青光眼盘沿缺失的分析

进行性青光眼患者的视神经损伤，其盘沿面积会逐渐缩小，盘沿形态不断改变。此横向研究在于建立一个青光眼盘沿缺失的模式。作者评价了８０１只青光眼及４９６只视力正常眼的立体彩色视盘照像。结果：与视力正常眼比较，青光眼盘沿缺失可发生于视盘任何部位，并根据青光眼病程的不同阶段而有好发区域。轻度青光眼损伤眼，盘沿缺失通常在视盘颞下区最明显；中度进行性青光眼损伤，盘沿减少在颞上部最明显。在很晚期青光眼，盘沿残留通常仅见于视盘鼻侧区，而且鼻上区明显大于鼻下区。结论：与弥散方式不同，青光眼盘沿缺失的发生，在各部分有一顺序。一般说，其开始于视盘颞下区，然后逐渐出现于颞上、颞侧水平，鼻下，最终是鼻上区。这与视野缺损的进展及筛板的形态学有关。这一发现对青光眼的早期诊断可能是重要的。     

青光眼盘沿缺失的分析

进行性青光眼患的视神经损伤，其盘沿面积会逐渐缩小，盘沿形态不断改变。此横向研究在于建立一个青光眼盘沿缺失的模式。作评价了８０１只青光眼及４９６只视力正常眼的立体彩色视盘照像。结果：与视力正常眼比较，青光眼盘沿缺失可发生于视盘任何部位，并根据青光眼病程的不同阶段而有好发区域。轻度青光眼损伤眼，盘沿缺失通常在视盘颞下区最明显；中度进行性青光眼损伤，盘沿减少在颞上部最明显。在很晚期青光眼，盘沿残留通     

正常人不同视盘类型和早期青光眼盘沿形态学研究

目的 :探讨正常人 (本文所称正常人为非青光眼者 ,下同 )不同视盘类型和早期青光眼盘沿形态学特征 ,以指导各种视盘类型青光眼的早期诊断。方法 :检查对象分五组 :①正常人小视盘 4 1只眼 ;②正常人大视盘 4 0只眼 ;③视盘斜入 4 2只眼 ;④正常人正常大小视盘 4 2只眼 ;⑤早期开角型青光眼 4 5只眼。利用计算机图像分析技术 ,测量视盘面积、盘沿面积、视杯面积和一周 (每 10°)的盘沿宽度 ,以此形态指标分析正常人不同视盘类型和早期青光眼的盘沿形态差异。结果 :①正常人不同视盘类型盘沿形态共同特点是盘沿从鼻侧到下 /上方逐渐变宽 ,在下 /上方偏鼻侧有一宽带区 ;而早期青光眼盘沿从鼻侧到下 /上方逐渐变窄 ,无变宽区。②视盘斜入上下方盘沿宽度基本相同 ,而大视盘下方盘沿最宽 ,小视盘上方盘沿最宽 ;鼻侧次之 ,颞侧最窄。大视盘C/D较大而盘沿宽度较窄 ,小视盘C/D较小而盘沿宽度较宽 ,视盘斜入也具有较大的C/D和较窄的盘沿宽度。③经多因素逐步判别分析 ,盘沿面积加C/D的正确判别率为 88 4 % ,以系列盘沿宽度为指标 ,下方偏颞侧 (6∶2 0 )和上方偏鼻侧 (1∶0 0 )两个盘沿宽度最为相关 ,其正确判断率为 90 6 %。结论 :正常人不同视盘类型和早期青光眼各具有不同的盘沿形态特征 ,计算机图像测量系列盘     

