Aging changes of the optic nerve head in relation to open angle glaucoma

Abstract

Aims-To determine the age related changes in optic nerve head structure in a group of normal subjects and assess the significance of any changes in relation to those found in open angle glaucoma. Methods-A group of 88 white volunteers and friends and spouses of patients with a normal visual field and normal intraocular pressure was studied. Two diVerent imaging and measurement devices were used (computer assisted planimetry and scanning laser ophthalmoscopy), and the results from each were compared. Measurements were made of the optic disc, optic cup, and neuroretinal rim areas, and the vertical optic disc diameter and cup/disc diameter ratio. Results-Neuroretinal rim area declined at the rate of between 0.28% and 0.39% per year. Vertical optic cup diameter and optic cup area increased with age. The mean cup/disc diameter ratio increased by about 0.1 between the ages of 30 and 70 years. Conclusions-Age related changes are significant and measurable, and should be taken into account when assessing the glaucoma suspect, and when estimating the rate of progression of glaucomatous optic neuropathy in patients with established disease. (Br J Ophthalmol 1997;81:840-845) Open angle glaucoma (OAG) is a progressive, irreversible, optic neuropathy, for which the major risk factors are raised intraocular pressure and older age. Visual field loss is associated with the increase in optic cup size and other structural changes that occur at the optic nerve head. It is a common condition, the incidence of which increases with age. Prevalence varies with ethnic origin and estimates have been calculated in a recent review of the literature.

The influence of age, gender, refractive error, and optic disc size on the optic disc configuration in Japanese normal eyes

“…Several papers have reported no correlation between age and the optic disc (Britton et al 1987;Carpel & Engstrom 1981;Funk et al 1989;Gundersen et al 1998;Jonas et al 1988;Varma et al 1994). On the other hand, some papers have reported such a correlation (Garway-Heath et al 1997;Healey et al 1997;Tsai et al 1992).…”

“…(Balazsi et al 1984;Mikelberg et al 1991;Repka & Quigley 1989). Indeed, several reports have revealed age-related changes in the optic disc configuration (Carpel & Engstrom 1981;Garway-Heath et al 1997;Healey et al 1997;Tsai et al 1992), while other reports have demonstrated no age-related changes (Britton et al 1987;Funk et al 1989;Gundersen et al 1998;Jonas et al 1988;Varma et al 1994). There are few reports, however, regarding factors influencing the normal optic disc among Asian people.…”

Differentiation by imaging of superior segmental optic hypoplasia and normal-tension glaucoma with inferior visual field defects only

“…The correlation between age and HRT parameters remains controversial [20][21][22], with some researchers reporting age-related optic nerve head changes in cross-sectional and longitudinal studies [20,21] and others finding no correlation between age and HRT parameters in a cross-sectional study [22]. Second, only a small number of SSOH and NTG subjects were enrolled in our study.…”

The Optic Nerve in Glaucoma

“…[10][11][12] Also, although assessment of visual function is critically important for all patients with glaucoma, there is evidence to suggest that many patients may show evidence of progressive optic disc damage before functional loss is detected by SAP. Both the Ocular Hypertension Treatment Study 13 and the European Glaucoma Prevention Study 14 demonstrated that a substantial proportion of patients with ocular hypertension who developed glaucoma showed a change first in optic disc photographs. However, despite being included as end points for glaucoma conversion in these studies, progressive optic disc damage has not yet been demonstrated to translate into worse clinically relevant outcomes for these patients.…”

“…[10][11][12][13][14][15] Because PPA is present in 15%-20% of normal eyes, its presence is less specific for glaucoma than DH, which occurs only in 0.6% of healthy eyes. 14,16 Given that DH is transient, lasting weeks to months, and that PPA is stable and progressive, it maybe advantageous to rely on PPA parameters for glaucoma diagnosis and monitoring. 11,15 PPA and PPA have been evaluated in glaucoma using quantitative analysis of optic nerve photographs (morphometry) typically by manually outlining and measuring the area of PPA using a slide projector, imaging processing software, or with confocal scanning laser ophthalmoscopy.…”