Parapapillary retinal vessel diameter in normal and glaucoma eyes. II. Correlations

The juxtapapillary diameters of the superior temporal and inferior temporal retinal artery and vein have been shown to be significantly smaller in glaucomatous eyes than in normal eyes. They had been measured in 473 eyes of 281 patients with chronic primary open-angle glaucoma and in 275 eyes of 173 normal subjects. In the current study the vessel diameters were correlated with intra- and parapapillary morphometric data and visual field indices. Only one eye per patient and subject was taken for statistical analysis. The retinal vessel calibers were significantly (P less than 0.001) correlated with: (1) the area of the neuroretinal rim as a whole and in four different optic disc sectors; (2) the rim width determined every 30 degrees; (3) the optic cup area and diameters; (4) the horizontal and vertical cup/disc ratios and (5) the quotient of them; (6) the retinal nerve fiber layer score; (7) the area of the parapapillary chorioretinal atrophy; and (8) the visual field indices. In the same eye the vessel caliber was smaller in that sector where the neuroretinal rim loss was highest and the retinal fiber layer score lowest. In intraindividual comparison the vessels were smaller in that eye with less neuroretinal rim tissue and lower nerve fiber layer score. No significant correlations were found with the form of the optic disc, the area of the peripapillary scleral ring, side, sex and refraction. The correlation coefficients were not significantly different when the control group was matched for age. The parapapillary retinal vessel diameter decreases with advancing glaucomatous optic nerve damage. It is correlated with morphometric intra- and parapapillary glaucomatous changes and perimetric defects.     

Parapapillary retinal vessel caliber. II. Caliber reduction in eyes with glaucoma (a papillometric study of 309 eyes with chronic simple glaucoma compared with 264 normal eyes)

The diameter of the temporal superior or inferior artery and vein was measured at the optic disk border and 2 mm from the disk center in 309 nonselected eyes with chronic primary open-angle glaucoma. The values obtained were compared with those of 264 nonselected normal eyes. The calibers of both vessels were significantly larger in the normal eyes than in the glaucomatous ones (p = 0.000 or p less than 0.01; Wilcoxon-Mann-Whitney test). Their diameters diminished significantly (p less than 0.001) with decreasing width and area of the neuroretinal rim as a whole and when divided into different optic disk sectors, and with increasing optic cup area, horizontal and vertical cup/disk ratios, area of the subtotal to total parapapillary choriopigmentepithelioretinal atrophy, perimetric loss, and glaucoma stage. Thus, the caliber of the parapapillary retinal vessels decreases significantly with increasing glaucomatous optic nerve damage.     

The retinal nerve fiber layer in normal and glaucomatous eyes. II. Correlations

The retinal nerve fiber layer is different in normal and glaucomatous eyes. We correlated semi-quantitative data of the retinal nerve fiber layer of 398 eyes with chronic primary open-angle glaucoma and of 234 normal eyes with the intra- and parapapillary morphometric signs and with the perimetric indices. The three parameters "sequence of the fundus sectors concerning the best visibility of the retinal nerve fiber bundles", "visibility of the nerve fiber bundles", and "localized defects" were significantly (p less than 0.001) correlated to 1) area of the neuroretinal rim as a whole and in four different optic disc sectors, 2) neuroretinal rim width determined every 30 degrees, 3) optic cup area, diameters and form, 4) horizontal and vertical cup/disc ratios and the quotient of the horizontal to vertical cup/disc ratio, 5) area and width of zone "Alpha", zone "Beta", and the total parapapillary chorio-retinal atrophy, 6) diameter of the retinal vessels, 7) grade of a "tesselated fundus", and 8) the visual field loss. If only the inferior temporal and the superior temporal sectors were considered, the retinal nerve fiber bundles were less visible in that sector with the largest notch in the neuroretinal rim, the smaller neuroretinal rim area and width, the thinner retinal vessels, and the larger zone "Alpha", zone "Beta", and total parapapillary chorio-retinal atrophy. The glaucomatous changes in the retinal nerve fiber layer are correlated in time and location with the intra- and parapapillary and the perimetric alterations. Evaluation of the retinal nerve fiber layer is a useful method to detect a glaucomatous optic nerve damage.(ABSTRACT TRUNCATED AT 250 WORDS)     

