Challenges of assessing the optic nerve in glaucoma

ABSTRACT

Optic nerve examination is the mainstay for glaucoma diagnosis and follow-up. Specific features of the optic disc and retinal nerve fiber layer (RNFL) need to be assessed in the context of the disease. Their description is qualitative and subjective and constitutes a challenge for the clinician. This review focuses glaucoma definitions and describes clinical examination protocols and their weaknesses. We also describe the imaging technologies that have been developed in an effort to achieve quantitative measurements which can be used to aid initial glaucoma diagnosis as well as follow-up, provided that their results are critically evaluated in combination with the clinical examination findings. We finally review imaging technologies’ evaluation in clinical as well as in population-based settings.

KEYWORDS:

• Optic disc
• imaging technologies
• OCT
• HRT
• objective optic disc measurements
• diagnostic algorithms

Financial and competing interests disclosure

The research has been co-financed by the European Union (European Social Fund –ESF) and Greek national funds through the Operational Program Education and Lifelong Learning of the National Strategic Reference Framework (NSRF), Research Funding Program, THALES Investigating in knowledge society through the European Social Fund. F. Topouzis has received grants/research support from Alcon Laboratories, Pfizer Inc, Novartis and Thea. F. Topouzis has received honoraria/consultant fees from Alcon, Merck & Co, Pfizer Inc, Bausch&Lomb, Novartis, Allergan and Humphrey Zeiss and has received honoraria/ speaker fees from Alcon. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.