CHAPTER 13 CLINICAL CASES INTRODUCTION

Transcription

1 2 CHAPTER 3 CLINICAL CASES INTRODUCTION The previous chapters of this book have systematically presented various aspects of visual field testing and is now put into a clinical context. In this chapter, clin- mic disorder and retinal disease. The selected cases are model cases. They present typical defect patterns of the disease rather than unusual cases and are reliable, free of artifacts and can be fully trusted. relevant clinical information. Background information on the patient s history as well as other diagnostic results such as visual acuity, IOP, fundus images, OCT scans and MRIs which are relevant for clinical decision making, are shown. In all examples, visual acuity is expressed in decimal units for uniformity, but the Octopus allows users to select different units when performing the test. In each are presented and summarized. An overview of all available cases is presented on the next page.

2 2 Chapter 3 Clinical cases GLAUCOMA SINGLE FIELD. Very early stage glaucoma (normal tension glaucoma) 2. Early stage glaucoma (normal tension glaucoma) 3. Early stage glaucoma (primary open-angle glaucoma) 4. Early stage glaucoma (with cataract). Early stage glaucoma (normal tension glaucoma). Early stage glaucoma (primary open-angle glaucoma). Moderate glaucoma (normal tension glaucoma) 8. Moderate glaucoma (primary open-angle glaucoma). Late stage glaucoma (normal tension glaucoma) NEUROLOGICAL DISEASES. Cerebral infarction (bilateral). Leber hereditary optic neuropathy (bilateral) 8. Bilateral optic neuritis (multiple sclerosis). Tuberculum sellae meningioma (bilateral) RETINAL DISEASES 2. Age-related macular degeneration 2. Branch central retinal artery occlusion. Macular hole. Branch central retinal vein occlusion GLAUCOMA TREND. Early to moderate glaucoma (normal tension glaucoma). Early to moderate glaucoma (primary open-angle glaucoma) 2. Early to moderate glaucoma (primary open-angle glaucoma) 3. Early to moderate glaucoma (normal tension glaucoma) 4. Early to moderate glaucoma (primary open-angle glaucoma). End-stage glaucoma (exfolitative glaucoma)

3 Glaucoma Single field 2 VERY EARLY STAGE GLAUCOMA (NORMAL TENSION GLAUCOMA) -year-old female, no family history Patient reported decreased visual acuity in both eyes and discomfort in left eye mmhg/ (sph) C/D =. Rim thinning at to o'clock position Optic disc hemorrhage and narrow slit-like RNFL defect at o'clock position Temporal alpha zone and beta zone peripapillary chorioretinal atrophy (PPA) Demo Jane, 4// (yrs) Right eye (OD) / //8 / 2:: %..% %...82% %...% %...% All test locations at p > % 2 2 Diffuse defect [db]: -. p > p < p < p <, % Defect Curve % in normal range Programs: 32 Standard White/White / Normal Questions / repetitions: 2 / 3 Parameters: 4 / asb III ms Duration: :4 MS [db]:. Catch trials: / (%), / (4%) - RF:. MD [< 2. db]: -. Refraction S/C/A: -3.2// VA:. Pupil [mm]: IOP [mmhg]: slv [< 2. db]:.8 CsLV [db]:. SF [db]:. OCTOPUS hemorrhage, and RNFL loss

4 28 Chapter 3 Clinical cases 2 EARLY STAGE GLAUCOMA (NORMAL TENSION GLAUCOMA) 3-year-old female, no family history Optic nerve cupping observed during unrelated emergency eye surgery 2 mmhg/.2.2 (sph) C/D =.8 Rim thinning and RNFL loss at to o'clock position Demo Jane, 42// (3yrs) Left eye (OS) / //2 / 4::4.. %..% %...82% %...% %...% % % 2 Diffuse defect [db]: -. Cluster of abnormal locations with p <. % p > p < p < p <, Programs: G Standard White/White / Normal Questions / repetitions: 48 / 3 Parameters: 4 / asb III ms Duration: :4 Catch trials: / (%), / (4%) - RF: 2. Refraction S/C/A: // VA:.2 Pupil [mm]:.3 IOP [mmhg]: 2 NTG MS [db]: 2. MD [< 2. db]:. slv [< 2. db]: 4.2 CsLV [db]: 3. SF [db]:. OCTOPUS Mild superior nasal step and mild superior paracentral scotoma

