Evaluation of the Optic Nerve Head in Glaucoma.

Suneeta Dubey,Monica Gandhi

doi:10.5005/jp-journals-10008-1146

Suneeta Dubey, Monica Gandhi

Open Access

https://doi.org/10.5005/jp-journals-10008-1146

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Abstract

ABSTRACTGlaucoma 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.

Highlights

Evaluation of the Optic Nerve Head in GlaucomaGlaucoma is an optic neuropathy leading to changes in the intrapaillary and parapaillary regions of the optic disk
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
The cardinal feature of glaucomatous optic neuropathy is the loss of NRR from the inner edge of the rim

Summary

Evaluation of the Optic Nerve Head in Glaucoma

Glaucoma is an optic neuropathy leading to changes in the intrapaillary and parapaillary regions of the optic disk. 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. It is important to determine if the optic disk is of an average size, larger or smaller than average for the given population. The circle has a diameter of 1.5 mm and an area of 1.77 mm[2] which is slightly smaller than the average disk With this one can determine if the disk is small, average or large in size. It is possible that the difference in disk sizes account for the asymmetry in other parameters like C:D ratio and the neuroretinal rim (Figs 2A and B)

Optic Disk Shape

Cup Disk Ratio in Relation to the Disk Size

The Neuroretinal Rim

Disk Hemorrhage

Retinal Nerve Fiber Layer

Peripapillary Atrophy