58 year old
2 years ago
OD +1.75/-0.75*129 20/25
OS +1.50 20/25
No Medical or Ocular History
This is a case presentation of a 58-year-old female diagnosed with anatomical “Narrow Angles” and a potential risk of angle-closure glaucoma during a comprehensive telemedicine eye exam. Glaucoma is a group of disease that can damage the optic nerve resulting in irreversible vision loss. This irreversible damage can be managed or better prevented if diagnosed and treated in a timely manner. While open-angle glaucoma is known to progress gradually with subtle or sometimes no initial symptoms, angle-closure glaucoma on the contrary is known to be a true eye care emergency causing acute rise in the intra-ocular pressures leading to complete loss of vision. This acute attack of angle-closure glaucoma can be avoided if diagnosed and treated using preventive measures. The following case study highlights how a comprehensive eye exam performed via telemedicine, detected and provided referral in a timely manner to execute preventive measures.
58-year-old female with no medical or ocular history presented for a routine eye exam. Patient denied history of any ocular or systemic abnormalities, surgeries, pain or trauma. Her glasses were 2 years old and she faced difficulties in her vision for distance and reading with them. The patient was hyperopic with best-corrected visual acuities of OU 20/20 for distance and near. On further clinical examination, digital slit lamp images showed - OU anterior chamber, cornea, iris and lens were within the normal limits but both her nasal and temporal angles OU were Grade 1. Non-contact intraocular pressure results were 16/17mmHg OD and 15/11mmHg OS. Patient’s visual field test and fundus images were within the normal limits. Patient was referred to an eye care professional for further dilated evaluation due to narrow angles and for possible preventative treatment. Patient was additionally educated regarding the signs of angle closure glaucoma and was advised to seek immediate medical care ASAP if they occur.
Though angle-closure glaucoma is not as common as open-angle glaucoma, it does present more severe symptoms and can cause rapid loss of vision. There are two forms of angle-closure glaucoma, acute and chronic. Acute angle-closure glaucoma occurs when there is a sudden block in the normal flow of aqueous humor between the iris and the lens. It may include severe symptoms like pain, vomiting, blurred vision, nausea, and a rainbow halo appearing around lights. It is a medical emergency that must be treated immediately, or it can result in blindness within one or two days. While chronic angle-closure glaucoma progresses gradually and can cause damage without severe symptoms, like open-angle glaucoma. As early detection and preventative treatments are very crucial in any glaucoma cases. Access to care via ocular telemedicine plays a significant role in reaching those potential patients that would not routinely have comprehensive eye exams. It not only serves as a bridge between in-person doctors and patients, but it also contributes in patient education and awareness.
OD Narrow Angles – Images 1 & 2
OS Narrow Angles – Images 3 & 4