5 Glaucoma Single field 2 3 EARLY STAGE GLAUCOMA (PRIMARY OPEN-ANGLE GLAUCOMA) OCT -year-old female, her brother has POAG Patient visited clinic to rule out glaucoma because of her family history mmhg / (sph) Inferior RNFL defects RNFL and ganglion cell loss inferotemporally at to 8 o clock position Demo Jane, 8// (yrs) Right eye (OD) / 2// / :3:8 Four-in-One Cluster analysis [db] MD [db] Nasal step, superior arcuate and superior paracentral defect Polar analysis % % T S I N 2 3 [db] RNFL loss inferortemporally 2 Local defect (glaucoma) 2 Diffuse defect [db]: 2.3 Structural damage suggested at to 8 o'clock position Programs: G Standard White/White / TOP Questions / repetitions: 2 / Parameters: 3.4 / 4 asb III ms Duration: 2:8 Catch trials: /4 (%), /4 (%) - RF:. Refraction S/C/A: VA [m]: Pupil [mm]: 3. IOP [mmhg]: NV: T3 V. 3 MS [db]:.4 MD [< 2. db]:. slv [< 2. db]: 4. GC thinning inferortemporally Nasal step, superior arcuate and superior paracentral defect apparent in Cluster Analysis position) and inferotemporal structural loss (fundus photo, RNFL & GC thickness map)

6 Chapter 3 Clinical cases 4 EARLY STAGE GLAUCOMA (WITH CATARACT) OCT -year-old male, no family history Patient reported defective vision in both eyes over the last months and glare at night while crossing roads mmhg/.. (sph), -.2 (cyl) x 8 Fundus image hazy due to cataract RNFL loss and ganglion cell loss at to o clock position Demo John, 44// (yrs) Left eye (OS) / 2/4/ / 4::8 Four-in-One 4.2 MD [db].4 Corrected cluster analysis [db] 2.2 Nasal step (local defect) Hazy due to cataract Polar analysis Diffuse defect (cataract) % 2 Local defect (glaucoma) % 3 [db] 2 N S I T Structural damage suggested at to o'clock position 2 Diffuse defect [db]: 2.3 Programs: G Standard White/White / TOP Questions / repetitions: / Parameters: 3.4 / 4 asb III ms Duration: 2:2 Catch trials: 2/4 (%), /4 (%) - RF: 2. Refraction S/C/A: VA [m]: Pupil [mm]: 3. IOP [mmhg]: NV: T3 V. 3 MS [db]:. MD [< 2. db]: 3.3 slv [< 2. db]: 3.4 EyeSuite Static perimetry, V3.. OCTOPUS 3 Both diffuse defect (due to cataract) and local defect (due to glaucoma) in Defect Curve Corrected Cluster Analysis (removing diffuse defect) shows superior nasal step position) and inferotemporal structural loss (fundus photo, RNFL & GC thickness map)

7 Glaucoma Single field EARLY STAGE GLAUCOMA (NORMAL TENSION GLAUCOMA) 8-year-old female, father had glaucoma Optic nerve cupping detected during routine medical visit mmhg/.2 -. (sph), -. (cyl) x 8 C/D =. Rim thinning and wide RNFL loss at to o'clock position Demo Jane, 44// (8yrs) Left eye (OS) / /3/4 / :43: %..% %...82% %...% %...% Absolute defect 2 2 (sensitivity threshold db) % % 2 Diffuse defect [db]: -. p > p < p < p <, Programs: G Standard White/White / Normal Questions / repetitions: 4 / 3 Parameters: 4 / asb III ms Duration: : Catch trials: 3/ (3%), / (%) - RF:. Refraction S/C/A:./-./8 VA:.2 Pupil [mm]:. IOP [mmhg]: 3 Gla MS [db]: 2. MD [< 2. db]: 2.2 slv [< 2. db]:.8 CsLV [db]:. SF [db]: 2.8 OCTOPUS Dense paracentral scotoma

