For Medical Doctors

Around 1960, when I started my practice, I had a patient whom I knew had Glaucoma. I took my time to look at the Optic Nerve for a sign that would be different. I found a shadow at the edge of the Optic Nerve tissue inside the rim, in the Inferior Temporal Quadrant. After I saw this in several other patients I knew I had something! I called it "The Shadow Sign." When I retired in 1986 I had a cross-file of over 100 cases. I talked about it for many years at teh Bascom Palmer Eye Institute in Miami, Florida, presented many cases in the Grand Rounds and taught it to several doctors.
On one occasion Dr. Edward Norton and Dr. Ralph Kirsch had 3 patients for Grand Rounds in one of the rooms at Jackson Memorial Hospital in Miami, Florida (before Bascom Palmer Eye Institute was completed). Dr. Norton called me and asked me to look at the patients' Optic Nerve for Glaucoma. In less than 10 seconds I told him "these two have Glaucoma and this one is normal." They did not say anything, and when I pressed them they told me I was right, but they did not show the cases in Grand Rounds. After the Bascom Palmer was completed, on one of the yearly Resident's Day celebrations in 1965, in one of the skits, they had one of the doctors sitting on a chair on the stage when another one entered the stage and said, "They told me that you have a patient with the "de la Vega Shadow Sign" so I came all the way from India to see it!"
The Shadow Sign is a long, narrow shadow that you can create at the edge of the Optic Nerve in the nerve fiber layer, just inside the rim of the Disc in the Inferior Temporal Quadrant, using the light of the Direct Opthalmoscope. The intensity and size of the shadow varies according to the degree of the Glaucoma, but it is always a long and narrow shadow two to three years before you can detect any changes in the visual field as confirmed by Dr. Lawton Smith, Professor of Opthalmology (I do not know anyone better to support this fact.) It is always present in cases of Glaucoma. The only use I have for the Direct Opthalmoscope is to look for the Shadow Sign. I know many doctors to whom I have taught it and they use it. To mention some at the Bascom Palmer: Dr. Forster, Dr. Anderson, and Dr. Parrish.
The Shadow Sign can be detected as follows:
(1) Shine the light of the Direct Opthalmoscope inside the disc: when you do this all the fibers of the Optic Nerve are equally illuminated; they all look pink.
(2) Now move the light in a brushing fashion towards the Temporal and Inferior Quadrant when light is about 1/2 to 2/3 outside the Disc and the rest of the light is inside the Disc. In cases of Glaucoma a narrow shadow appears within the Optic Nerve fibers just inside the rim of the Disc. You can reproduce the Shadow Sign in any patient with Glaucoma