Glaucoma Case Studies James C. Tsai, M.D. Associate Professor of Ophthalmology Director, Glaucoma Division Edward S. Harkness Eye Institute Columbia University

LD: Clinical History & Exam 78 y/o woman with glaucoma x 7 months PMHx: hypothyroid; Meds: Synthroid, Premarin Ocular Hx: negative; on Xalatan qhs OU Va: 20/40 OU, Ta: 17 OD, 22 OS (9:25 AM) SLE: 2+ NSC OU (+ PXE flakes), A/C D&Q Gonio: Grade II-III OU; CCT: 518 OD, 533 OS C/D ratio: 0.75 OD, 0.85 OS; thin temporally OU

LD: Clinical Assessment HVF: OD: WNL, OS: inf. arcuate defect/nasal step OCT3: OD: 88.0 microns, OS: microns Imp: PXF glaucoma w/ uncontrolled IOP (OS>OD) ? Thin CCT OU a risk factor Target IOP: mid-teens OU Treatment Plan: ??

Patient: J.D. 47 y.o. M w/ COAG & recurrent erosions FHx of POAG, Myopia (-4 to -6 D) Va 20/20 OU; IOP 18 OD, 16 OS cc: grayer & darker vision (OD > OS) C/D = 0.8 OD, 0.7 OS (cupped temporally) Meds: Betaxolol, Propine

Patient: J.D. Initial ALT OD, followed by ALT OS 1 year later: c/o worse vision (OS > OD) Va 20/20 OU; IOP 10 OD, 11 OS Diurnal curve: peak of 13 OU HVF: worse OU C/D = 0.9 OD; 0.85 OS

Patient: J.D. Neuro-ophthalmology consult: B-12 and folate: WNL CT of orbits: WNL 3 months later: IOP 16 OU; cc: OS dimmer TBX w/ MMC OS & OD 2 months later 5 year F/U: Va 20/20 OU; IOP 10 OD, 9 OS HVF stable OU; No visual loss

Visual Fields Pre-Surgery

Visual Fields Post-Surgery

Case Presentation 15 year old boy S/P trauma OD (tennis ball) Cc: Blurred vision OD x 3 months PMHx: negative Va: 20/200 OD, 20/20 OS IOP: 4 mm Hg OD, 15 mm OS SLE (OD): deep A/C, trace RBCs

Gonioscopy

Funduscopy

Anterior Ultrasound

Assessment Ocular hypotony OD (with maculopathy) Cyclodialysis cleft with concomitant angle recession Treatment: 1. Argon laser closure of cleft 2. Surgical closure of cleft Need to monitor for post-op IOP spike (? Concurrent Stage 1 glaucoma tube)

74 Year Old Female Followed in glaucoma clinic for COAG Noted progressive ↓ in vision Referred to retina clinic to evaluate macula VA:20/50 OD 20/80 OS 0.6 log unit RAPD OS Color 1/15 OU

Optic Disc Exam

Humphrey Visual Fields

Neuroimaging