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Fluorescein angiography in nonischemic optic disc edema.

OBJECTIVE: To determine whether nonischemic optic disc edema is associated with significant delay in fluorescein angiographic optic disc filling. METHODS: Fluorescein angiograms from 16 patients with acute papillitis, five with papilledema, and one with optic disc edema from orbital cavernous hemangioma were compared with those of age-matched controls. Early views of the optic disc were evaluated for onset of central retinal artery dye filling and both onset and completion of choroidal and prelaminar optic disc dye filling. Data were compared with our previously published figures for patients with nonarteritic anterior ischemic optic neuropathy (NAION) and a new group of patients aged 46 years and younger with NAION (NAIONy). Subgroup analysis was performed on data from patients with papillitis. RESULTS: Mean onset or completion of filling was not significantly delayed compared with controls for the central retinal artery, choroid, or prelaminar optic disc in patients with nonischemic optic disc edema, including the subgroup of patients with papillitis. In comparison, significant delay had been detected for onset and filling of prelaminar disc in typical NAION; similar significant delay was noted in this study for patients with NAIONy. No patients with nonischemic optic disc edema (including those with papillitis) demonstrated delay of disc filling by at least 5 seconds, while this feature was detected in 76% of patients with typical NAION and 62% of those with NAIONy. CONCLUSIONS: Optic disc filling delay is common in typical NAION and NAIONy; it is not a feature of nonischemic optic disc edema. This characteristic may aid in the differentiation of NAION from papillitis.

Acute Disease↗

[Echographic differential diagnosis of optic nerve widening].

INTRODUCTION: Standardized echography is a well-established examination technique in ophthalmology. Among other things one of the more important uses is the evaluation of the optic nerve and its abnormalities. One aspect is the use of the stretch-test (originally called the "30 degrees-test") for the differential diagnosis of optic nerve widening. Such widening can be caused by solid thickening of the optic nerve and/or its sheaths or by solid infiltration of the subarachnoidal space. More frequent is a widening of the optic nerve as a consequence of sheath distension by increased subarachnoidal fluid. PATIENTS AND METHODS: We present various cases of widened optic nerve patterns and explain the technique and diagnostic value of standardized echography, especially of the stretch-test. RESULTS: In widened optic nerve patterns due to fluid around the optic nerve parenchyma, a decreased optic nerve thickness will be found when performing the stretch-test (positive test result), whereas in solid lesions of the optic nerve no change of optic nerve thickness will be seen (negative test result). CONCLUSION: The stretch-test provides a reliable tool for the differential diagnosis of widened optic nerves.

Adult↗

Small neuroretinal rim and large parapapillary atrophy as predictive factors for progression of glaucomatous optic neuropathy.

PURPOSE: To evaluate which morphologic features of the optic disc are predictive factors for progressive neuroretinal rim loss in chronic open-angle glaucoma. DESIGN: Prospective, observational case series. PARTICIPANTS: The study included 394 eyes of 257 white patients with chronic open-angle glaucoma. Mean follow-up time was 31.8 months (median, 39.7 months). Progression of glaucoma was defined as loss of neuroretinal rim as detected by disc photographs. Presence of optic disc hemorrhages was not taken into account. METHODS: All patients underwent repeated qualitative and morphometric evaluation of color stereo optic disc photographs. Statistical analysis included Kaplan-Meier curves, and bivariate and multivariate Cox regression analysis adjusted for patients' ages. Dependency of left and right eyes from the same subject was taken into account. MAIN OUTCOME MEASURES: Qualitative and quantitative morphologic optic nerve head parameters. RESULTS: Progression of glaucomatous optic nerve changes was detected in 42 eyes (11%). At baseline of the study, neuroretinal rim area (total area, P = 0.03) was significantly smaller, and beta zone of parapapillary atrophy (total area, P = 0.04) was significantly larger in the progressive study group compared with the nonprogressive study group. Neither study group varied significantly in size and shape of the optic disc, optic cup depth, alpha zone of parapapillary atrophy, and diameter of the retinal arteries and veins (P > 0.05). Multiple Cox regression analysis revealed that the progression of glaucoma depended significantly on the area of the neuroretinal rim (temporal sector, P = 0.003) and beta zone of parapapillary atrophy (temporal inferior sector, P = 0.02). CONCLUSIONS: Important morphologic predictive factors for progression of the glaucomatous appearance of the optic nerve head in white persons are small size of neuroretinal rim and large area of beta zone of parapapillary atrophy. Progression of glaucomatous optic nerve head changes is independent of size and shape of the optic disc, size of alpha zone of parapapillary atrophy, retinal vessel diameter, and optic cup depth.

