Clinical imaging: OCT clinical indicators for functional testing – Case #6

113

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 #6

Case supplied by Fiona Barrett, Specsavers Cannonvale, QLD

Px: 62-year-old with Type II diabetes
IOPs: RE 14mmHg and LE 16mmHg
Additional Information: No FOH of glaucoma, angles open, no other remarkable risk factors

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

Click to reveal

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

  • Quality of the RE OCT is low, although there may be some thinning of the RNFL layers outside normal limits. The fundus image is also difficult to assess, with stereoscopic fundus examination the standard to assess the retina.
  • The quality score for the LE OCT is higher. The clear asymmetry in the superior and inferior portions of the RNFL, as well as the thinner ganglion cell complex, are appropriate indications to perform a visual field test for further assessment.

A complete clinical examination was conducted, including functional testing based on the indications in the LE scan. The visual field results are shown below.

Visual field results:

The visual field results show a normal field result in the RE, and an inferior nasal step outside of normal in the LE.

Taking their age into account, and due to correlating structural and functional defects, this patient was referred to ophthalmology as a glaucoma suspect.

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

Print