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 9
Patient Presentation: A 49-year-old myopic female with family history of primary open angle glaucoma (POAG) was referred by her optometrist with concern for glaucoma. Visual acuity was 20/20-1 OD and 20/20 OS. IOP was 20 mmHg OD and 26 mmHg OS. CCT was 560 μm OD and 545 μm OS. Scleral spur was visualized 360 degrees bilaterally on gonioscopy.
OCT ONH/RNFL and ganglion cell analysis (GCA) were performed and are shown below:
Question 1: What is the MOST accurate interpretation of the RNFL and GCA OCT findings?
Question 2: How would you best classify this patient’s left eye based on the provided OCT and visual field findings?
Question 3: How could you best manage this patient’s left eye?
References:
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Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002;120(6):701-830. doi:10.1001/archopht.120.6.701
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Gordon MO, Beiser JA, Brandt JD, et al. The Ocular Hypertension Treatment Study: Baseline Factors That Predict the Onset of Primary Open-Angle Glaucoma. Arch Ophthalmol. 2002;120(6):714–720. doi:10.1001/archopht.120.6.71
Learning Objectives:
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Differentiate ocular hypertension from established glaucoma by integrating intraocular pressure, OCT structural findings, and visual field testing.
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Apply risk-based clinical reasoning to determine when close observation versus intervention is appropriate in patients with ocular hypertension.
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Apply findings of the Ocular Hypertension Treatment Study into clinical practice.