Features of Optic Disc Progression in Patients With Ocular Hypertension and Early Glaucoma

Abstract

Purpose To determine the clinical features of optic disc progression in patients with ocular hypertension and early glaucoma. Patients 336 eyes of 168 patients with ocular hypertension or early glaucoma Methods Two glaucoma specialists independently graded the baseline and most recent optic disc photographs for optic disc progression. Optic disc progression was defined as: new or increased neuroretinal rim thinning (two or more clock hours), notching (one clock hour or less of thinning of the neuroretinal rim), excavation (undermining of the neuroretinal rim or disc margin), and nerve fiber layer defect(s). They also determined the location of these changes. Results Ninety-two of 336 eyes (27.4%) showed optic disc progression after a median of 6.1 years. Of those with progression, excavation occurred in 89% of eyes; rim thinning occurring in 54%; and notching occurring in 16%. Fifty-six percent (56%) had two or more features of progression. The inferotemporal quadrant was the most common location for progression, but more than one location of progression occurred in at least 30% of eyes with progression. Conclusions Optic disc progression occurred frequently in this cohort of ocular hypertension and early glaucoma patients. When evaluating the optic disc for glaucomatous progression, eye care providers should pay particular attention to increased excavation and neuroretinal rim thinning – especially in the inferotemporal quadrant.

Prospective Study of Eye Disease in Timor-Leste

“…Glaucoma characteristically has subtle optic disc changes in mild and moderate stages, with functional impairments only detectable in advanced disease. [26][27][28] The RAAB study conducted by Ramke et al 5 in 2012 reported the prevalence of glaucoma to be 2.9% in the blind and visually impaired groups. We found the prevalence to be much higher at 15.36%, which is in the context of a clinical cohort including all causes of glaucoma and improved sensitivity and specificity for detection.…”

One Year of Glaucoma Research in Review

“…Lloyd and colleagues 9 examined disc photographs in a group of 336 eyes of 168 patients with ocular hypertension or early glaucoma and found that 27.4% of eyes exhibited progression after a median of 6.1 years. Of the eyes with progression, excavation was seen in 89%, rim thinning in 54%, and notching in 16%.…”

“…The most common location of change was in the inferotemporal quadrant of the disc, although 30% of cases exhibited progression in more than 1 location. 9 …”

One Year of Glaucoma Research in Review

“…The most common location of change was in the inferotemporal quadrant of the disc, although 30% of cases exhibited progression in more than 1 location. 9 In assessing the optic nerve, Tatham et al 10 postulated a nonlinear relationship between retinal ganglion cell (RGC) estimate and cup-to-disc ratio. They concluded that cup-to-disc ratio is not sensitive for evaluating progressive neural losses in glaucoma, as small changes can be associated with large losses of RGCs.…”