Surgeons must evaluate nerve fiber layer for accurate glaucoma picture

PHILADELPHIA — Evaluating the nerve fiber layer can provide important early clues about the progression of glaucoma, according to a surgeon speaking here.

"Glaucoma is a disease of the retinal nerve fiber layer so we have to evaluate the nerve fiber layer," said Neil Choplin, MD, who estimated that fiber loss of up to 50% can occur before any visual field defect is detected.

"Some of the signs that we see in the disc are really presumptive," he said at a meeting celebrating the 40th anniversary of the Wills Eye Hospital glaucoma fellowship program. "An isolated look at the disc may not help you make a diagnosis."

He said examining rim deterioration can be a better indicator of disease progression than cup-to-disc ratios or intraocular pressure.

Dr. Choplin also presented an overview of techniques for evaluating the nerve fiber layer, including red-free ophthalmoscopy and photography, retinal thickness analysis, optical coherence tomography, confocal scanning laser ophthalmoscopy and scanning laser polarimetry.