DR. PRASANNA VENKATESH RAMESH

Dr.R. RAMESH, Dr.ANUGRAHA BALAMURUGAN

Abstract

It is challenging to detect glaucoma when there is a pre-existing neurological condition. This paper reports a 73 year old male with right homonymous hemianopia for 30 years, due to left occipital lobe infarct, diagnosed with early glaucoma. During his annual follow-up, he complained mild diminution of vision in the seeing field. On examination, the anterior segment was normal with fundus revealing temporal pallor and cup/disc ratio of 0.8 in both eyes. The IOP was 20 mm Hg in BE. Spectralis OCT interrogated the progression in the superior and inferior temporal nerve head sectors and confirmed a decrease in Bruch’s Membrane Opening-Minimum Rim Width and RNFL thickness. Damage correlated with the paracentral scotoma detected in the visual field previously unaffected by the neurological condition, in the Hood report. Ganglion Cell Layer progression analysis also confirmed glaucoma. With Spectralis, early diagnosis of glaucoma is not difficult, even with pre-existing neurological defects.