Differential Diagnosis of the Big Cup
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چکیده
Evaluation of the optic nerve head includes both observational and functional studies. Direct study of the optic disc often employs the hand held ophthalmoscope with the accessory use of a green light to allow improved visualization of the nerve fiber layer. Comprehensive analysis of the optic disc is better achieved using a stereoscopic view, which can be obtained directly through the use of various lenses at the slit lamp, by analysis of stereo disc photos, or through computerized tools such as the laser confocal ophthalmoscope. Photographic analysis of the nerve fiber layer is best performed using a wide angle, red-free study. Functional studies of the optic disc employ peripheral vision testing to carefully plot defects in the visual field. Taken together, the disc appearance in conjunction with visual field analysis, help the clinician make a definitive diagnosis or determine if other tests are required. Direct measurement of optic disc parameters can be made at the slit lamp. Absolute measurements of the disk or cup size depend on the viewing instrument and the use of mathematical formulas. Correction factors for the Goldmann lens are well documented in the literature . Interestingly, photographic measurements are approximately 1.27 times larger than those obtained with the Goldmann three mirror lens at the slit lamp . Hand held lenses such as the Volk 60D or the Volk Superfield noncontact lens require alternate equations that have been published . The neuroretinal rim size is a measurement that has been used in multiple studies of glaucomatous optic nerve damage. As compared with photographic measures, computerized tomography of the optic nerve, using the Heidelberg retinal tomograph, produce larger estimates of the neuroretinal rim size as a percentage of the optic disc . Furthermore, the discrepancy between these types of measurement increase with advanced glaucomatous insult. These studies reveal that absolute measurements are complex and longitudinal studies of individual optic nerves should be performed carefully with similar instruments. Direct comparisons between different evaluation strategies, for example photography, computerized imaging, and slit lamp biomicroscopy, may be misleading.
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تاریخ انتشار 2012