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8/21/2019 Optic disc assessment RNFL Overview
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OPTIC DISC
ASSESSMENT/RNFL
OVERVIEW
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Outline
I. Five rules for assessment of
the optic disc in glaucoma
II. Detecting glaucoma
III. Detecting progression
IV. Examples
V. Test your skills
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FIVE RULES FOR
ASSESSMENT OF THE
OPTIC DISC IN GLAUCOMA
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Five rules for assessment of
the optic disc in glaucoma (1)
1. Observe the scleral Ring toidentify the limits and sizeof the optic disc
Photo courtesy ofPhoto courtesy of KiKiHo ParkHo Park
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Five rules for assessment of
the optic disc in glaucoma (2)
1. Observe the scleral Ringto identify the limits andsize of the optic disc
Photo courtesy ofPhoto courtesy of KiKiHo ParkHo Park
2. Identify the size of theRim
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1. Observe the scleral Ring toidentify the limits and sizeof the optic disc
2. Identify the size of the Rim
Five rules for assessment of
the optic disc in glaucoma (3)
Photo courtesy ofPhoto courtesy of KiKiHo ParkHo Park
3. Examine the Retinal nervefibre layer
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1. Observe the scleral Ringto identify the limits andsize of the optic disc
2. Identify the size of the Rim
3. Examine the Retinal nervefibre layer
Five rules for assessment of
the optic disc in glaucoma (4)
Photo courtesy ofPhoto courtesy of KiKiHo ParkHo Park
4. Examine the Region ofperipapillary atrophy
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1. Observe the scleral Ringto identify the limits andsize of the optic disc
2. Identify the size of the Rim
3. Examine the Retinal nervefibre layer
4. Examine the Region ofperipapillary atrophy
Five rules for assessment of
the optic disc in glaucoma (5)
Photo courtesy ofPhoto courtesy of KiKiHo ParkHo Park
5. Look for Retinal andoptic disc haemorrhages
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Rule 1
Observe the scleral Ring
to identify the limits and size
of the optic disc
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Rim width= distance
between the scleral
ring and the locationwhere the vessel is
bent (cup border) ScleralScleralringring
Cup borderCup border
The scleral ring (1)
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ScleralScleral
ringring
Rim width= distance
between the scleral
ring and the locationwhere the vessel is
bent (cup border)
KinkingKinking
of the vesselof the vessel(cup border)(cup border)
The scleral ring (2)
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Optic disc size (1)
Extremely variable
A large cupdisc ratio may not necessarily
be pathological
Large discs have large cupdisc ratios,
even though the area of the neuroretinal
rim is normal
Pathological rim loss can be missed in asmall disc, especially if generalised
SEAGIG.Asia Pacific Glaucoma Guidelines. 20032004.
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Optic disc size (2)
Can be measured using the small lightspot of a direct ophthalmoscope
The spot size can be used to estimatewhether a disc is larger or smaller thanaverage
Other forms of evaluation
conventional photographic means withan overlay grid
optic nerve head analysis
SEAGIG.Asia Pacific Glaucoma Guidelines. 20032004.
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Small aperture (5 degree)
of Welch-Allen direct
ophthalmoscope
Normal size discNormal size disc
Large discLarge disc
Small discSmall disc
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Optic disc size (4)
Indirectophthalmoscopy and
slit lamp examination Use Volk slit lamp
biomicroscopy lenses
Measure size of slitbeam
Correction factors Volk 60D: !1.0
Volk 78D: !1.1
Volk 90D: !1.3
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Optic disc size (5)
HorizontalHorizontal
disc diameterdisc diameter
VerticalVertical
discdisc
diameterdiameterScleral
ring
Photo courtesy ofPhoto courtesy of KiKiHo ParkHo Park
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The size of the cup varies with the size of the disc
Large discs have large cups in healthy eyes
Cup size is proportional to disc size in normal eyes
Optic disc size (6)
Small Average Large
Right photo courtesy ofRight photo courtesy of KiKiHo ParkHo Park
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Optic disc size (7)
Be cautious
with myopic discs
ScleralScleral
ringring
Cup borderCup border
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Rule 2
Identify the size of the
neuroretinal Rim
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The neuroretinal rim (1)
More important than the cup
The cup defines the inner edge of the rim
where most signs of glaucoma appear
Loss of tissue from inner edge of the
rim
Cardinal feature of glaucomatous opticneuropathy
SEAGIG.Asia Pacific Glaucoma Guidelines. 20032004.
