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Editors Selection IGR 9-3

Clinical examination methods: Fluorescein angiography

Comment by George Spaeth on:

12492 Fluorescein leakage of the optic disc in glaucomatous optic neuropathy, Arend O; Remky A; Plange N et al., Graefe's Archive for Clinical and Experimental Ophthalmology, 2005; 243: 659-664

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Use of fluorescein to study vascular aspects in the living human eye was initiated approximately fifty years ago. In 1977 my monograph (Spaeth, GL: The Pathogenesis of Nerve Damage in Glaucoma: Contributions of Fluorescein Angiography, 1977) appeared reporting the results of fluorescein angiography in a variety of patients with different types of glaucoma and stages of the disease. One of the aspects studied in that investigation was staining of the optic disc. One conclusion was that "staining was not often present in normal controls, but it was observable in more than one-third of the glaucoma patients…" Interestingly, the frequency and amount of stain was highly correlated with the stage of glaucoma, the state of control of the glaucoma, decreased profusion of the optic disc, and moderately well with the pallor of the optic disc. This finding has been largely ignored, and the recent paper by Arend et al. (529) is a welcome return to an observation that could be of clinical significance. The senior author, Bernard Schwartz, has been one of the major contributors in the field of fluorescein angiography in glaucoma for many years.

The study by Arend et al. confirms that glaucomatous eyes are more likely to have leaky blood vessels around the disc than are normal individuals, and that the more severe the glaucoma the more likely the discs are to leak. Unfortunately, it is still not known why this occurs and the clinical significance, if any, remains unsettled. Nevertheless, the finding may be an important one and it is hoped that further investigations will provide clinical guidance in the future.

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