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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

doi: 10.1097/WON.0000000000000080
State-of-the-Art Review
Japanese Abstract

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.

Save Sight Institute (CLF, AJRW), University of Sydney, Sydney, Australia; Westmead Millennium Institute (AJRW), University of Sydney, Sydney, Australia; Moorfields Eye Hospital (GTP), London, United Kingdom; and Cambridge University Teaching Hospitals NHS Foundation Trust (KRM), Cambridge, United Kingdom.

Address correspondence to Clare L. Fraser, MBBS, MMed, FRANZCO, Save Sight Institute, 8 Macquarie Street, Sydney, NSW 2010, Australia; E-mail:

© 2013 by North American Neuro-Ophthalmology Society