Glaucoma or not glaucoma? ‐ How to navigate problematic cases?

Abstract

Optic neuropathies refer to a group of eye conditions that involve acute or chronic damage to the optic nerve, which is responsible for transmitting visual information from the eye to the brain. The optic nerve is made up of millions of nerve fibres that can be affected by a variety of primary or secondary insults, leading to progressive neurodegeneration of optic nerve axons, being projections of retinal ganglion cells. The most common optic neuropathies that we should consider in differential diagnosis represent glaucoma, ischemic, inflammatory, toxic, hereditary, traumatic, and compressive optic neuropathies.Although the visual field test is one of the most basic and oldest diagnostic method in ophthalmology, it represents a sophisticated test that allows to differentiate ongoing pathology, based on features of observed scotomas. The specific features include localization, steepness, relativity and symmetry of visual field defects. By combining those features with clinical anamnesis, imaging techniques and electrophysiological data, properly used visual fields can be a powerful tool to provide patients and other medical specialists with further direction of diagnostic process and treatment. This course aims to provide a series of cases‐based analysis of different visual field results, to establish certain universal rules and to provide useful tips, how to diagnose difficult glaucoma cases using perimetry and how to rule out non‐glaucomatous neuropathies, allowing to speed up and to properly direct the diagnostic process.