Cup-to-disc ratio: getting it right | OT Skills Guide

This video shows you how to obtain an accurate cup to disc ratio for your record keeping. It demonstrates methods for measuring the size of the disc and cup and how to decide whether the optic disc is likely to be normal.

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The cupping theory was mistakenly introduced in the 1850s. One hundred years later, instead of confirming the cupping theory, we introduced a cup-to-disc ratio parameter which inferred that the original (birth) cups begin enlarging as the disease progresses. However, the original cups of various sizes from 0.00 to 0.9 are actually the central meniscus of Kuhnt (fibrous remnants of Bergmeister’s papilla) which lie superficially on the nerve fiber layer of the disc, and have no relevance to glaucoma. The lamina cribrosa appears to be sinking in primary open-angle glaucoma resulting in the peripheral-to-central axotomy of nerve fibers at the scleral edge, as evidenced by disc excavation.

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