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The neuroretinal rim (2)
Features that indicate that glaucomatous
damage has already occurred
Notching of the rim (especially the disc margin)
Haemorrhage crossing the rim
Undercutting of the rim
Asymmetry of rim width between the eyes in the
absence of asymmetric disc size Abnormally thin rim in one or two sectors
SEAGIG.Asia Pacific Glaucoma Guidelines. 20032004.
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The neuroretinal rim (3)
An approximate rule is that a vertical
cupdisc ratio of > 0.7, or loss of rim to
the disc margin anywhere outside the
temporal sector, strongly suggests
glaucoma
This may not apply if the disc isextremely large or very tilted
SEAGIG.Asia Pacific Glaucoma Guidelines. 20032004.
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The ISNT rule (1)
Normally, the thickest to thinnest parts
of the neuroretinal rim of the optic disc
follow the ISNT rule:*
SEAGIG.Asia Pacific Glaucoma Guidelines. 20032004.
* The ISNT rule is followed in approximately 80% of eyes.
Any variation from this rule may help todetect glaucomatous damage
Inferior > Superior > Nasal > Temporal
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The ISNT rule (2)
Rim width =
distance between
border of disc andposition of bloodvessel bending
ISNT rule
Inferior > Superior > Nasal > Temporal
NN TT
II
SS
Photo courtesy ofPhoto courtesy of KiKiHo ParkHo Park
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Localised rim thinning/notching (1)
Photo courtesy ofPhoto courtesy of KiKiHo ParkHo Park
NotchingNotching
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Localised rim thinning/notching (2)
NotchNotch
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Localised rim thinning/notching
(3)
Photos courtesy ofPhotos courtesy of GTGTSunil and LSunil and L VijayaVijaya
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Localised rim thinning/notching (4)
Photos courtesy ofPhotos courtesy of GTGTSunil and LSunil and L VijayaVijaya
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Diffuse neuroretinal loss
Photos courtesy ofPhotos courtesy of GTGTSunil and LSunil and L VijayaVijaya
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Pallor (1)
Observe the colour of the rim to
identify pallor
A pale rim increases the likelihood
of a non-glaucomatous optic
neuropathy
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Pallor > cup
Pallor (2)
T
otalpallor
T
otalpallor
Pale rimPale rimCupNon-glaucomatous
neuropathy
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Pallor (3)
Cup
Diffuse pallorDiffuse pallor Pallor > cup
Non-glaucomatous
neuropathy
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Cup = pallorCup = pallor
Normal discNormal disc
If cup = pallor:If cup = pallor: normalnormal
If pallor > cup:If pallor > cup: neurological disorderneurological disorderor glaucoma with very high IOPor glaucoma with very high IOP
If cup > pallor:If cup > pallor: glaucoma or normalglaucoma or normal
Schwartz.Schwartz.ArchArch OphthalmolOphthalmol19731973; 89: 2727.2004 Remo Susanna Jr2004 Remo Susanna Jr
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Pallor (4)
Location of kinkingLocation of kinking
of the vessel of the vessel
PallorPallorCupCup
Photo courtesy ofPhoto courtesy of KiKiHo ParkHo Park
Cup > pallor
Suspect glaucoma
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Pallor (5)
Photos courtesy ofPhotos courtesy of GTGTSunil and LSunil and L VijayaVijaya
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Lamina cribrosa
Striated pattern(Susanna 1983)
Acquired optic pit(Radius et al. 1978)
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Acquired pit of optic nerve
(APON)
Photo courtesy of GT Sunil and LPhoto courtesy of GT Sunil and L VijayaVijaya
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APON
Photo courtesy of Ki Ho Park
Acquired optic pitAcquired optic pit
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Large discLarge cup
Normal optic nerve head
Remember that a
normal large disc
has a large cup
ISNT rule obeyed
Cup = pallor
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Rule 3
Examine the
Retinal nerve fibre layer
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Best performed using red-free light (red-free
photographs or green light)
Look at
Look for diffuseand localisedRNFL loss
Striations
Brightness
Visibility of peripapillary retinal
vessels
RNFL examination
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Red-free photography
Bright
striation
s
Right photo courtesy ofRight photo courtesy of KiKiHo ParkHo Park