8 2 Chapter 3 Clinical cases EARLY STAGE GLAUCOMA (PRIMARY OPEN-ANGLE GLAUCOMA) -year-old male, no family history Patient reported decreased visual acuity and blurred vision mmhg/ (sph), -. (cyl) x 8 C/D =.8 Small disc Rim thinning at to o'clock position Demo John, // (yrs) Left eye (OS) / 2// / :2:4.2. %..% %...82% %...% %...% % Local defect 2 2 Diffuse defect [db]: -. % p > p < p < p <, Programs: G Standard White/White / Normal Questions / repetitions: 44 / 3 Parameters: 4 / asb III ms Duration: 3:43 Catch trials: / (%), / (%) - RF:. Refraction S/C/A: -2./-./8 VA:. Pupil [mm]:. IOP [mmhg]: Very reliable test MS [db]:.2 MD [< 2. db]: 3.3 slv [< 2. db]: 8. CsLV [db]: 8. SF [db]:. OCTOPUS

9 Glaucoma Single field 3 MODERATE GLAUCOMA (NORMAL TENSION GLAUCOMA) -year-old female, no family history Patient reported decreased visual acuity in both eyes and discomfort in left eye mmhg/. -. (sph) C/D =. Rim thinning at 2 to o'clock position Vein angulation and bayoneting at 2 and o'clock position Demo Jane, 4// (yrs) Left eye (OS) / //8 / 2:2:3. 4. %..% %...82% %...% %...% % % Diffuse defect [db]: -. p > p < p < p <, Programs: 32 Standard White/White / Normal Questions / repetitions: 42 / 3 Parameters: 4 / asb III ms Duration: 2:3 Catch trials: /32 (%), 2/33 (%) - RF: 3. Refraction S/C/A: -3.2// VA:. Pupil [mm]:.8 IOP [mmhg]: Large slv shows severe local defect MS [db]: 8.4 MD [< 2. db]: 8.2 slv [< 2. db]:. CsLV [db]:. SF [db]: 2.2 OCTOPUS

10 4 Chapter 3 Clinical cases 8 MODERATE GLAUCOMA (PRIMARY OPEN-ANGLE GLAUCOMA) 2-year-old female, no family history Patient diagnosed with glaucoma during medical check-up 2 mmhg/.2-4. (sph), -.2 (cyl) x 8 C/D =. Rim thinning at to 8 o'clock position and notching at o clock position Large RNFL loss at to 8 o'clock position and small RNFL loss at o clock position Angulation of lower vein and undermining due to optic disc cupping Temporal alpha zone and beta zone peripapillary chorioretinal atrophy (PPA) Demo Jane, 4// (2yrs) Right eye (OD) / 2/2/ / ::3. 8. %..% %...82% %...% %...% % Absolute defects 8 8 (sensitivity threshold db) Diffuse defect [db]: -. % p > p < p < p <, Programs: G Standard White/White / Normal Questions / repetitions: 448 / 4 3 Parameters: 4 / asb III ms Duration: 4:8 MS [db]:.2 Catch trials: / (%), / (%) - RF:. MD [< 2. db]:.4 Refraction S/C/A: -3./-.2/8 VA:.2 Pupil [mm]: IOP [mmhg]: 3 slv [< 2. db]:.4 CsLV [db]:.3 SF [db]: 2. OCTOPUS

11 Glaucoma Single field LATE STAGE GLAUCOMA (NORMAL TENSION GLAUCOMA) 2-year-old male, no family history Patient reported decreased visual acuity in both eyes mmhg/.2.2 (sph), -. (cyl) x 8 C/D =. Rim disappearance at 2 and to 8 o clock position Narrowing of retinal artery Demo John, 4// (2yrs) Right eye (OD) / 2// / :: %..% %...82% %...% %...% % % Diffuse defect [db]: p > p < p < p <, Programs: G Standard White/White / Normal Questions / repetitions: 438 / 3 Parameters: 4 / asb III ms Duration: 3:3 MS [db]: 8. Catch trials: / (%), / (%) - RF: 2. MD [< 2. db]:. Refraction S/C/A: 2./-./8 VA:. Pupil [mm]: IOP [mmhg]: slv [< 2. db]:. CsLV [db]:. SF [db]: OCTOPUS Dense double arcuate defect with many locations showing absolute defects

12 Chapter 3 Clinical cases EARLY TO MODERATE GLAUCOMA (NORMAL TENSION GLAUCOMA) 4-year-old male, no family history Glaucoma was suspected after routine medical check-up mmhg/.2-2. (sph), -. (cyl) x 8 Rim thinning RNFL loss at o clock position 2 Rim thinning & RNFL loss at to 8 clock position indicating progression MD Mean defect slv Loss variance Cluster MD change. 2.4 db/year [db] 2 N S I T 2 MD change.8 db/year 2 2 Slope:.8dB / Yr (p<.%) Slope:.dB / Yr (p<.%) Structural progression suggested at to 8 o'clock position DD Diffuse defect LD Local defect Slope:.dB / Yr 2 2 Slope:.dB / Yr (p<.%) 8 2 Grayscale series shows expansion of superior nasal defect to a superior arcuate defect from 8 to 2 (Cluster MD change. to 2.4 db/year) Large (up to 3 db) progression at to 8 o clock position in Polar Trend Analysis Rim thinning and RNFL loss spreading from o clock position towards and 8 o clock position

