VARIOUS GLAUCOMATOUS OPTIC-NERVE APPEARANCES - CLINICAL CORRELATIONS

Purpose: To study the prevalence of risk factors for glaucoma as well as the pattern of visual field defects and their progression in patien ts with open angle glaucoma with different and distinct optic nerve ap pearances. Methods: One thousand seven hundred eleven optic disc stere o photographs of patients with glaucoma and ocular hypertension and of those suspected of having glaucoma were reviewed to identify pure exa mples of discs with four different optic disc appearances: focal ische mic discs, myopic glaucomatous discs, senile sclerotic discs, and gene ralized enlargement of the optic cup discs, The clinical charts of the selected patients were reviewed, with emphasis on the presence of pre determined ocular and systemic risk factors, Their automated visual fi elds also were analyzed, Results: Thirty-four patients with focal isch emic discs, 38 with myopic glaucomatous discs, 22 with senile scleroti c discs, and 23 with generalized enlargement of the optic cup discs we re selected. Patients with myopic glaucoma and generalized enlargement of the optic cup discs were significantly younger than patients with focal ischemic and senile sclerotic discs. There were more women in th e focal ischemic group, Patients with senile sclerotic discs had a sig nificantly higher prevalence of ischemic heart disease; they also had a higher prevalence of systemic hypertension, which did not reach stat istical significance, Migraine was 2.5 times more frequent in the foca l ischemic group than in the other groups. Intraocular pressure was si gnificantly higher in the generalized enlargement group. The pattern o f visual field defect in the four groups also was distinctly different . Conclusions: Patients with different disc appearances, selected only from their disc photographs, showed differences in their demographic characteristics, prevalence of certain systemic risk factors, intraocu lar pressure levels, and the pattern of their visual field damage, The se findings suggest that these various disc appearances probably repre sent different populations of patients with glaucoma with, possibly, d ifferent pathogenic mechanisms.