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Open Access Research article

Analysis of neuroretinal rim distribution and vascular pattern in eyes with presumed large physiological cupping: a comparative study

Flavio SS Lopes12, Syril Dorairaj3*, Daniela LM Junqueira2, Rafael L Furlanetto1, Luis Gustavo Biteli12 and Tiago Santos Prata12

Author Affiliations

1 Department of Ophthalmology, Federal University of São Paulo, Rua Sena Madureira, 1500 - Vila Mariana, São Paulo, SP 04021-001, Brazil

2 Glaucoma Unit, Hospital Medicina dos Olhos, Rua Salém Bechara, 297 - Centro, Osasco, SP 06018-180, Brazil

3 Department of Ophthalmology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, USA

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BMC Ophthalmology 2014, 14:72  doi:10.1186/1471-2415-14-72

Published: 27 May 2014



To investigate possible differences in neuroretinal rim distribution, vascular pattern, and peripapillary region appearance between eyes with presumed large physiological optic disc cupping (pLPC) and eyes with minimal optic disc excavation.


We prospectively enrolled consecutive subjects with pLPC and individuals with minimal excavation (optic disc excavation within normal limits; control group). All eyes had normal visual fields and untreated intraocular pressure (IOP) <21 mmHg. Eyes with pLPC required vertical cup-to-disc ratio (VCDR) ≥0.6 and ≥30 months of follow-up with no evidence of glaucomatous neuropathy. For controls, VCDR was limited to ≤0.5. We compared ocular signs and characteristics related to the neuroretinal rim distribution, vascular pattern, peripapillary region appearance and disc size between groups. Whenever both eyes were eligible, one was randomly selected for analysis.


A total of 74 patients (mean age, 45.6 ± 14.9 years) with pLPC and 45 controls (mean age, 44.8 ± 11.6 years) were enrolled (p = 0.76). Median disc size and VCDR was significantly larger in eyes with pLPC compared to controls (p < 0.01). The proportion of eyes with violation of the ISNT rule, laminar dot sign, nasal shifting of the central vessels, nasal excavation and baring of circumlinear vessel was significantly greater in the eyes with pLPC compared to controls (p < 0.01). There were no significant differences regarding the proportions of eyes with peripapillary atrophy between groups (p < 0.09). Finally, disc size was significantly associated with VCDR (r2 = 0.47, p < 0.01), with an increase of 0.21 in VCDR for each 1 mm2 in disc area.


Compared to normal controls, eyes with pLPC may present a higher proportion of optic nerve head findings frequently observed in glaucomatous eyes. This seems to be explained in part by the larger discs found in these eyes. We believe care should be taken while classifying them as glaucomatous or not based solely on these characteristics.

Glaucoma suspect; Intraocular pressure; Optic disc cup; Disc size