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Clinical Summary

A 70-year-old white woman with primary open-angle glaucoma was taking timolol 0.5% once daily and pilocarpine Ocusert 40s weekly, in both eyes. The right eye had a visual acuity of 20/25 with an intraocular pressure of 12 mm Hg. Slit-lamp examination revealed 2+ nuclear sclerosis of the crystalline lens, but was otherwise normal. The angle was open to the ciliary body band through 360°, Dilated ophthalmoscopy (A,B) showed marked cupping of the optic disc and loss of the neuroretinal rim inferotemporally A dense superior arcuate defect splitting fixation was noted on the Humphrey visual vield (D),

Optical Coherence Tomography

A 3.4 mm diameter circular tomogram (E) revealed atrophy of the retinal nerve fiber layer inferiorly The thinning was most significant from 7:00 to 9:00, consistent with the superior visual defect observed clinically

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