Change in appearance of the optic disc associated with lowering of intraocular pressure

This report provides additional documentation that the appearance of the optic disc may improve after intraocular pressure is lowered in patients with glaucoma. Photographic records of one of the authors (GLS) were reviewed retrospectively. Seven previously unreported cases showing apparent improvement of the optic disc were found, and the patients' charts were reviewed. In two cases the improvement was transient, and in five it was lasting. Patients with evidence of disc improvement had an age range of 5 to 55 years. In one case, the scleral ring decreased in size following the lowering of intraocular pressure. In the other cases, the disc appeared to "fill in" without change in the size of the scleral ring. When improvement is short-lived, it presumably represents edema. When of longer duration, it may be a response to anterior repositioning of a posteriorly displaced lamina cribrosa, a decrease in diameter of the scleral ring, hypertrophy and/or proliferation of glial cells, or return towards normal of axonal metabolism. Because apparent improvement in the appearance of the optic disc can be subtle, it is usually not sought and is probably often unrecognized. Its true incidence is still unknown but appears to be underestimated.