Glaucoma

Glaucomatous Optic Nerve

Glaucomatous optic nerve demonstrating notching of the disc rim superiorly. There is also sloping of the temporal disc rim.
  • Clinical evaluation of the optic disc can be performed via indirect or direct ophthalmoscopy techniques
  • Slit lamp indirect ophthalmoscopy is associated with use of a 78 or 90 diopter handheld lens, a Hruby lens, or a posterior pole contact lens
  • Photographic documentation of the optic disc and retinal nerve fiber layer is useful for baseline comparison
  • Newer disc and/or nerve fiber layer imaging techniques (e.g. OCT, HRT, GDx) are promising and may assist in clinical evaluation
  • Characteristic features of glaucomatous optic nerve include:
    • Generalized or focalized increase in the optic cup size and in the cup-disc ratio
    • Vertical enlargement of the optic cup as a result of retinal nerve fiber loss and/or disc rim loss (especially at the superior and inferior poles)
    • Asymmetric cupping ( 0.2 cup-disc ratio difference) between the two eyes
    • Changes in vessel configuration and caliber
    • Splinter hemorrhages
    • Increased visibility and thinning of the lamina cribrosa
    • Narrowing or notching of the neural rim
Glaucomatous cupping of the optic nerve.
  • Comments on the above two disc photographs (from the same patient):
    • Noticeable asymmetry of optic discs
    • Advanced glaucomatous cupping of the right optic nerve
    • Localized rim loss inferiorly and baring of the circumlinear vessel (left eye)
    • Nasalization and bayoneting of the vessels (more apparent in the right eye)
    • Baring of the lamina cribrosa (right eye)