A patient undergoing glaucoma screening has cup-to-disc ratios of 0.4 in the right eye and 0.7 in the left eye. What is the clinical significance of this finding?
- A It is a normal variant with no significance
- B It indicates bilateral papilledema
- C Asymmetry of 0.2 or more is suspicious for glaucomatous damage ✓
- D It is diagnostic of optic neuritis
Correct answer: C. Asymmetry of 0.2 or more is suspicious for glaucomatous damage
Explanation
Inter-eye cup-to-disc asymmetry of 0.2 or more is considered clinically significant and suspicious for glaucomatous optic neuropathy. Asymmetric cupping suggests the eye with the larger cup may have glaucomatous damage. While some asymmetry exists in normal population, a difference of 0.2 or more warrants further investigation with visual fields, OCT, and IOP measurement. It is not normal, and it does not indicate papilledema or optic neuritis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.