—We are grateful for Dr Sommer's remarks about the neuroretinal rim area in patients with suspected and early chronic glaucoma and for the opportunity to make a few further observations in response.All of us are striving to find an "ideal" marker that would become abnormal before the onset of classic visual field defects and should also become positive before optic nerve damage and generalized axon loss occur. Such a marker would probably give us the best opportunity to take preventive measures at much earlier stages of damage.There is evidence that axons are lost diffusely in the retina before localized visual field loss occurs.1-4 There is also evidence that contrast sensitivity,5 retinal receptive fieldlike functions,6 color disturbance,7 and overall loss of the differential threshold8 precede localized visual field defects. In the case of color disturbances, this value has been shown to be predictive
Drance SM, Balazsi G. Neuroretinal Rim Area-Reply. Arch Ophthalmol. 1984;102(11):1584. doi:10.1001/archopht.1984.01040031283004
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