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Normal Tension Glaucoma Suspect Case Studies

Patient Profile

54 year old



Eye Exam

2 years ago


OU 20/20




Routine Eye Exam For Failed DMV Exam

Visual Distance



Clinical examination, slit lamp images showed that the OU anterior chamber was quiet and deep, nasal and temporal angles were 1-2 and iris was flat with clear lens. Her IOP OD was 17mmHg and OS was 21mmHg at 6:30pm. OD visual field analysis showed inferior nasal defect while OS was normal. The defects in the OD visual field were repeatable on subsequent tests. The optic nerve analysis reported OD 0.85 C/D ratio with superior thinning and RNFL wedge defect at 11:00, while OS had 0.75 C/D ratio with possible inferior thinning and notching. As the diurnal curve of IOP for a patient could be very different at a different time of day, as a final impression patient was diagnosed as a glaucoma suspect, with a higher potential of Normal Tension Glaucoma (OD >> OS). The RNFL wedge defect OD was consistent with the visual field defect in OD. Large cupping was observed in both optic nerves with rim thinning. The OS notch and rim thinning may result in damage to the visual field OS if left untreated.


The final diagnosis was explained to the patient and she was referred to a glaucoma specialist for evaluation and treatment to prevent further damage. Currently, more than 3 million Americans are diagnosed with glaucoma. The overall glaucoma national rate is estimated to be 1.9% for the U.S. population with age 40 and higher. Majority of them are diagnosed after about 40% of irreversible peripheral visual loss. With an expected surge in the prevalence of glaucoma to be 4 million by 2030 in the USA, early glaucoma screening and diagnosing plays a crucial role to provide treatment in a timely manner. Comprehensive exams via telemedicine helps to improve access for medically underserved and high-risk patients. Providing cost effective screening, referring and educating patients regarding the risk of glaucoma and need for regular follow-up also contributes towards patient awareness.


OD Retinal images with optic nerve cupping and RNFL Wedge defect – Images 1 & 2

Markup of the wedge defect corresponding to the visual field defect – Images 3 & 4

OS Retinal images with optic nerve cupping and possible inferior  notching – Images 5 & 6




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