Clarification needed regarding large optic nerves

I need some clarification regarding large optic nerves and their relation to glaucoma.  Are large nerves considered to be a SIGN of the disease, or are they a RISK FACTOR?  If they're considered to be a sign, then aren't there many more factors to be taken into consideration concerning the appearance of the optic nerve such as color, shape, symmetry, etc?  Assuming all those other issues appear normal (other than the size), along with normal pressure and visual fields, then is the person considered at higher risk for glaucoma or are they still considered a glaucoma suspect merely based on their nerve size?  

[Michael J Kutryb, MD]

It is not the size of the nerve itself that is a risk factor but rather the relationship of the cup to the size of the nerve.  The thickness of the retinal nerve fiber around the optic nerve will be the most sensitive measure to determine if any glaucomatous damage is occuring.  I think you want a crystal ball to tell you if you will ever need to be on glaucoma treatment and the reality is that you may be at some risk and will need to be followed carefully to determine if there are any signs of early progression.  In general the danger from glaucoma is people who never get checked and never know they even have it until tremendous amounts of damage have already occurred.  If you know it's possibly coming you can start treatment before any real damage even occurs and have excellent long term health for the eyes.  It is very, very treatable for the vast majority of cases.  Make sure you see a glaucoma specialist ophthalmologist.