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Case 12-9. Inferior Nasal Step

Clinical Summary

A 87-year-old white man had glaucoma in his left eye associated with an intraocular pressure of 28 mm Hg and a visual acuity of 20/40, He had been taking carteolol 1% twice daily in this eye. Slit-lamp examination revealed evidence of pseudoexfoliation and 2-3+ nuclear sclerosis of the crystalline lens. Dilated ophthalmoscopy (A) showed a moderately cupped disc with thinning of the neuroretinal rim superotemporally. A Humphrey visual field (C) showed an advanced inferior nasal step.

Optical Coherence Tomography

The circular OCT image (D) showed a diffuse decrease in nerve fiber layer thickness throughout the image, with a focal area of thinning superotemporally. Within the superotemporal bundle, the nerve fiber layer thickness averaged at 1:00 was thinner than the 12:00 and 2:00 hours. In contrast, the thickness at 5:00 was greater than in the surrounding clock hours within the inferotemporal bundle.

Log Reflection

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