The contour of the juxtapapillary nerve fiber layer in glaucoma

Reliable structural markers for early glaucomatous optic nerve damage would facilitate the diagnosis of glaucoma at an early stage, possibly before visual field loss occurs. Computerized image analyses were used to develop and analyze new structural parameters for glaucomatous optic nerve damage. Multiple measurements of relative juxtapapillary nerve fiber layer height were made in glaucoma patients (n = 112), patients suspected of having glaucoma (n = 87), and in age-matched normal control subjects (n = 53). The average relative nerve fiber layer (NFL) height differed in glaucoma patients and normal subjects by 70 microns, but differences exceeded 100 microns at the superior and inferior poles of the disc. Mean values for "glaucoma suspects" were intermediate between those for the normal subjects and glaucoma groups. The ability of summary statistics of relative NFL height measurements to discriminate between normal and glaucomatous eyes was superior to that of the standard disc parameters cup-disc ratio, disc rim area, and cup volume. Measurements of relative NFL height correlated with indices of visual field loss; the strongest correlations occurred for measurements at the superior and inferior poles. Measurements of juxtapapillary NFL height may prove useful to detect glaucomatous optic nerve damage at an early stage and to accurately recognize progressive nerve damage over time.