Initial Glaucomatous Optic Disk and Retinal Nerve Fiber Layer Abnormalities and Their Progression

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We attempted to identify the initial glaucomatous changes of the optic disk and retinal nerve fiber layer and to analyze how these changes subsequently progressed. Of 61 eyes of 61 patients with ocular hypertension, 23 (38%) developed glaucoma during ten years of follow-up (range, five to 15 years). The initial sign of glaucomatous damage was diffuse enlargement of the optic disk cup in ten of 23 eyes or generalized thinning of the nerve fiber layer without localized changes in 12 of 23 eyes. We found localized optic disk damage in ten of 23 patients and localized retinal nerve fiber layer damage in 11 of 23 patients alone or in combination with diffuse damage. In 13 of 23 eyes, the cupping ended up in diffuse enlargement with even more profound thinning of the neural rim in the upper and lower temporal disk margins. There seems to be great variability in the appearance and progression of the initial glaucomatous optic disk and nerve fiber layer abnormalities in patients with increased intraocular pressure.

References (17)

  • P.J. Airaksinen et al.

    Diffuse and localized nerve fiber loss in glaucoma

    Am. J. Ophthalmol.

    (1984)
  • A. Tuulonen et al.

    Optic disk cupping and pallor measurements of patients with a disk hemorrhage

    Am. J. Ophthalmol.

    (1987)
  • K. Iwata

    Topographical analysis on the genesis of glaucomatous cupping

    Glaucoma

    (1979)
  • Y. Shiose

    “Quantitative disc pattern” as a new parameter for glaucoma screening

    Glaucoma

    (1979)
  • J.B. Jonas et al.

    Optic disc morphometry in chronic primary open-angle glaucoma. I. Morphometric intrapapillary characteristics

    Graefes Arch. Clin. Exp. Ophthalmol.

    (1988)
  • Y. Shiose et al.

    Relationship between mode of disc cupping and clinical features in primary open-angle and low-tension glaucoma

    Glaucoma

    (1987)
  • A. Sommer et al.

    Optic disc parameters and onset of glaucomatous field loss. I. Methods and progressive changes in disc morphology

    Arch. Ophthalmol.

    (1979)
  • J.E. Pederson et al.

    The mode of progressive disc cupping in ocular hypertension and glaucoma

    Arch. Ophthalmol.

    (1980)
There are more references available in the full text version of this article.

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This study was supported by the Sigrid Juselius Foundation, Helsinki, Finland, and the Alcon Research Institute Award. This study was presented in part at the Drance Glaucoma Fellowship Symposium, Vancouver, British Columbia, Canada, March 29, 1990.

Reprint requests to Anja Tuulonen, M.D., Department of Ophthalmology, University of Oulu, SF-90220, Oulu, Finland.

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