✍high IOP ( the only modifiable risk factor and diagnosis of glaucoma can be made without ) never forget this point
✍consistent VF defect consistent with RNFL defect
✍C/D ratio asymmetry > 0.2
✍Large vertical C/D ratio for disc size > 0.5
✍NRR notch or thinning (ISNT rule)
✍Vessel bayoneting and nasally displaced
✍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