title: Optic nerve cupping and the neuro-ophthalmologist.
abstract: BACKGROUND
  While glaucoma is the most common cause of optic disc cupping, it can also be seen in a number of congenital and acquired optic neuropathies. It behooves both glaucoma and neuro-ophthalmic specialists to be able to differentiate glaucoma from neurological conditions, which give a similar ophthalmoscopic appearance to the optic disc.
  
  
  METHODS
  This review is a combination of the authors' clinical experience from tertiary glaucoma and neuro-ophthalmology referral centers, combined with a literature review using PubMed.
  
  
  RESULTS
  Even for experienced observers, differentiation between glaucomatous and nonglaucomatous cupping can be difficult. In the majority of cases, this distinction can be made following a careful clinical examination combined with a variety of imaging techniques. Possible mechanisms, which lead to changes in optic disc morphology, are reviewed.
  
  
  CONCLUSIONS
  Differentiating glaucomatous from nonglaucomatous optic disc cupping can be a formidable challenge for the clinician. Examination of the patient combined with imaging of the retinal nerve fiber layer and optic disc topography provides a basis to resolve this clinical conundrum.
authors.affiliation: Save Sight Institute (CLF, AJRW), University of Sydney, Sydney, Australia; Westmead Millennium Institute (AJRW), University of Sydney, Sydney, Australia; Moorfields Eye Hospital (GTP), London, United Kingdom; and Cambridge University Teaching Hospitals NHS Foundation Trust (KRM), Cambridge, United Kingdom.
authors.forename: Clare L
authors.initials: CL
authors.lastname: Fraser
authors.forename: Andrew J R
authors.initials: AJ
authors.lastname: White
authors.forename: Gordon T
authors.initials: GT
authors.lastname: Plant
authors.forename: Keith R
authors.initials: KR
authors.lastname: Martin
mesh_terms: D003937:Diagnosis, Differential; D005901:Glaucoma / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D009462:Neurology; D009885:Ophthalmology; D009898:Optic Disk / Q000473:pathology; D020221:Optic Nerve Injuries / Q000150:complications*