Neuro-Ophthalmology

Case 1

Patient Presentation: A 64-year-old male was referred for assessment of possible glaucoma OU. He is unclear regarding his past medical history and notes no new visual symptoms. Visual acuity was 20/30 OD and 20/25 OS, intraocular pressure was 16 OD and 18 OS and there was no relative afferent pupillary defect. OCT of the retinal nerve fiber later (RNFL) and macular ganglion cell complex (GCC) are shown below.

Neuro-Ophthalmology 1-1.png
Neuro-Ophthalmology 1-2.png

Question: These OCT findings suggest which of the following:

Question: What visual field pattern do you expect to see based on the OCT findings?

Question: Why is the horizontal RNFL thinned in the right eye and vertical RNFL thinned in the left eye? (Best seen on the thickness and deviation maps)

Question: This patient’s left retrochiasmal lesion is:

Learning Objectives:

1. Retro-geniculate lesions (strokes, tumours, etc.) can cause retinal changes via retrograde trans-synaptic degeneration.

2. Important to keep in mind when seeing referrals for RNFL thinning