Once we understand that an increase in the size of the optic disk cup is due to loss of optic nerve fibers combined with some physical tissue rearrangements, it is quite clear that cupping begins as soon as nerve loss begins. Methods to detect cupping are more sensitive to the @entity726 damage than are present field testing methods. This conclusion is supported by large clinical studies and histological demonstration of nerve fiber loss prior to field @entity735 with abnormal cups, asymmetric cupping, or nerve fiber @entity854 . While automated perimetry is likely to increase the sensitivity of detection, better test methodologies are needed to combine with the objectivity of computer-assisted machines. @entity548 , nerve fiber layer defects, and @entity3641 are early signs of damage, supporting the conclusion that damage is present before field loss. A number of other methods await further testing to determine their effectiveness. The idea that the @entity726 is defined by a certain visual field finding on the Goldmann perimeter is not valid if we define @entity726 as an eye with a history of elevated IOP and @entity1781 . While such field loss is a convenient means of defining a particular stage of damage in @entity726 , there are clearly earlier stages of damage, whether we can always detect them or not. No @entity1 should be told that he or she does not have @entity726 , but rather has @entity2790 , based on a particular visual field finding. As testing and examination methods improve, so, hopefully, will our ability to determine whether damage is present. As this occurs, we will be better enabled to select most rationally those @entity1 who will benefit from therapy. The idea that field testing is relatively insensitive to the @entity726 damage might lead the skeptic to conclude that perimetry is not worth the trouble. This review has indicated that none of our present methods, ophthalmoscopic, psychophysical or otherwise, is perfect. But to omit using any of them (especially field testing) does a great disservice to the @entity726 @entity1 . The greatest usefulness of the new automated instruments is that adequate field testing is now available in a cost-effective form to every ophthalmic office. We need to strive for better detection and follow-up of @entity16 to prevent @entity1939 .

Early detection of XXXX . II. Changes in the appearance of the optic disk.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity548 :: ('MESH:D006470', 'Disease') :: ['Disk hemorrhages'] @entity16 :: ('MESH:D009422', 'Disease') :: ['glaucoma damage'] @entity726 :: ('MESH:D005901', 'Disease') :: ['disease glaucoma', 'glaucoma', 'earliest glaucoma'] @entity1939 :: ('MESH:D001766', 'Disease') :: ['needless blindness'] @entity735 :: ('MESH:D005124', 'Disease') :: ['loss in eyes'] @entity854 :: ('MESH:D018376', 'Disease') :: ['layer abnormalities'] @entity1781 :: ('MESH:D009901', 'Disease') :: ['optic nerve damage'] @entity2790 :: ('MESH:D009798', 'Disease') :: ['ocular hypertension'] @entity3641 :: ('MESH:D003117', 'Disease') :: ['color vision abnormalities']
@entity16 :: (MESH:D009422,Disease) :: ['glaucomatous damage']
