Atypical features signal when to image glaucomatous cupping

Imaging studies in typical glaucomatous cupping are usually unnecessary because the diagnosis can normally be made on clinical grounds alone (e.g., elevated IOP, glaucomatous cupping, nerve fiber layer visual field defects). In addition, glaucoma produces a specific and differentiating form of optic atrophy (i.e., cupping). Although most patients with glaucoma have an elevated IOP, some have normal-tension glaucoma.This article reviews the "red flags" for considering imaging in suspected glaucomatous optic atrophy.