Adolescent↗

The disc-macula distance to disc diameter ratio: a new test for confirming optic nerve hypoplasia in young children.

The disc-macula: disc diameter (DM:DD) ratio is the ratio of the horizontal distance between the center of the optic disc and the macula to the mean diameter of the optic disc, as evaluated from fundus photographs. The diagnosis of optic nerve hypoplasia may be difficult in cases in which the optic discs are slightly reduced in size, or when the double ring sign is absent and the condition is bilateral. The DM:DD ratio was calculated for six eyes of five children with ophthalmoscopically obvious optic nerve hypoplasia, 12 eyes of six children in whom the diagnosis of optic nerve hypoplasia was equivocal (but established by visual field examination and retinal red free photography), 13 eyes of eight children with optic atrophy, and 25 eyes of 17 children with normal optic discs. The DM:DD ratio was found to be significantly higher for both groups with optic nerve hypoplasia than for those with optic atrophy and the normal controls. For practical purposes, when the DM:DD ratio is greater than 3.0, the diagnosis of optic nerve hypoplasia should be seriously considered.

Adolescent↗

Omics in hereditary optic neuropathies: A systematic review of clinical studies with an integrated point of view.

Hereditary optic neuropathies are characterized by bilateral visual loss due to the degeneration of retinal ganglion cells, resulting in optic nerve degeneration and atrophy. Although the genetic origin of the main isolated and syndromic hereditary optic neuropathies has been characterized, the clinical phenotypes exhibit significant and poorly understood variability in both penetrance and expressivity. Additionally, the genetic and environmental factors that influence the onset of these optic neuropathies remain poorly understood, with limited biomarkers to predict disease progression or as readouts for therapeutic trials. Data-driven omics strategies allow deep phenotyping to improve our understanding of pathophysiological mechanisms and to search for new biomarkers and therapeutic targets. We explore whether the omics strategies applied to patients with hereditary optic neuropathies have provided such new insights. MEDLINE, Web of Science and EMBASE databases were screened for studies with terms relating to hereditary optic neuropathies, transcriptomics, epigenomics, proteomics, metabolomics and lipidomics in clinical studies exploring patients' samples. Out of 1244 references identified, 22 articles were included after double-masked data curation. These articles focused only on the 3 main forms of hereditary optic neuropathies, namely, OPA1-related dominant optic atrophy (n = 4), Leber hereditary optic neuropathy (n = 13), and Wolfram syndrome (n = 5). While the methodological designs and results of these studies were highly heterogeneous, they revealed molecular alterations that we have attempted to discuss at the integrated multi-omics level. This data integration highlighted several common pathophysiological mechanisms such as energetic impairment, endoplasmic reticulum stress, proteotoxic and oxidative stresses, lipid remodeling and altered amino acid and purine metabolisms, while suggesting potential new biomarkers and therapeutic targets. These findings underscore the potential of integrated multi-omics approaches to deepen our understanding of the phenotypic complexity of hereditary optic neuropathies and to support the development of innovative diagnostic and therapeutic strategies.

Humans↗

Development of dorsal-ventral polarity in the optic vesicle and its presumptive role in eye morphogenesis as shown by embryonic transplantation and in ovo explant culturing.

