Low Tension Glaucoma - 59 Year Old Woman
|
|
59-year-old woman has a history of glaucoma dating back to 1990. She had trabeculectomy in the left eye in 1998 and then persisted to lose vision despite normal intraocular pressures from low-tension glaucoma in the left eye. She is now on Cosopt and Travatan in both eyes. Her sister also has low-tension glaucoma. She had cataract surgery back in 2007 with subsequent YAG capsulotomy. She has had a floater in the eye since the YAG capsulotomy. On May 29th of 2009 she noted temporal flashes in the right eye, particularly at night and particularly on head movement. She is concerned about this because the right eye is her better eye.
VISUAL ACUITY: Vision OD is 20/20, OS is 20/16. IOP: OD 9, OS 6.
SLIT LAMP EXAM: The right eye posterior chamber intraocular lens is in good position with an open capsule. The left eye has a posterior chamber intraocular lens in good position.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.6. There is a posterior vitreous separation. With scleral depression, there are no retinal tears.
OS: Vertical C/D ratio is 0.9. There is an inferior notch to the optic nerve which is pale. There is no posterior vitreous separation.
OCT SCAN: The nerve fiber layer shows nerve fiber layer atrophy in both eyes but the right eye remains within normal limits with an average thickness of 94 microns. The left eye has an average nerve fiber layer thickness of 79 microns with particular thinning of the inferior pole. The optic nerve’s photos confirm clinical findings.
IMPRESSION:
1. LOW-TENSION GLAUCOMA – WORSE IN THE LEFT EYE THAN RIGHT EYE
2. ACUTE POSTERIOR VITREOUS SEPARATION WITHOUT TEARS – RIGHT EYE
DISCUSSION: I explained to the patient the right eye has had a vitreous separation. I assured her the risk of retinal tears is no more than 2% and the risk of retinal detachment of about 1:1000. I asked her to return for check in six weeks, sooner should she notice increased floaters or shadows.
|
Low Tension Glaucoma - Arrows show nerve fiber layer defect1174 views59-year-old woman has a history of glaucoma dating back to 1990. She had trabeculectomy in the left eye in 1998 and then persisted to lose vision despite normal intraocular pressures from low-tension glaucoma in the left eye. She is now on Cosopt and Travatan in both eyes.
Vision OD is 20/20, OS is 20/16. IOP: OD 9, OS 6.
(0 votes)
|
|
Low Tension Glaucoma1082 views59-year-old woman has a history of glaucoma dating back to 1990. She had trabeculectomy in the left eye in 1998 and then persisted to lose vision despite normal intraocular pressures from low-tension glaucoma in the left eye. She is now on Cosopt and Travatan in both eyes.
Vision OD is 20/20, OS is 20/16. IOP: OD 9, OS 6.
(0 votes)
|
|
Low Tension Glaucoma798 views59-year-old woman has a history of glaucoma dating back to 1990. She had trabeculectomy in the left eye in 1998 and then persisted to lose vision despite normal intraocular pressures from low-tension glaucoma in the left eye. She is now on Cosopt and Travatan in both eyes.
Vision OD is 20/20, OS is 20/16. IOP: OD 9, OS 6.
(0 votes)
|
|
Low Tension Glaucoma941 views59-year-old woman has a history of glaucoma dating back to 1990. She had trabeculectomy in the left eye in 1998 and then persisted to lose vision despite normal intraocular pressures from low-tension glaucoma in the left eye. She is now on Cosopt and Travatan in both eyes.
Vision OD is 20/20, OS is 20/16. IOP: OD 9, OS 6.
(0 votes)
|
|
Low Tension Glaucoma715 views59-year-old woman has a history of glaucoma dating back to 1990. She had trabeculectomy in the left eye in 1998 and then persisted to lose vision despite normal intraocular pressures from low-tension glaucoma in the left eye. She is now on Cosopt and Travatan in both eyes.
Vision OD is 20/20, OS is 20/16. IOP: OD 9, OS 6.
(0 votes)
|
|
|
|
|
|
|
59-year-old woman has a history of glaucoma dating back to 1990. She had trabeculectomy in the left eye in 1998 and then persisted to lose vision despite normal intraocular pressures from low-tension glaucoma in the left eye. She is now on Cosopt and Travatan in both eyes. Her sister also has low-tension glaucoma. She had cataract surgery back in 2007 with subsequent YAG capsulotomy. She has had a floater in the eye since the YAG capsulotomy. On May 29th of 2009 she noted temporal flashes in the right eye, particularly at night and particularly on head movement. She is concerned about this because the right eye is her better eye.
VISUAL ACUITY: Vision OD is 20/20, OS is 20/16. IOP: OD 9, OS 6.
SLIT LAMP EXAM: The right eye posterior chamber intraocular lens is in good position with an open capsule. The left eye has a posterior chamber intraocular lens in good position.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.6. There is a posterior vitreous separation. With scleral depression, there are no retinal tears.
OS: Vertical C/D ratio is 0.9. There is an inferior notch to the optic nerve which is pale. There is no posterior vitreous separation.
OCT SCAN: The nerve fiber layer shows nerve fiber layer atrophy in both eyes but the right eye remains within normal limits with an average thickness of 94 microns. The left eye has an average nerve fiber layer thickness of 79 microns with particular thinning of the inferior pole. The optic nerve’s photos confirm clinical findings.
IMPRESSION:
1. LOW-TENSION GLAUCOMA – WORSE IN THE LEFT EYE THAN RIGHT EYE
2. ACUTE POSTERIOR VITREOUS SEPARATION WITHOUT TEARS – RIGHT EYE
DISCUSSION: I explained to the patient the right eye has had a vitreous separation. I assured her the risk of retinal tears is no more than 2% and the risk of retinal detachment of about 1:1000. I asked her to return for check in six weeks, sooner should she notice increased floaters or shadows.
