✍ high IOP ( the only modifiable risk factor and diagnosis of glaucoma can be made without ) never forget this point
✍ Abnormal disc
✍ consistent VF defect consistent with RNFL defect
✍ >21 mmhg
✍ C/D ratio asymmetry > 0.2
✍ Large vertical C/D ratio for disc size > 0.5
✍ NRR notch or thinning (ISNT rule)
✍ Disc haemorrhage
✍ Vessel bayoneting and nasally displaced
✍ PPA (B-zone)
✍ Nasal step
✍ Paracentral scotoma
✍ Arcuate scotoma
✍ Altitudinal scotoma
✍ residual temporal
✍ central island of vision
🛑 ‘ISNt rule’ describes
☝ the normal contour of the disc rim
☝ thickest inferiorly, thinner superiorly, then nasally, and thinnest temporally.
☝ this rule often fails to apply when the optic discs have an anomalous configuration.
✍ Never forget 🚨 🚨 IOP does not need to be >21 mmhg to develop glaucomatous optic neuropathy.
✍ Anomalous optic discs are difficult to assess.
✍ raised IOP + normal disc + normal VF consider OHT
✍ raised IOP + suspicious disc + normal VF consider glaucoma suspect or preperimetric glaucoma
✍ raised IOP + suspicious disc + consistent VF defect consider highly suspicious and treated as glaucoma
✍ raised IOP + abnormal disc + consistent VF defect consider well established glaucoma
✍ Normal IOP+ normal disc + normal VF consider Normal
✍ normal IOP + suspicious disc + normal VF consider physiological cupping
✍ normal IOP + stable abnormal disc + stable VF defect consider congenital disc anomaly or previous disc insult
✍ normal IOP + evolving abnormal disc + evolving VF defect consider NTG