Optic nerve cupping

A 65-year-old male complains of losing his vision Retinal examination reveals optic nerve cupping. Peripheral vision loss is observed on visual field tests, and his intraocular pressure is increased. Following treatment with a drug, he has improved visual acuity and decreased intraocular pressure. 

Optic nerve head (optic disc) cupping. 

With the cornea removed, work the retina away from the eye cup by sqeezing gently on the scleral surface near the optic nerve and teasing the retina out with a fine haired brush. It is best to do this step with the eyecup sitting a small pool of PBS. This minimizes any tearing of the retina and makes handling easier. 

Vertical cupping of the optic nerve head Pattern standard deviation on visual fields Thin central corneal thickness < 555 mcm... 

Primary open-angle glaucoma (POAG) is a multifactorial chronic optic neuropathy with a characteristic acquired loss of optic nerve fibers. Cupping and atrophy of the optic disc occur in the absence of other known causes. Such damage develops in the presence of open anterior chamber angles. It produces characteristic visual field abnormalities. lOP is too high for the continued health of the eye. 

Several disorders may mimic glaucomatous ONH and/or visual field changes. Those that resemble structural glaucomatous optic neuropathy or interfere wdth assessment of glaucomatous cupping include optic disc anomalies, tilted discs, optic nerve drusen, optic nerve pits, optic nerve colobomas, myelinated nerve fibers, ischemic optic neuropathy and optic atrophy. 

Folate deficiency has been shown to be responsible for birth defects in rats. Armstrong and Monie (A4) have shown that malformations of the eyes occurred in folate-deficient fetuses and these included anophthalmia or microphthalmia, reduction or absence of the optic nerve fibers, duplication of the optic cup, and a number of other defects. However, in the rat these defects were associated with a deficiency of maternal folate during pregnancy particularly between the seventh and ninth days. 

Confocal scanning laser ophthalmoscopy can evaluate the optic disc and peripapillary retina in 3 dimensions and provide quantitative information about the cup, neuroretinal rim, and contour of the nerve fiber layer. 

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