Challenges of assessing the optic nerve in glaucoma

ABSTRACTOptic nerve examination is the mainstay for glaucoma diagnosis and follow-up. Specific features of the optic disc and retinal nerve fiber layer (RNFL) need to be assessed in the context of the disease. Their description is qualitative and subjective and constitutes a challenge for the clinician. This review focuses glaucoma definitions and describes clinical examination protocols and their weaknesses. We also describe the imaging technologies that have been developed in an effort to achieve quantitative measurements which can be used to aid initial glaucoma diagnosis as well as follow-up, provided that their results are critically evaluated in combination with the clinical examination findings. We finally review imaging technologies’ evaluation in clinical as well as in population-based settings.