In this case example, a patient was originally misdiagnosed with progressive glaucoma based on progressing superior field loss. However, subsequent testing showed that structural findings did not match functional findings. Fundus autofluorescence imaging prompted a new diagnosis of sector retinitis pigmentosa. The patient had already undergone trabeculectomy OS and was almost scheduled for a trabeculectomy OD.
A mentor once taught me that 95 percent of treatment is making the right diagnosis. Once the proper diagnosis is made, the treatment can easily be obtained by referring to a vast wealth of publications and internet sources or referring the patient to the proper specialist.
An “atypical” case of misdiagnosis is presented here. The patient, now middle-aged, had a misdiagnosed eye disease that almost resulted in unnecessary surgery.
A 67-year-old black female with a history of uncontrolled primary open-angle glaucoma (POAG), greater in the left eye, presented for a follow-up examination. She was on maximum medications and had undergone selective laser trabeculoplasty in both eyes and a trabeculectomy in the left eye. She was urged at multiple visits over the past year to undergo trabeculectomy in the right eye as well. The concern was that the patient’s glaucoma was progressing based on the visual field loss despite medical and surgical interventions and despite the fact that intraocular pressures (IOP) were maintained in the mid-teens.
The patient had severe (dense) arcuate superior field loss OU (Figure 1 left and middle). At her last follow-up visit, it was noted that the optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) findings did not correlate with the visual field findings (Figure 1 far right). Regardless, the patient was referred for a trabeculectomy consult in the right eye.
1. Lin J, Vander JF, Martin M, Katz LJ. Atypical retinitis pigmentosa masquerading as primary open angle glaucoma. J Glaucoma. 2007 Mar;16(2):268-70.