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Normal-Tension Glaucoma Masqueraders: Detection Using Optical Coherence Tomography

Kuo, Debbie S. MD; Asrani, Sanjay MD

doi: 10.1097/IJG.0000000000000578
Online Articles: Brief Reports

Purpose: Optical coherence tomography (OCT) has become an important tool in the diagnosis and management of glaucoma; however, there can be overlap in the OCT findings between glaucoma and other diseases. We describe the clinical examination finings and interpretation of OCT imaging that led to the diagnosis of glaucoma masqueraders in a clinical case series.

Materials and Methods: Four adult patients seen in the glaucoma clinic at the Duke Eye Center were included in a retrospective observational case series. Clinical presentation, history, examination, and testing (visual fields, scanning laser ophthalmoscopy, and spectral-domain OCT imaging) were reviewed.

Results: We report a case series of 4 patients and their spectral-domain OCT findings with retinal disease or nonglaucomatous optic neuropathy, who presented for evaluation of suspected or previously diagnosed normal-tension glaucoma. The first patient showed marked diffuse retinal nerve fiber layer (RNFL) and macular thinning on OCT due to cancer-associated retinopathy. The second patient, who demonstrated deep focal inferotemporal RNFL loss with a corresponding arc of macular thinning on OCT, had a previous branch retinal artery occlusion. The third patient’s OCT showed global RNFL and macular thinning from optic nerve hypoplasia. The last patient had bilateral, symmetric superior and temporal RNFL thinning on OCT with corresponding inferior arcuate defects, consistent with superior segmental optic nerve hypoplasia.

Conclusions: In light of the clinical context and examination, optic nerve and macular OCT can be beneficial in distinguishing between glaucoma and glaucoma mimics.

*Duke Eye Center, Duke University, Durham, NC

Palo Alto Medical Foundation, Palo Alto, CA

Disclosure: D.S.K. was supported by a fellowship from The Society of Heed Fellows. S.A. received lecture honoraria from Heidelberg Engineering.

Reprints: Sanjay Asrani, MD, Duke Eye Center, Duke University, 2351 Erwin Road, Durham, NC 27705 (e-mail:

Received September 11, 2016

Accepted September 26, 2016

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