Purpose: To provide an update on the role of optic nerve and peripapillary retinal nerve fiber layer imaging in glaucoma clinical practice and clinical trials. Design: Perspective. Methods: Review of recent literature and authors' clinical and laboratory studies. Results: Imaging technologies such as confocal scanning laser ophthalmoscopy, scanning laser polarimetry, and optical coherence tomography provide objective and quantitative measurements that are highly reproducible and show very good agreement with clinical estimates of optic nerve head structure and visual function. Structural assessments provided by imaging complement optic disk photography in clinical care and have the potential to identify relevant structural efficacy endpoints in glaucoma randomized clinical trials. As with other technologies, imaging may produce false identification of glaucoma and its progression; thus, clinicians should not make management decisions based solely on the results of one single test or technology. Conclusions: Although optic disk stereophotography represents the standard for documentation of glaucomatous structural damage in practice and research trials, advances in computerized imaging technology provide useful measures that assist the clinician in glaucoma diagnosis and monitoring and offer considerable opportunity for use as efficacy endpoints in clinical trials.
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