The Suspicious Nerve – Guilty Until Proven Innocent Introduction/Overview

1) Evaluation of the Optic Nerve requires descriptive quantitative and qualitative intrapapillary and parapapillary regions of the optic nerve head and the retinal nerve fiber layer (RNFL)variables including: a. Size and shape of the optic disc b. Size, shape and pallor of the neuroretinal rim c. Configuration and depth of the optic cup d. Cup-disc diameter ratio and cup-disc area ratio e. Position of the exit of the central retinal vessel trunk on the lamina cribrosa surface f. Presence and location of splinter-shaped hemorrhages g. Occurrence, size, configuration and location of parapapillary chorioretinal atrophy h. Diffuse and/or focal decrease of the diameter of the retinal arterioles i. Visibility of the retinal nerve fiber layer defects – local or diffuse 2) Unlike qualitative variables almost all quantitative variables have overlap between normal and glaucoma subjects...so qualitative variables are very important and have higher specificity in separating glaucoma eyes from normal eyes. 3) Despite technological advances, clinical identification of the optic nerve head characteristics remains the first step in diagnosis. a. Document with photographs and discograms 4) Goal: Differentiate between glaucomatous, nonglaucomatous, and normal optic nerves.