Small neuroretinal rim and large parapapillary atrophy as predictive factors for progression of glaucomatous optic neuropathy

PURPOSE: To evaluate which morphologic features of the optic disc are predictive factors for progressive neuroretinal rim loss in chronic open-angle glaucoma. DESIGN: Prospective, observational case series. PARTICIPANTS: The study included 394 eyes of 257 white patients with chronic open-angle glaucoma. Mean follow-up time was 31.8 months (median, 39.7 months). Progression of glaucoma was defined as loss of neuroretinal rim as detected by disc photographs. Presence of optic disc hemorrhages was not taken into account. METHODS: All patients underwent repeated qualitative and morphometric evaluation of color stereo optic disc photographs. Statistical analysis included Kaplan-Meier curves, and bivariate and multivariate Cox regression analysis adjusted for patients' ages. Dependency of left and right eyes from the same subject was taken into account. MAIN OUTCOME MEASURES: Qualitative and quantitative morphologic optic nerve head parameters. RESULTS: Progression of glaucomatous optic nerve changes was detected in 42 eyes (11%). At baseline of the study, neuroretinal rim area (total area, P = 0.03) was significantly smaller, and beta zone of parapapillary atrophy (total area, P = 0.04) was significantly larger in the progressive study group compared with the nonprogressive study group. Neither study group varied significantly in size and shape of the optic disc, optic cup depth, alpha zone of parapapillary atrophy, and diameter of the retinal arteries and veins (P > 0.05). Multiple Cox regression analysis revealed that the progression of glaucoma depended significantly on the area of the neuroretinal rim (temporal sector, P = 0.003) and beta zone of parapapillary atrophy (temporal inferior sector, P = 0.02). CONCLUSIONS: Important morphologic predictive factors for progression of the glaucomatous appearance of the optic nerve head in white persons are small size of neuroretinal rim and large area of beta zone of parapapillary atrophy. Progression of glaucomatous optic nerve head changes is independent of size and shape of the optic disc, size of alpha zone of parapapillary atrophy, retinal vessel diameter, and optic cup depth.     

Ophthalmoscopic appearance of the normal optic nerve head in rhesus monkeys

PURPOSE: To evaluate the ophthalmoscopic appearance of the normal optic disc, parapapillary region, and retinal nerve fiber layer in rhesus monkeys. METHODS: Color stereo fundus photographs of 17 normal eyes of 17 rhesus monkeys aged between 13 and 23 years were morphometrically evaluated. RESULTS: The neuroretinal rim was significantly (P: < 0.008) broadest in the inferior disc region followed by the superior disc region, the nasal region, and the temporal region. Retinal nerve fiber layer visibility was significantly highest in the inferior temporal fundus region followed by the superior temporal fundus region, the superior nasal fundus region, and the inferior nasal fundus region. It decreased significantly (P: < 0.001) with increasing age. The retinal arterioles were significantly (P: < 0.01) wider in the inferior temporal and superior temporal fundus regions than in the superior nasal and inferior nasal fundus regions. The alpha zone of parapapillary atrophy (14/17 or 82.4%) occurred significantly (P: < 0.001) more often than the beta zone (2/17 or 11.8%). In 15 eyes (88. 2%), the foveola was located inferior to a horizontal line drawn through the center of the optic disc. Neuroretinal rim shape and area and size of alpha and beta zones of parapapillary atrophy were independent of age. CONCLUSIONS: As in humans, in normal rhesus monkeys the neuroretinal rim has a typical physiologic configuration that spatially correlates with the retinal arteriole diameter, retinal nerve fiber layer visibility, and position of the foveola inferior to the center of the optic disc. Neuroretinal rim shape is independent of age. Retinal nerve fiber layer visibility decreases significantly with increasing age. These findings may be useful for the early detection and differentiation of experimental optic nerve damage in rhesus monkeys.     

