A 75-year-old woman presents with painless blurring of vision in the right eye for the last few months. The visual acuity is 6/60 in that eye. The photograph shows the optic disc.
Select ALL that are TRUE
The following features can be seen in the optic disc photo
a. Swelling of the optic disc
b. An extremely thin optic disc rim
c. Parapapillary atrophy
d. Nasal displacement of the central retinal vessels
Characteristics of glaucomatous optic disc include:
a. Disc haemorrhages
b. Thinning of the optic disc rim, usually nasally
c. Generalised/focal enlargement of the cup
Appropriate next steps in this patient would include:
a. A full ocular examination of both eyes including visual acuity (individual eyes), intraocular pressure measurements, examining the optic disc in the other eye and looking for secondary causes of glaucoma, such as uveitis or trauma
b. Discharging the patient if both eyes have poor vision from advanced glaucoma and nothing more can be done
c. Advising family members to be screened for glaucoma
1. Answer: b, c and d. There is no optic disc swelling. This disc shows advanced glaucomatous cupping of the optic disc.
2. a and c. Thinning of the optic disc rim is characteristic of glaucoma, but this usually occurs at the superior and inferior poles (see article “The optic nerve head in glaucoma”).
3. a and c. It is very important to do a full examination of both eyes. If the intraocular pressures are high they should be treated urgently. It is very important to stop further glaucomatous damage and vision loss. If patients have already developed vision loss due to glaucoma they should be given appropriate advice and support including referral to peer support groups, counselling services and access to appropriate low vision aids. Family members of glaucoma patients should be screened for glaucoma; this can be done by optometrists in some settings.