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Case #60 – Does my Myopic Patient Have Glaucoma? – Page 12 of 22

OS: first glaucoma evaluation (left) and 6 months later (right) Humphrey 24-2 visual field with size V target of the left eye. A size V target was chosen for this eye as the BCVA was 8/225 due to a macular scar. In December of 2020 there was a superior, central defect due to eccentric

Case #60 – Does my Myopic Patient Have Glaucoma? – Page 12 of 222022-07-05T20:36:14+00:00

Case #60 – Does my Myopic Patient Have Glaucoma? – Page 11 of 22

Visual FieldOD: first glaucoma evaluation (left) and 6 months later (right) Humphrey 24-2 visual field with size III target of the right eye. In December of 2020 there were superior temporal defects observed in the right eye. In June of 2021 there was possible progression of those superior temporal defects and also superior nasal

Case #60 – Does my Myopic Patient Have Glaucoma? – Page 11 of 222022-07-05T20:30:45+00:00

Case #60 – Does my Myopic Patient Have Glaucoma? – Page 10 of 22

Macula Ganglion Cell Count (GCC) Measurements in Myopic Patients Illustration that demonstrates the inferior vulnerability zone consists of macular fibers, and the superior vulnerability zone does not consist of macular fibers.10 The analysis of the inner retinal thickness in the macula is complementary to the RNFL scan and provides useful diagnostic information in glaucoma

Case #60 – Does my Myopic Patient Have Glaucoma? – Page 10 of 222022-07-05T20:28:40+00:00

Case #60 – Does my Myopic Patient Have Glaucoma? – Page 9 of 22

OCT Reference/Normative Database Exclusion criteria for the different OCT companies studies for their normative database.9 With each OCT scan, the result is compared to that specific company’s normative database. These databases were created by each company’s studies of “normal” individuals. Each company had a specific inclusion and exclusion criteria for those that would be

Case #60 – Does my Myopic Patient Have Glaucoma? – Page 9 of 222022-07-05T20:24:32+00:00

Case #60 – Does my Myopic Patient Have Glaucoma? – Page 8 of 22

Example of Temporalization of RNFL in Highly Myopic Patients OCT RNFL heat map and statistical analysis of an eye with spherical error of -6.75 D (top) and -2.00 D (middle). There is a decreased angle between the RNFL bundles showing greater temporalization of RNFL bundles in the more myopic eye.7 The bottom image shows

Case #60 – Does my Myopic Patient Have Glaucoma? – Page 8 of 222022-07-05T20:15:15+00:00

Case #60 – Does my Myopic Patient Have Glaucoma? – Page 7 of 22

Poor Segmentation on OCT One of the difficulties clinicians can have with the OCT in highly myopic patients is poor segmentation of the OCT to measure the thickness of the RNFL. It is important to look at the tomograms (bottom three images of each eye) to make sure the measurement is accurate. If there

Case #60 – Does my Myopic Patient Have Glaucoma? – Page 7 of 222022-07-05T20:10:59+00:00

Case #60 – Does my Myopic Patient Have Glaucoma? – Page 6 of 22

Cirrus RNFL OCT Cirrus OCT RNFL of this patient. Due to the long axial length of this patient, the left eye was not able to be imaged. When looking at the tomograms on the bottom left of the image, you can see the poor segmentation of the OCT making this scan inaccurate and

Case #60 – Does my Myopic Patient Have Glaucoma? – Page 6 of 222022-07-06T20:01:12+00:00

Case #60 – Does my Myopic Patient Have Glaucoma? – Page 5 of 22

Optomap color fundus photographs Note the tilted optic nerve heads with posterior staphylomas. Estimated C/D 0.75. Tilting of the optic nerve and posterior staphylomas commonly seen in highly myopic patients make the assessment more challenging and in some cases impossible. The chorioretinal macular scarring in the left eye fundus photograph (bottom) also complicates

Case #60 – Does my Myopic Patient Have Glaucoma? – Page 5 of 222022-07-05T20:08:14+00:00

Case #60 – Does my Myopic Patient Have Glaucoma? – Page 4 of 22

CASE 1:History / Chief Complaint:A 57-year old African American male with degenerative myopia presents for a follow up for glaucoma suspicion secondary to asymmetric optic nervesSeen initially in Primary Care in 2020 and second visit for glaucoma evaluation 6 months laterThe patient has no family history of glaucoma and has never used IOP lowering medicationsHistory

Case #60 – Does my Myopic Patient Have Glaucoma? – Page 4 of 222022-07-06T19:58:59+00:00

Case #60 – Does my Myopic Patient Have Glaucoma? – Page 3 of 22

Glaucoma is the leading cause of irreversible blindness worldwide.3 Glaucoma is a very complex condition that has many risk factors, including myopia. Previous epidemiological studies have reported the increased risk of developing Glaucoma in myopic patients. These studies span multiple decades, ethnic groups and populations around the world. The studies are the Blue Mountain Eye

Case #60 – Does my Myopic Patient Have Glaucoma? – Page 3 of 222022-07-05T19:46:24+00:00