The authors make the point that, based on cognitive bias, the general ophthalmologist may have a high threshold for considering non-glaucomatous optic neuropathies in patients who have optic nerve cupping and visual field loss. They found that patients with NGON had both lower MRW-BMOs and MRW-BMO:RNFLs than those with GON. The authors then compared the MRW-BMO and the MRW-BMO:RNFL ratio of the two groups. The diagnoses included in the NGON group included both arteritic and non-arteritic anterior ischaemic optic neuropathies as well as prior optic neuritis, optic nerve drusen and hereditary optic neuropathies. Twenty-seven patients with a diagnosis of normal-tension glaucoma (NTG) and 54 patients with non-glaucomatous optic neuropathies (NGON) were recruited for this study. The authors hypothesise that patients with non-glaucomatous optic neuropathies (NGON) can be distinguished from those with glaucomatous optic neuropathy (GON) by using optical coherence tomography (OCT) to assess the minimum rim width at Bruch’s membrane opening (MRW-BMO) and the ratio of MRW-BMO to the retinal nerve fibre layer thickness (MRW-BMO:RNFL). This is not only important to the patient in terms of treatment and visual outcome but also to the clinician who would like to minimise his or her exposure to litigation. Differentiating glaucomatous from non-glaucomatous optic neuropathies is critically important for those of us who practice neuro-ophthalmology as well as those specialising in glaucoma, comprehensive ophthalmology, and neurology. Ischaemic, inflammatory, compressive, and hereditary optic neuropathies as well as optic disk drusen can present as “normal pressure” glaucoma. Bruch’s membrane opening minimum rim width provides objective differentiation between glaucoma and nonglaucomatous optic neuropathies. Leaney JC, Nguyen V, Miranda E, Barnett Y, Admad K, Wong S, Lawlor M. Can OCT help us distinguish glaucoma from other optic neuropathies?
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