Violation of the ISNT rule in Nonglaucomatous pediatric optic disc cupping.

@article{Pogrebniak2010ViolationOT,
  title={Violation of the ISNT rule in Nonglaucomatous pediatric optic disc cupping.},
  author={Alexander E. Pogrebniak and Ben Wehrung and Katherine L. Pogrebniak and Rajesh K. Shetty and Pam Crawford},
  journal={Investigative ophthalmology \& visual science},
  year={2010},
  volume={51 2},
  pages={
          890-5
        }
}
PURPOSE To determine whether nonglaucomatous optic disc cupping in children violates the ISNT rule (which states that for normal optic discs the neuroretinal rim width is greatest in the order inferior >or= superior >or= nasal >or= temporal). METHODS Digital ocular fundus photographs from a random cohort of children with large optic disc cups of nonglaucomatous origin were analyzed in masked fashion by using computer graphic software. The diameter and perimeter of each optic disc and optic… 
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26 Citations
Background Citations
5
Methods Citations
2
Results Citations
2

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26 Citations

Clinical characteristics of nonglaucomatous optic disc cupping
TLDR
The key features that differentiated NGODC from GODC were the color of the optic disc rim and the correlation between visual field defects and the disc appearance, which aided in distinguishing between the two disorders.
Evaluation of the “IS” Rule to Differentiate Glaucomatous Eyes From Normal
TLDR
The ISNT rule alone has a high sensitivity but relatively low specificity but a combination of different features of the optic disc (increase of CDR and ISNT or IS rule) improves the specificity of optic disc evaluation for glaucoma.
Effect of Age and Disc Size on Rim Order Rules by Heidelberg Retina Tomograph
TLDR
TheISNT rule does not apply to neuroretinal rim area as measured by HRT, as only 18% of the eyes complied with the ISNT rule in this normative database, and the IS and IST rules seem to better represent the normative database.
Influence of Optic Disc Size on Identifying Glaucomatous Optic Neuropathy.
TLDR
Accurate identification of glaucomatous optic neuropathy was significantly influenced by optic disc size and the ISNT rule, and this was particularly evident for the large normal nerve and the small glaucatous nerve.
Applicability of ISNT Rule Using Bruch's Membrane Opening-based Optic Nerve Head Parameters
TLDR
BMO-based optic nerve head parameters exhibited higher diagnostic power for differentiating between normal and glaucomatous eyes based on the ISNT rule, compared with the classic method of using disc photographs.
Nasalised distribution of peripapillary retinal nerve fibre layers in large discs
TLDR
Results from this study could observe nasalisation of the peripapillary RNFL and superior retinal artery in patients with a large disc, which may help prevent misdiagnosis of glaucoma and improve the sensitivity and specificity of glAUcoma detection.
The accuracy of the inferior>superior>nasal>temporal neuroretinal rim area rule for diagnosing glaucomatous optic disc damage.
Application of the ISNT Rule to Neuroretinal Rim Thickness Determined Using Cirrus HD Optical Coherence Tomography
TLDR
The ISNT rule with rim thickness measured using Cirrus HD-OCT has limited clinical value in the diagnosis of glaucoma, and there is a topographic difference in inferior rim loss according to the stages ofglaucomatous damage.
ISNT rule satisfaction in Korean non-glaucomatous subjects
TLDR
The cup was absent in 15% of the assessed eyes, and the inferior was the most common quadrant with the thickest neuroretinal rim and the temporal, the thinnest, in eyes violating the ISNT rule.
The “ISN'T Rule” in Healthy Participant Optic Nerve Head by Confocal Scanning Laser Ophthalmoscopy
TLDR
In healthy participants the rim shape as measured by the HRT did not follow the ISN'T rule, except that the smallest rim part was located in the temporal disc region, and the thickness of the rim was similar in the superior and the inferior sectors by HRT.
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References

SHOWING 1-10 OF 29 REFERENCES
The ISNT rule and differentiation of normal from glaucomatous eyes.
TLDR
The ISNT rule is useful in differentiating normal from glaucomatous optic nerves and is unaffected by race.
Pattern of glaucomatous neuroretinal rim loss.
Vertical cup/disc ratio in relation to optic disc size
TLDR
The authors concluded that the vertical CDR is not normally distributed and its value as a clinical aid is best assessed by the predictive power of a positive test (rather than by isolated sensitivity and specificity values).
[Healthy optic discs with large cups--a diagnostic challenge in glaucoma].
TLDR
By the pronounced enlargement of cup measurements, decreasing nerve fibre thickness values and decreasing ratio of temporal-to-inferior width of the neuroretinal rim, large disks may easily be detected as false glaucomatous by morphometric analysis systems.
The size and shape of the optic disc in normal human eyes.
TLDR
The size, shape, and configuration of connective tissue of the optic disc in normal eye-bank eyes from 60 adults showed that the optic discs of blacks were larger and more oval than those of whites, though the axial lengths of the eyes in the two groups were not significantly different.
Shape of the neuroretinal rim and its correlations with ocular and general parameters in adult chinese: the beijing eye study.
Optic disc, cup and neuroretinal rim size, configuration and correlations in normal eyes.
TLDR
Four hundred and fifty-seven unselected normal human optic nerve heads of 319 subjects were evaluated by magnification-corrected morphometry of optic disc photographs, finding that the cup was significantly larger in discs with steep "punched-out" cups and neuroretinal rim area was broadest in the inferior optic disc region.
Planimetric optic disc parameters in normal eyes: a population-based study in South India.
TLDR
The disc area, the vertical cup to disc ratio and the neuroretinal rim area are normally distributed in the South Indian population and would form a basis for future comparisons in different forms of glaucoma.
Is the ISNT rule violated in early primary open-angle glaucoma—a scanning laser tomography study
TLDR
The inferior NRR is marginally wider than the superior NRR in about 2/3 of normal eyes, but could not be clinically appreciated in many of these, while the characteristic configuration of a normal optic disc with the rim width being greatest in the inferior disc region followed by the superior disc region was maintained even in most patients with early glaucoma.
RetCam image analysis of optic disc morphology in premature infants and its relation to ischaemic brain injury
TLDR
Premature infants with IVH 4 have an increased incidence of optic nerve hypoplasia and there was a trend towards reducing ODD, ODA, and OCA with increasing severity of IVH.
...
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