Your patient has a suspicious optic disc

A suspicious optic disc is one with a high degree of optic disc cupping. Generally if the cup-to-disc ratio is more than 0.5 – i.e., the vertical dimensions of the cup are more than half the total top-to-bottom distance of the disc – then there may be some degree of pathological cupping. Another cause for concern is asymmetry between the optic discs of the right and left eye. Usually the discs are relatively symmetrical. If there is a discrepancy between the cup–disc ratios of the eyes, then the eye with the larger cup may have glaucoma.

If the pressure is measured as normal and the disc is suspicious, the patient may have normal tension glaucoma. Such patients require routine referral for assessment.

A haemorrhage at the optic disc can be a sign of progression of glaucomatous damage and warrants routine referral in itself.