Dear student or new graduate. You've probably had some form of introduction to glaucoma and its relatives. See the clinical data here and tell me what would you do?
Chief Complaint - (1) Dry Eyes (2) Red conjunctiva - chronic
HPI This is a pleasant ambulatory 72-year old African American Male who presents to my care in April 2007 to establish primary eye care. He has been characterized as a "glaucoma suspect" since 2005 by another eyecare provider (ECP) with no medications at this time. He was lost to follow up from that visit until today.
He is in no acute distress and has no vision complaints, and no eye pain or diplopia.
Current Medical Problems
1. Hypertension
2. History of tophaceous gout, currently asymptomatic.
3. Osteoarthritis of his knees.
4. Neurosensory hearing loss
5. Hypothyroidism, on replacement with good level TSH.
6. Possible history of alcohol abuse which patient is currently denying.
Current Medications
1. Lisinopril 20 mg daily.
2. Allopurinol 300 mg daily.
3. Levoxyl 0.05 mg daily.
4. Enteric-coated aspirin 81 mg daily.
Relevant physical Examination
1. Current glasses OD 20/25 each eye
2. Tapp 14:00 20 each eye
3. Pachymetry OD 508 and OS 490
4. Gonioscopy open 360 degrees, Grade 4
5. Cortical cataracts in both eyes
6. Cup-to-disk ratios are OD 0.75 vertically and OS 0.65 vertically (
sorry no fundus description or disk photos)
7. Optic nerve head diameter optically measured as 2.0mm
On 08/27/2007, his entrance acuities were measured as 20/20 in each eye and his IOPs were 16 each eye at 10:30am
See attached GDX and visual fields by clicking here
http://www.geocities.com/rchom/FilePages/GrandRoundsPhotoIndex_007.html
Question:
1. What is your diagnosis?
2. If you do diagnose glaucoma, what is your rationale and your medical or surgical regimen/ plan?
3. If you do not treat, what do you say to the patient.
Richard Hom OD FAAO