Every three months, I have the opportunity to see a patient who goes way back in the lexicon of our practice. My grandfather stopped practicing about 30 years ago, and he saw this patient in the 1950s. This African-American male, now 78 years old, is a glaucoma patient of mine. His medical history is remarkable for systemic hypertension, for which he takes a daily dose of lisinopril.
Of note, he is functionally monocular, having suffered a severe wound to his left eye as a result of a BB gun when he was a young man. Unfortunately, that eye has no light perception.
Previously by Dr. Casella: Assessing visual crowding and its impact on glaucoma patients
Over the decade or so that he has been my patient, he has been mostly compliant. He has primary open-angle glaucoma of the right eye, which was diagnosed in the 1980s. He is phakic in that eye with mild nuclear sclerosis, and I currently have his intraocular pressure (IOP) under control with latanoprost (Xalatan, Pfizer) at bedtime and brimonidine (Alphagan, Allergan) 0.15% twice a day.
He last presented for a comprehensive eye examination in April 2019, at which time his IOP was 11 mm Hg in the right eye and 12 mmHg in the left eye by means of Goldmann applanation tonometry at 9:30 a.m.
Related: New technology helps IOP measurement
I have his target pressure set at 10 to12mmHg, as his glaucoma is moderate and because he is functionally monocular. His pretreatment pressures were in the mid-20s in each eye. Entering visual acuity was 20/25 in the right eye and no light perception in the left eye.
He was dilated at this visit, and fundus photography was obtained of his right eye (Figure 1). Severe scarring throughout his left eye precludes accurate optic nerve evaluation and photography.
He has been happy with his vision through his current spectacles for years and understands that he needs them to drive (uncorrected visual acuity is 20/80 in the right eye).