Optic Nerve Evaluation

1. scleral ring

2. rim size & position

3. retinal & disc hemorrhages

4. regions of peripapillary atrophy

5. RNFL

what are the 5 Rs in optic disc/RNFL evaluation?

vertical

do we care more about the vertical or horizontal disc diameter for glaucoma?

1.8, 1.7

the average vertical disc diameter is ___mm & horizontal disc diameter is ___mm

<1.5

a small disc has an average vertical diameter of _____mm

>2.2

a large disc has an average vertical diameter of ____mm

larger

African Americans have ______ optic discs

large

large discs will have _____ cups

small

small discs will have _____ cups

2

a physiological cup of 0.7 or greater occurs in ___% of normals

larger

in normal eyes, C/Ds are _____ horizontally than vertically

vertical

in glaucoma, ______ C/D increases faster than horizontal

F (more cause for concern but can be completely normal)

T/F: asymmetrical C/Ds always indicates glaucoma

inferior, superior, nasal, temporal

list the areas of the rim in order from thickest to thinnest in a normal eye

temporal rim tissue is = or greater than the vertical poles (superior or inferior)

when should rim tissue changes warrant concern for glaucoma?

notching

focal/local areas of axon loss resulting in little to no remaining rim tissue

3x more

an inferior notch is _________ common than a superior notch

30

notching may occur in ___% of pts

87

notching is ____% specific for glaucoma

inferotemporal or superotemporal

where does rim loss most often occur in early glaucoma?

nasal

with advanced rim loss from glaucoma, the _____ region is the last remnant

inferotemporal → superotemporal → temporal horizontal → nasal inferior → nasal superior

describe the progression of optic nerve damage

progression of field loss

rim tissue loss corresponds with what?

increases

a pale rim ______ the likelihood for a non-glaucomatous optic neuropathy

striations, brightness, visibility of parapapillary retinal vessels

what 3 things should you pay attention to when looking at the RNFL?

red-free light

what is RNFL examination best preformed under?

• diffuse loss of striate pattern

• increased visibility of retinal vessel borders (sharp wall of small retinal vessels is apparent, vessels are not covered by RNFL & are visualized clearly)

• mottled appearance of RPE

• fundus appears darker

describe the appearance of diffuse RNFL loss

wedge shaped dark area

describe the appearance of a localized RNFL loss

alpha zone

• irregular hypo & hyperpigmentation

• thinning of chorioretinal tissue

• outer side is retina

• inner side is beta zone

• pigment irregularities of RPE

• present in normal eyes

• corresponds to a relative scotoma

beta zone

• marked atrophy of the RPE & choriocapillaris

• large choroidal vessels become visible

• thinning of chorioretinal tissues

• more common in glaucomatous eyes but can be in normal eyes

• width inversely correlates w/ rim width at the same area

• progression associated w/ progressive glaucoma

• corresponds to an absolute scotoma

thinner

a larger beta zone → _____ rim

absolute

beta zone atrophy will result in _______ scotoma

relative

alpha zone atrophy will result in _______ scotoma

OAG

PPA is more common & greater in ______

T

T/F: the degree of PPA correlates w/ optic disc damage

T

T/F: the location of PPA correlates w/ the location of optic disc damage

T

T/F: location of PPA correlates w/ the location of VF defects

F

T/F: optic disc hemorrhages are not indicative of glaucoma progression

2-6mo

what is the timeline for an optic disc hemorrhage to resolve?

0-1, PVD

an optic disc hemorrhage is seen in ____% of the normal population due to what?

4-10

optic disc hemorrhages are found in ____% of eyes with glaucoma

20-25

optic disc hemorrhages are found in _____% of eyes with normal tension glaucoma

4-8

optic disc hemorrhages are found in ____% of eyes with high pressure glaucoma

5

____% of optic disc hemorrhages are bilateral

NTG

in what type of glaucoma are optic disc hemorrhages most common?

edge of NFL defect

where are optic disc hemorrhages most commonly seen?

F

T/F: an optic disc hemorrhage can occur in an area with no NFL tissue

no

are optic disc hemorrhages seen in advanced glaucoma?

unknown

what is the etiology of optic disc hemorrhages?

inferotemporal (or superotemporal)

where are optic disc hemorrhages most commonly seen?

20-25

______% of optic disc hemorrhages are on the nasal side of the optic nerve

20-60

____% of optic disc hemorrhages recur

myopic disc

cup asymmetry

inferior temporal notch

superior temporal rim loss

notch

inferior focal notch

inferior notching

inferior notching

diffuse loss of striations

diffuse RNFL loss

localized RNFL defect

inferior diffuse NFL loss

inferior diffuse NFL loss

superior wedge NFL defect

wedge NFL defect

notching of rim & NFL loss

drance heme

disc hemorrhage

disc hemorrhage

disc hemorrhage

disc hemorrhage

drance hemorrhage

drance hemorrhage

disc hemorrhage

disc hemorrhage

advanced cupping w/ laminar dots

lamina visible & total erosion to the trim

baring of circumlinear vessel

baring of circumlinear vessel

bean pot cup

bayonetting of retinal vessels

advanced glaucoma cupping