Optic disc changes in glaucoma.

Sir William Mackenzie (I835) was the first to describe raised intraocular pressure (IOP) in glaucoma. Following the introduction of the ophthalmoscope, the presence of glaucomatous cupping was soon recognized (Jacobson, I853; Jaeger, I854; von Graefe, 1854; Weber, i 855; and others) and was confirmed histopathologically by Miuller (1856). Mackenzie (i854) described flattened and atrophic nerves in glaucomatous eyes. Nerve fibre bundle defects were first described by Landesberg (I869) and later by Bjerrum (I889). Cavernous degeneration of the optic nerve in glaucoma was noted by Schnabel (1892). Although the association of optic disc and optic nerve changes and visual field defects with glaucoma has been well-established for over a century, much controversy has centred in the pathogenesis of these lesions in glaucoma. The syndrome described by von Graefe (1857a), in which cupping of the optic disc and field defects occur with no rise in IOP, has added to the confusion. Recent studies, briefly discussed below, have helped somewhat to clarify these problems (Hayreh, I969a,b, I970; Hayreh and Perkins, 1968, 1969; Hayreh, Revie, and Edwards, I970).