13 Glaucoma Trend EARLY TO MODERATE GLAUCOMA (PRIMARY OPEN-ANGLE GLAUCOMA) 8-year-old female, no family history mmhg/.. (sph), -.2 (cyl) x 2 Mild, slit-like RNFL loss at o clock position. No rim thinning or notching. 28 RNFL loss & additional rim thinning with undermining at to 8 o clock position indicating progression; laser scar at to 3 o clock position due to treated BRVO, which developed in during follow up MD Mean defect slv Loss variance [db] 2 S N T I 2 MD change.4 db/year 2 28 Slope:.4dB / Yr (p<.%) 2 28 Slope:.8dB / Yr (p<.%). -.4 Structural progression suggested at to 8 o'clock position DD Diffuse defect LD Local defect Slope: -.2dB / Yr Slope:.8dB / Yr (p<.%) Large progression at to 8 o clock position 2 28 Grayscale series shows expansion of superior nasal defect to a superior arcuate defect from 2 to 28 and mild inferotemporal sensitivity loss due to BRVO clusters (Cluster MD change. to 2. db/year) Large (up to 3 db) progression at to 8 o clock position in Polar Trend Analysis Rim thinning and RNFL loss spreading from o clock position towards and 8 o'clock position

14 8 Chapter 3 Clinical cases 2 EARLY TO MODERATE GLAUCOMA (PRIMARY OPEN-ANGLE GLAUCOMA) 3-year-old male, no family history 2 mmhg/.2 -. (sph), -. (cyl) x Rim thinning at to 2 o clock position. Rim notching at o clock position. RNFL loss at same positions. Optic disc hemorrhage at o clock position. 28 Rim thinning from to o clock position MD Mean defect slv Loss variance [db] 2 S N T I 2 28 Slope:.dB / Yr (p<.%) 28 Slope:.dB / Yr. -.4 Floor effect (near absolute sensitivity loss) Structural progression suggested at o'clock position DD Diffuse defect LD Local defect Slope:.2dB / Yr 28 Slope:.dB / Yr (p<.%) Large progression at o clock position 28 Grayscale series shows expansion of inferior arcuate defect to superior nasal side from to 28 clusters (Cluster MD change up to 2. db/year) Large (~ db) progression at o clock position in Polar Trend Analysis Rim thinning and RNFL loss spreading from to 2 o'clock position towards o'clock position

15 Glaucoma Trend 3 EARLY TO MODERATE GLAUCOMA (NORMAL TENSION GLAUCOMA) -year-old male, no family history mmhg/. -. (sph), -.2 (cyl) x 2 position. Temporal alpha zone and beta zone peripapillary chorioretinal atrophy (PPA). Challenging to identify changes because of small disc and severe myopia MD Mean defect slv Loss variance [db] 2 S N T I 2 2 Slope:.2dB / Yr (p<.%) 2 Slope:.8dB / Yr (p<.%).. Very fast progression in central visual field clusters Large progression suggested at inferior temporal optic disc DD Diffuse defect LD Local defect Slope:.dB / Yr 2 Slope:.dB / Yr (p<.%) 2 clusters (Cluster MD change 3.3 and.4 db/year) Challenging to asses structural changes, but large (up to 3 db) progression at o clock position in Polar Trend Analysis corresponding with RNFL loss in fundus image suggests glaucomatous progression

