The prevalence of cupping in end-stage arteritic and nonarteritic anteriorischemic optic neuropathy

Objectives To evaluate the prevalence of cupping in arteritic anterior isch emic optic neuropathy (AAION) and nonarteritic anterior ischemic optic neur opathy (NAION). Design: Retrospective, observational case series. Participants: Three hundred one patients. Methods: Review of clinical records and color fundus photographs. Main Outcome Measures: Photographic and clinical interpretation of optic ne rve appearance. Results: Ninety-two patients with AAION and 102 with NAION were included in the study, Disc photographs of 42 patients (48%) with AAION and 32 patient s (31 %) with NAION were available for reassessment. These were presented i n a masked fashion along with a random sample of 27 disc pairs considered t o be 'normal' and 27 disc pairs with 'established glaucoma' according to tw o examiners. Cupping was present in 92% of eyes with AAION secondary to gia nt cell arteritis and in 2% of eyes with NAION (kappa = 0.96; P < 0.001). Conclusions: The end-stage optic disc appearance in AAION secondary to gian t cell arteritis is cupping, whereas segmental or diffuse pallor without cu pping is the typical disc appearance after NAION.