Evaluation of the Optic Nerve Head in Glaucoma

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ABSTRACT

Glaucoma is an optic neuropathy leading to changes in the intrapaillary and parapaillary regions of the optic disk. Despite technological advances, clinical identification of optic nerve head characteristics remains the first step in diagnosis.

Careful examination of the disk parameters including size, shape, neuroretinal rim shape and pallor; size of the optic cup in relation to the area of the disk; configuration and depth of the optic cup; ratios of cup-to-disk diameter and cup-to-disk area; presence and location of splinter-shaped hemorrhages; occurrence, size, configuration, and location of parapapillary chorioretinal atrophy; and visibility of the retinal nerve fiber layer (RNFL) is important to differentiate between the glaucomatous and nonglaucomatous optic neuropathy.

How to cite this article: Gandhi M, Dubey S. Evaluation of the Optic Nerve Head in Glaucoma. J Current Glau Prac 2013;7(3):106-114.

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Most cited references 26

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Optic nerve damage in human glaucoma. II. The site of injury and susceptibility to damage.

H A Quigley, E M Addicks, W R Green … (1981)

We examined the histologic structure of the optic nerve head in 15 eyes of nine persons with a known glaucoma history. All had been seeing eyes, varying from normal visual acuity and visual field to advanced glaucoma damage. The site of damage to nerve fibers is the scleral lamina cribrosa, where there is local blockage of axonal transport. Early cup size increase prior to definite field loss results from loss of nerve fibers, not from damage to astrocytic glial cells of the nerve head. No selective damage to nerve head capillaries is seen in mildly damaged specimens. Scanning electron microscopic analysis suggests that the structure of the lamina cribrosa is an important determinant of the degree of susceptibility to damage by elevated intraocular pressure.

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Optic disc, cup and neuroretinal rim size, configuration and correlations in normal eyes.

Jost Jonas, G Naumann, G C Gusek (1988)

Four hundred and fifty-seven unselected normal human optic nerve heads of 319 subjects (163 men, 156 women, mean age 42.7 +/- 19.6 years) were evaluated by magnification-corrected morphometry of optic disc photographs. Mean optic disc surface measured 2.69 +/- 0.70 mm2 (0.80-5.54 mm2), mean diameter horizontally 1.76 +/- 0.31 mm (0.91-2.61 mm), and vertically 1.92 +/- 0.29 mm (0.96-2.91 mm). The form was slightly vertically oval. Optic cup area averaged 0.72 +/- 0.70 (0.00-3.41 mm2), mean horizontal cup diameter 0.83 +/- 0.58 mm (0.00-2.08 mm) and mean vertical diameter 0.77 +/- 0.55 mm (0.00-2.13 mm). The cup was significantly (P less than 0.0001) larger in discs with steep "punched-out" cups (1.37 +/- 0.62 mm2) compared to discs having cups with temporal flat slopes (0.59 +/- 0.39 mm2). Neuroretinal rim area ranged from 0.80 to 4.66 mm2 (mean 1.97 +/- 0.50 mm2), and was significantly correlated (P less than 0.00001) to the optic disc area. It was broadest in the inferior optic disc region (P less than 0.001), followed by the superior, nasal and temporal (P less than 0.001) regions. Horizontal cup/disc ratio (mean 0.39 +/- 0.28, minimum 0.00, maximum 0.87) was larger in 426 (93.2%) optic discs than the vertical one (mean 0.34 +/- 0.25, minimum 0.00, maximum 0.85). Concerning optic disc area, side differences of 0.10 mm2 or less were detected in 28%, of 0.2 mm2 or less in 46% and of 0.50 mm2 or less in 80% (cumulative frequencies). Concerning neuroretinal rim area, side differences of 0.10 mm2 or less were found in 31%, of 0.20 mm2 or less in 52% and of 0.50 mm2 or less in 84%.(ABSTRACT TRUNCATED AT 250 WORDS)

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An evaluation of optic disc and nerve fiber layer examinations in monitoring progression of early glaucoma damage.

R J Derick, Marc A. Sommer, H Quigley … (1991)

From annual examinations of 813 ocular hypertensive eyes, the authors compared optic disc and nerve fiber layer photographs in 2 age-matched subgroups: 37 eyes that converted to abnormal visual field tests at the end of a 5-year period and 37 control eyes that retained normal field tests. Disc change was detected in only 7 of 37 (19%) converters to field loss and in 1 of 37 (3%) controls. Progressive nerve fiber layer atrophy was observed in 18 of 37 (49%) converters and in 3 of 37 (8%) controls. Serial nerve fiber layer examination was more sensitive than color disc evaluation in the detection of progressive glaucoma damage at this early stage of glaucoma. The evaluation of cup-to-disc ratio or of the nerve fiber layer appearance in the initial photograph taken 5 years before field loss were equally predictive of future field damage. The position of nerve fiber layer defects was highly correlated with the location of subsequent visual field loss.

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Author and article information

Contributors

Monica Gandhi

Suneeta Dubey

Journal

Journal ID (nlm-ta): J Curr Glaucoma Pract

Journal ID (iso-abbrev): J Curr Glaucoma Pract

Journal ID (publisher-id): JOCGP

Title: Journal of Current Glaucoma Practice

Publisher: Jaypee Brothers Medical Publishers

ISSN (Print): 0974-0333

ISSN (Electronic): 0975-1947

Publication date (Print): Sep-Dec 2013

Publication date (Electronic): 06 September 2013

Volume: 7

Issue: 3

Pages: 106-114

Affiliations

Consultant, Department of Glaucoma and Anterior Segment, Dr Shroff’s Charity Eye Hospital, New Delhi, India

Author notes

Monica Gandhi, Consultant, Department of Glaucoma and Anterior Segment, Dr Shroff’s Charity Eye Hospital, New Delhi, India, e-mail: monicagandhi@yahoo.com

Article

DOI: 10.5005/jp-journals-10008-1146

PMC ID: 4741153

PubMed ID: 26997792

SO-VID: 35390d48-f1a7-418a-b990-67bc5991e5cf

License:

This work is licensed under a Creative Commons Attribution 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by/3.0/

Evaluation of the Optic Nerve Head in Glaucoma

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ABSTRACT

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NeuroImaging Methods

Most cited references 26

Optic nerve damage in human glaucoma. II. The site of injury and susceptibility to damage.

Optic disc, cup and neuroretinal rim size, configuration and correlations in normal eyes.

An evaluation of optic disc and nerve fiber layer examinations in monitoring progression of early glaucoma damage.

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