Clinical Guidelines prev next

Feb 08 2021

Optic Disc Cupping and Neuroimaging

posted by: Janet Swartz, EdD

During an NGS webinar, Dr. Joseph Panarelli cited a research article by David Greenfield, MD, et al., titled The Cupped Disc: Who Needs Neuroimaging?

One characteristics of normal tension glaucoma (NTG) is cupping of the optic nerve head. Disc cupping can also be a feature of nonglaucomatous disorders such as intracranial mass lesions. To differentiate between these diagnoses, neuroimaging tests are often included in the evaluation of patients with disc cupping associated with normal IOP. However, given the high cost of performing neuroimaging, the authors were interested in whether there are other data that can be used to differentiate NTG from intracranial mass lesions.

Results of a retrospective records review indicated that patients with glaucomatous cupping had significantly better visual acuity, greater average cup-to-disc ratios and vertical elongation of the optic cup, more frequent splinter hemorrhage and peripapillary atrophy, more visual field defects that bordered the horizontal midline, and more nerve fiber bundle visual field defects. In contrast, patients with nonglaucomatous cupping had significantly more visual field defects that bordered the vertical midline, pallor of the neuroretinal rim, and visual acuity less than 20/40. Because routine neuroimaging has a low sensitivity for detecting intracranial lesions, the authors recommend a more selective approach to ordering neuroimaging tests for patients. More information about the study methods and results can be found in the study abstract, which you can access from this link: The Cupped Disc