During his Academy presentation titled “Beyond Glaucoma: Recognizing Mimickers in Clinical Practice,” Matthew D. Bovenzi, OD, FAAO, Dipl(ABO), said that visual field loss and retinal nerve fiber layer (RNFL) thinning do not necessarily indicate glaucoma. In a series of case studies, he showed that recognizing patterns that fall outside the typical glaucoma presentation can help clinicians identify other optic nerve and retinal disorders.

Glaucoma is a progressive, generally bilateral, and asymmetric optic neuropathy that results in retinal ganglion cell apoptosis and thus presents with optic nerve cupping rather than true neuroretinal rim pallor. Therefore, a presentation that does not fit those characteristics should prompt clinicians to consider an alternative diagnosis. Potential mimickers include ischemic and compressive optic neuropathies, optic neuritis, optic disc drusen, congenital optic nerve anomalies, and retinal vascular disease. OM