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Case 6

Patient Presentation: A 57-year-old woman with a past medical history of hypertension was referred to a tertiary ophthalmology clinic to rule out glaucoma. The referring ophthalmologist noted her IOP max was 23 OD and 20 OS and that her OCT imaging was always “within normal limits.” She denied past ocular history, but did note her mother was diagnosed with glaucoma at age 65. She denied use of eye drops.
Her BCVA was 20/20 OD and 20/20 OS. IOP was 22 OD and 19 OS; there was no RAPD. OCT of RNFL/ONH were taken and are shown below:


Question 1: The RNFL thickness map and RNFL deviation map show both eyes’ RNFL thickness within the “green zone.” Is there anything concerning with this OCT RNFL?

Question 2: What type of disease is this classified as?

Question 3: What anatomical region of the RNFL is affected in this patient?

An OCT of the ganglion cell complex was conducted and is shown below:


Question 4: What is the main finding in this OCT GCC?

The patient underwent a 24-2 Humphrey Visual Field, which is shown below:


Question 5: What is the key finding in this OD 24-2 HVF?

Learning Objectives:
1. Approach OCTs like a radiologist, not a stock broker
2. The contralateral eye may be a better control than the normative database
3. TSNIT plot is the quarterback for glaucoma diagnosis and OCT interpretation
4. Look closely at the inferior macular vulnerability zone
5. Utilize OCT GCC to corroborate findings as this may be more sensitive than the OCT RNFL


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