Abstract

SO.03.04

Photography of the optic disc in observation of glaucoma progression

Mardin C. Y., Lämmer R.
Department of Ophthalmology, University Erlangen-Nürnberg, Erlangen

Objective: Aim was to investigate the ability of fundus photography of the optic disc to detect glaucoma progression.
Methods: In the Erlangen Glaucoma Registry more than 1500 patients with manifest glaucoma, suspects and normals werde examined since 1991. All eyes received an annual, standardized clinical examination. Furthermore sensory tests and morphological imaging was performed. The latter was done among other methods with 15°-stereo- photography with a telezentric Zeiss-fundus-camera on slide film. For morphometric analysis all slides were digitized and planimetry was performed with a digital software by AnalySIS. Disc parameters were disc area, area of the neuroretinal rim (NRR), the cup and parapapillary atrophy in different sectors and total. These findings were correlated with various glaucoma variables like perimetric findings and the appearence of disc hemorrhages in the course of the follow-up examinations. Progression in the course of the disease was defined as loss of NRR and retinal nerve fibre layer (RNF) and an increase of cup area. Statistical analysis was calculated with SPSS 11.5 on the basis of a muti-relational Oracle-database.
Results: In a study of normals and patients with ocular hypertension it could be shown, that in a long-term follow-up setting both normal and stable OHT loose NRR area significantly. The loss of NRR in progressive OHT was multiple. Similar findings were demonstrated in eyes with manifest glaucomatous damage to the optic disc. Both OHT and glaucomas with progression showed significant less NRR area at the begin of the study than stable patients. Lower NRR area must therefore be discussed as a significant risk factor for progression. Optic discs with recurrent hemorrhages showed an increased loss of NRR and RNF if compared with those with singular hemorrhages prior to progression of the visual field emphasizing the value to detect disc hemorrhages in the course of the disease and the role as another risk factor for progression.
Conclusions: Telezentric, color disc photography with high resolution and true colors shows early glaucoma progression both by analog, qualitative and digital quantitative variables. It still presents the gold standard in the documentation of the glaucomatous disc.
Supported by grant SFB 539 (Deutsche Forschungsgemeinschaft)

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