Dorsal and ventral specification in the early optic vesicle appears to play a crucial role in the proper development of the eye. In the present study, we performed embryonic transplantation and organ culturing of the chick optic vesicle in order to investigate how the dorsal-ventral (D-V) polarity is established in the optic vesicle and what role this polarity plays in proper eye development. The left optic vesicle was cut and transplanted inversely in the right eye cavity of host chick embryos. This method ensured that the D-V polarity was reversed while the anteroposterior axis remained normal. The results showed that the location of the choroid fissure was altered from the normal (ventral) to ectopic positions as the embryonic stage of transplantation progressed from 6 to 18 somites. At the same time, the shape of the optic vesicle and the expression patterns of Pax2 and Tbx5, marker genes for ventral and dorsal regions of the optic vesicle, respectively, changed concomitantly in a similar way. The crucial period was between the 8- and 14-somite stages, and during this period the polarity seemed to be gradually determined. In ovo explant culturing of the optic vesicle showed that the D-V polarity and choroid fissure formation were already specified by the 10-somite stage. These results indicate that the D-V polarity of the optic vesicle is established gradually between 8- and 14-somite stages under the influence of signals derived from the midline portion of the forebrain. The presumptive signal(s) appeared to be transmitted from proximal to distal regions within the optic vesicle. A severe anomaly was observed in the development of optic vesicles reversely transplanted around the 10-somite stage: the optic cup formation was disturbed and subsequently the neural retina and pigment epithelium did not develop normally. We concluded that establishment of the D-V polarity in the optic vesicle plays an essential role in the patterning and differentiation of the neural retina and pigment epithelium.

Animals↗

Optical imaging of parallel fiber activation in the rat cerebellar cortex: spatial effects of excitatory amino acids.

Using optical imaging, the effects of excitatory amino acids and their antagonists on the spatial pattern of activity evoked by the stimulation of parallel fibers in the cerebellar cortex of the anesthetized rat were examined. A vermal folium was stained with the stryrl voltage-sensitive dye RH-795 and imaged with a cooled charge-coupled service system during the activation of the parallel fibers with surface stimulation. Stimulation of the cerebellar cortex produced discrete "beams" of optical activity consistent with extracellular field recordings. The signal-to-noise ratio was excellent (> 10:1), reducing the number of stimuli, exposure time, and acquisition time needed to produce images. Extracellular field potential recordings were used to assay neuronal activity as well as the effects of the various excitatory amino acid agonists. Application of several glutamate receptor antagonists reversibly blocked the optical signals as well as the synaptic components of the extracellular field potentials. Neither N-methyl-D-aspartate nor its antagonist, (+/-)-2-amino-7-phosphonoheptanoic acid, had any affect on the optical signals or field potentials. These results indicate that the optical signal is not due to the evoked parallel fiber activity, but is generated mainly by postsynaptic targets and the parallel fiber synaptic action is primarily mediated by non-N-methyl-D-aspartate receptors. Other excitatory amino acid agonists had a differential effect on the optical response. Glutamate and kainate increased the "on beam" optical signal evoked by parallel fiber stimulation, in amplitude and width. In contrast, quisqualate always decreased the amplitude and width of the optical beam. Also, quisqualate produced an increase in fluorescence lateral to the optical beam, possibly due to an increase in "off beam" inhibitory activity. The changes in the extracellular field potentials were in agreement with the effects on the optical signals. Two possible mechanisms are proposed to account for the inhibitory effect of quisqualate. One is that quisqualate desensitizes Purkinje cell receptors, the other is that inhibitory interneurons in the cerebellar cortex are more preferentially excited with quisqualate application which in turn inhibits Purkinje cells both "on beam" and "off beam". In conclusion, voltage-sensitive dye optical signals evoked by stimulation of the cerebellar surface were imaged at high signal-to-noise levels using a cooled charge-coupled device system. Use of excitatory amino acid agonists and antagonists demonstrated that the optical signal was dependent on postsynaptic activity and confirmed that the parallel fiber postsynaptic action is primarily mediated by non-N-methyl-D-aspartate receptors.(ABSTRACT TRUNCATED AT 400 WORDS)

2-Amino-5-phosphonovalerate↗

Contrast response in visual cortex: quantitative assessment with intrinsic optical signal imaging and neural firing.

