Optic Disc Changes in Glaucoma : Diagnosing Glaucoma Case
The ISNT guideline
Optic disc haemorrhage
Retinal nerve fibre layer (RNFL)defects
- RNFL is seen with the green light on the slit lamp.
- RNFL can be photographed.
- RNFL analysers looking for loss of the retinal nerve fibre layer are available but are of limited use at present. They are very poor at screening for glaucoma but may be useful in monitoring ocular hypertension/early glaucoma for progression. Once there is moderate disease they are very poor at demonstrating subtle changes.
1. Morgan JE, Bourtsouki I, Rajkumar KN, et al. The accuracy of the inferior>superior>nasal>temporal neuroretinal rim area rule for diagnosing glaucomatous optic disc damage. Ophthalmology. 2012 Apr;119(4):723-30.
2. Hwang YH, Kim YY. Application of the ISNT rule to neuroretinal rim thickness determined using Cirrus HD optical coherence tomography. J Glaucoma. 2013 Nov 14.
3. Pogrebniak AE , Wehrung B, Pogrebniak KL, et al. Violation of the ISNT rule in nonglaucomatous pediatric optic disc cupping. Invest Ophthalmol Vis Sci. 2010 Feb;51(2):890-5.