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 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?
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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.