Want to take quizzes and track your credits?
A 70-year-old woman with an ocular history of primary open-angle glaucoma on latanoprost, bilateral trabeculectomies, and argon laser trabeculoplasties presented with several months of worsening vision in the left eye. On examination, her best-corrected distance visual acuity was 20/40 OD and 20/60 OS (baseline 20/40 OU). Pupils were equally round and reactive, without afferent pupillary defect. Findings of Amsler grid testing were notable for a small area of distortion inferiorly in the left eye. Intraocular pressures (IOPs) were 13 mm Hg in both eyes. Findings of anterior segment examination were unremarkable. Findings of dilated fundus examination were notable for cup-disc ratio of 0.9 in the right eye and 0.85 in the left eye with temporal thinning, stable from prior, and new intraretinal thickening in the left eye. Optical coherence tomography (OCT) imaging of the left eye revealed schiticlike separation of the outer plexiform and outer nuclear layers extending from the temporal edge of the optic nerve head to the fovea (Figure 1A), continuous with the peripapillary nerve sheath.
Please finish quiz first before checking answer.
Read the answer below and download your certificate.
Read the discussion below and retake the quiz.
Macular retinoschisis in the setting of glaucomatous optic atrophy
The patient’s decreased vision was due to macular retinoschisis, an abnormal splitting of the neuroretina associated with glaucomatous optic atrophy. Observation (choice C) is correct because the patient noted only mild distortion, and retinoschisis can remain stable1 or resolve spontaneously2,3 in up to 40% of cases.3 Schisis can resolve after vitrectomy,1 so surgery (choice A) could be pursued if symptoms worsened. Barrier laser (choice B), as described by Prinzi et al,4 has been used to treat retinoschisis in glaucoma; however, peripapillary laser photocoagulation carries risk of vision loss and the patient had only a 2-line decrease in vision. Testing for the RS1 gene (choice D) would be indicated if X-linked retinoschisis was suspected; however, this disease appears almost exclusively in boys.
Sign in to take quiz and track your certificates
JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC
Corresponding Author: Rajendra S. Apte, MD, PhD, Department of Ophthalmology and Visual Sciences, Washington University, 660 S Euclid Ave, Campus Box 8096, St Louis, MO 63110 (email@example.com).
Published Online: September 2, 2021. doi:10.1001/jamaophthalmol.2021.0939
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
You currently have no searches saved.