早期青光眼的盘沿形态学研究

青光眼早期损害的特征是颞下、颞上的视网膜神经纤维层缺损(RNFLD),并于相应区的视野弓形缺损。为了探讨青光眼视神经损害的发生规律,本研究利用计算机图象分析技术,测定一周(每(?)度)的盘沿宽度,以此形态指标分析早期青光眼与正常眼的盘沿形态差异以指导临床诊断,检查对象分两组:①正常对照组183只眼。②早期青光眼组175只眼。结果:正常组盘沿形态特征是下方盘沿宽度较上方宽,颞侧盘沿最窄,鼻侧盘沿最宽;早期青光眼组盘沿形态特征是下方盘沿宽度较上方更窄。用多因素逐步判别法对早期青光眼与正常眼进行判别分类,单纯用盘沿面积为指标,正确判断率为78％;用系列盘沿宽度为指标,经逐步判别筛选,以颞下及上方盘沿宽度最为相关,其正确判断率为94％。因后者除了与盘沿面积大小有关外,还与盘沿形态有关,依据盘沿形态特征有助于鉴别生理性大视杯(①大视盘,②视杯大,但下方盘沿宽于上方),发及发现小视盘青光眼(①小视盘及扩大不明显的视杯,②下方盘沿宽度比上方窄)     

应用HRT观察原发性开角型青光眼盘沿面积变化情况及其与视野缺损的对应关系

目的 对原发性开角型青光眼(POAG)患者和正常人盘沿面积进行比较,观察POAG盘沿面积变化特点,探讨POAG盘沿面积变化与视野缺损的对应关系.方法 利用海德堡视网膜断层扫描仪(HRT-Ⅱ)和Octo-pus101视野G2程序对29例(50只眼)POAG患者和27例(50只眼)正常人进行检测,将HRT检测的两组盘沿面积划分为6个区域进行比较,并将出现视野缺损的POAG患者盘沿面积减少最大区域与视野缺损较重部位进行一致性比较.结果 POAG患者和正常人各区域及总体盘沿面积间差异均有显著性(P<0.001),其中,以颞下区盘沿面积变窄最为明显,依次为颞上区、鼻下区、鼻上区,鼻侧区与颢侧区无明显差异.出现视野改变的POAG患眼盘沿面积变窄最明显区域与视野缺损较重部位一致性比较符合率为93.3%.结论 开角型青光眼盘沿面积较正常人明显变窄,颞下区最明显,盘沿面积改变与视野缺损有较好的一致性.HRT盘沿面积检测是POAG诊断的重要手段之一.     

青光眼视神经损害的三要素及其盘沿丢失的识别

诊断青光眼视神经损害的三要素为盘沿丢失、视网膜神经纤维层缺损（RNFLD）及视盘线状出血。三要素中如有两要素改变应诊断为视神经损害。对于盘沿丢失已往的教科书中均无明确描述,笔者认为识别盘沿丢失必须首先认识正常盘沿形态及其影响因素。大多数的正常盘沿形态符合ISNT法则,生理性大视杯也符合该法则。不符合ISNT法则者为盘沿丢失,或者为正常盘沿形态变异。后者如部分小视盘下方盘沿可比上方盘沿窄,判断是否上、下方盘沿丢失时应将其与鼻侧盘沿进行比较;横椭圆视盘鼻侧盘沿较宽,应上、下盘沿比较;视盘主干血管发出位置偏位、视盘倾斜也会影响盘沿形态。如果参照ISNT法则认识正常盘沿变异因素,就不难发现盘沿丢失。然而不是所有的盘沿丢失均为青光眼所致,应鉴别非青光眼性视神经损害。     

早期青光眼视神经损害进展的随诊研究

目的 探讨早期青光眼视神经损害随诊进展的情况.设计回顾性病例系列.研究对象初诊为早期青光眼视神经改变、随诊3年以上发生了视神经进展者164例197眼.方法 早期青光眼视神经损害者的初诊眼底照片与末次随诊照片在计算机图像配准软件处理下进行闪烁对比,发现有盘沿及神经纤维层缺损进展者,记录视神经进展的指标.应用Pearson相关性分析,评价盘沿进展程度与神经纤维层进展程度的相关性,盘沿进展部位与神经纤维层进展部位的相关性.主要指标视盘盘沿丢失进展程度、盘沿丢失进展部位、神经纤维层缺损进展的程度和部位.结果 随诊时间3～19年,平均随诊时间7年.早期青光眼盘沿丢失进展多数从下方开始,进而发展到上方盘沿、上下方盘沿均受损,晚期累及视盘颞侧、鼻侧,直至视杯呈同心圆状扩大盘沿弥漫性丢失,神经纤维层受损顺序与盘沿进展相对应.盘沿进展程度与神经纤维层缺损进展程度有相关性,相关系数r=0.44.P＜0.001,盘沿进展程度与神经纤维层进展程度有显著相关性,r=0.93,P＜0.001.结论 青光眼视神经进展多从下方或上方盘沿进展开始,晚期波及视盘鼻颞侧,盘沿进展多与相应神经纤维层缺损进展一致.眼底立体照相联合图像闪烁对比方法对于监测青光眼视神经进展是一种较理想的手段.     

