This article is more than 5 years old. Information may no longer be current.
Optic nerve examination essential
Click Here to Manage Email Alerts
SAN FRANCISCO — The essentials of optic nerve examination have five basic tenets: Systemic examination, optic disc size, neuroetinal rim, peripapillary region, disc hemorrhage and nerve fiber layer, Robert D. Fechtner, MD, said.
He called examining the optic nerve a “fundamental” of glaucoma care. Using the “ISNT rule,” for “Inferiorly, then Superiorly, Nasally, and thinnest Temporally,” which describes a typically healthy optic nerve, is a key to effective examination, he said. Clinicians should concentrate on the neuroretinal rim instead of the cup, he added.
“It’s (the cup) not what an optic nerve looks like,” he said.
Another essential of optic nerve examination is disc hemorrhage, which can precede visual field loss. He said at every examination of a glaucoma patient, he examines the optic nerve through the dilated pupil.
“There is no reason most glaucoma patients should not have their optic nerve observed at each examination,” he said. “You might find a disc hemorrhage.”
Dr. Fechtner spoke at Glaucoma Day, held here in conjunction with the American Society of Cataract and Refractive Surgery meeting.