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PubMed1976

Reevaluation of the optic disk vasculature.

The optic disk vessels of owl monkeys and humans were studied in whole mounts injected with silicone rubber and by serial sections of paraffin-embedded tissue. The capillary bed of the optic nerve head in continuous on one side with the retinal vessels and on the other side with the optic nerve behind the globe. The choriocapillaris is a separate capillary bed, even though it and the disk capillaries are both supplied by branches of the posterior ciliary artery. At the junction between choroid and optic disk is a cuff of vessels that seems equivalent to an anterior extension of the pial vessels. This cuff includes capillaries of the central nervous system, was well as arterial branches of the posterior ciliary artery that pass retrograde from the peripapillary choroid and sclera into the pial plexus. While not contradicting previous descriptions of the vascular anatomy in this region, we emphasized that the microvascular bed of the disk is anatomically an integral part of the retina-optic nerve vascular system and deemphasized its relationship to the choroidal vasculature.

Animals↗
PubMed1991

[Follow-up of patients suspected of glaucoma using computer-assisted analysis of the optic disk].

The Optic Nerve Head Analyzer was used for longitudinal monitoring of glaucoma suspects. Forty-one patients (76 eyes) were monitored for more than 12 months and 29 patients (51 eyes) for more than 18 months. A significant (p less than or equal to 0.06) decrease in the neuroretinal rim area was found in 8 of 51 eyes monitored greater than 18 months. Thirty-eight of 19 healthy subjects served as the control group. Only 1 of these 38 healthy eyes showed a significant decrease in the neuroretinal rim area (p = 0.04); this decrease is perhaps an artifact caused by the limited accuracy of the Optic Nerve Head Analyzer. From our data we conclude that longitudinal monitoring of patients for glaucoma by means of the Optic Nerve Head Analyzer is an adequate method of detecting ongoing glaucoma damage.

Adolescent↗
PubMed1988

Variability and reproducibility of optic disk topographic measurements with the Rodenstock Optic Nerve Head Analyzer.

Variability of optic disk topographic measurements obtained with the Rodenstock Optic Nerve Head Analyzer was determined by obtaining three separate images on one eye of ten normal subjects and nine subjects without glaucoma. Marking of the disk margin was performed in a random and masked fashion on each image three times by three independent observers. The overall variabilities of the measurements of the subjects with glaucoma were not statistically different from those of the normal subjects. Overall variability was about 0.2 mm2 for total disk area, 0.08 for cup/disk ratio, 0.2 mm2 for disk rim area, and 0.07 mm3 for cup volume. The largest component of the variability was the result of acquisition of separate images of the optic disk at different times. Observer inconsistency in marking the disk edge was relatively small. Based on the expected amount of random variability of the measurements, we proposed criteria for detecting significant change in the optic disk over time.

Adult↗
PubMed2004

Multimodal retinal image registration for optic disk segmentation.

OBJECTIVES: The analysis of the optic disk morphology with the means of the scanning laser tomography is an important step for glaucoma diagnosis. A method we developed for optic disk segmentation in images of the scanning laser tomograph is limited by noise, non-uniform illumination and presence of blood vessels. Inspired by recent medical research, we wanted to develop a tool for improving optic disk segmentation by registration of images of the scanning laser tomograph and color fundus photographs and by applying a method we developed for optic disk segmentation in color fundus photographs. METHODS: The segmentation of the optic disk for glaucoma diagnosis in images of the scanning laser tomograph is based on morphological operations, detection of anatomical structures and active contours and has been described in a previous paper. The segmentation of the optic disk in the fundus photographs is based on nonlinear filtering, Canny edge detector and a modified Hough transform. The registration is based on mutual information using simulated annealing for finding maxima. RESULTS: The registration was successful 86.8% of the time when tested on 174 images. Results of the registration have shown a very low displacement error of a maximum of about 5 pixels. The correctness of the registration was manually evaluated by measuring distances between the real vessel borders and those from the registered image. CONCLUSIONS: We have developed a method for the registration of images of the scanning laser tomograph and fundus photographs. Our first experiments showed that the optic disk segmentation could be improved by fused information from both image modalities.

Fundus Oculi↗
PubMed1996

Optic disk edema with a macular star.