Parapapillary chorioretinal atrophy in normal and glaucoma eyes. I. Morphometric data

Glaucomatous optic nerve damage is associated with alterations of the intra- and parapapillary optic disc area. We measured and compared the parapapillary region in 582 eyes of 321 patients suffering from chronic primary open-angle glaucoma and in 390 eyes of 231 normal subjects. Only one randomly assessed eye per patient and subject was taken for statistical analysis. Highly mopic eyes with a myopic refractive error of more than -8.00 diopters had been excluded. The parapapillary chorioretinal atrophy was divided into a peripheral zone "Alpha" with irregular hyper- and hypopigmentation, and a more central zone "Beta" characterized by whitish colour, visible large choroidal vessels and visible sclera. In the normal eyes both zones were significantly (P less than 0.001) largest and most common in the temporal horizontal sector, followed by the inferior temporal sector, the superior temporal sector and finally the nasal sector. In the glaucoma group both zones were significantly larger (P less than 0.0001; Mann-Whitney test) and more frequent than in the normal eyes (0.40 +/- 0.32 mm2 versus 0.65 +/- 0.49 mm2 for zone Alpha, 0.13 +/- 0.42 mm2 versus 0.79 +/- 1.17 mm2 for zone Beta). The differences were significant also for the earliest glaucoma stage of this study. They were most marked for the nasal parapapillary sector. Significant differences (P less than 0.001) between the normal group and the earliest glaucoma stage were: zone Alpha larger than 0.20 mm2 or broader than 0.20 mm in the temporal horizontal sector, total area of zone Alpha larger than 0.30 mm2, occurrence of zone Alpha in the nasal sector, and occurrence of zone Beta anywhere.     

Parapapillary atrophy and retinal vessel diameter in nonglaucomatous optic nerve damage

Parapapillary chorioretinal atrophy and decreased retinal vessel diameter occur in glaucomatous eyes. To evaluate the frequency and degree of these signs in nonglaucomatous optic neuropathy, the authors evaluated morphometrically and compared 47 patients with nonglaucomatous optic nerve atrophy from extraocular causes with 292 patients with primary open-angle glaucoma and 179 normal subjects. Eyes with anterior ischemic optic neuropathy were excluded. The parapapillary atrophy was differentiated into a central zone (beta) with sclera and large choroidal vessels visible by ophthalmoscopy and a peripheral zone (alpha) with irregular pigmentation. Both zones did not differ significantly in the eyes with nonglaucomatous optic neuropathy and the normal eyes. In the glaucomatous eyes, they were significantly larger and occurred more frequently. The retinal vessel diameter was significantly smaller in both groups with optic nerve atrophy than in the normal group. It was concluded that decreased retinal vessel diameters unspecifically suggest optic nerve atrophy. Evaluation of parapapillary chorioretinal atrophy can be helpful in differentiating nonglaucomatous from glaucomatous optic neuropathy.     

Optic disc morphometry in simple optic nerve atrophy

This study was undertaken to evaluate the optic disc changes in eyes with non-glaucomatous optic nerve damage. The intra- and parapapillary region was evaluated morphometrically in 106 eyes of 56 patients with simple optic nerve atrophy (SONA) and in 107 normal eyes of 57 subjects. Colour stereo optic disc diapositives were used. Only one randomly chosen eye per subject and patient was taken for statistical analysis. Characteristics of SONA were: decreased visibility of the parapapillary retinal nerve fibers, diminished retinal vessel diameter, and area with pallor larger than area with cupping. Size and form of the optic disc, neuroretinal rim, peripapillary scleral ring, and zone Alpha and Beta of the parapillary chorioretinal atrophy were not significantly different. Also, distinctness of a tesselated fundus, frequency of optic disc haemorrhages and frequency of bared circumlinear or bared cilioretinal vessels did not differ significantly. These morphologic features are helpful in the diagnosis and differential diagnosis of SONA.     

Morphologic predictive factors for development of optic disc hemorrhages in glaucoma

