By Mark S. Dikopf, MD; Pete Setabutr, MD; and Thasarat S. Vajaranant, MD
A 72-year-old man with glaucoma was referred for evaluation. His medical history included systemic hypertension (not on beta-blocker treatment), obstructive sleep apnea, hypercholesterolemia, and diet-controlled diabetes mellitus.
The patient’s BCVA was 20/20 OD and 20/25 OS. Examination revealed 1+ corneal punctate epithelial erosions OU, mild nuclear sclerosis OU, open angles on gonioscopy, and inferior thinning of the optic disc OU (Figure 1). IOP was 16 mm Hg OD and 14 mm Hg OS on a nightly prostaglandin analogue drop. Inferior nerve thinning was confirmed by OCT, and 24-2 automated perimetry revealed a fixation-threatening superior arcuate depression OD and a superior arcuate depression OS (Figure 2A). Continued use of the prostaglandin analogue was recommended.
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