Clinical Recognition of Glaucomatous Cupping

• Published in: American journal of ophthalmology 2018-09, Vol.193, p.xxviii-xxxviii
• Main Authors: Kirsch, Ralph E., Anderson, Douglas R.
• Format: Article
• Language: English
• Subjects: Glaucoma; Hypertension; Ophthalmology; Optic nerve
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2018.06.008

[...]available were the patients' clinical records, which contained narrative descriptions and disk diagrams. Since completing the formal study more than a year ago, we have of course made informal observations on all patients that came under our examination, including patients with other optic nerve diseases and with ocular hypertension. Loss of tissue in other sectors results in subsequent progression to total cupping.Normal Variations Because there is such variation in the normal disk configuration, it requires some degree of judgement to evaluate the disk for loss of nerve tissue in specific locations, and the diagnostic features would be difficult to quantitate. [...]we wish to emphasize a qualitative approach to evaluating the disk based on familiarity with the range of normal disk configuration. Most important in such disks with sloping margins is not to limit oneself by outlining a cup edge, but to take into account the three-dimensional shape. [...]in a stereoscopic slit lamp view or stereo photographs, the concavity of the cup is a vertically oriented ellipsoid into which could be nestled a vertically oriented football or egg. [...]the data of this investigation contain no evidence that will make easier the prediction of future disk damage or field loss in the normal, the suspect, or the frankly glaucomatous eye.