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Abstract #11978 Published in IGR 7-1
Glaucoma without cupping
Sherman J; Bass SJ; Slotnick SOptometry 2004; 75: 677-708
BACKGROUND: Although glaucoma can exist with normal intraocular pressures (IOPs), clinicians still rely on the presence of a large cup to 'flag' suspects, regardless of IOP, whereas a small cup at the same pressure level is often ignored. High-tech instruments offer a new dimension of evaluation in the objective assessment of structure when subjective tests of function and/or ophthalmoscopic observations are equivocal. CASE REPORTS: Thirteen cases are presented and show evidence of glaucoma based on glaucomatous visual-field defects, often with steadily rising intraocular pressures and retinal nerve fiber layer loss. Surprisingly, these patients maintained small C/D ratios. Accordingly, ophthalmoscopy and/or disk topography classified these disks as normal. CONCLUSIONS: Although unrecognized in virtually the entire world's ophthalmic literature, normal cup glaucoma is a real clinical entity. At least half the normal cup glaucoma cases presented herein have disk drusen (obvious, subtle, or occult), while others are highly myopic and/or have documented IOP spikes. Several of the cases defy classification and explanation at the present time.
Dr. J. Sherman, State University of New York, State College of Optometry, New York, New York 10036, USA. jsherman@sunyopt.edu
Classification:
2.14 Optic disc (Part of: 2 Anatomical structures in glaucoma)
6.8.2 Posterior segment (Part of: 6 Clinical examination methods > 6.8 Photography)