Skip to main content
The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 1997 Oct;81(10):840–845. doi: 10.1136/bjo.81.10.840

Aging changes of the optic nerve head in relation to open angle glaucoma

D Garway-Heath 1, G Wollstein 1, R Hitchings 1
PMCID: PMC1722014  PMID: 9486023

Abstract

AIMS—To determine the age related changes in optic nerve head structure in a group of normal subjects and assess the significance of any changes in relation to those found in open angle glaucoma.
METHODS—A group of 88 white volunteers and friends and spouses of patients with a normal visual field and normal intraocular pressure was studied. Two different imaging and measurement devices were used (computer assisted planimetry and scanning laser ophthalmoscopy), and the results from each were compared. Measurements were made of the optic disc, optic cup, and neuroretinal rim areas, and the vertical optic disc diameter and cup/disc diameter ratio.
RESULTS—Neuroretinal rim area declined at the rate of between 0.28% and 0.39% per year. Vertical optic cup diameter and optic cup area increased with age. The mean cup/disc diameter ratio increased by about 0.1 between the ages of 30 and 70 years.
CONCLUSIONS—Age related changes are significant and measurable, and should be taken into account when assessing the glaucoma suspect, and when estimating the rate of progression of glaucomatous optic neuropathy in patients with established disease.



Full Text

The Full Text of this article is available as a PDF (139.1 KB).

Figure 1  .

Figure 1  

Diagrammatic representation of important optic disc features.

Figure 2  .

Figure 2  

Age distribution of study subjects.

Figure 3  .

Figure 3  

Plot of neuroretinal rim area against optic disc area.

Figure 4  .

