Case Presentation
A 49-year-old male patient with moderate primary open-angle glaucoma in both eyes presented to Specialty Eye Centre for ongoing care with complaints of increased cataract-related symptoms. In addition to glaucoma, the patient presented with mild cataracts, moderate myopia, and dry eye. Central corneal thickness was 600 µm in both eyes, and the patient previously underwent selective laser trabeculoplasty (SLT). Currently, his intraocular pressure (IOP) is well controlled within the target range (<20 mmHg OD, <22 mmHg OS) on topical IOP-lowering medications. His optical coherence tomography (OCT) scan has been stable, but his visual field (VF) shows early-to-moderate VF loss.
MonacoPro (Optos), a next-generation ultra-widefield (UWF) scanning laser ophthalmoscopy, can capture UWF imaging as well as spectral-domain (SD) OCT, which can be analyzed with a reference database (RDB) that considers optic nerve head (ONH) size to support more accurate glaucoma predictions. Using the Optos MonacoPro, UWF color and stereo images were taken along with an ONH topography to monitor the optic disc and retinal nerve fiber layer (RNFL) in one imaging session.
Image Findings
On the UWF color images, a dark, blurred shadow was observed in the far retinal periphery, confirming the patient’s diagnosis of pigmentary glaucoma supported by the patient’s associated risk factors, including male gender and myopia. With pigment dispersion syndrome, it is common to observe pigment resting on the zonules, but typically this finding is visible only with a careful dilated slit lamp examination. In this case, we can leverage the multimodal imaging of MonacoPro to confidently monitor the patient’s glaucomatous changes and examine up to 200 degrees of the retinal periphery to capture additional insights into this patient’s overall condition.
The patient’s MonacoPro ONH scan, which also provides an RNFL line scan, remained stable. OCT findings were consistent with the nerve fiber layer absence visualized inferiorly on UWF stereo imaging, which also corresponded to the patient’s VF loss. Optos MonacoPro’s scanning laser ophthalmoscopy imaging, which provides clinically useful images even in eyes with dense cataracts, and high-quality SD-OCT imaging will prove valuable as this patient’s cataracts progress, and we plan for cataract surgery with minimally invasive glaucoma surgery.
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