While previous studies showed that intrinsic optical signals spatially correspond with electrophysiological responses in mammalian visual cortex, the quantitative correspondence of their response strengths is open to question. Measurement of both signals' strength as functions of visual stimulus contrast provides an opportunity for quantitative comparison. Towards that end, the spatial and temporal properties of the optical signal impose important constraints upon quantification of its strength. We used intrinsic optical signal imaging and single unit recording to measure responses to drifting gratings at contrasts ranging from 10-80% in cat area 18. We calculated the average difference images for pairs of oppositely moving, or orthogonally oriented, gratings at each contrast and evaluated three different methods for quantifying optical signal strength. After about 2.5 s, the spatial patterns of optical images and the time course of their strength were contrast-invariant. This "space-time-contrast separability" for optical response implies a spatial uniformity of the optical contrast response functions, provides an objective basis to guide temporal averaging of optical signals, and validates a scalar metric of optical signal strength. Optically measured contrast response functions increase monotonically and saturate at high contrasts, qualitatively resembling those from single units. However, quantitative comparison reveals a nonlinear relationship with neural firing, such that the optical response reaches half of its maximum when the neural response has reached only around 20% of its maximum. This relationship suggests that intrinsic optical signals are relatively more sensitive to weak signals than neural firing.

Animals↗

Damage to intracranial optic pathways in fatal closed head injury in man.

Head injury is a leading cause of visual impairment. This is partly due to direct trauma to the eye and optic nerve but much of the damage involves the intracranial optic pathways. We have studied the frequency, distribution and nature of the intracranial lesions of the optic pathways at autopsy in 45 cases of severe closed head injury, and examined the correlation between these post-mortem lesions and the ante-mortem clinical findings. Twenty-four of the patients had been involved in road traffic accidents. The ages ranged from 9 to 88 years (mean 46.4), the Glasgow Coma Score (GCS) on admission ranged from 3 to 15 (mean 5), and the survival time after injury from 2.5 h to15 days (mean 3.3 days). Skull fractures were present in 75.6% of the cases. Histological assessment included the use of immunohistochemistry for beta-amyloid precursor protein (beta-APP) and the microglial marker CD68. Axonal injury of varying severity was demonstrable in all cases, and in 39 (87%) the optic chiasm, tracts or radiations were involved, usually in more than one region. The severity of axonal injury was mild in 11 (24%), moderate in 9 (20%) and severe in 19 (42%) cases. The optic radiation at the level of the trigone of the lateral ventricle was particularly frequently and severely affected. The least affected parts of the intracranial optic pathways were the optic chiasm and the posterior segment of the optic nerve. The severity of injury to the optic pathways did not always reflect severity of axonal injury elsewhere in the brain and correlated poorly with the type of trauma (high- or low-velocity), presence of skull fractures or evidence of raised intracranial pressure (ICP). Of the 39 patients who survived more than 6 h, histological evidence of ischaemic injury to the primary optic cortex was present in 26 (67%) and was severe in 12. We conclude that the visual pathways are affected in a high proportion of patients with fatal closed head injury, nerve fibres in the optic radiations being particularly vulnerable. The findings suggest that damage to the posterior parts of the optic pathways may be under-diagnosed among patients with head injury.

Adolescent↗

Standardisation of platelet counting accuracy in blood banks by reference to an automated immunoplatelet procedure: comparative evaluation of Cell-Dyn CD4000 impedance and optical platelet counts.