Figure 4  

Plot of neuroretinal rim area against age of subjects.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Advanced Glaucoma Intervention Study. 2. Visual field test scoring and reliability. Ophthalmology. 1994 Aug;101(8):1445–1455. [PubMed] [Google Scholar]
  2. Airaksinen P. J., Tuulonen A., Alanko H. I. Rate and pattern of neuroretinal rim area decrease in ocular hypertension and glaucoma. Arch Ophthalmol. 1992 Feb;110(2):206–210. doi: 10.1001/archopht.1992.01080140062028. [DOI] [PubMed] [Google Scholar]
  3. Armaly M. F., Sayegh R. E. The cup-disc ratio. The findings of tonometry and tonography in the normal eye. Arch Ophthalmol. 1969 Aug;82(2):191–196. doi: 10.1001/archopht.1969.00990020193008. [DOI] [PubMed] [Google Scholar]
  4. Balazsi A. G., Drance S. M., Schulzer M., Douglas G. R. Neuroretinal rim area in suspected glaucoma and early chronic open-angle glaucoma. Correlation with parameters of visual function. Arch Ophthalmol. 1984 Jul;102(7):1011–1014. doi: 10.1001/archopht.1984.01040030813022. [DOI] [PubMed] [Google Scholar]
  5. Balazsi A. G., Rootman J., Drance S. M., Schulzer M., Douglas G. R. The effect of age on the nerve fiber population of the human optic nerve. Am J Ophthalmol. 1984 Jun;97(6):760–766. doi: 10.1016/0002-9394(84)90509-9. [DOI] [PubMed] [Google Scholar]
  6. Beck R. W., Messner D. K., Musch D. C., Martonyi C. L., Lichter P. R. Is there a racial difference in physiologic cup size? Ophthalmology. 1985 Jul;92(7):873–876. doi: 10.1016/s0161-6420(85)33942-8. [DOI] [PubMed] [Google Scholar]
  7. Bengtsson B., Krakau C. E. Some essential optical features of the Zeiss fundus camera. Acta Ophthalmol (Copenh) 1977 Feb;55(1):123–131. doi: 10.1111/j.1755-3768.1977.tb06101.x. [DOI] [PubMed] [Google Scholar]
  8. Bengtsson B. The alteration and asymmetry of cup and disc diameters. Acta Ophthalmol (Copenh) 1980 Oct;58(5):726–732. doi: 10.1111/j.1755-3768.1980.tb06685.x. [DOI] [PubMed] [Google Scholar]
  9. Bengtsson B. The variation and covariation of cup and disc diameters. Acta Ophthalmol (Copenh) 1976 Dec;54(6):804–818. doi: 10.1111/j.1755-3768.1976.tb01801.x. [DOI] [PubMed] [Google Scholar]
  10. Betz P., Camps F., Collignon-Brach J., Lavergne G., Weekers R. Biometric study of the disc cup in open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol. 1982;218(2):70–74. doi: 10.1007/BF02153714. [DOI] [PubMed] [Google Scholar]
  11. Britton R. J., Drance S. M., Schulzer M., Douglas G. R., Mawson D. K. The area of the neuroretinal rim of the optic nerve in normal eyes. Am J Ophthalmol. 1987 Apr 15;103(4):497–504. doi: 10.1016/s0002-9394(14)74271-0. [DOI] [PubMed] [Google Scholar]
  12. COLENBRANDER M. C. Measurement of the excavation. Ophthalmologica. 1960 Jun;139:491–493. doi: 10.1159/000303746. [DOI] [PubMed] [Google Scholar]
  13. Caprioli J. Clinical evaluation of the optic nerve in glaucoma. Trans Am Ophthalmol Soc. 1994;92:589–641. [PMC free article] [PubMed] [Google Scholar]
  14. Carpel E. F., Engstrom P. F. The normal cup-disk ratio. Am J Ophthalmol. 1981 May;91(5):588–597. doi: 10.1016/0002-9394(81)90056-8. [DOI] [PubMed] [Google Scholar]
  15. Chi T., Ritch R., Stickler D., Pitman B., Tsai C., Hsieh F. Y. Racial differences in optic nerve head parameters. Arch Ophthalmol. 1989 Jun;107(6):836–839. doi: 10.1001/archopht.1989.01070010858029. [DOI] [PubMed] [Google Scholar]
  16. Coffey M., Reidy A., Wormald R., Xian W. X., Wright L., Courtney P. Prevalence of glaucoma in the west of Ireland. Br J Ophthalmol. 1993 Jan;77(1):17–21. doi: 10.1136/bjo.77.1.17. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. FORD M., SARWAR M. FEATURES OF A CLINICALLY NORMAL OPTIC DISC. Br J Ophthalmol. 1963 Jan;47:50–52. doi: 10.1136/bjo.47.1.50. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Funk J., Dieringer T., Grehn F. Correlation between neuroretinal rim area and age in normal subjects. Graefes Arch Clin Exp Ophthalmol. 1989;227(6):544–548. doi: 10.1007/BF02169450. [DOI] [PubMed] [Google Scholar]
  19. Harrison R. J., Wild J. M., Hobley A. J. Referral patterns to an ophthalmic outpatient clinic by general practitioners and ophthalmic opticians and the role of these professionals in screening for ocular disease. BMJ. 1988 Nov 5;297(6657):1162–1167. doi: 10.1136/bmj.297.6657.1162. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Hitchings R. A. Glaucoma screening. Br J Ophthalmol. 1993 Jun;77(6):326–326. doi: 10.1136/bjo.77.6.326. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Hollows F. C., McGuiness R. The size of the optic cup. Trans Ophthalmol Soc Aust. 1966;25:33–38. [PubMed] [Google Scholar]
