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Case 12-19. Generalized Depression

Clinical Summary

An 80-year-old white man with primary open-angle glaucoma had borderline control of his intraocular pressure in his left eye. His medications included betaxolol 0.25% twice a day and pilocarpine 4% once daily. On examination, his visual acuity in this eye was 20/20 and the intraocular pressure was 19 mm Hg, Slit-lamp biomicroscopy revealed a normal anterior chamber and 1-2+ nuclear sclerosis of the crystalline lens. Dilated ophthalmoscopy (A) showed moderate to marked cupping of the optic disc and a slightly attenuated neuroretinal rim temporally Generalized depression was noted on a Humphrey visual field

Optical Coherence Tomography

A 3.4 mm diameter circular OCT tomogram (D) delineated moderate thinning in both the superotemporal (1:00 and 2:00) and inferotemporal (4:00 and 5:00) nerve fiber layer. The nasal nerve fibers, however, appeared to be spared.

Temporal

Log Reflection

Inferior

Superio

Nasal

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