Question 3: What is your assessment of the optic nerves and OCT and explain whether they are consistent with glaucoma?

Question 3: What is your assessment of the optic nerves and OCT and explain whether they are consistent with glaucoma?

Figure 2 – OCT RNFL scan

Figure 3 – OCT GCC scan

Figure 4 – RE and LE Optic disc photographs

Answer 3

The size of the optic disc appears average.  The disc appearance is not consistent with glaucoma. There is a cup to disc ratio of approximately 0.5 in each eye with no focal thinning of the neuroretinal rim superiorly or inferiorly as would be typical of glaucoma. There is pallor of the temporal neuroretinal rim in each eye, more marked on the right. There is no vertical elongation of the optic cup, no focal notching of the neuroretinal rim, no disc haemorrhage, and no retinal nerve fibre layer dropout in the superior or inferior RNFL bundles.

The OCT RNFL scan shows selective loss of the temporal RNFL (papillomacular bundle) in both eyes. This is not consistent with glaucomatous optic neuropathy. GCC analysis reveals macular ganglion cell thinning, particularly just nasal to the macula, worse in the right eye than the left.

These findings, particularly optic disc pallor and temporal RNFL loss, are associated with compressive optic neuropathy and are not features typically seen in patients with glaucomatous optic neuropathy.

End of answer 3