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Case 12-12. Superior Arcuate Scotoma

Clinical Summary

A 50-year-old white woman with normal tension glaucoma was being treated with timolol 0.5% twice daily and apraclonidine 0.5% in both eyes three times a day. On examination of her right eye, the intraocular pressure was 15 mm Hg and the visual acuity was 20/20. Slit-lamp examination was unremarkable and gonioscopv revealed the angles to be open to the ciliary body band. Fundus examination (A,B) displayed marked cupping with loss of the neuroretinal rim from approximately 6:00 to 9:00. A Humphrey visual field (D) revealed a dense superior arcuate scotoma splitting fixation.

Optical Coherence Tomography

A 3.4 mm diameter circular tomogram (E) around the optic disc was notable for extreme, diffuse attenuation of the inferior nerve fiber layer. There was relative preservation of the superior nerve fiber layer.

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