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Asymptomatic—but signs of trouble

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Regina Leung and Richard Lindsay
Richard Lindsay and Associates

Product
Nidek RS-3000 Advance OCT

Supplier
Designs For Vision

Our practice took the plunge last year and purchased a Nidek RS-3000 Advance OCT. This has been most useful in monitoring and diagnosing a range of ocular conditions, as well as assisting in the fitting of miniscleral and hybrid contact lenses.

In this article, we present two retinal detachment cases, one symptomatic and the other asymptomatic, to emphasise the merits of having an OCT in clinical practice. In both these cases, the OCT proved to be a highly valuable tool in the diagnosis and management of the patient.

Particularly worth highlighting is the significance of using the OCT in even asymptomatic cases as part of a routine eye examination, especially for patients with high myopia. This wonderful piece of equipment has been welcomed in the practice by our patients and the practitioners.

CASE REPORTS

Symptomatic

JF, a 42-year-old male with high myopia (about -12.50 D, R & L), presented at 5 pm on a Friday—naturally!—reporting recent onset decreased vision in his right eye. Visual acuity had decreased to a hazy 6/19 in the right eye (it was previously noted as 6/6), while the visual acuity in the left eye remained at 6/6.

Central visual field testing with the Amsler grid revealed a superior defect in the right eye; no defect was noted in the left eye. Dilated fundus examination showed the right peripheral retina to have a partial retinal detachment, with no sign of any accompanying retinal holes or tears.

We then conducted an OCT test on the patient to confirm our suspected diagnosis and were awestruck with the result (Figure 1), which clearly shows a macula-off retinal detachment and explains the patient’s decreased visual acuity.

The OCT image plainly shows that the neurosensory retina has been elevated from the hyperfluorescent retinal pigment epithelium. The patient was promptly referred to the Royal Victorian Eye and Ear Hospital for appropriate surgical management.

E21 Figure 1

Figure 1. A macula-off retinal detachment.

Asymptomatic

CC, a 40-year-old female with high myopia (about -9.00 D, R & L) presented to our practice for a routine contact lens after-care consultation with no reported complaints. Her ocular history was also notable for having bilateral keratoconus and as a result of this condition, she had had corneal graft surgery performed on her right eye about 16 years earlier.

Visual acuities with the contact lenses were R 6/7.5, L 6/9.5—as they had been for the previous few years. Dilated fundus examination revealed no abnormalities in the left eye. The right eye also appeared normal, although the fundus was more difficult to visualise due to some moderate opacification of the corneal graft.

OCT of the left eye was unremarkable, while OCT of the right eye revealed a long-standing neurosensory retinal detachment inferiorly (Figure 2) due to an atrophic hole. The retinal detachment was presumably long-standing as the OCT image shows a significant thinning of the retina, especially the outer nuclear layer.

Central threshold visual field testing revealed a corresponding superior defect in the right eye. The patient was subsequently referred to a retinal specialist who surgically treated the condition by means of a scleral buckle.

E21 Figure 2

Figure 2. A long-standing neurosensory retinal detachment inferiorly



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