CC: 65 y.o. man with complaints of painless, gradual loss of vision OS. HPI: Patient complained of a painless, gradual loss of vision OS over several months. He saw an eye doctor and was diagnosed with angle closure glaucoma. He was sent to the U of Iowa for evaluation, treatment, and possible laser peripheral iridotomy (LPI). PMH: healthy, no medications, and no FH of glaucoma. Exam: mRx: PLANO OU Best corrected visual acuities: 20/20 OD, barely hand motion vision OS. Pupils: >3.0 LU RAPD OS (very large). EOM: full OU VF (see below) IOP: 19 mmHg OD, 71 mmHg OS DFE: retina exam notable for normal macula, vessels, and periphery OU. Optic nerves: 0.4 C/D OD, almost complete cup OS (see photos below). SLE: OD notable for 1-2+ nuclear sclerosis cataract, OS see photos below. Gonioscopy: moderately open angles OU. Not occludable OU. (+) Sampolesi line OS. GVF OD - Full Field GVF OS with severe VF loss Slit Lamp OS: moderate injection, no cells seen in anterior chamber Slit Lamp OS: moderate corneal edema, and moderately deep anterior chamber Slit Lamp OS: undilated pupil exam notable for white, fluffy material around pupil margin. Slit Lamp OS: dilated exam notable for ground glass appearance of anterior lens capsule Right Optic Nerve: normal Left Optic Nerve: almost complete cup Feel free to discuss the following: What tests should you order (I'll post labs when asked for them)? What's the differential diagnosis? What's the diagnosis? What is the treatment of choice, surgically and/or medically?