Abstract
To evaluate the effects of the presence of glaucomatous visual field defects and of intraocular pressure elevations on optic nerve head topography, we analyzed 148 left optic nerve heads of 148 patients using laser scanning tomography. The optic discs are classified according to computerized static perimetry and documented IOP readings: 101 discs show normal visual fields (36 normal discs, 22 ocular hypertensives, 28 normotensive glaucoma suspects and 15 ocular hypertensive glaucoma suspects), 47 discs (34 high-pressure glaucoma discs, 13 normal-tension glaucoma discs) demonstrate glaucomatous visual field damage. A two-way analysis of variance discloses significant differences (P<0.01) between the groups of optic discs classified according to perimetry for most topometric parameters evaluated exept for disc area. Classification according to documented IOP (cut off at 21 mmHg) results in larger disc areas in normotensive discs compared to hypertensive optic nerve heads in the study population. Results suggest that large discs may be susceptible to glaucomatous visual field damage at statistically normal IOP readings.
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Abedin S, Simmons RJ, Grant M (1982) Progressive low-tension glaucoma. Treatment to stop glaucomatous cupping and field loss when these progress despite normal intraocular pressure. Ophthalmology 89:1–6
American Academy of Ophthalmology Quality of Care Committee. Glaucoma Panel (1989) Primary open-angle glaucoma. Preferred Pract Patt pp 1–31
Anderson DR (1987) Relationship of peripapillary haloes and crescents to glaucomatous cupping. In: Krieglstein GK (ed) III. Glaucoma update. Springer, Berlin Heidelberg New York, pp 103–105
Armaly MF (1970) Optic cup in normal and glaucomatous eyes. Invest Ophthalmol Vis Sci 9:425–429
Bengtsson B (1976) The variation and covariation of cup and disc diameters. Acta Ophthalmol 54:804–818
Burk ROW (1992) Die dreidimensionale topographische Analyse der Papille als Bestandteil der Glaukomdiagnostik. Ophthalmologe 89:190–203
Caprioli J (1990) Automated perimetry in glaucoma. Am J Ophthalmol 111:235–239
Caprioli J, Spaeth GL (1985) Comparison of the optic nerve head in high- and low-tension glaucoma. Arch Ophthalmol 103:1145–1149
Carassa RG, Schwartz B, Takamoto T (1991) Increased preferential optic disc asymmetry in ocular hypertensive patients compared with control subjects. Ophthalmology 98:681–691
Chi T, Ritch R, Stickler D, Pitman B, Tsai C, Hsieh FY (1989) Racial differences in optic nerve head parameter. Arch Ophthalmol 107:836–839
Davanger M (1989) Low-pressure glaucoma and the concept of the IOP tolerance distribution curve. Acta Ophthalmol 67:256–260
Drance SM (1972) Some factors in the production of low tension glaucoma. Br J Ophthalmol 56:229–242
Drance SM (1985) Low-tension glaucoma. Enigma and opportunity. Arch Ophthalmol 103:1131–1133
Dreher AW, Tso PC, Weinreb RN (1991) Reproducibility of topographic measurements of the normal and glaucomatous optic nerve head with the laser tomographic scanner. Am J Ophthalmol 111:221–229
Elschnig A (1924) Glaukom ohne Hochdruck und Hochdruck ohne Glaukom. Z Augenheilkd 52:287–296
Fazio P, Krupin T, Feitl ME, Werner EB, Carré DA (1990) Optic disc topography with low-tension and primary open angle glaucoma. Arch Ophthalmol 108:705–708
Flammer J (1987) Theoretische Grundlagen der automatischen Perimetrie. In: Gloor B (ed) Automatische Perimetrie. Enke, Stuttgart, pp 1–31
