Optic Disc Progression in Ocular Hypertension, Early Glaucoma
Optic Disc Progression in Ocular Hypertension, Early Glaucoma
Purpose: To determine the clinical features of optic disc progression in patients with ocular hypertension and early glaucoma.
Patients: A total of 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 (2 or more clock hours), notching (1 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 2 or more features of progression. The inferotemporal quadrant was the most common location for progression, but more than 1 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.
The features of glaucomatous optic neuropathy include a vertical elongation of the optic cup with associated decreases in the neuroretinal rim area and nerve fiber layer (NFL) loss. In addition, morphologic changes of the glaucomatous optic disc correlate with characteristic patterns of visual field loss. Although eye care providers cite these features as the sine qua non of glaucoma, recent definitions have also emphasized the progressive nature of untreated glaucoma, suggesting that progressive change should also be considered as requisite for a diagnosis of glaucoma. Clinicians may detect these progressive changes of glaucoma by documenting repeatable worsening of the visual field or progressive structural damage to the optic nerve head or retinal NFL.
Studies have demonstrated that progressive optic disc changes occur commonly as a feature of glaucomatous progression. Recently, several clinical trials have used progressive disc changes as an endpoint for glaucomatous progression and for the conversion from ocular hypertension to glaucoma. These studies showed that progressive disc change is an important indicator of progressive glaucomatous optic neuropathy and a key sign of the development and worsening of glaucomatous damage to the visual system.
Surprisingly, only a few studies describe the features of progressive optic disc changes in patients with early glaucoma or ocular hypertension. Pederson showed increased generalized cupping as the most common feature of progressive disc changes in ocular hypertension patients. Tuulonen, who also studied ocular hypertensive patients, found an equal number of generalized and focal disc changes among patients with progressive disc changes. Odberg showed generalized enlargement of the optic cup with the majority of the cases exhibiting increased cupping in the superiotemporal or inferotemporal quadrants. These studies provide valuable insight to eye care providers regarding the common features related to progressive disc changes in glaucoma. However, Pederson did not require stereophotographs (a current standard for evaluation of the optic nerve head) and the studies by Tuulonen and Odberg were limited by smaller sample sizes.
In this study, we sought to determine the most common optic disc changes in patients with ocular hypertension or early glaucoma using serial, stereoscopic photographs of the optic disc in a large cohort study of patients. The results of this study will help eye care providers recognize early optic disc changes in their glaucoma suspect, ocular hypertensive, and glaucoma patients.
Abstract and Introduction
Abstract
Purpose: To determine the clinical features of optic disc progression in patients with ocular hypertension and early glaucoma.
Patients: A total of 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 (2 or more clock hours), notching (1 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 2 or more features of progression. The inferotemporal quadrant was the most common location for progression, but more than 1 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.
Introduction
The features of glaucomatous optic neuropathy include a vertical elongation of the optic cup with associated decreases in the neuroretinal rim area and nerve fiber layer (NFL) loss. In addition, morphologic changes of the glaucomatous optic disc correlate with characteristic patterns of visual field loss. Although eye care providers cite these features as the sine qua non of glaucoma, recent definitions have also emphasized the progressive nature of untreated glaucoma, suggesting that progressive change should also be considered as requisite for a diagnosis of glaucoma. Clinicians may detect these progressive changes of glaucoma by documenting repeatable worsening of the visual field or progressive structural damage to the optic nerve head or retinal NFL.
Studies have demonstrated that progressive optic disc changes occur commonly as a feature of glaucomatous progression. Recently, several clinical trials have used progressive disc changes as an endpoint for glaucomatous progression and for the conversion from ocular hypertension to glaucoma. These studies showed that progressive disc change is an important indicator of progressive glaucomatous optic neuropathy and a key sign of the development and worsening of glaucomatous damage to the visual system.
Surprisingly, only a few studies describe the features of progressive optic disc changes in patients with early glaucoma or ocular hypertension. Pederson showed increased generalized cupping as the most common feature of progressive disc changes in ocular hypertension patients. Tuulonen, who also studied ocular hypertensive patients, found an equal number of generalized and focal disc changes among patients with progressive disc changes. Odberg showed generalized enlargement of the optic cup with the majority of the cases exhibiting increased cupping in the superiotemporal or inferotemporal quadrants. These studies provide valuable insight to eye care providers regarding the common features related to progressive disc changes in glaucoma. However, Pederson did not require stereophotographs (a current standard for evaluation of the optic nerve head) and the studies by Tuulonen and Odberg were limited by smaller sample sizes.
In this study, we sought to determine the most common optic disc changes in patients with ocular hypertension or early glaucoma using serial, stereoscopic photographs of the optic disc in a large cohort study of patients. The results of this study will help eye care providers recognize early optic disc changes in their glaucoma suspect, ocular hypertensive, and glaucoma patients.
