New findings in the evaluation of the optic disc in glaucoma diagnosis

PURPOSE OF REVIEW: Ophthalmoscopical evaluation of the optic disc is a feasible and largely accessible method to diagnose glaucoma. Many qualitative parameters have been described in glaucomatous optic neuropathy. Considering individual variations in the details of topography or tissue components damaged by the glaucomatous process, however, adequate identification of glaucomatous optic disc signs requires training and experience. Without adequate guidelines of optic disc examination, the physician may miss important aspects that could lead to adequate diagnosis or identification of progression in a patient with established glaucoma. This paper presents a systematic approach for the examination of the optic disc and retinal nerve fiber layer to aid the detection of glaucoma. RECENT FINDINGS: Optic disc qualitative parameters are better than quantitative parameters in separating glaucomatous from normal eyes. The sequential evaluation of optic disc size, neuroretinal rim size and shape, retinal nerve fiber layer, presence of peripapillary atrophy, and presence of retinal or optic disc hemorrhages enhances the ability to detect glaucomatous damage and its progression. SUMMARY: Ophthalmologists should be familiar with glaucomatous optic disc signs that can be identified during clinical examination. A simple systematic approach may allow improved diagnosis and management of glaucoma.     

Ranking of optic disc variables for detection of glaucomatous optic nerve damage

PURPOSE: To describe optic disc variables assessed by evaluation of clinical optic disc photographs and to compare sensitivity and specificity of these optic disc parameters in identifying patients with ocular hypertension who have nerve fiber layer defects and normal visual fields and patients with visual field defects. METHODS: The study included 500 normal subjects, 132 patients with ocular hypertension with retinal nerve fiber layer defects and normal visual fields (preperimetric glaucoma), and 840 patients with glaucomatous visual field defects. Color stereo optic disc photographs were morphometrically evaluated. RESULTS: Highest diagnostic power for the separation between the normal group and the preperimetric glaucoma group had the vertical cup-to-disc diameter ratio corrected for its dependence on the optic disc size, total neuroretinal rim area, rim-to-disc area ratio corrected for disc size, and cup-to-disc area ratio corrected for disc size. Diagnostic power was lower for rim area in the temporal inferior and temporal superior disc sector, cup area corrected for disc size, and horizontal cup-to-disc diameter ratio corrected for disc size. Less useful for the differentiation between the normal subjects and the preperimetric glaucoma group were size of zones alpha and beta of parapapillary chorioretinal atrophy, and ratios of neuroretinal rim width and rim area comparing various optic disc sectors with each other. CONCLUSIONS: In subjects with ocular hypertension with retinal nerve fiber layer defects and normal conventional achromatic visual fields, the vertical cup-to-disc diameter ratio corrected for optic disc size, total neuroretinal rim area, rim-to-disc area ratio, and cup-to-disc area ratio corrected for disc size are the most valuable optic disc variables for early detection of glaucomatous optic nerve damage. Correction for optic disc size is necessary for optic disc variables directly or indirectly derived from the optic cup. Parapapillary atrophy is less important in the early detection of glaucoma.     

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.     

Five rules to evaluate the optic disc and retinal nerve fiber layer for glaucoma.

A systematic approach for the examination of the optic disc and retinal nerve fiber layer is described that will aid in the detection of glaucoma. This approach encompasses 5 rules: evaluation of optic disc size, neuroretinal rim size and shape, retinal nerve fiber layer, presence of parapapillary atrophy, and presence of retinal or optic disc hemorrhages. A systematic process enhances the ability to detect glaucomatous damage as well as the detection of progression, and facilitates appropriate management.     

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 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)     

Evaluation of the retinal nerve fiber layer in glaucoma

The health of the optic nerve in glaucoma can be evaluated by examination of the retinal nerve fiber layer with red free illumination. Retinal nerve fiber layer defects have been shown in some studies to precede enlargement of optic cupping and visual field defects in glaucoma patients. Detection of glaucomatous damage at an earlier stage in the disease may prevent subsequent visual field loss. Retinal nerve fiber layer evaluation may give important information in the management and treatment of glaucoma patients.     

