BACKGROUNDANDOBJECTIVE: To characterize the range of retinal nerve fiber layer (RNFL) and standard automated perimetry damage in eyes with large vertical cup-disc ratio (VCDR). PATIENTS AND METHODS: Complete examination, standard automated perimetry, scanning laser polarimetry with variable corneal compensation, and optical coherence tomography (OCT) of the RNFL and optic nerve head were performed. LargeVCDR was defined as ≥0.80 using stereoscopic disc examination and OCT optic nerve head analysis. Structural and functional characteristics were assessed separately in eyes with a disc area of less than 2 mm2, 2 to 2.5 mm2 and greater than 2.5 mm2. RESULTS: Fifty-seven eyes of 57 subjects were enrolled. A broad range in mean deviation (2.0 to-32.8 dB) and mean RNFL thickness with OCT (24.3-100.4 μm) and scanning laser polarimetry with variable corneal compensation (24.0-61.7 μm) was identified. Predictors of standard automated perimetry severity using multiple linear regression were mean RNFL thickness using OCT (P=.001) and scanning laser polarimetry (P=.001), OCT-vertical cup diameter (P=.003), temporal, superior, nasal, inferior, temporal standard deviation (P=.03), and OCT-disc area (P=.04). Eyes with an OCTdisc area of less than 2 mm2 demonstrated significantly greater standard automated perimetry damage, RNFL loss using OCT and scanning laser polarimetry, and OCT-rim area (P=.002, .0007, .03, and < .0001, respectively) compared with eyes with a disc area of greater than 2.5 mm2. CONCLUSIONS: Eyes with large VCDR have a wide range of RNFL atrophy and standard automated perimetry damage. Small optic discs are associated with more advanced glaucomatous injury. BACKGROUND AND OBJECTIVE: To characterize the range of retinal nerve fiber layer (RNFL) and standard automated perimetry damage in eyes with large vertical cup-disc ratio (VCDR). PATIENTS AND METHODS: Complete examination, standard automated perimetry, scanning laser polarimetry with variable corneal compensation , and optical coherence tomography (OCT) of the RNFL and optic nerve head were performed. LargeVCDR was defined as ≥0.80 using stereoscopic disc examination and OCT optic nerve head analysis. Structural and functional properties of Structural differences in eyes with a disc area of ​​less than 2 mm2, 2 to 2.5 mm2 and greater than 2.5 mm2. RESULTS: Fifty-seven eyes of 57 subjects were enrolled. A broad range in mean deviation (2.0 to -32.8 dB) and mean RNFL thickness with OCT (24.3-100.4 μm ) and scanning laser polarimetry with variable corneal compensation (24.0-61.7 μm) was identified. Predictors of standard automated perimetry severity using multiple linear regression were mean RNFL thickness using OCT (P = .001) and scanning laser polarimetry (P = .001), OCT-vertical cup diameter (P = .003), temporal, superior, nasal, inferior, temporal standard deviation ), with OCT-disc area (P = .04). Eyes with an OCTdisc area of ​​less than 2 mm2 showed significantly more standardized automated perimetry damage, RNFL loss using OCT and scanning laser polarimetry, and OCT-rim area (P =. 002, .0007, .03, and <.0001, respectively) compared with eyes with a disc area of ​​greater than 2.5 mm2. CONCLUSIONS: Eyes with large VCDR have a wide range of RNFL atrophy and standard automated perimetry damage. are associated with more advanced glaucomatous injury.