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Chapter 12

Case 12-13. Superior Arcuate Scotoma

Clinical Summary

A 65-year-old black woman was taking levobunolol 0.25% in both eyes for primary open-angle glaucoma. On examination of her right eye, the visual acuity was 20/20 with correction and the intraocular pressure was 14 mm I Ig. Slit-lamp examination was unremarkable. The angle was open to the ciliary body band on gonioscopy. Dilated fundus examination (A,B) showed moderate to marked cupping and the neuroretinal rim was attenuated from 5:00 to 7:00. A corresponding nerve fiber layer defect was also observed- A Humphrey visual field (D) showed an early superior arcuate scotoma.

Optical Coherence Tomography

A 3.4 mm diameter circular tomogram (E) was acquired around the optic disc- Moderate thinning of the nerve fiber layer was observed diffusely with marked attenuation inferiorly and inferotemporally.

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