|
Jump
to the Solution by clicking here
Physical
Examination Findings (Click on Image to Enlarge)
Visual
Field OD, Threshold 24-2 (Click on Image to Enlarge)
Visual
Field OS, Threshold 24-2 (Click
on Image to Enlarge)
Case History:
43-year old woman presents for routine diabetic retinal examination. She has had Type 2 DM for the past 4 years. Her most recent HbA1c was 11.0%; CR 0.5, BUN 9, Total Chol 276, Triglycerides 625, HDL 55, LDL "off the scale". Because of asymmetry of each disk, I ordered a 24-2. twice and both fields were consistent (1 month
apart)
Questions:
-
Is
this Glaucoma?
-
How
would you manage this patient?
What
Dr. Hom Says:
Frequently, a 0.90 optic nerve cup gives
sufficient justification for further testing of the nerve fiber
layer, visual field and even a direct measurement of the nerve fiber
layer. The visual field was distinctly abnormal but atypical for
glaucoma. He OCT was normal. But the MRI did show some calcification
of the grey matter. A vascular accident or even a brain tumor is
still possible causes and are awaiting those results. As a
precaution, the patient was started on Xalatan, 1 drop, each eye,
once a night, at bedtime.
Go
to Top of Page
Click
here for Dr. Hom's Response
Click
Here to Return to Grand Rounds Case Index
Return
to Home Page
|
