Clinical imaging: OCT clinical indicators for functional testing – Case #10

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With a focus on diagnosis of eye disease, particularly glaucoma, the following clinical images demonstrate the importance of performing appropriate functional testing when it is clinically indicated in structural assessment.

Case #10

Case supplied by Vincent Meehan, Specsavers Townsville Castletown, QLD

Px: 79-year-old female
IOPs: RE 16mmHg and LE 12mmHg

OCT widefield reports:

Consider the structural information provided in the OCT scans above:

  • What’s normal?
  • What’s abnormal?
  • Are there any clinical indications for functional testing?

Discussion

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The OCT widefield reports contain the following clinical indicators for functional testing:

  • RE and LE superior RNFL thinning outside normative limits, more obvious when referencing the TSNIT graphs. Mild inferior peripapillary atrophy also present.
  • Large vertical CD ratios in both eyes. Although within normative limits, this may also be a reasonable indication for further functional testing.

Visual field results:

The visual field results show an infero-nasal defect in both eyes with GHT index outside normal limits. This case highlights the importance of conducting further functional testing for any RNFL or ganglion cell complex defects to comprehensively assess for disease.

This patient is currently being seen by an ophthalmologist and was diagnosed with normal-tension glaucoma, managed with Xalacom.

More in the ‘OCT clinical indicators for functional testing’ series
Case #1 and series introduction
Case #2
Case #3
Case #4
Case #5
Case #6
Case #7
Case #8
Case #9
Case #10

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