Journal of Neuro-Ophthalmology

Skip Navigation LinksHome > December 2013 - Volume 33 - Issue 4 > Optic Nerve Cupping and the Neuro-Ophthalmologist
Journal of Neuro-Ophthalmology:
doi: 10.1097/WON.0000000000000080
State-of-the-Art Review

Optic Nerve Cupping and the Neuro-Ophthalmologist

Fraser, Clare L. MBBS, MMed, FRANZCO; White, Andrew J. R. MBBS, PhD, FRANZCO; Plant, Gordon T. MD, FRCP, FRCOphth; Martin, Keith R. DM, MRCP, FRCOphth

Section Editor(s): Liu, Grant T. MD; Kardon, Randy H. MD, PhD

Japanese Abstract
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Background: While glaucoma is the most common cause of optic disc cupping, it can also be seen in a number of congenital and acquired optic neuropathies. It behooves both glaucoma and neuro-ophthalmic specialists to be able to differentiate glaucoma from neurological conditions, which give a similar ophthalmoscopic appearance to the optic disc.

Evidence Acquisition: This review is a combination of the authors' clinical experience from tertiary glaucoma and neuro-ophthalmology referral centers, combined with a literature review using PubMed.

Results: Even for experienced observers, differentiation between glaucomatous and nonglaucomatous cupping can be difficult. In the majority of cases, this distinction can be made following a careful clinical examination combined with a variety of imaging techniques. Possible mechanisms, which lead to changes in optic disc morphology, are reviewed.

Conclusions: Differentiating glaucomatous from nonglaucomatous optic disc cupping can be a formidable challenge for the clinician. Examination of the patient combined with imaging of the retinal nerve fiber layer and optic disc topography provides a basis to resolve this clinical conundrum.

© 2013 by North American Neuro-Ophthalmology Society


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