Approach to the diagnosis and differentiation of glaucomatous and nonglaucomatous optic neuropathies

Abstract

Optic neuropathy denotes degeneration of the retinal ganglion cells with functional and structural impairment of the optic nerve. Functional damage of the optic nerve can be evaluated by checking visual acuity, color vision, pupillary function, and perimetric visual fields. Characteristic optic nerve head changes are usually evident in glaucomatous and nonglaucomatous optic neuropathies, and the loss of optic nerve fiber bundles can be confirmed and quantified with optical coherence tomography (OCT). Although an optic neuropathy can often be diagnosed with careful history taking and clinical examination, differentiating glaucomatous from nonglaucomatous optic neuropathies may not be straightforward. This chapter summarizes and highlights the important features of history taking, clinical examination, and investigation that are required to differentiate between glaucomatous and nonglaucomatous optic neuropathies. With increasing popularity of the use of spectral-domain OCT for the evaluation of glaucomatous and nonglaucomatous optic neuropathies, an update on its application to detect and monitor optic nerve degeneration is also discussed.