16 Chapter 3 Clinical cases 4 EARLY TO MODERATE GLAUCOMA (PRIMARY OPEN-ANGLE GLAUCOMA) IOP/VA uncorr OCT -year-old female Patient showed advanced disc damage at presentation Suboptimal IOP control under topical medication, but patient refused surgery mmhg ( mmhg pre-treatment)/. 28 Pathologically low peripapillary RNFLT in inferotemporal sectors 28 Advanced disc damage (C/D=.) MD Mean defect slv Loss variance 2. Fast superior paracentral progression [db] 2 S N T I 2 MD change. db/year. -. Slope:.dB / Yr (p<.%) Slope:.4dB / Yr (p<.%) DD Diffuse defect LD Local defect 28 2 Slope:.2dB / Yr No diffuse progression Significant local progression Slope:.dB / Yr (p<.%) 28 Grayscale series shows progression of superior arcuate and both superior and inferior paracentral defects from 28 to progression in superior arcuate and superior and inferior paracentral clusters (Cluster MD change up to 2. db/year) Up to 3 db progression at infero- and superotemporal test locations in Polar Trend Analysis spatially related to further RNFLT loss between 28 and

17 Glaucoma Trend END-STAGE GLAUCOMA (EXFOLITATIVE GLAUCOMA) OCT -year-old female further medication during follow up 8 4 mmhg (43mmHg pre-treatment)/.. (sph) 28 Severe peripapillary RNFLT loss No change in the average peripapillary RNFLT 28 C/D=. MD Mean defect Floor effect (MD > 2 db, no progression) slv Loss variance [db] 2 S N T I 3 Slope:,dB / Yr Slope: -,2dB / Yr (p<%) Fast superior. and inferior paracentral progression -. DD Diffuse defect Floor effect (DD > 2 db, no progression) LD Local defect 28 2 Slope: -,db / Yr Slope:,dB / Yr 28 measurement range) 2 to 2 db progression at 8 to o clock position (papillomacular bundle) in Polar Trend Analysis not Polar and Cluster Trend Analysis indicate late-stage glaucomatous progression

18 2 Chapter 3 Clinical cases CEREBRAL INFARCTION (BILATERAL) -year-old male, no family history Patient experienced occipital headache and optic agnosia of name, letters, etc. Diagnosed with cerebral infarction in left temporal lobe Previous central serous chorioretinopathy in left eye Demo John, 33// (yrs) Left eye (OS) / //2 / :3: %..% %...82% %...% %...% % 3 Sensitivity loss at fixation Diffuse defect [db]: -. % Vertical drop characteristic for quadrantanopia p > p < p < p <, Programs: G Standard White/White / Normal Questions / repetitions: 4 / 2 3 Parameters: 4 / asb III ms Duration: :4 Catch trials: /2 (%), 4/2 (%) - RF:. Refraction S/C/A:./-./ VA:.4 Pupil [mm]:.4 IOP [mmhg]: 4 MS [db]: 8.3 MD [< 2. db]: 8.4 slv [< 2. db]: 2.4 CsLV [db]: 2. SF [db]:. OCTOPUS

19 Neuro Single field 3 OD mmhg/.. (sph), 2. (cyl) x ; OS 2 mmhg/.4. (cyl) x No abnormality Demo John, 33// (yrs) Right eye (OD) / //2 / :: %..% %...82% %...% %...% % % 2 Diffuse defect [db]: -. p > p < p < p <, Programs: G Standard White/White / Normal Questions / repetitions: 4 / 3 Parameters: 4 / asb III ms Duration: : Catch trials: /2 (%), / (%) - RF: 3. Refraction S/C/A:./-2./ VA:. Pupil [mm]:. IOP [mmhg]: 4 MS [db]:. MD [< 2. db]:.8 slv [< 2. db]:.3 CsLV [db]:.3 SF [db]: 2. OCTOPUS infarction in left temporal lobe decrease in visual acuity (.4)

20 4 Chapter 3 Clinical cases LEBER HEREDITARY OPTIC NEUROPATHY (BILATERAL) 3-year-old male, no family history Patient reported decreased visual acuity in right eye Patient diagnosed with central serous chorioretinopathy and retinal hemorrhage Patient diagnosed with Leber hereditary optic neuropathy based on maternal mitochondrial DNA test Demo John, 3// (3yrs) Left eye (OS) / //2 / 2:: %..% %...82% %...% %...% % % Diffuse defect [db]: V4e I4e I3e I3a Programs: 32 Standard White/White / Normal Questions / repetitions: 8 / 3 Parameters: 4 / asb III ms Duration: :2 Catch trials: / (%), 4/3 (3%) - RF:. Refraction S/C/A: // VA: Pupil [mm]:. IOP [mmhg]: p > p < p < p <, MS [db]: 4.2 MD [< 2. db]: 4. slv [< 2. db]:.2 CsLV [db]:.2 SF [db]:. OCTOPUS

