Useful Papers

Ophthalmoscopic evaluation of the optic nerve head.
Jonas JB, Budde WM, Panda-Jonas S.
Surv Ophthalmol. 1999 Jan-Feb;43(4):293-320. Review.
This extremely thorough review gives fantastically detailed advice on evaluation and classification of optic discs, and is a great place to start. Importantly, contains lots of useful images.

Tilted optic disks.
Witmer MT, Margo CE, Drucker M.
Surv Ophthalmol. 2010 Sep 10;55(5):403-28. Epub 2010 Jul 10.
Tilted discs are a common finding, but can be extremely difficult to assess clinically. This paper therefore gives invaluable advice on the clinical manifestations, diagnosis / misdiagnosis and ancilliary tests required in dealing with such discs. Again, lots of great images and diagrams.

The disc damage likelihood scale: reproducibility of a new method of estimating the amount of optic nerve damage caused by glaucoma.
Spaeth GL, Henderer J, Liu C, Kesen M, Altangerel U, Bayer A, Katz LJ, Myers J, Rhee D, Steinmann W.
Trans Am Ophthalmol Soc. 2002;100:181-5; discussion 185-6.
It is widely accepted that using vertical cup to disc ratios is not a perfect way of assessing glaucomatous discs and their progression. This is one of the original papers by Dr George Spaeth and his team, describing the Disc Damage Likelihood Scale (DDLS) and its application in clinical assessment.

Similarly the following 2 papers look into the reliability of this system and its superiority over conventional examination techniques.
See also the
tutorial on the DDLS, edited by Dr Spaeth.

Reliability of the disk damage likelihood scale.
Henderer JD, Liu C, Kesen M, Altangerel U, Bayer A, Steinmann WC, Spaeth GL.
Am J Ophthalmol. 2003 Jan;135(1):44-8.

Evaluating a new disc staging scale for glaucomatous damage: the ability to detect change over time.
Henderer J, Wang Y, Bayer A, Altangerel U, Schwartz L, Schmidt C.
Eur J Ophthalmol. 2009 May-Jun;19(3):404-10.

Clinical assessment of stereoscopic optic disc photographs for glaucoma: the European Optic Disc Assessment Trial.
Reus NJ, Lemij HG, Garway-Heath DF, Airaksinen PJ, Anton A, Bron AM, Faschinger C, Holló G, Iester M, Jonas JB, Mistlberger A, Topouzis F, Zeyen TG.
Ophthalmology. 2010 Apr;117(4):717-23. Epub 2010 Jan 4.
How good do you think ophthalmologists really are at assessing optic discs? That is the question addressed by this interesting study, which thankfully shows that ophthalmologists are generally accurate in their assessment, but with considerable variability between clinicians. It also demonstrates that whilst humans are good, technology can do a better job...