Prophylactic and therapeutic platelet transfusions are increasingly used for patients with conditions associated with thrombocytopenia in order to prevent the development of potentially life threatening bleeding. These clinical strategies have led to a significant expansion in platelet unit manufacture, and this now represents a major resource and cost commitment for blood banks. As part of the manufacturing process, blood banks are required to implement control procedures, and the determination of platelet counts in particular is necessary to confirm that the quality of platelet unit production meets the standards defined by national or international guidelines. Apart from linearity analysis and comparisons of platelet counts given by different instruments, there has been no systematic standardisation of platelet counting methods in blood bank practice because to date there has been no suitable reference method for counting platelets in citrate anticoagulants. The recent introduction of an automated immunoplatelet procedure on the Cell-Dyn CD4000 provides a means of determining a true platelet count that is unaffected by changes induced either by storage or anticoagulant. The CD4000 in its routine configuration also provides simultaneous impedance and optical platelet counts and this study was therefore undertaken in order to compare all three different platelet counting methods in parallel with a representative series of platelet units. Platelet counts determined after sub-sampling of platelet units into EDTA vs plain non-anticoagulated tubes revealed no differences in impedance or immunoplatelet counts but generally lower optical counts when aliquoted into tubes that did not contain EDTA. This study therefore routinely used EDTA for platelet unit sub-samples. Comparative results of platelet counts for buffy coat platelet units (n = 36) aliquoted into EDTA indicated that the impedance count was higher than the reference immunoplatelet count by a mean factor of 1.25 while the optical count was lower by a mean factor of 0.87. The degree of impedance count overestimation was particularly consistent while the optical count underestimation was more variable. Linearity studies of 10 fresh platelet units showed no deviation in the range 0-2305 x 10(9) l(-1) for impedance and 0 to 1420 x 10(9) l(-1) for the optical counts, and the relative numerical relationships between impedance and optical counts were conserved throughout the range of dilutions tested. In the CD4000 optical analysis, blood samples anticoagulated with EDTA showed a distinctive elliptical population distribution that fell within the system thresholds. In contrast, the optical pattern observed for platelet units (in CPD) and ACD-anticoagulated venous blood showed a wider 90 degrees scatter with a population of platelet events above the upper parallel discriminator. As these were excluded from the optical count (but were still identified as platelets by the immunoplatelet method) it meant that the optical counts of samples in citrate-based anticoagulants were systematically lower than immunoplatelet counts. Platelet units (n = 15) analysed daily over a seven day period of storage revealed that the greatest decline in platelet counts was with the optical measurement while the most stable value was obtained by impedance analysis. The results of the immunoplatelet analysis further suggested a progressive increase in small platelets with increasing storage time. The use in this study of a standardised immunoplatelet reference method to examine the question of analyser suitability for determining platelet counts/yields of platelet units thus provided a number of important findings. An impedance platelet counting method is utilised by the great majority of haematology instruments in current use, and in common with the CD4000 analyser, a correction factor is employed to take account of RBC/platelet coincidence. This study found that when analysed samples such as platelet units were RBC-free, that an inappropriate correction factor was applied. Consequently, the CD4000 impedance platelet count will provide reliable platelet counts, irrespective of the day of platelet unit storage, when a factor of 1.25 is applied to the system-reported result. By comparison, optical methods are more likely to be affected by subtle morphological changes that may result from anticoagulants or progressive storage time. The method limitations documented by this study may well affect many other analysers and mean that the implementation of process control statistics related to platelet counts may be less reliable than previously assumed. It is suggested that standardisation could be much better achieved if there was some form of system cross-calibration that was referenced to an independent method such as an immunoplatelet assay. It is proposed that studies of this type should be extended to a wide assessment of platelet count accuracy of blood bank instruments in order to standardise data within national organisations. If consistent inter-instrument correction factors such as those documented here can be identified, it would considerably increase the relevance of determining platelet counts in production control processes.

Adult↗

Interlaminar connections of the superior colliculus in the tree shrew. III: The optic layer.