PURPOSE: To evaluate which optic disc parameters are predictive factors for the development of disc hemorrhages in chronic open-angle glaucoma. METHODS: The prospective comparative clinical observational study included 432 eyes of 281 white patients with chronic open-angle glaucoma. Mean follow-up time was 38.8 months (median, 31.5). Eyes in the whole study group were divided into those with an optic disc hemorrhage during the follow-up period (hemorrhagic group; n = 38; 8.8%), those without disc hemorrhages and with neuroretinal rim loss as sign of progression of glaucoma (rim loss group; n = 42; 9.7%), and those with neither disc hemorrhages nor neuroretinal rim loss (stable group; n = 352; 81.5%). Color stereo optic disc photographs were obtained repeatedly in all patients and subjected to qualitative and morphometric evaluation. RESULTS: At baseline, neuroretinal rim area was significantly (P < 0.03) smaller and the beta zone of parapapillary atrophy (temporal lower sector) was significantly (P < 0.03) larger in the hemorrhagic group than in the stable group. Both study groups did not vary significantly (P > 0.05) in optic disc size and shape, optic cup depth, alpha zone of parapapillary atrophy, and retinal vessel diameter. In multivariate analysis, the neuroretinal rim area was the only significant predictor of hemorrhages. The hemorrhagic group and the rim loss group did not differ significantly (P > 0.05) in any optic disc parameter measured. CONCLUSIONS: In chronic open-angle glaucoma, morphologic predictive factors for the development of disc hemorrhages are small size of neuroretinal rim and, possibly, a large parapapillary beta zone. Development of disc hemorrhages is independent of optic disc size and shape, size of alpha zone of parapapillary atrophy, retinal vessel diameter, and optic cup depth. Optic nerve heads in eyes with eventual development of disc hemorrhages and in eyes with eventual progressive rim loss without observed disc hemorrhages do not differ markedly in appearance.     

The retinal nerve fiber layer in normal eyes

The retinal nerve fiber layer is different in normal and glaucomatous eyes. The authors used red-free photographs to examine the retinal nerve fiber layer in 234 normal eyes. The retinal nerve fiber layer was most visible in the inferior temporal arcade, followed by the superior temporal arcade, then by the temporal macular area, and finally the nasal area. This distribution was significantly (P less than 0.0001) correlated to (1) the configuration of the neuroretinal rim, which was significantly broadest at the inferior disc pole followed by the superior one, (2) the juxtapapillary caliber of the retinal vessels, which were significantly wider in the inferior temporal arcade than in the superior temporal arcade, and (3) the location of the foveola 0.53 +/- 0.34 mm inferior to the middle point of the vertical optic disc axis. The retinal nerve fiber layer decreased with age. No correlation occurred with sex or right or left eye. No localized retinal nerve fiber layer defects were seen. These features of the normal retinal nerve fiber layer are important for diagnosis of retinal nerve fiber layer changes secondary to optic nerve damage in the diseased eye.     

Influence of cilioretinal arteries on neuroretinal rim and parapapillary atrophy in glaucoma

PURPOSE: The pattern of neuroretinal rim loss and increase in the area of parapapillary atrophy in glaucoma depend on the localization of the central retinal vessel trunk in the lamina cribrosa. The purpose of the present study was to determine whether, in a similar way, the pattern of rim loss and progression of parapapillary atrophy are influenced by the presence and position of cilioretinal arteries. METHODS: Color stereo optic disc photographs (15 degrees) for morphometric evaluation of the optic nerve head were used to compare the appearance of the optic disc in 41 patients exhibiting unilateral or bilateral cilioretinal arteries in the temporal horizontal disc region with the optic disc morphology of 127 patients without cilioretinal arteries. The areas of the neuroretinal rim and alpha and beta zones of parapapillary atrophy were measured in the total disc and in four disc sectors. RESULTS: Eyes with and eyes without cilioretinal arteries did not differ significantly in the areas of neuroretinal rim and alpha and beta zones of parapapillary atrophy, when measured in the whole optic disc and in the four disc sectors separately; in ratios of the temporal horizontal area to total area of rim and parapapillary atrophy; and in the ratio of temporal horizontal rim area-to-nasal rim area, neither in an interindividual comparison nor in an intraindividual intereye comparison. CONCLUSIONS: In contrast to the position of the central retinal vessel trunk, presence and position of cilioretinal arteries do not markedly influence the pattern of neuroretinal rim loss and progression of parapapillary atrophy in glaucoma.     