21 Neuro Single field CENTRAL CFF OD OS mmhg/ 3 cm, hand motion Pale optic discs in both eyes OD 32 Hz; OS 42 Hz Demo John, 3// (3yrs) Right eye (OD) / //2 / 3:: %..% %...82% %...% %...% % % Diffuse defect [db]: Programs: 32 Standard White/White / Normal Questions / repetitions: 2 / 3 Parameters: 4 / asb III ms Duration: 8: Catch trials: / (%), 3/ (%) - RF:. Refraction S/C/A: // VA: Pupil [mm]:.2 IOP [mmhg]: p > p < p < p <, MS [db]: 2. MD [< 2. db]: 8.2 slv [< 2. db]:. CsLV [db]:. SF [db]:.8 V4e I4e I3e I3c I2e OCTOPUS Dense sensitivity loss in center of both eyes

22 Chapter 3 Clinical cases 8 BILATERAL OPTIC NEURITIS (MULTIPLE SCLEROSIS) 2-year-old female, no family history Demo Jane, // (2yrs) Left eye (OS) / 2//3 / 4::8. 4. %..% %...82% %...% %...% % % Diffuse defect [db]: V4e I4e I3e I3b I2e I2b Ie Programs: 32 Standard White/White / Normal Questions / repetitions: / 2 3 Parameters: 4 / asb III ms Duration: 2: Catch trials: /3 (%), /32 (3%) - RF:. Refraction S/C/A:.2/-./8 VA:. Pupil [mm]:.3 IOP [mmhg]: p > p < p < p <, MS [db]:. MD [< 2. db]:. slv [< 2. db]: 4.4 CsLV [db]: 3. SF [db]: 2. OCTOPUS

23 Neuro Single field CFF MRI OD 3 mmhg/..2 (sph),. (cyl) x 8 OS mmhg/..2 (sph),. (cyl) x 8 No abnormality OD 34 Hz; OS 44 Hz Demo Jane, // (2yrs) Right eye (OD) / 2//3 / 4:4: %..% %...82% %...% %...% % % Diffuse defect [db]: Programs: 32 Standard White/White / Normal Questions / repetitions: 8 / 4 3 Parameters: 4 / asb III ms Duration: :38 MS [db]:. Catch trials: / (%), 2/ (%) - RF: 3. MD [< 2. db]: 3. Refraction S/C/A:.2/-./8 VA:. Pupil [mm]: IOP [mmhg]: 3 OCTOPUS p > p < p < p <, slv [< 2. db]: 4. CsLV [db]: 4. SF [db]:. 2 3 V4e I4e I3e I3b I2e I2b Ie Ia 3 Intact peripheral visual field Sensitivity loss on lower temporal side of vertical meridian in both eyes (i.e., mild bitemporal hemianopia) chiasm

24 8 Chapter 3 Clinical cases TUBERCULUM SELLAE MENINGIOMA (BILATERAL) 4-year-old male, no family history Demo John, 4// (4yrs) Left eye (OS) / 2//2 / 2:2:.. %..% %...82% %...% %...% V4e I4e I3e 8 I2e Ie Diffuse defect [db]: -. % % Absolute defect stopping at vertical midline p > p < p < p <, Programs: 32 Standard White/White / Normal Questions / repetitions: 4 / 3 Parameters: 4 / asb III ms Duration: :34 Catch trials: /2 (%), /2 (33%) - RF:. Refraction S/C/A:./-./ VA:. Pupil [mm]:. IOP [mmhg]: MS [db]: 3. MD [< 2. db]: 3. slv [< 2. db]: 2.4 CsLV [db]: 2.4 SF [db]:.4 OCTOPUS

25 Neuro Single field CFF MRI OD 2 mmhg/. 2. (sph) OS 3 mmhg/.2. (sph),. (cyl) x Pale optic disc with slight cupping Slight bending of blood vessels OD 2 Hz; OS 4 Hz Meningioma in tuberculum sellae Demo John, 4// (4yrs) Right eye (OD) / 2//2 / 3:4: %..% %...82% %...% %...% % % Diffuse defect [db]: Programs: 32 Standard White/White / Normal Questions / repetitions: 33 / 3 Parameters: 4 / asb III ms Duration: :2 Catch trials: /8 (%), 8/ (42%) - RF: 2. Refraction S/C/A:.// VA:. Pupil [mm]:. IOP [mmhg]: 3 p > p < p < p <, MS [db]: 4.3 MD [< 2. db]: 2.8 slv [< 2. db]:.8 CsLV [db]:. SF [db]: 2. V4e I4e I3e I2e Ie OCTOPUS Complete sensitivity loss (heterononymous hemianopia) temporally of vertical meridian

