Chronic Human Glaucoma Causing Selectively Greater Loss of Large Optic Nerve Fibers

Eighteen eyes of 12 persons with chronically elevated intraocular pressure (IOP) were studied histologically to determine the number and diameter of optic nerve fibers. In some eyes, automated perimetry had been performed. Optic nerve fibers larger than the mean diameter were killed more rapidly than smaller fibers, although no fiber size was completely spared at any stage of atrophy. The number of optic nerve fibers varies considerably among normal eyes. The authors confirmed that the death of a substantial proportion of optic nerve fibers precedes detectable visual field loss.