  22. Jonas J. B. Declining disc rim area. Ophthalmology. 1992 Aug;99(8):1182–1183. [PubMed] [Google Scholar]
  23. Jonas J. B., Gusek G. C., Naumann G. O. Optic disc, cup and neuroretinal rim size, configuration and correlations in normal eyes. Invest Ophthalmol Vis Sci. 1988 Jul;29(7):1151–1158. [PubMed] [Google Scholar]
  24. Jonas J. B., Müller-Bergh J. A., Schlötzer-Schrehardt U. M., Naumann G. O. Histomorphometry of the human optic nerve. Invest Ophthalmol Vis Sci. 1990 Apr;31(4):736–744. [PubMed] [Google Scholar]
  25. Jonas J. B., Nguyen N. X., Naumann G. O. The retinal nerve fiber layer in normal eyes. Ophthalmology. 1989 May;96(5):627–632. doi: 10.1016/s0161-6420(89)32838-7. [DOI] [PubMed] [Google Scholar]
  26. Jonas J. B., Schmidt A. M., Müller-Bergh J. A., Schlötzer-Schrehardt U. M., Naumann G. O. Human optic nerve fiber count and optic disc size. Invest Ophthalmol Vis Sci. 1992 May;33(6):2012–2018. [PubMed] [Google Scholar]
  27. Klein B. E., Klein R., Sponsel W. E., Franke T., Cantor L. B., Martone J., Menage M. J. Prevalence of glaucoma. The Beaver Dam Eye Study. Ophthalmology. 1992 Oct;99(10):1499–1504. doi: 10.1016/s0161-6420(92)31774-9. [DOI] [PubMed] [Google Scholar]
  28. Kruse F. E., Burk R. O., Völcker H. E., Zinser G., Harbarth U. Reproducibility of topographic measurements of the optic nerve head with laser tomographic scanning. Ophthalmology. 1989 Sep;96(9):1320–1324. doi: 10.1016/s0161-6420(89)32719-9. [DOI] [PubMed] [Google Scholar]
  29. Lichter P. R. Variability of expert observers in evaluating the optic disc. Trans Am Ophthalmol Soc. 1976;74:532–572. [PMC free article] [PubMed] [Google Scholar]
  30. Littmann H. Zur Bestimmung der wahren Grösse eines Objektes auf dem Hintergrund des lebenden Auges. Klin Monbl Augenheilkd. 1982 Apr;180(4):286–289. doi: 10.1055/s-2008-1055068. [DOI] [PubMed] [Google Scholar]
  31. MacKean J. M., Elkington A. R. Referral routes to hospital of patients with chronic open-angle glaucoma. Br Med J (Clin Res Ed) 1982 Oct 16;285(6348):1093–1095. doi: 10.1136/bmj.285.6348.1093. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Mikelberg F. S., Drance S. M., Schulzer M., Yidegiligne H. M., Weis M. M. The normal human optic nerve. Axon count and axon diameter distribution. Ophthalmology. 1989 Sep;96(9):1325–1328. doi: 10.1016/s0161-6420(89)32718-7. [DOI] [PubMed] [Google Scholar]
  33. Pickard R. THE ALTERATION IN SIZE OF THE NORMAL OPTIC DISC CUP. Br J Ophthalmol. 1948 Jun;32(6):355–361. doi: 10.1136/bjo.32.6.355. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Primrose J. Early signs of the glaucomatous disc. Br J Ophthalmol. 1971 Dec;55(12):820–825. doi: 10.1136/bjo.55.12.820. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Quigley H. A., Addicks E. M., Green W. R. Optic nerve damage in human glaucoma. III. Quantitative correlation of nerve fiber loss and visual field defect in glaucoma, ischemic neuropathy, papilledema, and toxic neuropathy. Arch Ophthalmol. 1982 Jan;100(1):135–146. doi: 10.1001/archopht.1982.01030030137016. [DOI] [PubMed] [Google Scholar]
  36. Quigley H. A., Brown A. E., Morrison J. D., Drance S. M. The size and shape of the optic disc in normal human eyes. Arch Ophthalmol. 1990 Jan;108(1):51–57. doi: 10.1001/archopht.1990.01070030057028. [DOI] [PubMed] [Google Scholar]
  37. Quigley H. A., Vitale S. Models of open-angle glaucoma prevalence and incidence in the United States. Invest Ophthalmol Vis Sci. 1997 Jan;38(1):83–91. [PubMed] [Google Scholar]
  38. Rudnicka A. R., Edgar D. F., Bennett A. G. Construction of a model eye and its applications. Ophthalmic Physiol Opt. 1992 Oct;12(4):485–490. [PubMed] [Google Scholar]
  39. SNYDACKER D. THE NORMAL OPTIC DISC. OPHTHALMOSCOPIC AND PHOTOGRAPHIC STUDIES. Am J Ophthalmol. 1964 Dec;58:958–964. [PubMed] [Google Scholar]
  40. Schwartz B. Optic disc changes in ocular hypertension. Surv Ophthalmol. 1980 Nov-Dec;25(3):148–154. doi: 10.1016/0039-6257(80)90091-0. [DOI] [PubMed] [Google Scholar]
