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Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.

On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.

A dilated fundus examination was performed demonstrating the following:

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Glaucoma

Case 5

Patient Presentation: A 73-year-old female presented to a comprehensive ophthalmology clinic for her annual follow-up visit. Her visual acuity was 20/20 OU. IOP was 16 OD and 26 OS. ONH/RNFL OCT and Macular Cube OCT analyses were completed and shown below:

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Question: What main abnormality is seen on ONH/RNFL OCT OS?

A. Bow-tie atrophy

B. Reduced RNFL thickness in the inferior and superior vulnerability zones

C. Nasal insertion of RNFL into disc

D. Temporal insertion of RNFL into disc

Question: What features on OCT suggest glaucoma in the left eye?

A. Cup-to-disc ratio of 0.72

B. Thin inferior and superior vulnerability zones

C. Reduced inferior neuro-retinal rim thickness

D. All of the above

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Visual Fields were performed and shown below.

Question: What is the likely diagnosis in this patient?

A. Pre-Perimetric Glaucoma

B. Ocular Hypertension

C. Moderate Glaucoma

D. Chronic BRVO

Learning Objectives:
1. Interpreting OCT RNFL and macular cube images in patients with pre-perimetric glaucoma.
2. Identifying RNFL deficits corresponding to the inferior and superior vulnerability zones.
3. Identifying reduced retinal thickness corresponding to the macular vulnerability zone.
4. Correlating OCT deficits with visual field changes.

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