Optic Nerve in Glaucoma (Manado 2011)

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MaharaniOphthalmology Department

Medical Faculty, Diponegoro University

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GLAUCOMA

Intaocularpressure

Optic

disc

Visual

Field

Introduction

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Optic Disc

Most of clinically detectable

changes Susceptible Early sign

%O&MAL''GLAUCOMA ''

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Direct Ophthalmoscope

Oldest Most (idely used a)out $*+

magnication

porta)le, simply to usescreening large num)ers

a)ility

relative smallpupil

lac- o.stereopsis

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Indirect Ophthalmoscope

not recommended

+ magnication inade/uate detecting small detail

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0lit1lamp 2echni/uescom)ined (ith variety o. lens

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3igh po(er concave contact lens3ru)y lens

1** D mounted to slit1lamp very small eld o. vie( good /uality stereopsis di4cult to o)tain

0lit1lamp 2echni/uescom)ined (ith variety o. lens

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3igh po(er conve+ lens!#D, 56D and 7#D lens

e+cellent stereopsis !#D $+ magnication 56D $8$+ magnication 7#D $8+ (ider eld o. vie(

smaller pupil

Slit-lamp Techniquescombined with variety of lens

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Fundus Dra(ing

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Fundus 9hotography

permanent record allo(s .or detailed e+pense o. the .undus camera s-illed and e+periencedtechnician

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3&2

OT

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%ormal Optic Disc

0i:e and 0hape o. 2he Disc vertical diameter ;

hori:ontal A.rican ; Asian ;

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%ormal Optic Disc

0i:e and 0hape o. 2he Cup near the center o. the disc shape = round to hori:ontally

oval hori:ontal diameter = # > "8$mm

Cup1Disc &atio correlate to disc si:e "? normal disc CD& #,5

%ormal Optic Disc

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%euroretinal &im disc margin 11 edge o. cup I0%2 rule

%ormal Optic Disc

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Glaucomatous OpticDisc

0cleral &ing

%eural &im &etinal nerve )erlayer

Disc haemorage

9eripapillary atrophy

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0cleral &ing

optic disc si:e nodi@erence

LA&G< DI0C 0MALL DI0C

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%eural &im

9&I%0I9AL 9A23OLOGIC Loss o. neural rim

donut rather than theholeB

Di@use and locali:ed

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%eural &im

locali:ed loss o. %& I0%2 rule )rea-

65? glaucoma

%O2C3I%G

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%eural &im

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Cup Asimetry

- CDR- CDR simetris padasimetris pada99.5%99.5% populasipopulasi

-- AsimetryAsimetry > 0.1> 0.1 < 7% of population< 7% of population

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&etinal %erve Fi)er Layer

%O&MAL

right1Dar-1right 9attern

Important compare)et(een " eyes

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&etinal %erve Fi)er Layer

Slitlikeor Groovelike1arcuate nerve )er

)undle1not a sign o.a)normality1li-ely to )e a)normal

1optic disc visualeld%O&MAL

1 Close .ollo(1up

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&etinal %erve Fi)er Layer

Wedge-shaped defects1easiest to detect1sup in. arcuate

1%2G

locali:ed &%FLde.ect

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&etinal %erve Fi)er Layer

Diuse or generalized RNFLloss1most common

1most di4cult to detect1more common in high IO9

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Disc 3emorrhages

splinter Eameshaped chronic ischaemic O%3 " > "? glaucomacases %2G ; OAG ; O32in.erotemporal

transient, may recurIOA Meeting !th Manado "#$$

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associated notching! "#$% defect indication of early progressiveglaucomatous damage eliminated &'D! systemic diss!anticoagulant

Disc 3emorrhages

%O2C3I%G

&%FL D

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9eripapillaryAtrophy

(ona )etainner crescent

adHacent to the disc visi)le sclera (ona *lpha outer crescent

more peripheralirregular

hypopigmentation andhyperpigmentation

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Vascular Changes

%asali:ationnot spesic .or

glaucoma

ayonetting&arely seen innormal

AO%

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Vascular Changes

aring vasculer

Circumlinear vessel%ot specic .orglaucoma*#? in normalpopulation

A&I%G

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GLAUCOMA'

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L< &