WEDGE DEFECT REVEALS NERVE FIBER LOSS

A 69 year old man presented with a history of cataract surgery for a routine eye examination with no complaints.  His visual acuity was 20/20 in each eye.  He has minimal optic nerve cupping and 15mmHg intraocular pressure in each eye.  There would normally be no suspicion of  glaucoma given this data. 

An Optomap image of the right fundus revealed a suspicious looking wedge defect superiorly.

An optical coherence tomography revealed an interesting dip in the retinal nerve fiber layer in the same area as the wedge defect.  The macular ganglion cell scan showed no thinning.  To treat or not to treat?

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