正常人不同类型视乳头及早期青光眼患者视乳头形态学研究

目的：探讨正常人不同类型视乳头及早期青光眼患者视乳头形态学特征,以指导青光眼的早期诊断。方法：将收集到的眼底照片分为4组：正常人小视乳头组41只眼,正常人大视乳头组40只眼,正常人大或小视乳头组42只眼,早期开角形青光眼组45只眼。利用计算机图像分析技术,测量视乳头、盘沿、视杯面积向周围（每10^0）盘沿宽度。结果：（1）正常人不同类型视乳头组的盘沿宽度曲线均在下或上方形成双峰,在鼻、颞侧形成谷底。大视乳头组下方盘沿最宽,小视乳头组上方盘沿最宽,鼻侧次之,颞侧最窄。（2）早期青光眼盘沿宽度典线下或上方双峰消失,其曲线低于鼻侧象限、高于颞侧象限。（3）经多因素逐步判别分析,盘沿面积加杯／盘比值的正确判断率为85．7％,以系列盘沿宽度为指标,下方偏颞侧（6：20）和上方偏鼻侧（1：00）两个盘沿宽度最为相关,其正确判断率为90．6％。结论：评价盘沿形态时应以其自身的鼻侧盘沿宽度作为标准,比较其上、下方盘沿宽度是否变窄,有利于生理性大视杯与早期青光眼的鉴别。     

生理性大视杯及早期青光眼的盘沿形态研究

目的探讨生理性大视杯与早期青光眼的差异。方法侧重分析、研究盘沿的形态。研究对象分两组：（１）生理性大视杯：Ｃ／Ｄ＞０．６，视盘面积大于２．８ｍｍ２，随诊３～６年盘沿无改变，眼压及视野均正常，共５４例（８８只眼）。（２）早期青光眼：在随诊中有盘沿丢失或视野缺损，但Ｃ／Ｄ＜０．８者共６８例（８９只眼）。反映形态的指标有：（１）系列盘沿宽度；（２）视杯形态参数，即垂直Ｃ／Ｄ与水平Ｃ／Ｄ的比值。结果生理性大视杯与早期青光眼在形态上的差异：（１）前者视盘大；（２）前者的视杯为横椭圆形，后者视杯呈竖椭圆形；（３）前者的盘沿以下方最宽，上方次之，鼻侧、颞侧盘沿宽度较窄；后者因早期以下方盘沿丢失最常见，所以下方盘沿宽度较上方者窄或相同。结论视杯形态＋盘沿面积＋视盘面积的组合，在多因素判别分析的回代中符合率最高。     

正常眼压性青光眼视神经损害的临床观察

目的　探讨正常眼压性青光眼 (NPG)患者视神经损害的临床表现 ,综合性医院眼科从临床角度对NPG进行早期诊断。方法　对 2 6例NPG患者视神经损害所致眼底和视野改变的临床特点作回顾性系统分析。结果　视神经损害眼底表现为视盘盘沿形态改变和视网膜神经纤维层 (RN FL)缺损。引入盘沿宽度比概念 :以自身鼻侧盘沿宽度N为标准和下方盘沿宽度I作比较 ,N≥I为阳性指标 ,检出N≥I者 42眼 (占 80 77% ) ;对照以颞侧盘沿宽度T和下方宽度I比较 ,T≥I者 2 2眼 (占 42 3 1% )。两种方法经统计学处理 ,差异有非常显著性 (χ2 =14 5 6,P <0 0 1)。检出RNFL缺损 44眼 (占 84 62 % ) ,其中局限性缺损 3 5眼 ,弥漫性缺损 9眼。视野情况 :平均缺损MD为10 87dB± 2 41dB ,平均视野敏感度MS为 15 5 8dB± 3 0 8dB。检出不同程度视野形态缺损 3 7眼 ,阳性率为 71 15 %。结论　正常眼压性青光眼视神经损害主要表现为眼底视盘盘沿形态改变和RNFL缺损。盘沿形态改变以自身鼻侧盘沿宽度N为标准与下方盘沿宽度I相比较较合理 ,N≥I有诊断意义。视野改变为其提供重要诊断依据。     

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.     

