Glaucoma Without Cupping? – Page 29 of 39
Case 5: Optomap® Fundus Image OD
Glaucoma Without Cupping? – Page 28 of 39
Case 4: Comparative Sagittal MRI The above images compare the sagittal MRI scans of a normal control (left image) and the 49 year old patient (right image). The patient shows volume loss in the ventral pons (blue circle) and cerebellum (red circle) when compared to the normal control. * See the
Glaucoma Without Cupping? – Page 27 of 39
Case 4: Diagnosis The patient is a glaucoma suspect but this pattern of RNFL loss is not typical of glaucoma. A non-glaucomatous optic neuropathy is hence possible. Olivopontocerebellar Atrophy (OPCA) aka Spinal Cerebellar Ataxia (SCA) is indicated by the MRI scans.
Glaucoma Without Cupping? – Page 26 of 39
Case 3: Optomap® plus with Resmax™ Image and Cirrus™ RNFL Thickness Analysis The right and left Optomap® plus with Resmax™ images are of an asymptomatic 49 year old attorney. VA is 20/20 and central fields are essentially normal. There is moderate diffuse loss temporally in each eye which is more difficult to observe
Glaucoma Without Cupping? – Page 25 of 39
Case 3: Optomap® plus with Resmax™ , GDx, and VF The superior temporal RNFL defect OD is confirmed with the GDx VCC and the inferior nasal visual field loss. As in a previous case, the field loss appears more extensive than one might predict and likely represents diffuse loss superimposed upon the more
Glaucoma Without Cupping? – Page 24 of 39
Case 3: Optomap® plus with Resmax™ Green Separation Image OD The true RNFL defect can easily be confused with a blood vessel (red arrow) when ophthalmoscopic viewing is limited to the area immediately around the disc. A third RNFL abnormality lies between the two thus far considered. This one is more obvious towards
Glaucoma Without Cupping? – Page 23 of 39
Case 3: Optomap® plus with Resmax™ Color Image OD In contrast to the RNFL defect that fans out towards the periphery, the more narrow defect above it appears to be a RNFL "slit".5 This slit does not widen towards the periphery. In his RNFL book, Harry Quigley uses the term slit to refer to
Glaucoma Without Cupping? – Page 22 of 39
Case 3: Optomap® plus with Resmax™ Approximately 15 minutes = 0.25 clock hour = 25,000 RNFL axons
Glaucoma Without Cupping? – Page 21 of 39
Case 3: Optomap® plus with Resmax™, GDx, and VF The RNFL defects correspond with GDx abnormalities. The inferior nasal field defect in this left eye appears denser than what one would anticipate based upon the optos® images and the GDx. There is likely diffuse RNFL loss in addition to the more obvious
Glaucoma Without Cupping? – Page 20 of 39
Case 3: Optomap® plus with Resmax™ Green Separation Image OS A true RNFL defect tapers as it approaches the optic disc. Such real RNFL defects are often very difficult to observe when in close proximity to the disc such as in this case. There are at least 2 reasons for the apparent disappearance of