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Bright
striations
Diffuse loss
of striations
Diffuse RNFL loss (1)
Diffuse loss of striate pattern
Increased visibility of retinal vessel borders
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Diffuse RNFL loss (2)
Normal RNFLDiffuse RNFL loss
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Localised RNFL loss (1)
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Localised RNFL loss (2)
Localised RNFL defectWedge-shaped dark area
Photos courtesy ofPhotos courtesy of KiKiHo ParkHo Park
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Localised RNFL loss (3)
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Localised RNFL loss (4)
Better seen with red-free light
Hoyt WFHoyt WF et alet al.. InvestInvest OphthalmolOphthalmol19731973; 12: 81429.2004, Remo Susanna Jr2004, Remo Susanna Jr
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Localised RNFL loss (5)
Wedge-shaped
dark area
Photo courtesy ofPhoto courtesy of KiKiHo ParkHo Park
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Localised RNFL loss (6)
Wedge-shaped
dark area
Photo courtesy ofPhoto courtesy of KiKiHo ParkHo Park
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Localised RNFL loss (7)
Photos courtesy ofPhotos courtesy of KiKiHo ParkHo Park
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Rule 4
Examine the Region of
peripapillary atrophy
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Peripapillary atrophy (1)
Alpha zone
Hypo- and hyper-
pigmented areas
Present in normal as wellas in glaucomatous eyes
Beta zone
Atrophy of the retinal
pigment epithelium and
choriocapillaris
Large choroidal vessels
become visible
More common in
glaucomatous eyes
Photo courtesy ofPhoto courtesy of KiKiHo ParkHo Park
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Alpha zone
Beta zone
Sensitivity2030%
Specificity
80%
360 ring
normotensive
senile sclerotic
glaucoma
Jonas JB et al. Invest Ophthalmol Vis Sci2000; 41: 176473.
Peripapillary atrophy (2)
zone
zone
Photo courtesy ofPhoto courtesy of KiKiHo ParkHo Park
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Peripapillary atrophy (3)
Beta zone
Width of beta zoneinversely correlateswith rim width atsame area
Larger beta zone!thinner rim
Progression of betazone associatedwith progressiveglaucoma
Thin rimThin rim
LargerLarger zonezone
Photo courtesy ofPhoto courtesy of KiKiHo ParkHo Park
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Peripapillary atrophy (4)
Photos courtesy ofPhotos courtesy of GTGTSunil and LSunil and L VijayaVijaya
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Peripapillary atrophy (5)
Photos courtesy ofPhotos courtesy of GTGTSunil and LSunil and L VijayaVijaya
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Rule 5
Look for Retinal and
optic disc haemorrhages
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Optic disc haemorrhage (1)
Photo courtesy of Ki Ho Park
Flame-shapedFlame-shaped
haemorrhagehaemorrhage
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Optic disc haemorrhage (2)
Photo courtesy of Prin RojanaPongpun
Flame-shapedhaemorrhage
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Optic disc haemorrhage (3)
Middle and right photos courtesy ofMiddle and right photos courtesy of KiKiHo ParkHo Park
Detection of disc haemorrhages requires
careful optic disc examination
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Optic disc haemorrhage (4)
Detection of disc haemorrhages requires
careful optic disc examination
Photos courtesy ofPhotos courtesy of KiKiHo ParkHo Park
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Optic disc haemorrhage (5)
Normally disappears after 13 months
Indicative of glaucomatous progression
Photos courtesy ofPhotos courtesy of KiKiHo ParkHo Park
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Optic disc haemorrhage (6)
Normally disappears
after 13 months
Indicative ofglaucoma
progression
Flame-shapedFlame-shaped
haemorrhagehaemorrhage
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Optic disc
haemorrhage (7)
Photos courtesy of GT Sunil and L Vijaya
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DETECTING GLAUCOMA
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ISNT rule is not obeyed
GlaucomaGlaucoma
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Glaucoma small disc
Peripapillary atrophy
Narrowing of retinal arteries
Generalised RNFL
Large cup for a small disc
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HaemorrhageHaemorrhage
Read RM, Spaeth GL. Trans Am Acad Ophthalmol
Otolaryngol1974; 78: OP25574.