Friedenwald JS (1949) Primary glaucoma. I. Terminology, pathology and physiological mechanisms. Trans Am Acad Ophthalmol Otolaryngol 53:169–174
Gafner F, Goldmann H (1955) Experimentelle Untersuchungen über den Zusammenhang von Augeninnendrucksteigerung und Gesichtsfeldschddigung. Ophthalmologica 130:357–377
Gloor B (1987) Automatische Perimetrie beim Glaukom. In: Gloor B (Hrsg) Automatische Perimetrie. Enke, Stuttgart, pp 87–135
Gloor BP, Robert Y (1989) Evaluation der Glaukome. Häufig verkannte Glaukomsituationen. Klin Monatsbl Augenheilkd 194:376–382
Graefe A von (1854) Vorläufige Notiz über das Wesen des Glaucoma. Arch Ophthalmol 1:371–382
Graefe A von (1862) III. Über die glaucomatöse Natur der “Amaurosen mit Sehnervenexcavation” und über das Wesen und die Classification des Glaucoms. Arch Ophthalmol 8.2:271–297
Gramer E, Althaus G (1990) Bedeutung des erhöhten intraokularen Drucks für den glaukomatösen Gesichtsfeldschaden. Klin Monatsbi Augenheilkd 197:218–224
Gramer E, Leydhecker W (1985) Glaukom ohne Hochdruck. Eine klinische Studie. Klin Monatsbi Augenheilkd 186:262–267
Gramer E, Althuas G, Leydhecker W (1986) Lage und Tiefe glaukomatöser Gesichtsfeldausfälle in Abhängigkeit von der Fläche der neuroretinalen Randzone bei Glaukom ohne Hochdruck, Glaucoma simplex, Pigmentglaukom. Eine klinische Studie mit dem Octopus-Perimeter 201 und dem Optic Nerve Head Analyzer. Klin Monatsbi Augenheilkd 189:190–198
Greve EL, Geijssen C (1983) Comparison of glaucomatous visual field defects in patients with high and low intraocular pressures. In: Greve EI, Heijl A (eds) Fifth international visual field symposium, Junk, The Hague, pp 101–105
Haffmans JHA (1862) Beiträge zur Kenntnis des Glaukoms. III. Resultate. Aus dem Holländischen deutsch bearbeitet von M Schmidt. Arch Ophthalmol 8.2:143–178
Hayreh SS (1969) Blood supply of the optic nerve head and its role in optic atrophy, glaucoma, and oedema of the optic disc. Br J Ophthalmol 53:721–748
Heijl A, Lindgren G (1989) Test-retest variability in glaucomatous visual fields. Am J Ophthalmol 108:130–135
Heilmann K (1974) On the reversibility of visual field defects in glaucomms. Trans Am Acad Ophthalmol Otolaryngol 78:304–308
Hernandez MR, Luo XX, Andrzejewska W, Neufeld AH (1989) Age-related changes in the extracellular matrix of the human optic nerve head. Am J Ophthalmol 107:476–484
Ido T, Tomita G, Kitazawa Y (1991) Diurnal variation of intraocular pressure of normal-tension glaucoma. Influence of sleep and arousal. Ophthalmology 98:296–300
Jonas J, Airaksinen PJ, Robert Y (1988) Definitionsentwurf der intra- und parapapillären Parameter für die Biomorphometrie des Nervus Opticus. Klin Monatsbl Augenheilkd 192:621
Jonas JB, Zäch FM, Gusek GC, Guggenmoos-Holzmann I, Naumann GOH (1989) Pseudoglaucomatous physiologic large cups. Am J Ophthalmol 107:137–144
Jonas JB, Fernandez M, Naumann GOH (1991) Correlation of the optic disc size to glaucoma susceptibility. Ophthalmology 98:675–680
Krieglstein KG (1990) Differentialdiagnose des Niederdruckglaukoms Z Prakt Augenheilkd 11:197–207
Krieglstein KG, Waller WK, Leydhecker W (1987) The vascular basis of the positional influence on the intraocular pressure. Graefe's Arch Clin Exp Ophthalmol 206:99–106
Levene RZ (1980) Low-tension glaucoma. Surv Ophthalmol 24:621–663
Leydhecker W (1973) Glaukom. Ein Handbuch, 2nd edn Springer, Berlin Heidelberg New York
