Structural reversibility of optic-disc cupping in glaucoma: pathophysiology, imaging assessment, and clinical implications

Background/Objectives: Reversibility of glaucomatous optic-disc cupping, following intraocular pressure (IOP) reduction, represents a fascinating structural response observed in both pediatric and adult patients. This review summarizes evidence on its mechanisms, diagnostic evaluation, and clinical significance. Methods: A comprehensive review of experimental, clinical, and imaging-based studies investigating optic-disc cupping reversibility was conducted. Findings were categorized by patient population, imaging technique, and follow-up duration. Results: Experimental models established a strong correlation between IOP reduction and optic-disc structural recovery. Pediatric glaucoma demonstrated the greatest reversibility due to enhanced ocular tissue elasticity, whereas adult cases showed limited yet measurable structural changes after sustained IOP lowering. Imaging modalities, including confocal scanning laser ophthalmoscopy and spectral-domain optical coherence tomography (SD-OCT), consistently confirmed quantitative disc-shape changes correlated with pressure reduction. Conclusions: Although optic-disc cupping reversal reflects biomechanical and glial remodeling rather than true neuronal recovery, it remains an important biomarker of successful IOP control. Advanced imaging provides valuable insights into optic-nerve-head (ONH) biomechanics and may improve glaucoma management.