[Structural diagnostics of course observation for glaucoma].

BACKGROUND: Imaging of the structural progression of glaucoma enables measurement of the neuroretinal rim of the optic disc, retinal nerve fibre layer and thickness of the ganglion layer.
METHODS: High resolution disc photography, laser scanning tomography, scanning laser polarimetry and optical coherence tomography (OCT) are the current methods of choice to document and measure progression of this chronic degenerative disease.
RESULTS: Loss of the neuroretinal rim is only a few mm(2) or mm(3) per year and has to be differentiated from age-related loss which shows less change over the years. The most pronounced loss is temporal both superior and inferior. Thinning of the retinal nerve fibre layer follows the same pattern with significant annual changes of only 6-7 µm. Modern OCT devices deliver measurements of the macula ganglion cell complex which can be even more sensitive than the thickness of the retinal nerve fibre layer. Qualitative criteria for structural progression are papillary hemorrhage, rarification of papillary vessels and specific changes of the retinal pigment epithelium.
CONCLUSIONS: Structural loss due to glaucoma can be imaged and measured with different methods in different tissues. The evaluation of significant changes is still the responsibility of the ophthalmologist by taking all findings into account.