Lewis RA, Hayreh SS, Phelbs CD (1983) Optic disk and visual field correlations in primary open-angle and low-tension glaucoma. Am J Ophthalmol 96:148–152
Perkins ES (1973) The Bedford glaucoma survey. I. Long-term follow-up of borderline cases. Br J Ophthalmol 57:179–185
Quigley HA, Addicks EM (1982) Quantitative studies of retinal nerve fiber layer defects. Arch Ophthalmol 100: 807–814
Quigley HA, Dunkelberger GR, Green WR (1989) Retinal ganglion cell atrophy correlated with automated perimetry in human eyes with glaucoma. Am J Ophthalmol 107:453–464
Quigley HA, Dorman-Pease ME, Dunkelberger GR, Brown A (1990) Changes in collagen and elastin in the optic nerve head in chronic human and experimental monkey glaucoma. Invest Ophthalmol Vis Sci 31:564
Read RM, Spaeth GL (1974) The practical clinical appraisal of the optic disc in glaucoma: the natural history of cup progression and some specific disk-field correlations. Trans Am Acad Ophthalmol Otolaryngol 78:255–274
Schulzer M, Drance SM, Carter J, Douglas GR (1990) Biostatistical evidence for two distinct chronic open angle glaucoma populations. Br J Ophthalmol 74:196–200
Schwartz B (1973) Cupping and pallor of the optic disc. Arch Ophthalmol 89:272–277
Schwartz B, Tomita G, Takamoto T (1991) Glaucoma-like discs ] with subsequent increased ocular pressures. Ophthalmology 98:41–49
Shiose Y (1990) Intraocular pressure: new perspectives. Surv Ophthalmol 34:413–435
Sonnsjb B, Bengtsson B, Krakau CET (1989) Observation concerning the course of glaucoma. Arch Ophthalmol 67:261–264
Tomlinson A, Phillips CI (1969) Ratio of optic cup to optic disc in relation to axial length of eyeball and refraction. Br J Ophthalmol 53:765–768
Trew DR, Smith SE (1991) Postural studies in pulsatile ocular blood flow: I. Ocular hypertension and normotension. Br J Ophthalmol 75:66–70
Tuulonen A, Airaksinen PJ (1991) Initial glaucomatous optic disc and retinal nerve fiber layer abnormalities and their progression. Am J Ophthalmol 111:485–490
Yablonski ME, Zimmerman TJ, Kass MA, Becker B (1980) Prognostic significance of optic disc cupping in ocular hypertensive patients. Am J Ophthalmol 89:585–592
Zeimer RC, Ogura Y (1989) The relation between glaucomatous damage and optic nerve head mechanical compliance. Arch Ophthalmol 107:1232–1234
Zeimer RC, Wilensky JT, Gieser DK (1990) Presence and rapid decline of early morning intraocular pressure peaks in glaucoma patients. Ophthalmology 97:547–550
Zeimer RC, Deepak PE, Ogura Y (1990) The possible viscoelastic etiology of glaucoma damage. Invest Ophthalmol Vis Sci 31:565
Zinser G, Harbarth U, Schröder H (1990) Formation and analysis of three-dimensional data with the laser tomography scanner LTS. In: Nasemann JE, Burk ROW (eds) Laser scanning ophthalmoscopy and tomography. Quintessenz, München, pp 243–252
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This study was supported in part by a grant from the Deutsche Forschungsgemeinschaft DFG Vo 437/1-1
Correspondence to: R.O.W. Burk
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Burk, R.O.W., Rohrschneidern, K., Noack, H. et al. Are large optic nerve heads susceptible to glaucomatous damage at normal intraocular pressure?. Graefe's Arch Clin Exp Ophthalmol 230, 552–560 (1992). https://doi.org/10.1007/BF00181778
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DOI: https://doi.org/10.1007/BF00181778