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Enhanced depth imaging optical coherence tomography of the optic nerve head improves correct diagnosis in glaucoma suspects without glaucomatous optic disc morphology

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An 83-year-old woman with a long history of glaucoma and optic disc drusen (ODD) was referred for neuro-ophthalmological second opinion. The patient had been treated for decades with bilateral intraocular pressure (IOP)-lowering eye drops, laser trabeculoplasty and trabeculectomy and had severe, bilateral loss of visual fields and retinal nerve fibre layer (RNFL) thinning on optical coherence tomography (OCT) despite IOP that never exceeded 24 mm Hg. On ophthalmoscopy, only a single ODD was visible in the left eye and no optic disc cupping was apparent in either eye. Enhanced depth imaging OCT (EDI-OCT) of the optic nerve head revealed bilateral multiple, large, deep ODD, which in itself could easily explain the visual field loss and RNFL thinning of this patient. Optic nerve head examination using EDI-OCT is highly recommended for patients with a history of glaucoma but without optic nerve head cupping to avoid a potential misdiagnosis with consequent unnecessary treatment.

Original languageEnglish
Article numbere248109
JournalBMJ Case Reports
Volume15
Issue number2
Number of pages4
ISSN1757-790X
DOIs
Publication statusPublished - 2022

Bibliographical note

© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.

    Research areas

  • Aged, 80 and over, Female, Glaucoma/complications, Humans, Intraocular Pressure, Optic Disk/diagnostic imaging, Tomography, Optical Coherence/methods, Visual Field Tests, Visual Fields, glaucoma, visual pathway

ID: 75774284