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Chapter 12

Case 12-4. Superior Nasal Step

Clinical Summary

À 62-year-old white woman with primary open-angle glaucoma had an intraocular pressure on examination of 19 mm H g in her right eye while taking levobunolol twice a day and pilocarpine 4% four times daily Her visual acuity was 20/20, and a Humphrey visual field (D) showed a superior nasal step. Dilated fundus examination (A,B) revealed a moderately cupped disc with thinning of the neuroretinal rim inferotemporally

Optical Coherence Tomography

A 3.4 mm diameter scan (E) taken in a clockwise circle around the optic disc showed marked attenuation of the inferotemporal nerve fiber layer from 7:00 to 8:00, consistent with the superonasal visual field defect.

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