Korean J Ophthalmol.  2018 Feb;32(1):38-44. 10.3341/kjo.2017.0031.

Factors Affecting ISNT Rule Satisfaction in Normal and Glaucomatous Eyes

  • 1Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea. xcski@hanmail.net
  • 2Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
  • 3Department of Ophthalmology, SMG-SNU Boramae Medical Center, Seoul, Korea.


To determine the factors that influence the satisfaction of the "˜ISNT rule' (neural rim width: inferior ≥ superior ≥ nasal ≥ temporal) in normal and glaucomatous eyes.
The medical records of patients that visited Boramae Medical Center, Seoul, Korea, were reviewed. Each group of normal and glaucomatous eyes was divided into subgroups based on whether or not they satisfied the ISNT rule. ISNT rule assessment was performed by measuring the rim width with stereoscopic optic disc photographs using ImageJ software. Logistic regression analysis was performed to determine the factors that affect ISNT rule satisfaction.
Seventy-seven normal eyes and 97 glaucomatous eyes were included in the study. The ISNT rule was intact in 59 (76.6%) of the normal eyes and was violated in 71 (73.2%) of the glaucomatous eyes. Logistic regression analysis revealed a significant influence of axial length in violation of the ISNT rule in the normal eye group, while the mean deviation value was a significant factor for violation of the ISNT rule in the glaucomatous eye group.
The ISNT rule should be cautiously applied when evaluating normal eyes with long axial lengths. In addition, the ISNT rule might not be as effective for detecting early glaucoma.


Axial length; Glaucoma; Nerve fibers; Optic disk; Optic nerve diseases
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