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Macular Fluid in a Patient With a Reported History of Normal-Tension Glaucoma

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A patient with a history of normal-tension glaucoma presented with a blurred spot in the central vision of the right eye. Examination showed best-corrected visual acuity of 20/50 OD, 20/30 OS, and intraocular pressure of 13 mm Hg OU. In the right eye, dilated fundus examination and optical coherence tomography (OCT) of the macula revealed subretinal fluid and cystoid spaces within the outer nuclear layer and inner nuclear layer in the nasal macula (Figure 1). Results of the left eye fundus examination and macular OCT were normal. In both eyes, the optic cup appeared very deep with a large cup-disc ratio.

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A patient with a history of normal-tension glaucoma presented with a blurred spot in the central vision of the right eye. Examination showed best-corrected visual acuity of 20/50 OD, 20/30 OS, and intraocular pressure of 13 mm Hg OU. In the right eye, dilated fundus examination and optical coherence tomography (OCT) of the macula revealed subretinal fluid and cystoid spaces within the outer nuclear layer and inner nuclear layer in the nasal macula (Figure 1). Results of the left eye fundus examination and macular OCT were normal. In both eyes, the optic cup appeared very deep with a large cup-disc ratio.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Eileen S. Hwang, MD, PhD, Department of Ophthalmology and Visual Sciences, University of Utah, 65 Mario Capecchi Dr, Salt Lake City, UT 84132 (eileenhwang@yahoo.com).

Published Online: January 6, 2022. doi:10.1001/jamaophthalmol.2021.3326

Conflict of Interest Disclosures: Dr Hwang reports nonfinancial support from Regeneron, Beaver Vistec, Katalys, Alcon, and Bausch & Lomb. Dr Kim reports personal fees from Allergan, Adverum, Astellas, Genentech, Novartis, and Regeneron and research support from Heidelberg, Notal Vision, and Optos. No other disclosures were reported.

Meeting Presentation: This work was presented by Dr Kim at the Hawaiian Eye/Retina Meeting; January 13, 2018; Kihei, Hawaii.

Additional Contributions: We thank Marriner Altmann, CRA, OCT-C, CPT, Medical College of Wisconsin/Froedtert Eye Institute, for obtaining the images. She did not receive compensation.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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