medication. Follow-up examinations showed stable reduction in his IOP to 11 mm Hg OU (both eyes) and no further progression of his ONH or RNFL defects.