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
[su_accordion][su_spoiler title=”Click to reveal” open=”no” style=”fancy” icon=”chevron” anchor=”” class=””]
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.
[/su_spoiler][/su_accordion]
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