Which finding on fundus examination is consistent with advanced glaucoma?

Which finding on fundus examination is consistent with advanced glaucoma?

• A. Optic disc cupping with a large cup-to-disc ratio
• B. Diffuse arteriolar narrowing
• C. Retinal hemorrhages limited to the macula
• D. Drusen

Answer: (A)

Advanced glaucoma damages the optic nerve fibers, leading to excavation of the optic nerve head, i.e., cupping. As ganglion cells die, the neuroretinal rim thins and the cup becomes larger relative to the disc, producing a large cup-to-disc ratio. This pattern, especially with marked vertical cupping and rim thinning, is the classic fundus finding in advanced glaucoma. The other options point to different conditions—diffuse arteriolar narrowing is more typical of hypertensive retinopathy, macular hemorrhages suggest macular or diabetic issues, and drusen indicate age-related macular degeneration—not glaucomatous optic neuropathy. Thus, optic disc cupping with a large cup-to-disc ratio best fits advanced glaucoma.

Advanced glaucoma damages the optic nerve fibers, leading to excavation of the optic nerve head, i.e., cupping. As ganglion cells die, the neuroretinal rim thins and the cup becomes larger relative to the disc, producing a large cup-to-disc ratio. This pattern, especially with marked vertical cupping and rim thinning, is the classic fundus finding in advanced glaucoma. The other options point to different conditions—diffuse arteriolar narrowing is more typical of hypertensive retinopathy, macular hemorrhages suggest macular or diabetic issues, and drusen indicate age-related macular degeneration—not glaucomatous optic neuropathy. Thus, optic disc cupping with a large cup-to-disc ratio best fits advanced glaucoma.