Optic disk edema with a macular star is a descriptive term encompassing a heterogeneous group of disorders. The clinical features include sudden visual loss, swelling of the optic disk, peripapillary and macular exudates that may occur in a star pattern, and cells in the vitreous. Herein we describe the clinical features, potential etiologic factors, differential diagnosis, work-up, and natural history of this entity. Although optic disk edema with a macular star is usually idiopathic, infectious causes, especially syphilis, Lyme disease, cat-scratch disease, and toxoplasmosis, should be considered. The macular exudate likely results from primary optic nerve disease, not from inflammation of the retina; therefore, we prefer the term "idiopathic optic disk edema with a macular star" for idiopathic cases rather than "neuroretinitis." When optic disk swelling and macular star are associated with focal or multifocal inflammatory lesions in the retina (retinitis), especially if an infectious cause is documented, the term "neuroretinitis" is appropriate. The prognosis for visual recovery is usually good, but residual visual loss may be severe in a few cases. Patients with a recurrent type of the disease may not experience pronounced improvement in optic nerve function. The macular exudate may not develop in cases of disk edema until 2 weeks after the patient's initial assessment; thus, patients who have acute papillitis with a normal macula should be reexamined within 2 weeks for development of a macular star. The presence of a macular star militates strongly against subsequent development of multiple sclerosis.

Diagnosis, Differential↗
PubMed1997

Optic disk appearance in pseudoexfoliation syndrome.

PURPOSE: To evaluate the optic disk appearance in eyes with pseudoexfoliation syndrome. METHODS: Clinical data and color stereo optic disk photographs of 99 patients with pseudoexfoliative glaucoma and 42 nonglaucomatous subjects with pseudoexfoliation syndrome were compared with those of 658 patients with primary open-angle glaucoma and of 364 normal subjects. RESULTS: Mean optic disk area was significantly (P = .009) smaller in the pseudoexfoliative glaucomatous eyes (mean +/-SD, 2.52 +/- 0.49 mm2) than in the primary open-angle glaucoma eyes (2.71 +/- 0.63 mm2). Correspondingly, mean optic disk area was significantly (P = .04) smaller in the pseudoexfoliative nonglaucomatous eyes (2.48 +/- 0.52 mm2) compared with the normal eyes without pseudoexfoliation (2.67 +/- 0.67 mm2). Comparing the pseudoexfoliative subgroups with the nonpseudoexfoliative subgroups separately in the glaucomatous and the nonglaucomatous groups, no significant differences were found for neuroretinal rim area, size of alpha and beta zones of the parapapillary atrophy, and diameters of the retinal arterioles and venules at the disk border. In the glaucomatous group, the maximal intraocular pressure measurements were significantly (P < .001) higher in the pseudoexfoliative subgroup than in the subgroup with primary open-angle glaucoma. CONCLUSIONS: Except for a slightly smaller optic disk, eyes with pseudoexfoliative glaucoma and eyes with primary open-angle glaucoma do not vary significantly in their optic disk appearance despite significantly higher intraocular pressure peaks in pseudoexfoliative glaucoma. In eyes with pseudoexfoliation syndrome, a small optic disk does not predispose to glaucoma. In contrast with the anterior segment of the eye, the optic disk does not show pathognomonic features for pseudoexfoliation.

Aged↗
PubMed2003

Bilateral optic disk melanocytoma in a 10-month-old infant.

PURPOSE: To report bilateral optic disk melanocytoma in a healthy infant, METHOD: Case report. RESULTS: A 10-month-old healthy boy presented with intermittent right exotropia. Dilated fundus examination showed a heavily pigmented mass within both optic disks. The optic disks were hypoplastic, and there was diffuse retinal pigment epithelial mottling around the optic disks. Systemic evaluation including thyroid function tests, pituitary gland hormone levels, adrenal gland hormone levels, and magnetic resonance imaging of the brain revealed normal findings. After 1 year, the lesions remained stable, and the patient was healthy with normal growth and development. CONCLUSION: Bilateral optic disk melanocytoma is uncommon. Although this patient had no systemic problem, a literature review revealed an association of bilateral optic disk melanocytoma, optic disk hypoplasia, and central nervous system abnormalities such as meningioma and hypopituitarism. Systemic evaluation for central nervous system abnormalities is warranted in such cases.

Humans↗
PubMed2005

Optic nerve cyst associated with optic disk pits.

PURPOSE: To report a case with two optic disk pits which were associated with an optic nerve cyst in the same eye. METHODS: Observational case report. RESULTS: A 47-year-old patient noted visual impairment in the right eye. On examination the best corrected visual acuity in the right eye was 20/80 and in the left eye was 20/20. Biomicroscopy revealed, in the right eye, a very pale optic disk with two optic disk pits without macular elevation. Magnetic resonance imaging (MRI) revealed a well circumscribed 6 x 6-mm(2) round cystic lesion within the right optic nerve sheath adjacent to the temporal aspect of the right optic nerve at its retrobulbar segment, which compressed and displaced the nerve. CONCLUSIONS: In the case of an extremely pale optic disk with congenital pits and visual impairment without macular detachment, radiological examination is indicated in order to exclude the possibility of coexisting optic nerve anomalies.

