Eric Schmidt, O.D., says that remembering these pearls will help you identify and treat optic nerve damage in primary open angle glaucoma.

• The advanced glaucoma intervention study (AGIS) showed that African-Americans respond better initially to ALT followed by surgical trabeculectomy; Caucasians respond better initially to trabeculectomy followed by ALT.
• The axons in the superior and inferior poles of the ONH have less structural support and are more predisposed to glaucomatous damage than are other axons.
• Asymmetrical damage within the eye and between the two eyes is specific for glaucoma.
• Optic nerve damage should correlate specifically with VF loss, as in Ida�s case. You should be able to predict the VF defect based on the optic nerve head appearance and vice-versa. This is another hallmark of glaucoma.

When asymmetrical damage is present on the ONH, you should see a corresponding change in the NFL. In Ida�s case, a wedge defect of the inferior NFL was easily visible when I used the red-free filter and high illumination of the slit lamp. Again, the change in the NFL corresponds directly with the superior VF defect.