Inter-eye differences in chronic open-angle glaucoma patients with unilateral disc hemorrhages

OBJECTIVE: Flame-shaped optic disc hemorrhages are a hallmark of glaucomatous optic neuropathy. The purpose of this study was to evaluate which parameters differ between companion eyes with and without an optic disc hemorrhage in patients with chronic open-angle glaucoma. DESIGN: Comparative (companion eye) observational case series. PATIENTS: The study included 99 white patients with bilateral chronic open-angle glaucoma and unilateral flame-shaped optic disc hemorrhages. METHODS: All patients underwent qualitative and morphometric evaluation of color stereo optic disc photographs. MAIN OUTCOME MEASURES: Size and shape of the optic disc, neuroretinal rim and parapapillary atrophy, diameter of the retinal vessels, intraocular pressure measurements, and both mean value and loss variance value of the visual field examination. RESULTS: In an intraindividual inter-eye comparison, the eyes with disc hemorrhages and the contralateral eyes without disc bleeding did not vary significantly (P > 0.20) in size and shape of the optic disc and neuroretinal rim, optic cup depth, size of alpha and beta zone of parapapillary atrophy, retinal vessel diameter, intraocular pressure measurements, refractive error, and perimetric indices. CONCLUSIONS: In bilateral chronic open-angle glaucoma, the development of unilateral optic disc hemorrhages does not depend on inter-eye differences in size and shape of the optic disc, neuroretinal rim and parapapillary atrophy, diameter of the retinal vessels, intraocular pressure measurements, or visual field loss.     

Exit of the retinal central vascular trunk and extent of para-papillary atrophy]

PURPOSE: To evaluate whether the position of the central retinal vessel trunk exit on the lamina cribrosa spatially correlates with the location of parapapillary atrophy in glaucoma. METHODS: Color stereo optic disc photographs of 79 patients with primary or secondary open-angle glaucoma and 53 normal subjects were morphometrically evaluated. We determined the position of the central retinal vessel trunk exit on the lamina cribrosa surface and measured the area of parapapillary atrophy in four 90 degrees quadrants. RESULTS: After correction for normal values, the beta zone area of parapapillary atrophy in the glaucoma eyes was significantly larger, when measured in the disc quadrant most distant to the central retinal vessel trunk exit than as if measured in the quadrant containing the vessel trunk exit. CONCLUSIONS: Position of the central retinal vessel trunk exit on the lamina cribrosa influences the location of parapapillary atrophy in glaucoma. The longer the distance to the central retinal vessel trunk exit, the more enlarged is parapapillary atrophy.     

Morphometry of the human lamina cribrosa surface

The lamina cribrosa is a sieve-like perforation in the posterior part of the sclera, that allows passage of the retinal ganglion cell axons and central retinal vessels and preserves a pressure gradient between the intraocular and extraocular space. It has been termed the primary site of glaucomatous damage to the optic nerve. Using electron microscopy, the authors morphometrically evaluated the inner surface of the lamina cribosa in 40 normal human donor eyes. There were 14 men and 21 women with a mean age of 52 +/- 22 yr (10-82 yr). Mean single pore area (0.004 +/- 0.001 mm2) and summed pore area were significantly (P less than 0.05) larger and the ratio of summed pore area to lamina area was higher in the inferior and superior regions than in the temporal and nasal regions. The ratio decreased with increasing lamina cribrosa size. Count, size, form, and density of the pores were statistically independent of age, sex, side, and lamina cribrosa form. Pore count and summed pore area (mean: 0.92 +/- 0.22 mm2) increased significantly with enlarging lamina cribrosa size. The area of the lamina cribrosa openings for passage of the central retinal vessels was independent of the lamina cribrosa size. The high ratio of summed pore area to lamina area and the large single pore area may be pathogenetically important for the increased glaucoma susceptibility in the inferior and superior disc regions. The lack of a correlation between lamina cribrosa size and the area of the lamina cribrosa openings for the retinal vessels may explain why central retinal vessel occlusions occur independently of optic disc size.     

Parapapillary chorioretinal atrophy in normal and glaucoma eyes. II. Correlations

The parapapillary chorio-pigment-epithelio-retinal atrophy in glaucomatous eyes is significantly larger than in normal eyes. In a previous study its area and frequency have been measured in 582 eyes of 321 patients with chronic primary open-angle glaucoma and in 390 eyes of 231 normal subjects. In the current study the parapapillary changes were correlated with intrapapillary morphometric data and with perimetric indices. The parapapillary chorioretinal atrophy was significantly correlated with the neuroretinal rim area, the horizontal and vertical cup/disc ratios, the quotient of horizontal to vertical cup/disc ratio, the retinal nerve fiber layer score, and the mean visual field loss. It was larger in the same sector where the neuroretinal rim loss was more marked. The correlation coefficients were generally higher for zone "Beta," characterized by complete chorioretinal atrophy with visible large choroidal vessels and sclera, than for zone "Alpha," which showed irregular hypo- and hyperpigmentation. The parapapillary chorioretinal atrophy was correlated in location and time with the intrapapillary glaucomatous changes. It deserves attention in glaucoma diagnosis and follow-up. Its evaluation is especially valuable in eyes with small optic nerveheads (disc size less than 1.6 mm2) in which the intrapapillary glaucomatous changes occur later than the parapapillary ones.     

