Clinical imaging: OCT clinical indicators for functional testing – Case #9

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

Case #9

Case supplied by Melina D’Agostini, Specsavers Tea Tree Plaza, SA

Px: 35-year-old female attending for routine check-up. No diplopia, flashes / floaters or other remarkable symptoms. Some trouble with seeing high-contrast print.
IOPs: RE 12mmHg and LE 11mmHg

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:

  • Thinning of the RNFL layers outside normative limits, as well as nasal ganglion cell layer (GCL) thinning outside normative limits in the RE
  • Generalised loss of RNFL and GCL, more infero-temporally
  • Asymmetric retinal nerve fibre presentation between the two eyes.

Visual field results:

The visual field results show a right defect localised to the upper supero-temporal quadrant and a left defect also localised largely to the upper supero-temporal quadrant.

The patient was referred urgently to an ophthalmologist for a homonymous superior quadrantanopia. The ophthalmologist agreed with the diagnosis and ordered further MRI imaging.

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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