June 2015
Volume 56, Issue 7
ARVO Annual Meeting Abstract  |   June 2015
Retinal Nerve Fiber Layer Thinning on Optical Coherence Tomography in Eyes with Small Disc Sizes
Author Affiliations & Notes
  • Bryan Paul Jones
    Ophthalmology, New York University, New York, NY
  • Jonathan Kahn
    Ophthalmology, New York University, New York, NY
  • Footnotes
    Commercial Relationships Bryan Jones, None; Jonathan Kahn, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 4566. doi:
  • Views
  • Share
  • Tools
    • Alerts
      This feature is available to authenticated users only.
      Sign In or Create an Account ×
    • Get Citation

      Bryan Paul Jones, Jonathan Kahn; Retinal Nerve Fiber Layer Thinning on Optical Coherence Tomography in Eyes with Small Disc Sizes. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4566.

      Download citation file:

      © ARVO (1962-2015); The Authors (2016-present)

  • Supplements

Purpose: Cup-to-disc ratio measurement by slit lamp biomicroscopy may be insufficiently sensitive to detect glaucomatous damage in eyes with smaller disc sizes. We conducted a cross-sectional study comparing clinical assessments of cup-to-disc ratio, disc height and disc width with areas of thinning on ocular coherence tomography (OCT) of the retinal nerve fiber layer (RNFL).

Methods: We included a random sample of fourty-two eyes in twenty-five patients. One doctor carefully measured the cup-to-disc ratio, disc height and disc width of dilated eyes by slit lamp biomicroscopy before performing OCT RNFL using a Zeiss OCT. Eyes with and without glaucoma or suspicion thereof were included. Eyes were excluded if the OCT examination had a quality rating of less than 7/10. Patients were considered glaucoma suspects if cup-to-disc ratio was greater than 0.5 and/or OCT results demonstrated generalized or focal RNFL thinning. For each cup-to-disc ratio, we compared the number of patients with full RNFL to those with possible glaucomatous thinning.

Results: Of the eyes with a clinical cup-to-disc ratio of 0.4, four of seven (57%) had borderline or overt segmental RNFL thinning on OCT. Two of nine (22%) eyes with a cup-to-disc ratio of 0.5 had similar RNFL thinning on OCT. All thirteen eyes with cup-to-disc ratios of 0.3 or less had a full RNFL on OCT. Half of the 0.4-0.5 C/D eyes with thinning on OCT had disc heights of less than 1.6mm, while all of the 0.4-0.5 C/D eyes without thinning were greater than 1.6mm in disc height. Of the 0.4 to 0.5 C/D eyes, eyes with RNFL thinning on OCT had a median disc height of 1.7mm, versus 1.9mm in eyes without thinning.

Conclusions: Over one third of eyes with a cup-to-disc ratio from 0.4 to 0.5 had focal thinning on OCT RNFL, typically in the setting of a small disc. Since patients with cup-to-disc ratios of 0.5 or less are typically not flagged as glaucoma suspects, standard clinical practice may be missing a substantial number of patients deserving further glaucoma workup. If corroborated by a larger cross-sectional or prospective cohort study, small disc size should be considered in assessing glaucoma risk and could lead to earlier detection and treatment of glaucoma in patients with small discs.


This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.