Case 12-11. Paracentral Scotoma

Clinical Summary

A 66-year-old white woman had been under treatment

tor normal tension glaucoma for the past four vears. Her current ocular medications included betaxolol 0.5% twice a day and carbachol three times daily. On examination of her right eye, the visual acuity was 20/20 and the intraocular pressure was 18 mm Hg. Slit-lamp examination and gonioscopy were both unremarkable, with visualization of the ciliary body band throughout 360°. Dilated ophthalmoscopy (A,B) showed marked cupping of the optic disc and loss of the neuroretinal rim from approximately 7:00 to 10:00. A disc hemorrhage was present at approximately the 1:00 position. A Humphrey visual field (D) revealed a superior paracentral scotoma extending to the blind spot.

Optical Coherence Tomography

A 3.4 mm diameter circular OCT tomogram (E) around the optic disc showed generalized thinning of the nerve fiber layer throughout the image. The most severe thinning occured between 7:00 and 9:00, consistent with both the loss of neuretinal rim in that region and the superior paracentral scotoma. The nerve fiber layer thickness exhibited a broad depression that reached a minimum of 20 (irn in this region.

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