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Review
. 2013 Sep-Dec;7(3):106-14.
doi: 10.5005/jp-journals-10008-1146. Epub 2013 Sep 6.

Evaluation of the Optic Nerve Head in Glaucoma

Monica Gandhi  1 , Suneeta Dubey  1
Affiliations
Review

Evaluation of the Optic Nerve Head in Glaucoma

Monica Gandhi et al. J Curr Glaucoma Pract. 2013 Sep-Dec.

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.

Keywords: Disk anomalies.; Neuroretinal rim; Optic cup; Optic disk; Optic disk hemorrhage; Parapaillary atrophy; Retinal nerve fiber layer.

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Conflict of interest statement

Source of support: Nil

Conflict of interest: None declared

Figures

Fig. 1
Fig. 1
To determine disk size decrease the height of the slit beam to coincide with the disk margin.
Fig. 2A
Fig. 2A
Asymmetry in disk size leading to asymmetry in CD ratio. Left disk is larger
Fig. 2B
Fig. 2B
Note the difference in 2 eyes of same patient. The right eye is larger with larger CD ratio and thinner NRR. Asymmetry in CD ratio is due to disk size and also glaucomatous Involvement of the NRR
Fig. 3
Fig. 3
Vertically oval disk. Vertical diameter longer than horizontal diameter
Figs 4A to c
Figs 4A to c
(A) Torted disk, (B) tilted disk, (C) tilted bean shaped disk
Fig. 5
Fig. 5
Variation in disk shape in myopes
Fig. 6
Fig. 6
Large disk with large cup, average size disk with average sized cup and no cup in a small disk
Fig. 7
Fig. 7
To determine the cup margin–the second kink (blue arrow) is the cup edge (the first kink in the vessel-red arrow)
Fig. 8
Fig. 8
Inferior notch. Note the associated retinal nerve fiber layer defect
Figs 9A to c
Figs 9A to c
(A) Disk hemorrhage, (B) after 3 months–hemorrhage replaced by wedge shaped RNFL defect inferiorly, (C) red free picture of same highlighting RNFL
Fig. 10
Fig. 10
Splinter hemorrhage typical of glaucoma
Fig. 11
Fig. 11
Hemorrhage at disk due to diabetic retinopathy
Fig. 12
Fig. 12
RNFL defect superior. Better seen in red free photograph below
Fig. 13
Fig. 13
RNFL defect superior and inferior. Also note presence of bipolar notch. Red free photo below
Fig. 14
Fig. 14
Morning glory syndrome
Fig.15
Fig.15
Optic disk coloboma
See this image and copyright information in PMC

References

    1. Nangia V, Matin A, Bhojwani K, Kulkarni M, Yadav M, Jonas JB. Optic disc size in a population-based study in central India: the Central India Eye and Medical Study (CIEMS). Acta Ophthalmol. 2008 Feb;86(1):103–104. - PubMed
    1. Jonas JB, Thomas R, George R, Berenshtein E, Muliyil J. Optic disc morphology in south India: the Vellore Eye Study. Br J Ophthalmol. 2003 Feb;87(2):189–196. - PMC - PubMed
    1. Sekhar GC, Prasad K, Dandona R, John RK, Dandona L. Planimetric optic disc parameters in normal eyes: a population-based study in South India. Indian J Ophthalmol. 2001 Mar;49(1):19–23. - PubMed
    1. Jonas JB, Gusek GC, Naumann GO. Optic disc, cup and neuroretinal rim size, configuration and correlations in normal eyes. Invest Ophthalmol Vis Sci. 1988 Jul;29(7):1151–1158. - PubMed
    1. Ramrattan RS, Wolfs RC, Jonas JB, Hofman A, de Jong PT. Determinants of optic disk characteristics in a general population. The Rotterdam Study. Ophthalmology. 1999 Aug;106(8):1588–1596. - PubMed

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