  41. Schwartz J. T., Reuling F. H., Garrison R. J. Acquired cupping of the optic nerve head in normotensive eyes. Br J Ophthalmol. 1975 Apr;59(4):216–222. doi: 10.1136/bjo.59.4.216. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Sommer A., Katz J., Quigley H. A., Miller N. R., Robin A. L., Richter R. C., Witt K. A. Clinically detectable nerve fiber atrophy precedes the onset of glaucomatous field loss. Arch Ophthalmol. 1991 Jan;109(1):77–83. doi: 10.1001/archopht.1991.01080010079037. [DOI] [PubMed] [Google Scholar]
  43. Sommer A., Miller N. R., Pollack I., Maumenee A. E., George T. The nerve fiber layer in the diagnosis of glaucoma. Arch Ophthalmol. 1977 Dec;95(12):2149–2156. doi: 10.1001/archopht.1977.04450120055003. [DOI] [PubMed] [Google Scholar]
  44. Sommer A., Pollack I., Maumenee A. E. Optic disc parameters and onset of glaucomatous field loss. I. Methods and progressive changes in disc morphology. Arch Ophthalmol. 1979 Aug;97(8):1444–1448. doi: 10.1001/archopht.1979.01020020106002. [DOI] [PubMed] [Google Scholar]
  45. Sommer A., Tielsch J. M., Katz J., Quigley H. A., Gottsch J. D., Javitt J. C., Martone J. F., Royall R. M., Witt K. A., Ezrine S. Racial differences in the cause-specific prevalence of blindness in east Baltimore. N Engl J Med. 1991 Nov 14;325(20):1412–1417. doi: 10.1056/NEJM199111143252004. [DOI] [PubMed] [Google Scholar]
  46. Sommer A., Tielsch J. M., Katz J., Quigley H. A., Gottsch J. D., Javitt J., Singh K. Relationship between intraocular pressure and primary open angle glaucoma among white and black Americans. The Baltimore Eye Survey. Arch Ophthalmol. 1991 Aug;109(8):1090–1095. doi: 10.1001/archopht.1991.01080080050026. [DOI] [PubMed] [Google Scholar]
  47. Sponsel W. E. Tonometry in question: can visual screening tests play a more decisive role in glaucoma diagnosis and management? Surv Ophthalmol. 1989 Feb;33 (Suppl):291–300. [PubMed] [Google Scholar]
  48. Stürmer J., Poinoosawmy D., Broadway D. C., Hitchings R. A. Intra- and inter-observer variation of optic nerve head measurements in glaucoma suspects using disc-data. Int Ophthalmol. 1992 Sep;16(4-5):227–233. doi: 10.1007/BF00917966. [DOI] [PubMed] [Google Scholar]
  49. Teal P. K., Morin J. D., McCulloch C. Assessment of the normal disc. Trans Am Ophthalmol Soc. 1972;70:164–177. [PMC free article] [PubMed] [Google Scholar]
  50. Tielsch J. M., Katz J., Quigley H. A., Miller N. R., Sommer A. Intraobserver and interobserver agreement in measurement of optic disc characteristics. Ophthalmology. 1988 Mar;95(3):350–356. doi: 10.1016/s0161-6420(88)33177-5. [DOI] [PubMed] [Google Scholar]
  51. Tsai C. S., Ritch R., Shin D. H., Wan J. Y., Chi T. Age-related decline of disc rim area in visually normal subjects. Ophthalmology. 1992 Jan;99(1):29–35. doi: 10.1016/s0161-6420(92)32017-2. [DOI] [PubMed] [Google Scholar]
  52. Tuck M. W., Crick R. P. Relative effectiveness of different modes of glaucoma screening in optometric practice. Ophthalmic Physiol Opt. 1993 Jul;13(3):227–232. doi: 10.1111/j.1475-1313.1993.tb00463.x. [DOI] [PubMed] [Google Scholar]
  53. Varma R., Quigley H. A., Pease M. E. Changes in optic disk characteristics and number of nerve fibers in experimental glaucoma. Am J Ophthalmol. 1992 Nov 15;114(5):554–559. doi: 10.1016/s0002-9394(14)74482-4. [DOI] [PubMed] [Google Scholar]
  54. Varma R., Steinmann W. C., Scott I. U. Expert agreement in evaluating the optic disc for glaucoma. Ophthalmology. 1992 Feb;99(2):215–221. doi: 10.1016/s0161-6420(92)31990-6. [DOI] [PubMed] [Google Scholar]
  55. Varma R., Tielsch J. M., Quigley H. A., Hilton S. C., Katz J., Spaeth G. L., Sommer A. Race-, age-, gender-, and refractive error-related differences in the normal optic disc. Arch Ophthalmol. 1994 Aug;112(8):1068–1076. doi: 10.1001/archopht.1994.01090200074026. [DOI] [PubMed] [Google Scholar]
  56. Wilensky J. T., Kolker A. E. Peripapillary changes in glaucoma. Am J Ophthalmol. 1976 Mar;81(3):341–345. doi: 10.1016/0002-9394(76)90251-8. [DOI] [PubMed] [Google Scholar]
  57. Wormald R. P., Wright L. A., Courtney P., Beaumont B., Haines A. P. Visual problems in the elderly population and implications for services. BMJ. 1992 May 9;304(6836):1226–1229. doi: 10.1136/bmj.304.6836.1226. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from The British Journal of Ophthalmology are provided here courtesy of BMJ Publishing Group

RESOURCES