Optometry case study – Glaucoma suspect

GLAUCOMA SUSPECT

by Michael Cheng, Specsavers

Reason for visit: 63 year old caucasian male presents as spectacles damaged, no other problems reported.
GH:Type 2 diabetes 10 years under control with medication.
Meds: Nutritional supplements
POH: : RE cornea, foreign body from welding, longstanding.
FOH: Mother- ARMD
LEE. 12/12 ago

Examination
Pupils: E&A DNC
No RAPD OU
Refraction:
R: -4.50/-1.75×80 6/6-
L: -3.75/-1.75×97.5 6/6
Add: +2.25 n6
No significant change from previous eye examination.

Ocular examination
Anterior chamber – open angles, 1:1 ratio to corneal thickness.
Quiet OU.
Lens – nuclear opacity grade 2.5 OU
RE C:D 0.4
LE C:D 0.5 Slight thinning of superior rims OU
Blood vessels – normal
Macula and peripheral retina – normal

IOPs
RE: 31mm Hg
LE: 21 mm Hg at 12.20 pm

Discussion

An overview of preceding eye examinations is given below:
2009 IOPs RE 21, LE 19
2011 IOPs RE 27 LE 22
Repeat IOPs and fields requested on collection of spectacles. These did not take place.
2012 IOPs RE 17, LE 15.
Patient was suffering headaches so visual fields were measured and a bilateral defect found. Px was referred to rule out a possible stroke. Discharged by neurologist , no follow up of field defect.
2013 IOPs RE 20 LE 16.

Previous records not reviewed, no field test carried out. In hindsight the visual field defect detected in 2012 was probably glaucomatous, the innocuous appearance of the optic nerve heads (never being recorded > 0.45) may have explained why this was not considered. Fluctuating IOPs could have made the diagnosis more difficult again.
This case illustrates the importance of reviewing previous records, in particular the advice and management section.

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