Optic disc morphology in pigmentary glaucoma

AIM—To evaluate the morphology of the optic nerve head in eyes with pigmentary glaucoma.
METHODS—Colour stereo optic disc photographs of 62 patients with pigmentary glaucoma and 566 patients with primary open angle glaucoma were morphometrically evaluated. By prestudy selection, mean visual field defect and neuroretinal rim area were not significantly different between the two groups (p=0.89 and p=0.45).
RESULTS—The pigmentary glaucoma group did not vary significantly (p >0.10) from the primary open angle glaucoma group in size and shape of the optic disc, configuration of neuroretinal rim, depth of optic cup, area of alpha zone of parapapillary atrophy, diameter of retinal vessels at the disc border, and frequency of disc haemorrhages and localised retinal nerve fibre layer defects. The beta zone of parapapillary atrophy was slightly, but not statistically significantly (p=0.06), smaller in the pigmentary glaucoma group. The mean maximal intraocular pressure and mean intraocular pressure amplitude were significantly (p<0.001) higher in the pigmentary glaucoma group.
CONCLUSIONS—In contrast with the characteristic morphology of the anterior segment and despite significantly higher intraocular pressure peaks and a larger pressure amplitude, eyes with pigmentary glaucoma compared with eyes with primary open angle glaucoma do not show a pathognomonic morphology of the optic disc and retinal nerve fibre layer. The slightly smaller beta zone of parapapillary atrophy may correspond to higher intraocular pressure in pigmentary glaucoma.

Keywords: optic disc morphology; pigmentary glaucoma; secondary open angle glaucoma     

Shape of the neuroretinal rim and position of the central retinal vessels in glaucoma.

Glaucomatous neuroretinal rim loss can occur in a sequence of sectors with the temporal inferior disc sector as the first and the nasal superior disc sector as the last to be affected. This study evaluated whether the position of the central retinal vessel trunk is correlated with this pattern of glaucomatous rim loss. Morphometrically stereo colour optic disc photographs of 157 glaucomatous eyes and 67 normal eyes were checked. In the normal and glaucomatous eyes, the central retinal vessel trunk was located eccentrically in the upper nasal quadrant of the optic disc. Taking into account the vertically oval disc shape, the distance to the central vessel trunk was largest for the temporal inferior disc region and shortest for the nasal superior disc area. An abnormal form of the glaucomatous neuroretinal rim was found in eyes with an atypical location of the retinal vessel trunk. Also in these glaucomatous eyes, the rim loss was usually most and least marked in that sector with the longest and shortest distance, respectively, to the central retinal vessel trunk. One could infer that the sequence of rim loss in glaucoma is dependent upon the distance of the region to the central retinal vessel trunk; the further away the region from the retinal vessel trunk, the more likely it is to be affected by rim loss. This suggest that the distance from the central retinal vessels is one factor among others that is correlated with the regional vulnerability of the neuroretinal rim to the glaucomatous process.     

Optic nerve head appearance in juvenile-onset chronic high-pressure glaucoma and normal-pressure glaucoma