Nasal cupping
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NotchNotch
RNFL defectRNFL defect PeripapillaryPeripapillary
atrophy (atrophy (beta zone)beta zone)
Notch (1)
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Notch (2)
Photos courtesy of GT Sunil and L Vijaya
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Images courtesy of GT Sunil and L Vijaya
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Notch (3)
Photos courtesy of GT Sunil and LPhotos courtesy of GT Sunil and L VijayaVijaya
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Images courtesy ofImages courtesy of GTGTSunil and LSunil and L VijayaVijaya
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Cupdisc ratio asymmetry > 0.2*
*After accounting for disc size asymmetry.
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Notching
RNFL loss
Glaucoma (1)
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Glaucoma (2)
Cup asymmetry exceeds disc asymmetry
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Glaucoma (3)
Localised loss of both
inferior and superior
neuroretinal rim Classic inferior notch
(small arrows)
RNFL defect in
superior and inferiorarcuate area (large
arrows)
Photo courtesy of Prin RojanaPongpun
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Glaucoma (4)
Neuroretinal rim
thinning
The cup extends tothe disc rim
Circumlinear blood
vessel baring
Bayoneting of theblood vessels
Peripapillary atrophy
Photo courtesy of Prin RojanaPongpun
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DETECTING PROGRESSION
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10 years
Generalised rim thinning
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Enlargement of localised RNFL defectEnlargement of localised RNFL defect
4 years
Progressive rim thinning (1)
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Progressive rim thinning (2)
A
B
Images courtesy ofImages courtesy of GTGTSunil and LSunil and L VijayaVijaya
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5 years
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5 months
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10 years
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Save me,please
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EXAMPLES
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Example 1
Glaucoma or normal?
Use the 5 rules
1 Observe the scleral Ring
to identify the limits of theoptic disc and its size
2 Identify the size of the Rim
3 Examine the Retinal nervefibre layer
4 Examine the Region ofperipapillary atrophy
5 Look for Retinal and opticdisc haemorrhages
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1. Small disc size
2. Rim thinning(inferiorly)
ISNT rule:3. Localised RNFL
defect (inferiorly)
4. No significantperipapillary atrophy
5. Haemorrhage
GLAUCOMA
Example 1
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Example 2
Glaucoma or normal?
Use the 5 rules
1 Observe the scleral Ring
to identify the limits of theoptic disc and its size
2 Identify the size of the Rim
3 Examine the Retinal nervefibre layer
4 Examine the Region ofperipapillary atrophy
5 Look for Retinal and opticdisc haemorrhages
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1. Average disc size
2. Normal rim
ISNT rule:
3. Normal RNFL
4. No significant
peripapillary atrophy
5. No haemorrhage
NORMAL
Example 2
+
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Example 3
Glaucoma or normal?
Use the 5 rules
1 Observe the scleral Ring
to identify the limits of theoptic disc and its size
2 Identify the size of the Rim
3 Examine the Retinal nervefibre layer
4 Examine the Region ofperipapillary atrophy
5 Look for Retinal and opticdisc haemorrhages
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1. Average disc size
2. Notching (inferiorly
and superiorly)
ISNT rule:
3. RNFL loss
4. No significant
peripapillary atrophy
5. No haemorrhage
GLAUCOMA
Example 3
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Example 4
Glaucoma or normal?
Use the 5 rules
1 Observe the scleral Ring
to identify the limits of theoptic disc and its size
2 Identify the size of the Rim
3 Examine the Retinal nervefibre layer
4 Examine the Region ofperipapillary atrophy
5 Look for Retinal and opticdisc haemorrhages
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1. Average disc size
2. Rim thinning
(inferiorly)
ISNT rule:
3. RNFL loss: diffuse
4. Peripapillary atrophy:
beta zone
5. No haemorrhage
GLAUCOMA
Example 4
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Example 5
Glaucoma or normal?
