Optic nerve disk in glaucoma – Optic Illusion and reality

Kubena Tomas and Cernosek Pavel

Glaucoma Service, Zlin, Czech Republic

During ophthalmoscopic examination of the optic nerve disk by our sight we are affected by optic illusion in both plane and stereoscopic perception of the disk.

According to the literature the area of disk varies from 0,8 to 6,0 mm, thus it varies 7 times. But according to our experience we would say it varies only 3x. This is caused by our natural perception of  the disk diameter. When we think one disk is 3x larger than the other, actually it is 7x.

In C/D ratio we often suppose that increasing C/D ratio is in straight relation with degree of glaucoma neuropathy. But it is not true, because glaucoma functional changes are in straight relation with decrease of neuroretinal rim area, which corresponded with increase of area C/D ratio. Relationship between linear and area C/D ratio will be demonstrated. In linear C/D 0,5 the area of the rim is 75% of the disk. In linear C/D 0,7 is area of the rim 50% of the disk.

At stereoscopic examination of the disk we suppose, that we see the plane of the disk in 90 degree angle to the axis of our view. But naturally the plane of the disk is tilted its temporal part toward back. The result of this is that we perceive the disk more vertically oval that really is, the temporal slope of the cup we perceive less steep and the nasal slope of the cup we perceive more steep that really is.