Polarimetric measurement of retinal nerve fiber layer thickness in glaucoma diagnosis

PURPOSE: To evaluate reliability and diagnostic value of polarimetric measurements of the retinal nerve fiber layer (RNFL) thickness in the diagnosis of glaucoma. METHODS: The study included 81 eyes with perimetric glaucoma with glaucomatous changes of the optic disc and visual field defects; 52 eyes with preperimetric glaucoma with glaucomatous optic disc abnormalities and normal achromatic visual fields; and 70 normal eyes. For determination of reliability, four examiners repeated polarimetric measurements five times in ten normal subjects. RESULTS: The polarimetric variables were significantly correlated with increasing mean visual field defect and decreasing neuroretinal rim area. In correlation analyses with visual field defects, correlation coefficients were highest for the variable "superior/nasal ratio" and "the Number," a variable calculated by the neural network of the device. In correlations with neuroretinal rim area, correlation coefficients were highest for measurements of the inferior nerve fiber layer thickness. The preperimetric glaucoma group and the control group differed significantly in the variables "superior/nasal ratio" and "the Number" and, to a smaller degree, in the variables "superior/temporal ratio" and "superior/inferior ratio." The Number variable had a sensitivity of 82% and 58% at a predefined specificity of 80% in separating perimetric glaucoma patients and preperimetric glaucoma patients, respectively, from control subjects. Reproducibility of the polarimetric measurements ranged between 70% and 89%. CONCLUSION: Polarimetric measurements of the RNFL thickness can detect glaucomatous optic nerve damage in patients with visual field loss, and in some patients with preperimetric glaucomatous optic nerve damage. Considering the fast performance, easy handling, and low maintenance costs, RNFL polarimetry may be helpful in glaucoma diagnosis.     

Clinical implications of peripapillary atrophy in glaucoma

PURPOSE OF REVIEW: To elucidate peripapillary atrophy in glaucomatous optic neuropathy; its ranking in the morphologic diagnosis of the glaucoma, and its value for the differentiation of various types of chronic open-angle glaucoma, for the separation of glaucomatous eyes from nonglaucomatous eyes, and for the detection of progression of glaucoma. RECENT FINDINGS: Recent studies showed an association of peripapillary atrophy with glaucoma and the eventual development of glaucomatous disc hemorrhages independent of a small neuroretinal rim area, and an association between increasing peripapillary atrophy and progressive glaucoma. A ranking of optic disc parameters to detect glaucomatous damage revealed that the alpha and beta zones of peripapillary atrophy, compared with neuroretinal rim parameters, are less useful. Pseudoexfoliation syndrome without glaucoma is not a risk factor for peripapillary atrophy. In arteritic anterior ischemic optic neuropathy, peripapillary atrophy does not enlarge. Peripapillary atrophy does not differ markedly between Europeans and South Indians. In contrast to the position of the central retinal vessel trunk, the presence and position of cilioretinal arteries do not markedly influence the progression of peripapillary atrophy in glaucoma. SUMMARY: Peripapillary chorioretinal atrophy is one among several morphologic variables to detect glaucomatous abnormalities. Ranking optic disc variables for the detection of glaucomatous optic nerve damage, peripapillary atrophy is a variable of second order. It is useful for the differentiation of various types of chronic open-angle glaucomas. In contrast to glaucomatous eyes, eyes with nonglaucomatous optic nerve atrophy, including eyes after arteritic anterior ischemic optic neuropathy, do not show an enlarged peripapillary atrophy.     

