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Glaucoma without cupping.

Jerome Sherman1, Sherry J Bass, Samantha Slotnick

  • 1State University of New York, State College of Optometry, New York, New York 10036, USA. jsherman@sunyopt.edu

Optometry (St. Louis, Mo.)
|December 16, 2004
PubMed
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Glaucoma can occur with normal intraocular pressure (IOP) and small optic nerve cups, challenging traditional diagnostic methods. This study highlights "normal cup glaucoma" as a distinct clinical entity requiring further recognition and investigation.

Area of Science:

  • Ophthalmology
  • Optometry

Background:

  • Clinicians often rely on large optic cup-to-disc ratios to diagnose glaucoma, potentially overlooking cases with normal intraocular pressures (IOPs).
  • Advanced imaging technologies offer objective structural assessments to complement functional tests and ophthalmoscopic observations in equivocal cases.

Observation:

  • Thirteen glaucoma cases exhibited glaucomatous visual-field defects, progressive IOP elevation, and retinal nerve fiber layer loss.
  • These patients surprisingly maintained small cup-to-disc (C/D) ratios, leading to normal classifications by ophthalmoscopy and disk topography.

Findings:

  • Normal cup glaucoma is a clinically significant entity, though largely unrecognized in ophthalmic literature.
  • Disk drusen were present in at least half of the normal cup glaucoma cases.

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  • Other cases were associated with high myopia and/or documented IOP spikes.

    • Implications:

    • This research underscores the need to reconsider diagnostic criteria for glaucoma, particularly in cases with normal IOP and small optic cups.
    • Further investigation into the pathophysiology and diagnostic markers for normal cup glaucoma is warranted.
    • Clinicians should be aware of this entity to ensure timely diagnosis and management, potentially improving patient outcomes.