The patient's last complete/last time seen was on 12/01/15 with Dr. Morris. Here for a VF/Gonio/IOP check today. CC: Patient reports mild watering OU only, denies itch. denies changes to vision. The patient is being followed for: 1. Mild glaucoma suspect OU due to borderline RNFL and previous VF defects 2. Pseudophakia OU 3. Trace epiretinal membrane OU 4. Hypertension without angiopathy OU 5. Hyperopia OS, astigmatism OU, presbyopia OU OCULAR HX: Pain/Discomfort Scale 1/10: 0 [-] Trauma: [+] Surgery: cataract surgery OU 2008 - Eye specialists in Chilli. [-] Strabismus: [-] Glaucoma: [-] Flashes: [+] Floaters: since surgery, occasional, stable, OU [-] Diplopia: Other: ocular migraine FAM. OC HX: unknown [-]Glaucoma [-]Blindness [-]Retinal Detachment [-]Macular Degeneration Other: MED HX: (-)DM (+)HTN: on meds (+)Hyperlipidemia: on meds (-)CVA (-)Cancer (-)Hepatic (-)Renal (-)Cardiovascular (-)Respiratory (+)Neurological: bipolar disorder, migraines (-)Genitourinary (+)Hemotologic: patient reports running anemic on blood counts (+)Endocrine: hypothyroid (-)Musculoskeletal (-)Autoimmune (+)Gastrointestinal: GERD PSHX: (-)Smoke (-)ETOH Current Medications Reviewed Allergies - INFLUENZA, TRAMADOL CURRENT SPECTACLE RX and ENTERING VA: OD: plano -0.50 x 158 20/20 OS: +1.50 -1.00 x 175 20/20-2 ADD: +2.50 PERRL; APD: [-] EOM: full/ no diplopia/pain OU SLIT LAMP EXAM: Lids/Lashes: clear OU Sclera/Conjunctiva: quiet and clear OU Cornea: CE scars OU; no staining OU ANTERIOR CHAMBER: OD: Deep/Dark/Quiet OS: Deep/Dark/Quiet IRIS: OD: Flat and Intact, No Rubeosis OS: Flat and Intact, No Rubeosis TONOMETRY: OD: 10 OS: 10 TIME: 10:41AM on 05/24/16 INTERNAL (90D undilated) NERVE: OD: 0.30/0.30 hor/vert, healthy rim tissue OHN Size determined by 78D size x 1.1 [+]Small vertical optic disc diameter ~1.3 mm Rim Evaluation [+]ISNT Retinal nerve fiber layer. [-]wedge-shaped arcuate dark areas emanating from the optic disc greater than an arteriole wide. Parapapillary Atrophy [+]Zone Alpha PPA Optic disc hemorrhage [-]Drance OS: 0.35/0.35 hor/vert, malinserted, healthy rim tissue; nasal drusen - not appreciated on undilated view today OHN Size determined by 78D size x 1.1 [+]Small vertical optic disc diameter ~1.3 mm Rim Evaluation [+]ISNT Retinal nerve fiber layer. [?]wedge-shaped arcuate dark areas emanating from the optic disc greater than an arteriole wide - possible defect superior nasal Parapapillary Atrophy [+]Zone Alpha PPA Optic disc hemorrhage [-]Drance ADDITIONAL TESTS: (+) VISUAL FIELD EVALUATION: Octopus 32/TOP OD: Reliability - moderate (78/4 #questions/repetitions) Indices: MD:2.2 LV:11.5 Pattern of defect: paracentral with other scattered points Quadrants involved: concentrated superior temporal Central four points involved: yes, superior 2 central points Crosses midline (horizontal / vertical): crosses vertical Repeatability (comparing to baseline and last) - compared to 06/25/14, new paracentral defect (previous field was clear), but moderate reliability compared to baseline optopus from 2012, new paracentral defect and does not repeat the inf nasal step seen at baseline OS: Reliability - poor (80/6 #questions/repetitions; 2/4 FP and 2/4 FN) Indices: MD: 6.8 LV: 35 Pattern of defect: dense inferior arcuate with small defect superiorly Quadrants involved: all four Central four points involved: yes, bottom 2 central points Crosses midline (horizontal / vertical): yes vertical and horizontal Repeatability (comparing to baseline and last) - compared to 06/25/14, new inferior arcuate and superior defects (previous field was clear), but poor reliability compared to baseline octopus from 2012, repeatable inferior arcuate but does not repeat the superior defect seen at baseline (+) GONIOSCOPY: Angles open/-PAS/-NVA/-Recession OU OD OS CB CB CB CB CB CB CB CB ASSESSMENT: 1. Mild glaucoma suspect OU due to borderline RNFL and previous/current VF defects -low risk suspect a. IOP 05/24/16: 10/10 - untreated OU b. OCT 12/1/15: borderline thinning OD, OS but stable OU to 2014 c. Optos 11/24/14: stable cupping OU d. visual field 05/24/16: new paracentral defect OD new inferior arcuate OS e. gonioscopy 05/24/16: open angles to CB 360 OU f. pachymetry 09/21/12: 563/555: slight thicker than average CCT OD>OS g. GDx 06/25/14: NFI= 30/24: superior thinning OD, WNL OS; stable OU to 03/28/13 PLAN: 1. Educated patient on findings from today's exam & need for repeat field given the new defects noted today OU compared to clear fields from 2014. Low suspicion for true defects as the OCT RNFL findings are stable, the ONH appearance is stable and IOP is in a good range with avg pachys. Although not appreciated today, drusen noted previously OS may be contributing to possible VF defect? Patient's emotional status/concern for the bright lights of the VF machine causing a migraine may be playing a role in the poor reliabilty and new defects seen today. Patient agrees to plan for repeat field in 3 months. Please consider testing OS first. Monitor as follows: a. IOP 08/2016 b. repeat OCT 12/2016 complete exam c. repeat photos 12/2016 complete exam d. repeat visual field 08/2016 e. repeat gonioscopy 05/2017 f. repeat pachymetry PRN g. repeat GDx PRN RTC 08/2016 repeat HVF (OS test first)/ IOP check