Figure 3
Representative Case No. 2 in the Glaucoma Conversion Group. (A, C, E) right eye, (B, D, F) left eye. A 45-year-old man visited a health screening center in 2011. Screening fundus photographs showed the large optic disc cupping with violation of the ISNT rule in both eyes. The right eye showed horizontal cupping without the peripapillary atrophy (PPA), whereas the left eye showed vertical cupping with small area of PPA (PPA area-to-disc area ratio = 0.24) and the bayoneting of a superior optic disc vessel. The vertical cup-to-disc ratio, the disc ovality, the central retinal vessel trunk nasalization and the baseline intraocular pressure (IOP) were 0.80, 1.06, 70% and 17 mmHg in the right eye and 0.83, 1.15, 63% and 18 mmHg in the left eye, respectively. There was mild sclerosis of the retinal arteries in both eyes. The baseline risk score was 14.28 in the right eye and 15.45 in the left eye, respectively (A and B). In the following year, the thinning of inferotemporal retinal nerve fiber layer was suspected only in the left eye, which became more evident in 2013 (C and D). During the follow up period, the left eye showed very slow progression of inferotemporal retinal nerve fiber layer defect (RNFLD) and an additional RNFLD in the superotemporal area. The mean IOP, the peak IOP and the IOP fluctuation were 15.7, 18 and 1.97 mmHg in the right eye and 16.5, 21 and 2.74 mmHg in the left eye, respectively. In 2020, the patient was eventually referred to a glaucoma clinic at a tertiary referral hospital and anti-glaucoma medication has been administered in the left eye since a glaucoma specialist confirmed definite thinning of superotemporal and inferotemporal RNFL on the optical coherence tomography and corresponding visual field defect on the automated perimetry. The most recent RNFL photographs taken at the glaucoma clinic in 2021 showed large superotemporal and inferotemporal RNFLDs in the left eye, while there was no definite RNFLD in the right eye (E and F).
