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Abstract #12581 Published in IGR 7-3
Reconsideration of the glaucomatous disc and visual field
Wakakura MNeuro-Ophthalmology Japan 2005; 22: 184-193
Ophthalmologists often make erroneous diagnoses of glaucoma, since the clinical entity of normal tension glaucoma has been established and is recognized to have a high prevalence. To highlight the various factors that play an important role in the diagnostic definition of glaucoma, this report presents information on the cupping of the optic disc and visual field. Statistically significant differences are observed in the optic disc appearance when patients with open-angle glaucoma, which includes normal tension glaucoma, are compared to both normal subjects and patients with other optic neuropathic entities. However, when clinical observations are made in subjects with congenital cupping and excavation of high myopic disc, and also in patients with idiopathic optic neuritis, anterior ischemie optic neuropathy, and late stage Leber's hereditary optic neuropathy, such differences are not always noted. This study also presents data on many cases with either a tilted disc or optic nerve hypoplasia that have been erroneously diagnosed as glaucoma. Usually the clinical diagnosis of typical cases does not result in any confusion between patients with glaucoma and those with ischemic optic neuropathy, and in fact, the current concept of optic neuropathy due to ischemia has been extended to include ischemic optic neuropathy of the young, chronic optic neuropathy, and autoimmune optic neuropathy possibly due to vasculitis of nutrient vessels to the optic nerve. These variants of ischemic neuropathy require that reconsideration of the definition or pathogenesis of glaucoma in addition to the exact nomenclature that needs to be used for glaucoma be undertaken. LA: Japanese
Dr. M. Wakakura, Inouye Eye Hospital, 4-3, Kandasurugadai, Chiyoda-ku, Tokyo 101-0062, Japan
Classification:
10 Differential diagnosis e.g. anterior and posterior ischemic optic neuropathy
