Cupping

[patricia61]

Well, I went and saw the optometrist in my town (I wanted to put my mind at ease before seeing the ophthalmologist next month) - he dilated my eyes and did a thorough retinal check with three different instruments.
He told me my retinas very good and likewise that my optics nerves were healthy and symmetrical. My IOP was 15 both eyes.
HOWEVER he did mention moderate cupping and it wasn't until i left his office that i realized that was NOT a good thing.
He told my eyes were in perfect health as I was leaving and made no mention of coming back in any time soon. Now, why wouldn't he have mentioned the cupping? Doesn't that mean glaucoma or is he  quietly monitor me without telling me?
(I'd ask him these questions, but he's not in the office till Monday).

[TracyD35]

Hello, I have a 16 year old son that was diagnosed 3 years ago with bone cancer (Ewing Sarcoma), we've had ups and downs ever since. Today I took my son to see the Opthamolgist for his yearly check up and his eye sight has not changed since last year, however he now has cupping of the Optic Nerve in both eyes and Glaucoma does not run in the family and they went back to his last visit and his Optic Nerve was normal so I was wondering if his cancer could be causing this or maybe even the chemotherapy he was receving could have caused it. Does this type of thing normally come on slowly or does it come on agressively if it Glaucoma?

Thank you,
Tracy

[Jeanmatt]

My husband was involved in over 7 explosions while serving in Iraq and afghanistan, he has a problem focusing with his right eye, and it sometimes wont respond to the finger test and has a tendency to stay in the outside corner of his eye, he is going to be given the cupping test next week could these explosions have casued injury to his optic nerve

[John C Hagan]

Yes, as I said 90% of "normal people" without glaucoma have C/D of .4 or less. That means that 10% that don't have glaucoma have C/D that can range up to .7  anything larger than that is really scary.

The converse is that someone with a .3 C/D could have glaucoma. In that case it's presumed that they were born with a C/D less than .3 and as the glaucoma developed the C/D enlarged. People that are quite farsighted often have C/D of 0.0  in fact their nerves often look swollen (pseudo-papilledma).

Generally as we get older the C/D increases some even in the absence of glaucoma.

Use the "images" feature of Google internet search engine and search "optic nerve cupping" or "optic nerve cupping due to glaucoma"  You will have a much better understanding of what the eye physician (ophtalmologist) is looking for.


JCH MD

[patricia61]

Last question, can you have cupping with a HEALTHY optic nerve?

[John C Hagan]

Not urgent, not a glaucoma diagnosis, do mention. Ask for a copy of your eye optometric exam and take it to the appointment with the ophthalmologist and keep a copy for your medical records.

JCH MD

[patricia61]

Sorry about that last blank entry - my keyboard is sensitive.

One last question - Is this something urgent? Or is it OK just to mention to the next doctor I see that on such-and-such a date, during a dilated exam, it was noted I had moderate cupping? it's not a glaucoma diagnosis, is it?

[patricia61]

Thank you SOOO much for clarifying that, doctor. I will be giving him a call first thing Monday. The part I don't understand is him going on to tell me my optic nerves are healthy (his words). Yet writing that in the file. Maybe he did it so as not to worry me. Well, I'm worried!

[John C Hagan]

"cupping" is a term applied to the optic nerve on the back of the eye. The optic nerve generally has a "dimple" or "cup".  Ophthalmologists use a ratio called the cup to disk ration "C/D ration".  An estimate is made of the width of the cup to the width of the whole optic serve. It is usually expressed as a decimal tenth. A flat optic nerve with no cup would be C/D = .0  an optic nerve ravaged by glaucoma that is 'cupped out" would be C/D = 1.0   So the possibilies are: 0, .1,.2,.3.,.4,.5,.6,.7,.8,.9,1.0      Some physicians express two numbers one being the verticle C/D and the other being the horizontal C/D. It has been shown that these are not exact numbers. There are large variations from observer to observer and even from the same observer from visit to visit.

90% of the population without glaucoma have C/D ratios of .4 or less. So a larger C/D might indicate glaucoma. However it's very complicated. You can have glaucoma with a small C/D and not have glaucoma with a large C/D. Other factors need to be taken into account like family history of glaucoma, age, corneal thinness, intra ocular pressure (remeber you IOP varies from hour to hour just like your blood pressure and your blood sugars. Many patients with glaucoma have normal IOPs for some or even most of a 24 hour period, conversely patients without glaucoma may top out over 21 for part of the day). Another factor is if the C/D are different in each eye, usually they're the same size.

When I see a patient with a C/D ratio or .5 or more I always tell them and explain what it means so that the next ophthalmologist that examines the patient will know it's been noted before.

I would never tell a person they had "moderate cupping" without explaining what it meant and giving them "the number" to add to their medical records.  Sometimes I'll take a photograph of the optic nerves as a baseline. A new and wonderful instrument the OCT (optical coherence tomography) instrument has taken a lot of the guessing out of these issues and if there's any question at all that's the test I go to.

JCH MD