Features of Optic Disc Progression in Patients With Ocular Hypertension and Early Glaucoma

Purpose: To determine the clinical features of optic disc progression in patients with ocular hypertension and early glaucoma.Patients: A total of 336 eyes of 168 patients with ocular hypertension or early glaucoma.Methods: Two glaucoma specialists independently graded the baseline and most recent optic disc photographs for optic disc progression. Optic disc progression was defined as: new or increased neuroretinal rim thinning (2 or more clock hours), notching (1 clock hour or less of thinning of the neuroretinal rim), excavation (undermining of the neuroretinal rim or disc margin), and nerve fiber layer defect(s). They also determined the location of these changes.Results: Ninety-two of 336 eyes (27.4%) showed optic disc progression after a median of 6.1 years. Of those with progression, excavation occurred in 89% of eyes; rim thinning occurring in 54%; and notching occurring in 16%. Fifty-six percent (56%) had 2 or more features of progression. The inferotemporal quadrant was the most common location for progression, but more than 1 location of progression occurred in at least 30% of eyes with progression.Conclusions: Optic disc progression occurred frequently in this cohort of ocular hypertension and early glaucoma patients. When evaluating the optic disc for glaucomatous progression, eye care providers should pay particular attention to increased excavation and neuroretinal rim thinningespecially in the inferotemporal quadrant.