Objective: To examine the morphology of the optic disc in eyes with high-pressure open-angle glaucoma.

Methods: Using color stereo optic slides, 306 eyes of 183 patients with secondary open-angle glaucoma and 65 eyes of 35 patients with juvenile open-angle glaucoma (group I) were morphometrically examined and compared with 1119 eyes of 585 patients older than 40 years and suffering from with primary open-angle glaucoma (group II).

Results: The eyes of group I as compared to group II showed significantly (P < 0.0001) higher maximal intraocular pressure values and a significantly (P < 0.05) smaller optic disc and parapapillary atrophy. There was a tendency towards steeper and deeper cupping and a lower frequency of optic disc hemorrhages in group I than in group II. The optic disc shape did not vary significantly between the two groups.

Conclusions: Minor parapapillary atrophy suggests high-pressure glaucoma. Barotrauma may be associated with a mostly diffuse damage of the optic nerve. The only slight enlargement of the parapapillary atrophy in the eyes with high-pressure glaucoma indicates that the development of the parapapillary atrophy may at least partially be independent of an elevation of intraocular pressure. The optic disc shape is not useful to identify eyes with high-pressure glaucoma.