Neuro-Ophthalmology

Case 21

Patient Presentation: A 23-year-old female was referred to a neuro-ophthalmology clinic for possible optic disc edema. Her past medical history was significant for obesity. Visual acuity was 20/25 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: 

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There are indistinct nasal optic disc margins in both eyes.

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Visual fields show non-specific depressed points in both eyes.
An OCT RNFL was performed below:

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Question: What pathology is seen on the OCT RNFL? 

A 5-line Raster OCT of the optic nerve heads were conducted and shown below:

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Question: What disease process is seen on the above OCT images?

Following conservative management, the patient returned for a 6-month follow-up. Her fundus photo of the right eye (shown below) demonstrated marked improvement of the blurred nasal disc margin. This change was also appreciated in the left eye. 

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The HD Cross OCT over the optic nerve OD at the 6-month follow-up is shown below:

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Question: What is the key difference in this follow-up OCT macula image compared to initial presentation? 

Learning Objectives:

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

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