Case 12-5* Superior Nasal Step

Clinical Summary

A 50-year-old white man had uncontrolled primary open-angle glaucoma despite a medical regimen of timolol 0,5% and pilocarpine 4% both twice daily In the right eye, his visual acuity was 20/160 and the intraocular pressure was 24 mm Hg. Slit-lamp examination and gonios-copy were normal and the angle was fully open to the ciliary body band. The right eye showed marked cupping and there was loss of the neuroretinal rim from approximately 6:00 to 9:00 (A, B), A localized superior nasal step was observed on a Humphrey visual field (D),

Optical Coherence Tomography

A circular tomogram (E) around the optic disc at a diameter of 3,4 mm demonstrated marked thinning of the nerve fiber laver from 6:00 to 9:00, consistent with the lack

of neuroretinal rim in that region. The nerve fiber laver thinning was greater than that predicted bv the visua! Meld defect alone.

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