26 Chapter 3 Clinical cases 2 AGE-RELATED MACULAR DEGENERATION 4-year-old male, no family history Patient reported decreased visual acuity in left eye 3 mmhg/.2. (sph),. (cyl) x 8 Exudative age-related macular degeneration in macula area Demo John, 42// (4yrs) Left eye (OS) / 2// / 4:38:48 Greyscale (CO) %..% %...82% %...% %...% % % 2 Diffuse defect [db]: -. p > p < p < p <, M-pattern Programs: M Standard White/White / Normal Questions / repetitions: / 2 Parameters: 4 / asb III ms Duration: :3 Catch trials: /38 (%), 2/38 (%) - RF: 2. Refraction S/C/A: -.// VA:.3 Pupil [mm]:. IOP [mmhg]: MS [db]:.4 MD [< 2. db]: 3. slv [< 2. db]:. CsLV [db]:.2 SF [db]: 3. OCTOPUS M-pattern ( ) used for a high resolution of the macula

27 Retina Single field 2 BRANCH CENTRAL RETINAL ARTERY OCCLUSION -year-old female, no family history 4 mmhg/. 4. (sph),. (cyl) x 8 Ischemia-induced retinal edema in area of blood vessels caused by occlusion of the downward branch of the central retinal artery Demo Jane, // (yrs) Left eye (OS) / 2// / :3: Greyscale (CO).3.3 %..% %...82% %...% %...% % % Diffuse defect [db]: Programs: M Standard White/White / Normal Questions / repetitions: 3 / 2 Parameters: 4 / asb III ms Duration: 2: MS [db]:. Catch trials: /3 (%), 3/3 (8%) - RF: 4.2 MD [< 2. db]:. Refraction S/C/A: -2./-./8 VA:. Pupil [mm]: IOP [mmhg]: p > p < p < p <, slv [< 2. db]:.3 CsLV [db]:. SF [db]: 4. V4e I4e I3e I2e Ie OCTOPUS M-pattern ( ) used for a high resolution of the macula retinal artery Fixation is spared, corrected visual acuity of. is maintained Kinetic perimetry shows absolute defect outside nasally

28 2 Chapter 3 Clinical cases MACULAR HOLE -year-old female, no family history Patient reported distorted vision in right eye 2 mmhg/.2. (sph), 2. (cyl) x 8 Demo Jane, 3// (yrs) Right eye (OD) / 2//3 / 3::4 Greyscale (CO) %..% %...82% %...% %...% % % 2 Diffuse defect [db]: -. M-pattern Signficant foveal defect at p <.% p > p < p < p <, Programs: M Standard White/White / Normal Questions / repetitions: / 2 Parameters: 4 / asb III ms Duration: 8:3 MS [db]: 2. Catch trials: /3 (3%), 2/3 (%) - RF: 4. MD [< 2. db]: 4.3 Refraction S/C/A:./-2./8 VA:.2 Pupil [mm]: IOP [mmhg]: 4 slv [< 2. db]: 3.8 CsLV [db]: 3. SF [db]:. OCTOPUS M-pattern ( ) used for a high resolution of the macula

29 Retina Single field 3 BRANCH CENTRAL RETINAL VEIN OCCLUSION -year-old male, no family history Patient reported decreased visual acuity in left eye, blurred and double vision mmhg/.2 3. (sph), 2. (cyl) x Retinal hemorrhage and soft exudate along RNFL in lower retinal arcade Demo John, // (yrs) Left eye (OS) / /3/ / :44: Greyscale (CO) %..% %...82% %...% %...% % Diffuse defect [db]: -. % Diffuse & local defect p > p < p < p <, Programs: G Standard White/White / Normal Questions / repetitions: 4 / 3 Parameters: 4 / asb III ms Duration: :3 Catch trials: / (4%), / (%) - RF: 2. Refraction S/C/A:./-2./ VA:.2 Pupil [mm]:.2 IOP [mmhg]: Very reliable test MS [db]:. MD [< 2. db]:. slv [< 2. db]: 4. CsLV [db]: 4. SF [db]: 2. OCTOPUS