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.