Clinical recognition of glaucomatous cupping

Ralph E. Kirsch, Douglas R. Anderson

Research output: Contribution to journalArticlepeer-review

74 Scopus citations


In an effort to define identifying ophthalmoscopic characteristics of normal and glaucomatous disks, we made a comparative study of those in glaucomatous eyes (high intraocular pressure and field loss) and in normal eyes (normal tonography, normal fields and no history of elevated intraocular pressure). We found that a magnified stereoscopic view of the disk by slit lamp fundus examination or stereoscopic fundus photography is the best means of evaluating the disk. In glaucoma, one or more of the following is present: (1) total cupping of the disk, (2) a cup that extends upward or downward to touch the margin of the disk, or (3) a cup that is vertically oval. These findings relate to a preferential destruction of nervefibres fromtheBjerrum region, which enter the optic nerve at the superior and inferior poles of the disk. In contrast, normal disks have cups that are round or horizontally oval, and even when the cup is large there is a rim of tissue along the entire disk circumference. We believe that conscious attention to the concept of a "vertically oval" cup will greatly improve our ability to reliably identify disks that have suffered glaucomatous damage.

Original languageEnglish (US)
Pages (from-to)442-454
Number of pages13
JournalAmerican journal of ophthalmology
Issue number3
StatePublished - Mar 1973

ASJC Scopus subject areas

  • Ophthalmology


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