Ophthalmoscopy in the detection of optic disc and retinal nerve fiber layer changes in early glaucoma (summary)

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  • Ophthalmoscopy in the detection of optic disc and retinal nerve fiber layer changes in early glaucoma

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It is clear that in advanced glaucoma we can easily detect changes in the ocular fundus characteristic of this disease by indirect ophthalmoscopy. The optic disc shows middle cup expansion and a corresponding retinal nerve fiber layer (RNFL) defect in the arcuate area. Paracentral scotomata and the nasal step stage that can be detected with the Goldmann perimeter are generally accepted as signs of early overt glaucoma. Quigley’ has reported, however, that at this stage about 50% of retinal ganglion axons are lost. In the earlier stages of glaucoma, optic disc changes indicative of the disease are more difftcult to detect. In our institute, two trained ophthalmologists attempted to identify fundus abnormalities in 30 glaucomatous eyes with early scotomata using indirect ophthalmoscopy. Their rates of success were 13% and 16%, respectively. Using stereophotography, however, they identified abnormalities in 90% and 93% of these eyes, respectively. Therefore, stereophotography is the recommended method for detection of glaucoma in its earliest stage.

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