A 67-year-old male who was the victim of blunt trauma to the right eye 50 years earlier attended for a periodic examination. He was new to the area and admitted to a family history of glaucoma.
His medical history was remarkable only for several uneventful surgical procedures. He took no medications except vitamin supplements. A decade ago he had cataract extraction with intraocular lens (IOL) implantation and subsequent YAG-capsulotomy in the right eye.
Previously from Dr. Semes: When diabetes goes from bad to worse
Visual acuity was correctable to 20/20 in each eye. Age-appropriate lens changes were noted in the phakic left eye. The intraocular pressure (IOP) was measured with Goldmann applanation tonometry at 18 mm Hg in each eye.
Dilated fundus evaluation revealed optic discs consistent with myopic refractive correction, normal retinal vasculature in each eye, age-appropriate macular appearance, and post-traumatic retinopathy superior to the right optic nerve head.
Corneal hysteresis (Figure 1) as well as optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) were performed to demonstrate changes indicative of glaucoma despite the normal Goldmann applanation tonometry but in view of the positive family history and the patient’s age.
A scan through the area affected by the trauma revealed absence of inner retina (cross-section on OCT—Figures 2A and 2B), and absence of retinal vasculature within both the inner and outer retina on the OCTA images (Figures 3A and 3B). A steep-margined absolute scotoma was demonstrated on threshold visual field testing.
OCTA shows potential
The potential for observing more subtle vascular changes in glaucoma and vascular disorders has been highlighted in the recent literature.1–9