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A male patient CB (date of birth 31/12/1962) attended for a routine eye examination in July. The refraction was isometric and unremarkable (R -1.50/-0.75 x 10 (6/5), L -2.00/-0.25 x 5 (6/5)), pressures within normal limits (R 11 mmHg, L 12mmHg with non-contact tonometry) and a Henson suprathreshold screening revealed no field defect (threshold established at 32 dB).
Ophthalmoscopy did, however, show a significant asymmetry of the optic discs (Figure 1). The right disc has a vertical cup/disc ratio of 0.5, variable margin definition and early peripapillary atrophy. The overall disc appears paler than the left, though the neuroretinal rim appears adequately perfused. The left disc has a much smaller cup, a ratio of around 0.2 and a more oval and regular margin. The disc appears a little darker, possibly mostly to do with the smaller cup. The patient was referred routinely to rule out the possibility of any neuropathic disease of the right eye.
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