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Case 12-6. Superior Nasal Step

Clinical Summary

A 67-year-old white woman with primary open-angle glaucoma maintained an intraocular pressure of 23 mm Hg in her right eye. Her ocular medications included timolol 0.5% twice daily and pilocarpine 4"r tour times a day. Dilated fundus examination (A,B) of the right eve revealed advanced cupping with absence of the neuroretinal rim from 6:00 to 9:00. A Humphrey visual field (D) showed an advanced nasal step.

Tomography

A circular tomogram (E) around the optic nerve head at a diameter of 3.4 mm showed marked thinning of the nerve fiber layer from 6:00 to 9:00 corresponding to the loss of neuroretinal rim and the superior portion of the nasal step observed clinically. Moderate thinning of the superotemporal nerve fiber layer was also noted in the image consistent with the inferior area of scotoma.

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