Which fundoscopic finding is most characteristic of glaucomatous damage?

• A. Disc swelling
• B. Notching of the neuroretinal rim
• C. Cotton-wool spots
• D. Pallor

Answer: (B)

Glaucomatous damage shows up as loss of retinal nerve fiber layer and thinning of the neuroretinal rim with progressive cupping of the optic disc. The hallmark sign is a notch—localized, wedge-shaped thinning of the neuroretinal rim—often occurring at the inferior or superior rim. This focal rim thinning reflects targeted loss of retinal ganglion cell axons and corresponds to the characteristic arcuate visual field defects seen in glaucoma.

Disc swelling points to conditions like papilledema or optic neuritis; cotton-wool spots are microinfarcts seen in diabetic or hypertensive retinopathy; pallor indicates optic atrophy from various causes. The notch in the neuroretinal rim is the classic indicator that the damage is glaucomatous rather than a generalized disc change or other retinal pathology.