Use the 5 rules
1 Observe the scleral Ring
to identify the limits of theoptic disc and its size
2 Identify the size of the Rim
3 Examine the Retinal nervefibre layer
4 Examine the Region ofperipapillary atrophy
5 Look for Retinal and opticdisc haemorrhages
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1. Large disc size
2. Normal
ISNT rule:
3. Normal RNFL
4. No significant
peripapillary atrophy
5. No haemorrhage
NORMAL
Example 5
+
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Example 6
Glaucoma or normal?
Use the 5 rules
1 Observe the scleral Ring
to identify the limits of theoptic disc and its size
2 Identify the size of the Rim
3 Examine the Retinal nervefibre layer
4 Examine the Region ofperipapillary atrophy
5 Look for Retinal and opticdisc haemorrhages
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1. Average disc size
2. Rim thinning(inferiorly)
ISNT rule:3. RNFL loss: diffuse
(inferiorly)
4. Peripapillary atrophy:beta zone
5. Haemorrhage:reabsorbing
GLAUCOMA
Example 6
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TEST YOUR SKILLS
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Evaluation form
Name: _________________________________ Date: ___/___/____
TEST #: _________
( ) 1. ISNT rule not obeyed
( ) 2. Vertical enlargement of the cup( ) 3. Peripapillary atrophy: beta and or alpha zone
( ) 4. Notching
( ) 5. Nasal cupping
( ) 6. Disc haemorrhages
( ) 7. Localised or diffuse pallor of the optic disc
( ) 8. Localised RNFL defect
( ) 9. Diffuse loss of the RNFL
( ) 10. Acquired pit of the optic disc
CONCLUSION
( ) Glaucoma
( ) Normal
X
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103/156
2004 Remo Susanna Jr2004 Remo Susanna Jr
Test I
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104/156
2004, Remo Susanna Jr2004, Remo Susanna Jr Test 1
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105/156
2004, Remo Susanna Jr2004, Remo Susanna Jr Test 2
8/21/2019 Optic disc assessment RNFL Overview
106/156
2004, Remo Susanna Jr2004, Remo Susanna Jr Test 3
8/21/2019 Optic disc assessment RNFL Overview
107/156
Test 42004, Remo Susanna Jr2004, Remo Susanna Jr
8/21/2019 Optic disc assessment RNFL Overview
108/156
Test 52004, Remo Susanna Jr2004, Remo Susanna Jr
8/21/2019 Optic disc assessment RNFL Overview
109/156
Test 62004, Remo Susanna Jr2004, Remo Susanna Jr
8/21/2019 Optic disc assessment RNFL Overview
110/156
Test 72004, Remo Susanna Jr2004, Remo Susanna Jr
8/21/2019 Optic disc assessment RNFL Overview
111/156
Test 82004, Remo Susanna Jr2004, Remo Susanna Jr
8/21/2019 Optic disc assessment RNFL Overview
112/156
Test 92004, Remo Susanna Jr2004, Remo Susanna Jr
8/21/2019 Optic disc assessment RNFL Overview
113/156
2004, Remo Susanna Jr2004, Remo Susanna Jr Test 102004, Remo Susanna Jr2004, Remo Susanna Jr
8/21/2019 Optic disc assessment RNFL Overview
114/156
2004 Remo Susanna Jr2004 Remo Susanna Jr
Test I
Put your 3D glasses on
8/21/2019 Optic disc assessment RNFL Overview
115/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 1
8/21/2019 Optic disc assessment RNFL Overview
116/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 2
8/21/2019 Optic disc assessment RNFL Overview
117/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 3
8/21/2019 Optic disc assessment RNFL Overview
118/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 4
8/21/2019 Optic disc assessment RNFL Overview
119/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 5
8/21/2019 Optic disc assessment RNFL Overview
120/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 6
8/21/2019 Optic disc assessment RNFL Overview
121/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 7
8/21/2019 Optic disc assessment RNFL Overview
122/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 8
8/21/2019 Optic disc assessment RNFL Overview
123/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 9
8/21/2019 Optic disc assessment RNFL Overview
124/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 10
8/21/2019 Optic disc assessment RNFL Overview
125/156
