In a patient with an intraocular pressure (IOP) of 32 mmHg, what change would you expect to observe during a fundoscopic exam?

A patient with an intraocular pressure (IOP) of 32 mmHg is experiencing elevated pressure within the eye, which is a hallmark of glaucoma, particularly open-angle glaucoma. During a fundoscopic exam, an important finding associated with this condition is an increase in the cup-to-disc ratio.

The cup-to-disc ratio refers to the comparison of the size of the optic cup (the central depression in the optic disc) to the overall size of the optic disc. In glaucoma, increased intraocular pressure can lead to optic nerve damage, resulting in an enlarging cup. This change occurs as the healthy nerve fibers die, causing a more pronounced optic cup due to the loss of neural tissue. Therefore, an increase in the cup-to-disc ratio is indicative of glaucomatous damage and reflects the progression of the disease.

The presence of a high IOP alone is significant but must be assessed alongside the structural changes observed in the fundoscopic exam, particularly the cup-to-disc ratio, which helps in monitoring the optic nerve health and progression of glaucoma.