The contour of the juxtapapillary nerve fiber layer in glaucoma

Reliable structural markers for early glaucomatous optic nerve damage would facilitate the diagnosis of glaucoma at an early stage, possibly before visual field loss occurs. Computerized image analyses were used to develop and analyze new structural parameters for glaucomatous optic nerve damage. Multiple measurements of relative juxtapapillary nerve fiber layer height were made in glaucoma patients (n = 112), patients suspected of having glaucoma (n = 87), and in age-matched normal control subjects (n = 53). The average relative nerve fiber layer (NFL) height differed in glaucoma patients and normal subjects by 70 microns, but differences exceeded 100 microns at the superior and inferior poles of the disc. Mean values for "glaucoma suspects" were intermediate between those for the normal subjects and glaucoma groups. The ability of summary statistics of relative NFL height measurements to discriminate between normal and glaucomatous eyes was superior to that of the standard disc parameters cup-disc ratio, disc rim area, and cup volume. Measurements of relative NFL height correlated with indices of visual field loss; the strongest correlations occurred for measurements at the superior and inferior poles. Measurements of juxtapapillary NFL height may prove useful to detect glaucomatous optic nerve damage at an early stage and to accurately recognize progressive nerve damage over time.     

The diagnostic value of optic nerve imaging in early glaucoma

In the last decade, new imaging techniques have been added to conventional fundus photography and have been evaluated for use in early glaucoma. They all measure the loss of neuroretinal rim or retinal nerve fiber layer as a correlate to glaucomatous ganglion cell and axon loss. The value of optic disc photography, planimetry, laser scanning tomography, laser scanning polarimetry, and optical coherence tomography for the diagnosis of glaucomatous eyes in a preperimetric or early perimetric stage is analyzed on the basis of sensitivity, specificity, and receiver operating characteristics (ROC) curves. It becomes clear that all these techniques allow a more or less semi-automated evaluation of the optic disc and retinal nerve fiber layer but still have their limitations in the diagnosis of a very early, preperimetric stage of the glaucoma disease.     

合并近视的原发性开角型青光眼视盘形态和视网膜神经纤维层改变

目的 探讨合并近视的原发性开角型青光眼(primary open-angle glaucoma with myopia,M-POAG)视盘形态和视网膜神经纤维层(retinal nerve fiber layer,RNFL)改变的特点及其临床意义。 方法 对38例63只合并近视[(－6.92±3.79)D]、高眼压性[(32.00±9.36) mm　Hg(1 mmHg=0.133 kPa)原发性开角型青光眼(primary open-angle glaucoma,POAG)作眼底彩色照相,利用计算机图像分析设备分析视盘形态及RNFL 缺损的变化,并与单纯原发性开角型青光眼(simple primary open-angle glaucoma,S-POAG)的相应临床检查资料进行比较。 结果 M-POAG视盘形态和RNFL萎缩除具有与S-POAG相同的一般表现外,尚有其特征性改变：视盘呈椭圆形(垂直或水平)、斜入及部分缺损形,色泽苍白;视杯形态各异,呈碟形(28.6%)、垂直形(25.4%)、倾斜形(23.8%)、锅形(9.5%)及局限与同心圆形等;盘沿面积及杯/盘横径比值显著低于S-POAG组(P<0.05,P＜0.001)。视盘凹陷偏心 多向下方。RNFL局限性萎缩主要出现在下方视网膜;弥漫性RNFL萎缩与合并高度近视的中后期POAG视野缺损密切相关(P<0.005)。 结论 M-POAG的视盘形态特征以及RNFL改变特点有助于在合并高度近视的POAG中的临床诊断。(中华眼底病杂志,2000,16:81-84)     

HRT视盘参数在原发性开角型青光眼早期诊断中的作用

目的:在众多海德堡视网膜断层扫描仪(heidelberg retina tomogragh,HRT)测定的视盘参数中,筛选出最有助于青光眼早期诊断的视盘参数。方法:用HRT测定23例视野损害较轻的青光眼患者和23例正常人的视盘参数(杯盘面积比、盘沿面积、盘沿容积、视杯容积、视杯形态测量、视杯高度变异轮廓和平均神经纤维层厚度)作逐步判别分析。结果:盘沿面积和杯盘面积比对青光眼早期诊断最有帮助,其诊断敏感度和特异度分别为87%和96%。结论:本组资料盘沿面积和杯盘面积比是区分青光眼和正常眼最好的判别因素。     

