Glaucoma without cupping.
BACKGROUND
Although glaucoma can exist with normal intraocular pressures (IOPs), clinicians still rely on the presence of a large cup to "flag" suspects, regardless of IOP, whereas a small cup at the same pressure level is often ignored. High-tech instruments offer a new dimension of evaluation in the objective assessment of structure when subjective tests of function and/or ophthalmoscopic observations are equivocal.


METHODS
Thirteen cases are presented and show evidence of glaucoma based on glaucomatous visual-field defects, often with steadily rising intraocular pressures and retinal nerve fiber layer loss. Surprisingly, these patients maintained small C/D ratios. Accordingly, ophthalmoscopy and/or disk topography classified these disks as normal.


CONCLUSIONS
Although unrecognized in virtually the entire world's ophthalmic literature, normal cup glaucoma is a real clinical entity. At least half the normal cup glaucoma cases presented herein have disk drusen (obvious, subtle, or occult), while others are highly myopic and/or have documented IOP spikes. Several of the cases defy classification and explanation at the present time.
Sherman
Jerome
J
State University of New York, State College of Optometry, New York, New York 10036, USA. jsherman@sunyopt.edu
Bass
Sherry J
SJ
Slotnick
Samantha
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005654:Fundus Oculi; D005901:Glaucoma / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D012189:Retrospective Studies; D058609:Visual Field Tests; D014794:Visual Fields