Blood Flow Velocity↗
PubMed2001

Interobserver variability of optic disk variables measured by confocal scanning laser tomography.

PURPOSE: To assess the interobserver variation of confocal laser scanning tomographic measurements of the optic nerve head and to address the question of whether the addition of clinical optic disk photographs is helpful in outlining the optic disk margin and in reducing the observer-related variation of the measurements. PATIENTS AND METHODS: Optic disk variables for 16 eyes of 16 patients with glaucoma, generated by confocal laser scanning laser tomography (Heidelberg Retina Tomograph), were independently evaluated by four experienced glaucoma specialists, and the interobserver variability was calculated. A second separate review by the same observers included the use of clinical stereoscopic color optic nerve head photographs to aid definition of the optic disk margin. RESULTS: Optic disk parameters with the smallest interobserver variation were cup shape measure, maximum cup depth, height variation contour, and mean height contour. The intraobserver variation of these parameters did not increase when clinical optic disk slides were additionally available. Parameters with the highest interobserver variation were volume below surface, volume below reference, volume above surface, and volume above reference. The observer variation of these optic disk parameters increased significantly for two of the four examiners when clinical optic disk slides were additionally available for outlining the optic disk margin. CONCLUSION: Confocal laser scanning tomography of the optic nerve head can be improved significantly if clinical optic disk photographs are additionally available to help in outlining the optic disk margin. Because interobserver variation in the tomographic optic disk measurements can be significant, even if experienced observer are involved, tomographic optic disk measurements may be centralized in reading centers in the case of multicenter studies.

Diagnostic Techniques, Ophthalmological↗
PubMed1987

Positional changes in the vasculature of the optic disk in glaucoma.

We analyzed 34 sets of optic disk photographs from 19 patients with glaucoma who had been followed up for ten years to evaluate changes in the position of the vasculature of the optic disks over time. Each photograph was analyzed by an image analyzer's edge-defining program for optic disk analysis and by three experienced clinicians. Image analysis of the blood vessels in 16 optic disks showed positional centrifugal shifts. The clinicians consistently noted changes in the appearance of seven optic disks. The difference between the results obtained using the image analyzer and those obtained by clinical observation was significant (P less than .05).

Adult↗
PubMed1997

Correlation between mean visual field loss and morphometric optic disk variables in the open-angle glaucomas.

PURPOSE: To correlate morphologic changes of the optic disk with mean visual field defect in glaucoma. METHODS: Color optic disk photographs of 302 patients with primary open-angle glaucoma, 53 patients with pseudoexfoliative glaucoma, and 55 patients with normal-pressure glaucoma were morphometrically evaluated. The data were correlated with mean visual field defect. RESULTS: The correlation between mean visual field defect and neuroretinal rim area was similar to a logarithmic function. The visual field deteriorated slightly in the early stage and markedly in the advanced stages of glaucoma. A discrepancy between normal visual field and abnormal optic disk occurred more often in young than in old patients. Neuroretinal rim shape, total rim area, and rim area in the temporal inferior and temporal superior disk sectors correlated best with mean visual field loss. Alpha and beta zones of peripapillary atrophy and diameter of retinal arterioles were less clearly correlated. Calculated rim variables that were corrected for optic disk area did not markedly improve the correlation coefficients. In eyes with normal visual fields, rim shape was the most important disk variable for detecting glaucomatous optic nerve damage. There were no patients with glaucomatous visual field loss and an unremarkable optic disk. CONCLUSIONS: In early glaucoma, changes are more marked in optic disk appearance than in the visual field, suggesting that at least for some patients, for early glaucoma diagnosis, optic disk appearance is more important than perimetry, whereas for follow-up examination, perimetry may be more useful than optic disk morphometry. The most useful planimetric optic disk parameters are neuroretinal rim shape and rim area.

Adult↗
PubMed1993

Growth of the human optic disk and nerve during gestation, childhood, and early adulthood.

We measured vertical and horizontal diameters of the optic disk and retrobulbar optic nerve in eyes from 95 patients on whom autopsies were performed at the UCLA Medical Center over a 20-year period. Ages at death ranged from 4.8 months' gestation to 21.9 years. Optic disk surface area and nerve cross-sectional area were calculated for each subject by using the formula for an ellipse. Approximately 50% of the growth of the optic disk and nerve occurs by 20 weeks' gestation, and 75% by birth; 95% of the growth occurs before the age of 1 year. All optic disk and nerve measurements correlate strongly (correlations > .67; P < .0001) with subject height and globe anteroposterior diameter. We applied our results to the current understanding of optic disk and nerve development, and compared them to previous clinical and pathologic studies of optic nerve dimensions in adults and older children.