Nachfolgeuntersuchung von Augen mit chronischem Offenwinkelglaukom und streifenförmigen Papillenblutungen

PURPOSE: To evaluate the frequency of neuroretinal rim loss in glaucomatous eyes with ophthalmoscopically detected optic disc hemorrhages. METHODS: The prospective comparative clinical observational study included 78 eyes from 69 Caucasian patients with chronic open-angle glaucoma and a flame-shaped optic disc hemorrhage at the time of presentation, and 386 eyes from 252 patients with chronic open-angle glaucoma without disc hemorrhages. All patients underwent repeated qualitative and morphometric evaluation of color stereo optic disc photographs. RESULTS: Patients with disc hemorrhages were older than patients without hemorrhages and showed an initially smaller neuroretinal rim area. Of the 78 eyes with disc hemorrhages 39 showed loss of neuroretinal rim during the follow-up period. For the remaining 39 eyes, no changes of the neuroretinal rim could be detected on optic disc photographs. Of the 386 eyes without disc hemorrhages 71 showed loss of neuroretinal rim during the follow-up period. A survival analysis confirmed a hazard ratio of three between eyes with and without disc hemorrhages and a hazard ratio of 1.85 per decade of patient's age (multivariate analysis). CONCLUSIONS: Disc hemorrhages lead to a 3-fold increase of risk for further retinal rim loss in eyes with chronic open-angle glaucoma.     

Optic disc morphometry correlated with confocal laser scanning Doppler flowmetry measurements in normal-pressure glaucoma

PURPOSE: To examine the relationship between morphologic optic disc parameters and hemodynamic parameters as measured by confocal laser scanning Doppler flowmetry in patients with normal-pressure glaucoma. METHODS: The study included 91 eyes of 54 patients with normal-pressure glaucoma (mean age: 57.7 +/- 9.8 years), and 136 eyes of 77 age-adjusted normal controls. Color stereo optic disc photographs were morphometrically examined, and confocal laser scanning flowmetry (Heidelberg Retinal Flowmeter) in the neuroretinal rim inside of the optic disc, and in the retina close to the temporal and nasal border of the optic nerve head was performed. RESULTS: Mean confocal laser scanning flowmetric measurements in the neuroretinal rim, temporal parapapillary retina, and nasal parapapillary retina were significantly (P<0.03) lower in the normal-pressure glaucoma group than in the age-adjusted control group. Correspondingly, mean confocal laser scanning flowmetric measurements within the neuroretinal rim decreased significantly, with relatively low correlation coefficients, decreasing neuroretinal rim area (P = 0.016; correlation coefficient r2 = 0.026), and increasing mean visual field defect (P = 0.011; r2 = 0.029). Measurements were statistically independent of alpha zone (P = 0.38; r2 = 0.004) and beta zone (P = 0.57; r2 = 0.002) of parapapillary atrophy. CONCLUSIONS: Confocal laser scanning flowmetric measurements within the neuroretinal rim were lower in eyes with normal-pressure glaucoma than in age-matched normal eyes. Confocal laser scanning flowmetric measurements decrease with increasing glaucomatous optic nerve damage. There is, however, a marked variability preventing a clear relationship between stage of glaucoma and decrease in confocal laser scanning flowmetric measurements. The correlation between parapapillary atrophy and confocal laser scanning flowmetric measurements is not statistically significant in normal-pressure glaucoma.     

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。     

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.     

Is the nasal optic disc sector important for morphometric glaucoma diagnosis?

