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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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Case Reports: Unusual presentation of more common disease/injury
Enhanced depth imaging optical coherence tomography of the optic nerve head improves correct diagnosis in glaucoma suspects without glaucomatous optic disc morphology
  1. Hamid Ahmadi1,2,3,
  2. Miriam Kolko1,2,3 and
  3. Steffen Hamann1,2
  1. 1Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
  2. 2Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  3. 3Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
  1. Correspondence to Dr Hamid Ahmadi; hamid.ahmadi.01{at}regionh.dk

Abstract

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.

  • glaucoma
  • visual pathway

https://doi.org/10.1136/bcr-2021-248109

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    Footnotes

    • Contributors The first draft of the manuscript was written by HA, and all the authors provided their comments. SH examined the patient, authored the figures and reviewed the manuscript. MK examined the patient and reviewed the manuscript. All authors read, edited and approved the case report.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.