OBJECTIVE: To evaluate the appearance of the optic nerve head in chronic high-pressure glaucoma and normal-pressure glaucoma. DESIGN: Clinic-based cross-sectional study. PARTICIPANTS: The study included 52 eyes with normal-pressure glaucoma and 28 eyes with juvenile-onset primary open-angle glaucoma that served as models for chronic high-pressure glaucoma. METHODS: Color stereo optic disc photographs and wide-angle retinal nerve fiber layer photographs were morphometrically examined. MAIN OUTCOME MEASURES: Localized retinal nerve fiber layer defects; parapapillary chorioretinal atrophy; disc hemorrhages; optic cup shape; retinal arteriole narrowing. RESULTS: Both study groups did not vary significantly in count of localized retinal nerve fiber layer defects, size of parapapillary atrophy, optic cup depth, steepness of disc cupping, rim/disc area ratio, diameter of retinal arterioles, and frequency and degree of focal retinal arteriole narrowing. In normal-pressure glaucoma versus juvenile open-angle glaucoma, localized retinal nerve fiber layer defects were significantly broader, disc hemorrhages were found significantly more often and were larger, and neuroretinal rim notches were present more frequently and were deeper. CONCLUSIONS: Chronic high-pressure glaucoma and normal-pressure glaucoma show morphologic similarities in the appearance of the optic nerve head. The lower frequencies of detected disc hemorrhages and rim notches in high-pressure glaucoma may be due to a smaller size of hemorrhages and localized retinal nerve fiber layer defects in high-pressure glaucoma. Both glaucoma types have morphologic features in common, suggesting that they may possibly belong to a spectrum of the same pathologic process.     

The retinal nerve fiber layer in normal eyes and in glaucoma. I. Semiquantitative data of 398 eyes with glaucoma

Atrophy of the optic nerve is associated with changes of the retinal fiber layer (RNFL). Using red-free photographs the authors examined the RNFL of 398 eyes with chronic primary open-angle glaucoma and compared it with the RNFL of 234 normal eyes. The glaucoma group was divided into five stages and the fundus into four sectors. Differences between the normal and glaucoma eyes were: (1) The sequence of the sectors, with regard to the best visibility of the retinal nerve fiber bundles, was changed. In the normal eyes the nerve fiber bundles were most often best visible in the inferior temporal sector, followed by the superior temporal sector, the temporal horizontal area and finally the nasal region. In the glaucoma group the nerve fiber bundles were significantly more often best detectable in the superior temporal sector and the temporal horizontal area. (2) The degree of visibility of the retinal nerve fibers decreased significantly with increasing glaucoma stage. (3) Localized defects were seen in 15% of the eyes with glaucoma and none of the normal eyes. The specificity of this qualitative parameter was, therefore, 100%. The defects were found most often in the superior and inferior temporal regions. These differences between normal and glaucomatous eyes were also significant for the first glaucoma stage of this study. The localization of the foveola below the optic disk center (0.53 +/- 0.34 mm in the glaucoma group and 0.55 +/- 0.29 mm in the normal eyes) was not significantly different.     

Morphology of the optic papilla in glaucoma. II. Secondary chronic open angle glaucoma

Previous studies have shown that the chronic open-angle glaucomas form a heterogeneous spectrum of diseases which have in common an open anterior chamber angle and glaucomatous optic nerve damage. Purpose of this study was to evaluate whether the appearance of the optic disc shows specific features among various types of secondary chronic open-angle glaucoma. METHODS: Clinical data and color-stereo optic disc photographs of 126 patients with pseudoexfoliative glaucoma and 47 patients with pigmentary glaucoma were compared with those of 501 patients with primary open-angle glaucoma (POAG) and of 481 normal subjects. The glaucoma groups did not differ in neuroretinal rim nor in perimetric mean defect. RESULTS: Mean optic disc area was significantly smaller in the pseudoexfoliative glaucoma eyes (2.54 +/- 0.51 mm2 vs. 2.71 +/- 0.63 mm2, p = 0.03) than in the primary open-angle glaucoma eyes. The pigmentary glaucoma group did not vary significantly from the primary open-angle glaucoma group in size of the optic disc. No significant differences were found for neuroretinal rim area, configuration of neuroretinal rim, depth of optic cup and diameters of the retinal arterioles and venules at the disc border between the secondary glaucoma groups and the POAG group respectively. Size of zone beta of the parapapillary atrophy was slightly, but not significantly smaller in the secondary glaucoma groups than in POAG. In the secondary glaucoma groups, the maximal intraocular pressure measurements were significantly (p < 0.001) higher than in the group with POAG. All glaucoma groups had a significantly smaller neuroretinal rim, significantly smaller retinal arterioles, and significantly larger parapapillary atrophy compared to the normal group. CONCLUSIONS: Except of a slightly smaller optic disc in eyes with pseudoexfoliative glaucoma, eyes with secondary glaucoma due to pseudoexfoliation or due to pigmentary dispersion do not vary significantly in their optic disc morphology compared to POAG and do not show pathognomonic features of the optic disc despite marked changes in the anterior segment of the eye.