BACKGROUND/AIM: Since the central retinal vessel trunk usually located in the nasal optic disc sector can render difficult the delineation of the neuroretinal rim and optic disc, the aim of this study was to evaluate whether the nasal region of the optic nerve head is important, or can be left out, for the morphometric glaucoma diagnosis. METHODS: The clinical observational study included 1337 patients with primary or secondary open angle glaucoma and 649 normal subjects. The glaucoma group was divided into 1187 patients with glaucomatous visual field defects ("perimetric glaucoma"), and into 150 patients with optic nerve head changes and normal visual fields ("preperimetric glaucoma"). Colour stereo optic disc photographs were morphometrically evaluated. RESULTS: Highest diagnostic power for the separation between the normal group and the perimetric glaucoma group, and for the differentiation between the normal group and the preperimetric glaucoma group, had the sum of inferotemporal rim area plus superotemporal rim area, the sum of inferotemporal rim area plus superotemporal rim area plus temporal rim area, and the inferotemporal rim area as single parameter. The lowest diagnostic precision had the nasal rim area as single parameter or in combination with rim measurements in other disc sectors. CONCLUSION: Excluding the nasal optic disc sector does not markedly decrease the diagnostic power of morphometric optic disc analysis in glaucoma diagnosis. It may have importance for an automated computerised morphometric detection of glaucomatous optic nerve damage.     

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.     

Central retinal vessel trunk exit and location of glaucomatous parapapillary atrophy in glaucoma

OBJECTIVE: 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. DESIGN: Clinic-based, observational, cross-sectional study. PATIENTS: Color stereo optic disc photographs of 95 patients with primary or secondary open-angle glaucoma and 65 healthy persons were morphometrically evaluated. The intrapapillary and parapapillary region was divided into four quadrants. We determined the position of the central retinal vessel trunk exit on the lamina cribrosa surface and measured the area of parapapillary atrophy and neuroretinal rim in the four quadrants. MAIN OUTCOME MEASURES: The area of neuroretinal rim and parapapillary atrophy and the position of the central retinal vessel trunk exit. RESULTS: Comparing measurements between opposite disc quadrants showed that beta zone of parapapillary atrophy was significantly (P < 0.05) larger and that the neuroretinal rim was significantly smaller when beta zone and neuroretinal rim were measured in the disc quadrant most distant to the central retinal vessel trunk exit, than if the beta zone and neuroretinal rim were measured in the quadrant containing the vessel trunk exit. Comparing measurements in the disc quadrants between eyes with different positions of the central retinal vessel trunk exit revealed that, in the respective disc quadrant, the beta zone was significantly larger and the neuroretinal rim was smaller in eyes with the vessel trunk exiting in the opposite disc quadrant than in eyes with the vessel trunk exit located in the respective disc quadrant where the measurements were obtained. 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 and the smaller is the neuroretinal rim. This relationship agrees with the spatial relationship between glaucomatous neuroretinal rim loss and enlarged parapapillary atrophy in glaucoma. Diagnostically, it may indicate that, in eyes with an abnormal configuration of parapapillary atrophy or with an abnormal position of the central retinal vessel trunk exit, early glaucomatous rim changes should be looked for in the disc sector that is most distant to the central retinal vessel trunk exit and where parapapillary atrophy may be relatively large.     

Optic nerve head topographic measurements and retinal nerve fiber layer thickness in physiologic large cups

PURPOSE: To evaluate the parameters of optic nerve head (ONH) and retinal nerve fiber layer (RNFL) in patients with large cup/disc ratio (CDR) and normal neuroretinal rim configuration who have normal perimetry (physiologic large cups, LC) and to compare these parameters with those of the normal and early glaucoma patients. METHODS: Using Heidelberg retinal tomography (HRT) and optical coherence tomography (OCT), 30 patients with LC, 29 normal subjects, and 31 early glaucoma patients were examined. One eye from each subject was randomly selected. RESULTS: Significant differences between LC and glaucomatous eyes (GE) were found in parameters indicating loss of nerve fibers, such as rim area, rim volume, and mean RNFL thickness. However, there was no difference between LC and normal eyes (NE) in RNFL thickness, rim area, and rim volume. LC was able to be defined as a normal central excavation with a large disc and large CDR with a normal rim area. CONCLUSIONS: HRT ONH parameters and RNFL thickness obtained with OCT may be useful for differentiating between glaucoma and LC eyes.