Page 20 - 21st Century Perspective - Glaucoma Supplement

Figure 12.​ After obtaining a third visual field, it can be readily observed that the cluster of nasal scotomas seen previously has
grown, indicating progressive glaucomatous optic neuropathy.

Now, we have a solid diagnosis mandating therapeutic intervention. At that time, latanoprost was
prescribed, and a few years later, a second drop was added to the patient’s regimen to achieve a
target range of IOP. Had we first seen the patient in 2018, we would have initiated therapy with
Vyzulta (latanoprostene bunod 0.024%, Bausch + Lomb) in the hope that it would outperform
latanoprost and delay the need for adding a second drop by a few years.

Two lessons can be learned from this case. First, it is important check IOP at different times of the

day to avoid missing swings in the diurnal pattern (Icare HOME tonometry would further enhance
this search for peak IOP by including IOP readings outside of regular office hours). Second, the eye
doctor must know how to competently read and interpret visual field data.

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