Clinical imaging: OCT clinical indicators for functional testing – Case #7

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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 #7

Case supplied by Jeena Tan, Specsavers Mornington, VIC

Px: A middle-aged female patient
IOPs: RE 15mmHg and LE 18mmHg
Additional information: No FOH of glaucoma, angles open. Patient presented for a six-month review, following a previous examination for intermittent “tingling sensations” on the left side of the face. Functional testing was previously completed.

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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Consider the following clinical indicators for functional testing:

  • There appears to be infero-temporal thinning of the RNFL in the LE, outside normative ranges
  • The discs appear healthy with a larger CD ratio, although vertical CD ratios are within normal ranges
  • The patient’s IOPs are asymmetrical by 3mmHg

A range of factors, in conjunction with the patient’s presentation, contributed to the decision to conduct functional testing. Visual field results are shown below.

Visual field results:

The visual field results show largely normal fields, with results being similar to the previous visual field results from the earlier examination six months ago.

The patient was asked about a history of viral illness, and an intermittent history of cold sores and lip lesions was reported. The patient was referred to an ophthalmologist for a neuro-ophthalmological work up, with the patient’s GP included in the referral correspondence.

The GP’s reports relayed a normal MRI from the previous year, with the ophthalmologist recommending a referral to a neurologist for further work up, and a routine review of the patient’s optic nerves and general ocular health in two years.

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

Specsavers optometrists can now access additional OCT training based on this series on iLearn using the following path: Available Courses > Optometrist > Optical coherence tomography (OCT) > 04: OCT Case Studies
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