Measurement of relative nerve fiber layer surface height in glaucoma

A new parameter of structural optic nerve damage from glaucoma is reported, the relative nerve fiber layer surface height (RNFLH). Relative nerve fiber layer surface height is calculated from magnification-corrected surface contour measurements of the peripapillary retina made with computerized image analysis of stereoscopic videographic images. The technique measures the average height of the nerve fiber layer surface within a circumference 200 microns from the disc edge, as detected with narrow-band green light, with respect to a standardized reference plane. This parameter was examined in a group of 36 glaucoma patients with early to moderate visual field loss, and in 33 age-matched normal controls. The measured surface of the peripapillary nerve fiber layer was, on the average, 74 microns lower in glaucomatous eyes than in normal eyes, a statistically significant difference (P = 0.000). The ability of RNFLH to distinguish glaucomatous eyes from normal eyes was tested by its sensitivity (83%) and specificity (88%), which were greater than the sensitivities and specificities of computerized measurements of cup-disc ratio, disc rim area, and cup volume. This approach represents a step toward the identification of quantitative structural parameters to reflect the number of retinal ganglion cell axons that enter the optic nerve. Such measurements may facilitate the early diagnosis of glaucoma and provide important information on rates of ganglion cell death in aging and disease.     

An evaluation of optic disc and nerve fiber layer examinations in monitoring progression of early glaucoma damage.

From annual examinations of 813 ocular hypertensive eyes, the authors compared optic disc and nerve fiber layer photographs in 2 age-matched subgroups: 37 eyes that converted to abnormal visual field tests at the end of a 5-year period and 37 control eyes that retained normal field tests. Disc change was detected in only 7 of 37 (19%) converters to field loss and in 1 of 37 (3%) controls. Progressive nerve fiber layer atrophy was observed in 18 of 37 (49%) converters and in 3 of 37 (8%) controls. Serial nerve fiber layer examination was more sensitive than color disc evaluation in the detection of progressive glaucoma damage at this early stage of glaucoma. The evaluation of cup-to-disc ratio or of the nerve fiber layer appearance in the initial photograph taken 5 years before field loss were equally predictive of future field damage. The position of nerve fiber layer defects was highly correlated with the location of subsequent visual field loss.     

Relationship of optic disk topography and visual function in patients with large cup-to-disk ratios

PURPOSE: To determine if topographic differences exist between large cup-to-disk ratio (C/D) eyes with standard achromatic automated perimetry (SAP) abnormalities and those with only short-wavelength automated perimetry (SWAP) abnormalities. DESIGN: Cross-sectional study. METHODS: The setting was a referral university-based clinical practice. We selected one eye of 72 patients with a vertical C/D of at least 0.8 by ophthalmoscopy. Patients performed SWAP, SAP, and confocal scanning laser ophthalmoscopy. We compared optic disk topography in eyes with and without visual field abnormalities and controlled for the influence of disk area. RESULTS: Disk area was a confounder of many topographic measures. After controlling for disk area, eyes with abnormal SAP had differences in rim volume, cup shape, rim area, retinal nerve fiber layer thickness, and retinal nerve fiber layer cross-sectional area when compared with eyes with normal SAP (P <.05). Rim volume and rim area were different in the SWAP comparison (P <.05). CONCLUSIONS: Investigators should control for disk area when evaluating topographic measures by confocal scanning laser ophthalmoscopy. In eyes with a large C/D, optic disk topography is more glaucomatous in eyes with SAP abnormalities than in those with only SWAP abnormalities. Eyes with large C/D and only SWAP abnormalities may have fewer glaucomatous optic disk changes than such eyes with SAP abnormalities. This indicates that SWAP is likely to correspond to abnormalities in optic disk topography at an earlier stage of glaucomatous optic neuropathy than SAP. Therefore, clinicians should consider SWAP testing in glaucoma suspects to detect glaucomatous visual field loss at an earlier stage of structural loss.     

