Neuro-Ophthalmology

Case 10

Patient Presentation: A 64-year-old female was referred to neuro-ophthalmology clinic for bilateral blurred optic disc margins. Her past medical history was significant for obesity. Visual acuity was 20/40 OD and 20/30 OS with equal pupil sizes and no RAPD. Colour vision was 14/14 on Ishihara plates OU. Fundus photos and Humphrey 24-2 SITA-fast visual fields are shown below:

Neuro-Ophthalmology 10-1.png

There are indistinct nasal optic disc margins in both eyes.

Neuro-Ophthalmology 10-2.png

Visual fields show non-specific depressed points in both eyes.

An OCT RNFL was performed below:

Neuro-Ophthalmology 10-3.png

Question: What pathology is seen on the OCT RNFL?

Neuro-Ophthalmology 10-6.png
Neuro-Ophthalmology 10-7.png

Question: A spectralis OCT of the optic nerve heads were conducted and shown above. What disease process is seen on the above OCT images?

References:

1. Hedges TR, Flattem NL, Bagga A. Vitreopapillary traction confirmed by optical coherence tomography. JAMA Ophthalmol 2006;124(2):279-281.

Learning Objectives:

1. To recognize signs of vitreopapillary traction on OCT and to include in the differential of asymptomatic optic disc edema.