To estimate the usefulness of photographs of the retinal nerve fiber layer in demonstrating glaucomatous neural tissue changes, we examined such photographs of 51 patients with glaucoma, 52 patients with ocular hypertension, and 29 normal individuals. The photographs were assessed in a masked fashion. A semiquantitative damage score was given in subsectors of the arcuate, papillomacular, and nasal nerve fiber bundle areas, separately for localized and diffuse loss of nerve fibers. The coefficients of variation of the reproducibility of retinal nerve fiber layer assessment were 0.22 for diffuse damage and 0.11 for localized damage. We detected abnormal retinal nerve fiber layer changes in 48 of the patients with glaucoma, in 27 of those with ocular hypertension, and in five of the normal control subjects. Generalized reduction of nerve fibers with or without localized defects was more common in patients with glaucoma than in those with ocular hypertension whose abnormal findings were primarily localized defects.