Optometry - Journal of the American Optometric Association
Volume 75, Issue 11 , Pages 677-708, November 2004

Glaucoma without cupping

  • Jerome Sherman, O.D.

      Affiliations

    • State University of New York, State College of Optometry
    • The Eye Institute and Laser Center, New York, New York
    • Corresponding Author InformationCorresponding author: State University of New York, College of Optometry, 33 West 42nd Street New York, New York 10036.
    • ,
  • Sherry J. Bass, O.D.

      Affiliations

    • State University of New York, State College of Optometry
    • ,
  • Samantha Slotnick, O.D.

      Affiliations

    • State University of New York, State College of Optometry

Article Outline

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.

Key Words: Case reports, cupping, GDx, glaucoma, HRT, intraocular pressure, ocular hypertension, OCT, optic nerve head

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Sponsel WE. Tonometry in question: can visual screening tests play a more decisive role in glaucoma diagnosis and management?. Surv Ophthalmol. 1989;33(Suppl):291–300
  2. Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002;120:701–713
  3. Zangwill LM, Bowd C, Berry CC, et al. Discriminating between normal and glaucomatous eyes using the Heidelberg Retinal Tomograph, GDx Nerve Fiber Layer Analyzer, and Optical Coherence Tomograph. Arch Ophthalmol. 2001;119:985–993
  4. Bass SJ, Sherman J. Optic disk evaluation and the use of hi-tech in the diagnosis of glaucoma. Optometry. 2004;75:277–296
  5. Jonas JB, Nguyen NX, Naumann GO. The retinal nerve fiber layer in normal eyes. Ophthalmology. 1989;96:627–632
  6. Ritch R, Mudumbai R, Liebmann JM. Combined exfoliation and pigment dispersion: paradigm of an overlap syndrome. Ophthalmology. 2000;107:1004–1008
  7. Varma R, Tielsch JM, Quigley HA, et al. Race-, age-, gender-, and refractive error-related differences in the normal optic disk. Arch Ophthalmol. 1994;112:1068–1076
  8. Caprioli J, Spaeth GL. Static threshold examination of the peripheral nasal visual field in glaucoma. Arch Ophthalmol. 1985;103:1150–1154
  9. Ballon BJ, Echelman DA, Shields MB, et al. Peripheral visual field testing in glaucoma by automated kinetic perimetry with the Humphrey Field Analyzer. Arch Ophthalmol. 1992;110:1730–1732
  10. Johnson CA. Diagnostic value of short-wavelength automated perimetry. Curr Opin Ophthalmol. 1996;7:54–58
  11. Johnson CA, Sample PA, Cioffi GA, et al. Structure and function evaluation (SAFE): I. criteria for glaucomatous visual field loss using standard automated perimetry (SAP) and short wavelength automated perimetry (SWAP). Am J Ophthalmol. 2002;134:177–185
  12. Samples JR, van Buskirk M, Shults WT, et al. Optic nerve head drusen and glaucoma. Arch Ophthalmol. 1985;103:1678–1680
  13. Pickett JE, Terry SA, O’Connor PS, et al. Early loss in central visual acuity in glaucoma. Ophthalmology. 1985;92:891–896
  14. Douglas GR, Drance SM, Schulzer M. The visual field and nerve head in angle-closure glaucoma. Arch Ophthalmol. 1975;93:409–411
  15. Caprioli J. Correlation between disk appearance and type of glaucoma. In:  Varma R,  Spaeth GL editor. The optic nerve in glaucoma. Philadelphia: Lippincott; 1993;p. 91–98
  16. Jonas JB, Gusek GC, Naumann GO. Optic disk, cup and neuroretinal rim size, configuration, and correlations in normal eyes. Invest Ophthalmol Vis Sci. 1988;29:1151–1158(Correction: Invest Opthalmol Vis Sci 1991;32:1893.)

PII: S1529-1839(04)70222-5

doi:10.1016/S1529-1839(04)70222-5

Optometry - Journal of the American Optometric Association
Volume 75, Issue 11 , Pages 677-708, November 2004

Article Tools