Qualitative morphologic characteristics of normal and glaucomatous optic papillae

Abstract

Using optic disk photographs, qualitative morphologic characteristics of the optic nerve head were determined in 251 nonselected normal eyes and 308 eyes with chronic primary open-angle glaucoma. These characteristics were correlated to morphometric (both intra- and parapapillary) and perimetric data. The highest degree of accuracy in distinguishing normal from glaucomatous optic disks was found with the characteristics "localization of narrowest point of neuroretinal rim outside the temporal horizontal optic disk sector" (85.5%) and "changes in the parapapillary retinal nerve fiber layer" (87.9%). The signs "baring of circumlinear vessels," "baring of cilioretinal arteries," "epipapillary flame-shaped hemorrhages," and "bridging of the vessel trunk" were highly specific for glaucomatous optic nerve damage (94.4%-100%) and less sensitive (5.8%-25.3%). Bayonetlike vessel kinking," "prevalence of cupping nasal to the main vessel trunk," "baring of the lamina cribrosa pores," and "undermining of the cup border" were less useful in qualitative evaluation of the optic disk. The location of the central artery in relation to the central vein (nasal in 98.4%), prevalence of the cilioretinal arteries, and the total number of circumlinear vessels were not significantly correlated to changes associated with glaucoma and are therefore of no importance for optic disk evaluation in glaucoma.