High Disc Cup Ratio

[starr363]

Hello,

I have seen two opthamologists and both consider me to
be a glaucoma suspect bec of my disc cup ratio is 55% in
one eye and 60% in the other eye.  My field vision tests
and pressures are normal so they both said to just
keep an eye on things to make sure nothing worsens.
The last doctor told me that 40% is the highest they
like to see the ratio but he told me not to worry since
mine hasnt changed in the last few years - he did
say it could be totally normal for me.  Have you seen
any patients with a large cup ratio (I hope I am using the correct
terminology here) that did not turn out to be glaucoma
and was just  normal for them.

Thank you for any insight.

starr363

[Ruthiejb]

I recently learned that I'm in the same situation as you and my doctor said the same thing as yours, that it may be normal for me.  But the only way to know for sure is to monitor me over time for changes.  My pressure, corneal thickness and visual field are all normal.  My only risk factor is a larger than normal cup-to-disc ratio.  He told me that he considers me a "low glaucoma suspect".  I just found out that my sister (we're twins, but fraternal..not identical) was told the same thing today by her eye doctor.  So, I'm assuming this is a genetic thing that we were both born with.  

[starr363]

According to my eye doctor one of my corneas is
thinner than the other so she added 1 to my IOP.
Even with this my IOP is in the normal range - the
high end of normal but normal nonetheless.  With
this and the high disc cup ratio, do you agree that
I am still a glaucoma suspect or would you
consider medication based on the info. I have given.
I know it is impossible without seeing all my
records - I do have normal visual field tests.
Thanks for any input.

starr363

[Sandra M Brown, MD]

The vast majority of patients with a cup-to-disc ratio > 0.5 are perfectly fine.  The C:D ratio is affected by race (larger in blacks), prescription (larger in nearsighted people), and most of all genetics (you get what your parents have).  You do need to have your corneal thickness measured as this affects what the "real" eye pressure is - if your corneas are thin then your eye pressure is probably higher than recorded.  If your corneal thickness is normal, your eye pressure is normal, your visual field is normal, and the C:D ratio is not changing, then this sure isn't anything to lose sleep over.