Clinical imaging: OCT clinical indicators for functional testing – Case #5

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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 #5

Case supplied by Run Yan, Specsavers Mornington, VIC

Px: 74-year-old male
IOPs: RE 11mmHg and LE 14mmHg

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:

  • Thinner inferior rim on RNFL Analysis in both eyes
  • Larger CD ratios, with the vertical CD ratio in the LE being outside normal ranges
  • Thinner ganglion cell layers outside normal ranges in both eyes.

Functional testing was conducted, and the visual field results are shown below.

Visual field results:

The visual field results show a superior nasal step in the RE and superior nasal defect in the LE. Both visual field results have a GHT that is outside normal limits, and the right visual field has a mean deviation of -5.03dB.

According to the RANZCO Referral Pathway for Glaucoma Management, this patient has early glaucoma. The patient was referred to an ophthalmologist and is now being cared for collaboratively by the optometrist and ophthalmologist.

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

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