The normal cup-disk ratio

We determined the cup-disk ratios of 580 individuals, ranging in age from 4 to 91 years, with a Hruby lens; we also determined the cup-disk ratios of 289 of the 580 with a direct ophthalmoscope. All had applanation pressures of 18 mm Hg or less. There was no linear relationship (covariation) between cup-disk ratio and refractive error or intraocular pressure, but there was a tendency toward increasing cup-disk ratio with increasing age. The mean cup-disk ratio in the group examined with the Hruby lens was 0.38 and that in the group examined with the direct ophthalmoscope was 0.25. With either method almost all eyes had cup-disk ratios of 0.7 or less. In 9% of the eyes the cup was ovoid. In only 10% of these cases was the vertical cup-disk ratio greater than the horizontal cup-disk ratio, and in only one case was this difference 0.2 or more. The Hruby lens method consistently gave a slightly larger cup-disk ratio than the direct ophthalmoscope did. However, there was seldom a disparity of more than 0.2. The Hruby lens or biomicroscopic lens should be used to determine the fullest extent of the contour of the cup. Any cup-disk ratio of 0.7 or more, any vertical cup-disk ratio larger than the horizontal cup-disk ratio, and any disparity between the direct ophthalmoscope estimation and Hruby lens estimation of more than 0.2 should be viewed with suspicion.