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Detection of optic nerve variation is essential part of glaucoma evaluation
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KOLOA, Hawaii — A careful evaluation of the optic nerve is "indispensable" to early detection of glaucoma, according to an expert.
Jody R. Piltz-Seymour, MD, described the various factors glaucoma specialists should consider in their evaluation of the optic nerve. She explained why she feels this is critical here at Hawaiian Eye 2007.
"You can have glaucoma diagnosed and followed well before visual field loss is detected, so a careful evaluation of the optic nerve is indispensable," said Dr. Piltz-Seymour, who was named Speaker of the Day yesterday. "Imaging has revolutionized following the progression of glaucoma and helping in its diagnosis, but nothing replaces looking carefully at the optic nerve," she said.
When it comes to looking for optic nerve irregularities, Dr. Piltz-Seymour said, "the more you look, the more you'll see."
She advised attendees to use stereopsis and magnification when possible; to look for contour changes in both color and shape; and compare the eye to a normal optic nerve as well as to the contralateral eye.
Use the acronym SHIP to remember the four elements to evaluate, she said. These include size, hemorrhage, the "ISN'T" rule and peripapillary atrophy.
The ISN'T rule refers to the inferior, superior, nasal and temporal thickness of the neural retinal rim, Dr. Piltz-Seymour said. She also stressed that size is important when it comes to optic nerve evaluation.
"You need to have an appreciation of the size of the optic nerve to appreciate whether the cup/disc ratio you are looking at is significant," she said.
Dr. Piltz-Seymour said she advocates the inclusion of a baseline photo of the optic nerve in the patient's chart so she can easily see what changes have occurred.