Adolescent↗
PubMed1983

Basics of videodisc and optical disk technology.

This article outlines basic videodisc and optical disk technology. Both optical and capacitance videodisc technology are described. Optical disk technology as a mass digital image and data storage device is defined and briefly compared with other established information storage media including magnetic tape and microforms. The article includes a look into the future of videodisc and optical disk.

Information Systems↗
PubMed1987

[Disorders of function in pitting of the optic disk].

Using 44 eyes with optic disk pits as reference material, these pits are described with particular attention to the functional disturbances which accompany them. Visual acuity is reduced in about 50% of eyes thus affected. In two-thirds of the cases the deterioration in visual acuity occurs suddenly and without warning, prompting the patient to see an ophthalmologist. The cause of the sudden disturbance of vision is the formation of subretinal fluid, which presumably originates in the vitreous and then passes through the pit into the subretinal space. In the present study it was demonstrated that pits in the optic disk are also accompanied by a defect in the nerve fiber layer. Under meticulous examination these scotomas can be identified both in static perimetry by their steep scotoma rims and ophthalmoscopically by the absence of the nerve fiber layer and of subretinal fluid. The nerve fiber defects often cause only small scotomas which go unnoticed by the patient. In some cases, when they affect the center, they can also result in reduced visual acuity and strabismus.

Adolescent↗
PubMed1976

The central vascular pattern of the eyeground in children with drusen of the optic disk.

In a series of 50 children with optic disk drusen the anomaly was found to be associated with unusual properties. A cilioretinal artery was more frequent in the series with drusen than in a control series of the same age. The emergence and course of the central retinal vessels were studied in the right-sided fundi of 46 of the children and in two control series (the fundi of the "better" eyes of 46 strabismic children and the fundi of one of the eyes of 10 children or young adults with papilledema). Analysis of the measurements indicated that early branching of the central vessels and vascular tortuosity are so frequently associated with optic disk drusen that they can be considered features of the anomaly. On the other hand, the fundal vascular features in papilledema seem to be distinguishable by the method used from those associated with optic disk drusen. When the peripapillary choroidal vascular pattern was studied by fluorescein angiography, choriocapillaris filling was delayed in about the half of the angiograms. The aberrant vascular features found on and around optic disks with drusen can be explained by an embryonic affection of the developing vascular system at the optic nerve head. In this respect the anomaly seems to resemble congenital disorders of mesodermal origin.

Adolescent↗
PubMed2001

Optical coherence tomography in optic disk pit maculopathy treated by the macular buckling procedure.

PURPOSE: To report optical coherence tomography in optic disk pit maculopathy treated with macular scleral buckling procedure. METHODS: Twenty six eyes (26 patients) with optic disk pit maculopathy were treated with macular buckling procedure and evaluated with optical coherence tomography. In group 1, five eyes were evaluated with optical coherence tomography before and after macular buckling procedure. In group 2, 21 eyes were evaluated with optical coherence tomography after macular buckling procedure. With optical coherence tomography, cross-sectional, horizontal retinal images were obtained through the fovea and optic disk pit. RESULTS: In group 1, four of five eyes showed absorption of intraretinal fluid 7 to 9 months after macular buckling procedure. After absorption of fluid, retinal thickness in the foveal center ranged from 128 to 178 microm. In one eye the channel from optic disk to fovea reopened and fluid reappeared. In group 2, 20 of 21 eyes showed absorption of intraretinal schisis and subretinal fluid after macular buckling procedure. After absorption of fluid, retinal thickness in the foveal center ranged from 119 to 216 microm. CONCLUSIONS: In optic disk pit maculopathy, optical coherence tomography enabled morphologic assessment of the retina before and after macular buckling procedure. In the successfully treated cases the permanent closure of the connection between the optic disk pit and the intraretinal schisis was demonstrated. Eventual disappearance of schisis and subretinal fluid was depicted. It was also proved that the thickness of the macula returned to normal and visual acuity improved.

Adolescent↗
PubMed1976

Congenital anomalies of the optic disk.

Six patients had congenital anomalies of the optic disk: epipapillary fibrous tissue, peripapillary pigmentary disturbance, and anomalies in the size of the optic disk and in the retinal vessels. Congenital anomalies of the optic disk form a spectrum in which many of the ophthalmoscopic features are shared and in which visual function varies.

Adolescent↗