Correlation of the optic disc size to glaucoma susceptibility

Previous studies have suggested that a larger optic disc size in blacks as compared with whites is related to the increased glaucoma susceptibility in blacks. In an intraindividual bilateral comparison of 245 white patients with open-angle glaucoma, the authors evaluated whether the glaucomatous optic nerve damage was greater or less in the eye with the larger optic nerve head. Highly myopic eyes were excluded. The difference in optic disc area of one eye as compared with the contralateral eye was not significantly correlated to the differences in visibility of retinal nerve fiber bundles and mean visual field defect between the two eyes. Mean perimetric loss and the retinal nerve fiber layer index were not significantly higher in the eye with the larger or smaller optic nerve head. This indicates that in whites, high myopes excluded, the susceptibility to glaucomatous optic nerve fiber loss may be independent of the optic disc size.     

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.     

Optic disc size and optic nerve damage in normal pressure glaucoma.

BACKGROUND--Recent reports indicate that eyes with normal pressure glaucoma have larger optic discs than eyes with primary open angle glaucoma or normal eyes. This study was performed to find whether, in normal pressure glaucoma, a large disc is associated with more optic nerve damage than a small disc. METHODS--Colour optic disc photographs of 74 patients with normal pressure glaucoma were assessed morphometrically. RESULTS--Taking the study group as a whole, the optic disc size decreased significantly (p = 0.04) with increasing visual field defect. In an intraindividual bilateral comparison, the side differences in the disc area of the right minus the left eye of the same individual were not significantly correlated with the side differences in the mean visual field defect. CONCLUSIONS--The results indicate that the eye with the larger optic disc, when compared with the contralateral eye with the smaller optic nerve head, showed neither a significantly more marked nor less pronounced glaucomatous optic nerve damage. It suggests that for a given patient the degree of glaucomatous optic nerve atrophy was not markedly associated with the optic disc size. The finding that patients with large visual field defects had smaller discs than patients with moderate perimetric loss may indicate that the results of previous cross sectional studies reporting on an unusually large disc size in normal pressure glaucoma may be due partially to selection.     

Bilateral visual field defects with optic disc drusen and secondary open angle glaucoma with PEX--clinical correlation with the HRA

BACKGROUND: Arcuate visual field defects are a typical sign of glaucomatous damage. Elevated intraocular pressure in combination with pseudoexfoliation syndrome (PSX) manifests the diagnosis glaucoma. Beyond this state, in microdiscs with optic disc drusen, the exact classification of the visual field defects is crucial. CASE REPORT: A 57-year-old male with pseudoexfoliation glaucoma was referred because of progressive glaucomatous visual field defects. The visual acuity was right 20/40 and left 20/25. Maximum intraocular pressure was 36 mm Hg. A simple optic nerve atrophy was diagnosed superonasally. The optic disc size was OD 2.24 mm(2) and OS 1.89 mm(2) (HRT I). An Ultrasound B-mode scan demonstrated the diagnosis of optic disc drusen. Over a follow-up of 1 year, a growth tendency was observed, especially in the superonasal quadrant. The mulberry-shaped surface of the drusen was visualized with infrared reflection images (HRA II, 830 nm). Confocal scanning laser ophthalmoscopy (HRA II, excitation 488 nm, 500 nm notch filter) showed an increased intrapapapillary autofluorescence (> 50 % papillary area: OD 1.67 mm(2), OS 1.26 mm(2)). This technique could detect drusen in areas that looked normal in classical retinoscopy. CONCLUSION: The differential diagnosis of arcuate scotomas includes simple optic nerve atrophy and glaucomatous optic nerve atrophy. Optic disc drusen in glaucoma eyes can obscure the main cause of progressive visual field loss. Superficial optic disc drusen can be measured planimetrically over the years. An adequate reduction of intraocular pressure should be realized in these eyes.