1. Is it necessary to find optic nerve damage to confirm a diagnosis of glaucoma? In some cases, evidence of optic nerve damage is not required to diagnose glaucoma, such as secondary glaucoma, primary closed-angle glaucoma, congenital glaucoma, etc. For primary open-angle glaucoma we generally need evidence that optic nerve damage has occurred or evidence of a high risk of imminent optic nerve damage to confirm the diagnosis of glaucoma. Because for some patients with elevated IOP or atypical glaucomatous optic nerve visual field changes without optic nerve damage, we generally treat them as suspected cases and closely monitor the progression of the disease. After all, the diagnosis of primary open-angle glaucoma is a disease that requires lifelong treatment. So I would be more cautious. The decision to give treatment to a suspected case is based on a comprehensive assessment of the patient’s age, systemic condition, and the degree of risk of optic nerve damage. For patients with limited life expectancy, medication may not always be given in order to improve the quality of life of the patient, but perhaps simple observation is sufficient. What is the most effective means of early detection of optic nerve damage? There are many means to detect optic nerve damage, including fundus photography, OCT, GDX, HRT and visual field. However, the most effective means of detecting early damage include fundus stereoscopic photographs of the optic disc (especially time series of photographs); OCT analysis of optic disc nerve fiber thickness and measurement of macular nodal cell complex thickness; followed by visual field and GDX nerve fiber thickness analysis. Certain electrophysiological examinations that measure specific cellular functions in the macula, such as IC-vep, may also be valuable for early detection of optic ganglion cell damage. 3.What problems can be detected by fundus stereophotography? Do the results of different hospitals affect the diagnosis? Will different doctors’ interpretations lead to different conclusions? A fundus stereoscopic photograph is a three-dimensional photograph of the optic disc pattern of the eye, usually two photographs are taken at the same time, and special equipment or lenses are needed to read the results. Its value lies in detecting subtle structural changes along the disc rim of the optic disc. If a standard stereoscopic photograph of the fundus optic disc is met, the results should be essentially the same from hospital to hospital and will not affect the diagnosis. However, different doctors, because of their experience and different criteria for judging damage, may make different judgments about the same photographic results. Such interpersonal bias cannot be completely avoided. 4. Is MRI helpful in the diagnosis of glaucoma? Yes, it is helpful, especially for some patients who do not have high intraocular pressure and may have abnormal cerebrospinal fluid function, and it is meaningful for excluding the head, pituitary gland and other occupying lesions causing optic nerve damage. However, MRI imaging of the optic nerve itself is of little value in determining optic nerve damage.