2004 Remo Susanna Jr2004 Remo Susanna Jr
Test I
Discussion
8/21/2019 Optic disc assessment RNFL Overview
126/156
Small disc
Small cup
RNFL reflex
Normal
Test 12004, Remo Susanna Jr2004, Remo Susanna Jr
8/21/2019 Optic disc assessment RNFL Overview
127/156
Disc
haemorrhage
ISNT rule not
obeyed
Glaucoma
Test 22004, Remo Susanna Jr2004, Remo Susanna Jr
8/21/2019 Optic disc assessment RNFL Overview
128/156
Large disc
Large cup
ISNT rule obeyed
Normal RNFL
Pallor = cup
Normal
Test 32004, Remo Susanna Jr2004, Remo Susanna Jr
8/21/2019 Optic disc assessment RNFL Overview
129/156
Notching superiorly
Beta zone
Superior and inferior
RNFL drop-out
ISNT rule not
obeyed
Glaucoma
Test 42004, Remo Susanna Jr2004, Remo Susanna Jr
8/21/2019 Optic disc assessment RNFL Overview
130/156
Beta zone
Notching
superiorly and
inferiorly
Haemorrhage
Glaucoma
Test 52004, Remo Susanna Jr2004, Remo Susanna Jr
8/21/2019 Optic disc assessment RNFL Overview
131/156
Inferior notching
Inferior beta zone
Inferior RNFL defect
Glaucoma
Test 62004, Remo Susanna Jr2004, Remo Susanna Jr
8/21/2019 Optic disc assessment RNFL Overview
132/156
ISNT rule not
obeyed
Inferior
peripapillaryatrophy
Inferior notching
Nasal cupping
Glaucoma
Test 72004, Remo Susanna Jr2004, Remo Susanna Jr
8/21/2019 Optic disc assessment RNFL Overview
133/156
ISNT rule obeyed
Whitish RNFL reflex
Normal disc
Test 82004, Remo Susanna Jr2004, Remo Susanna Jr
8/21/2019 Optic disc assessment RNFL Overview
134/156
Small disc
Beta zone
Large cup for
a small disc
Nasal cupping
Glaucoma
Test 92004, Remo Susanna Jr2004, Remo Susanna Jr
8/21/2019 Optic disc assessment RNFL Overview
135/156
ISNT rule not
obeyed
Inferior
peripapillaryatrophy
Inferior notching
Nasal cupping
Glaucoma
Test 102004, Remo Susanna Jr2004, Remo Susanna Jr
8/21/2019 Optic disc assessment RNFL Overview
136/156
2004 Remo Susanna Jr2004 Remo Susanna Jr
Test II
Put your 3D glasses on
8/21/2019 Optic disc assessment RNFL Overview
137/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 1
8/21/2019 Optic disc assessment RNFL Overview
138/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 2
8/21/2019 Optic disc assessment RNFL Overview
139/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 3
8/21/2019 Optic disc assessment RNFL Overview
140/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 4
8/21/2019 Optic disc assessment RNFL Overview
141/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 5
8/21/2019 Optic disc assessment RNFL Overview
142/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 6
8/21/2019 Optic disc assessment RNFL Overview
143/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 7
8/21/2019 Optic disc assessment RNFL Overview
144/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 8
8/21/2019 Optic disc assessment RNFL Overview
145/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 9
8/21/2019 Optic disc assessment RNFL Overview
146/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 10
8/21/2019 Optic disc assessment RNFL Overview
147/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 11
8/21/2019 Optic disc assessment RNFL Overview
148/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 12
8/21/2019 Optic disc assessment RNFL Overview
149/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 13
8/21/2019 Optic disc assessment RNFL Overview
150/156
A
B
2004, Remo Susanna Jr2004, Remo Susanna Jr Test 14
8/21/2019 Optic disc assessment RNFL Overview
151/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 15
8/21/2019 Optic disc assessment RNFL Overview
152/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 16
8/21/2019 Optic disc assessment RNFL Overview
153/156
Right eye
Left eye2004, Remo Susanna Jr2004, Remo Susanna Jr Test 17
8/21/2019 Optic disc assessment RNFL Overview
154/156
A
B
2004, Remo Susanna Jr2004, Remo Susanna Jr Test 18
8/21/2019 Optic disc assessment RNFL Overview
155/156
2004 Remo Susanna Jr2004 Remo Susanna Jr Test 19
8/21/2019 Optic disc assessment RNFL Overview
156/156
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