Study of the optic papilla and nerve fiber layer in glaucoma]

BACKGROUND: For diagnosis and follow-up of glaucoma an exact evaluation of the optic nerve disc and the nerve fiber layer is necessary. METHODS: The slit-lamp evaluation of the optic nerve disc and nerve fiber layer is presented as well as the evaluation with the Nerve Fiber Analyzer and the Heidelberg Retina Tomograph. RESULTS: Signs of a glaucomatous optic disc include a difference of more than 0.2 in the vertical cup to disc (CD) ratio between the eyes, a vertical CD ratio exceeding more than 0.1 the horizontal, larger CD ratios in small optic discs, notching of the neuroretinal rim, an enlarged zone beta of parapapillary chorioretinal atrophy, and peripapillary hemorrhages. Atrophy of the nerve fiber layer may be localized or diffuse. Both types of atrophy may be present at the same time. CONCLUSIONS: Knowledge of all signs of the glaucomatous optic disc and forms of nerve fiber layer atrophy allows an earlier diagnosis of glaucoma and an earlier recognition of progression.