These experiments were designed to test the idea that the optic layer in the tree shrew, Tupaia belangeri, is functionally distinct and provides a link between the visuosensory superficial and the premotor intermediate layers of the superior colliculus. First, cells in the optic layer were intracellularly labeled with biocytin in living brain slices. Compared to cells in the adjacent lower part of the superficial gray layer, which have apical dendrites that ascend toward the tectal surface, optic layer cells have dendritic fields that are restricted for the most part to the optic layer itself. The differences in dendritic-field location imply that superficial gray and optic layer cells have different patterns of input. The axons of optic layer cells terminate densely within the optic layer and, in addition, project in a horizontally restricted fashion to the overlying superficial gray and subjacent intermediate gray layers. This pattern also is different from the predominantly descending interlaminar projections of lower superficial gray layer cells. Next, cells in the intermediate gray layer were labeled in order to examine the relationships between optic layer cells and these subjacent neurons that project from the superior colliculus to oculomotor centers of the brain stem. Neurons in the upper part of the intermediate gray layer send apical dendrites into the optic layer and therefore can receive signals from the superficial gray layer either directly, from descending axons of lower superficial gray layer cells, or indirectly, through intervening optic layer cells. In contrast, lower intermediate gray layer cells have more radiate dendritic fields that are restricted to the intermediate gray layer. Thus, these lower cells must depend on descending projections from optic or upper intermediate gray layer cells for signals from the superficial gray layer. Together, these results support the idea that the optic layer is a distinct lamina that provides a link between the superficial and intermediate gray layers. They also are consistent with the traditional view that descending intracollicular projections play a role in the selection of visual targets for saccades.

Animals↗

Optic flow helps humans learn to navigate through synthetic environments.

Self-movement through an environment generates optic flow, a potential source of heading information. But it is not certain that optic flow is sufficient to support navigation, particularly navigation along complex, multi-legged paths. To address this question, we studied human participants who navigated synthetic environments with and without salient optic flow. Participants used a keyboard to control realistic simulation of self-movement through computer-rendered, synthetic environments. Because these environments comprised series of identically textured virtual corridors and intersections, participants had to build up some mental representation of the environment in order to perform. The impact of optic flow on learning was examined in two experiments. In experiment 1, participants learned to navigate multiple T-junction mazes with and without accompanying optic flow. Optic flow promoted faster learning, mainly by preventing disorientation and backtracking in the maze. In experiment 2, participants found their way around a virtual city-block environment, experiencing two different kinds of optic flow as they went. By varying the rate at which the display was updated, we created optic flow that was either fluid or choppy. Here, fluid optic flow (as compared with choppy optic flow) enabled participants to locate a remembered target position more accurately. When other cues are unavailable, optic flow can be a significant aid in wayfinding. Among other things, optic flow can facilitate path integration, which involves updating a mental representation of place by combining the trajectories of previously travelled paths [corrected].

Adolescent↗

Metastatic neoplasms in the optic disc: the 1999 Bjerrum Lecture: part 2.

BACKGROUND: Little information is available on metastatic tumors to the optic disc. OBJECTIVE: To determine the clinical features and prognosis of patients with optic disc metastasis. DESIGN: Retrospective chart review. RESULTS: Of 660 consecutively evaluated patients with intraocular metastasis, 30 (4.5%) (31 eyes) had metastatic cancer to the optic disc; 24 (80%) were women and 6 (20%) were men. Mean age at the time of ocular diagnosis was 55 years. The primary neoplasm was in the breast in 13 patients (43%), in the lung in 8 (27%), in the intestine in 1 (3%), in the kidney in 1 (3%), and in the prostate in 1 (3%); the primary neoplasm was never determined in 6 patients (20%). The optic disc metastasis was unilateral in 29 patients (97%) and bilateral in 1 (3%). Ophthalmoscopically, the disc metastasis appeared as a diffuse enlargement of the optic disc in 26 eyes (84%) and as a distinct nodule in 5 (16%). There was an adjacent juxtapapillary choroidal component to the metastatic disc lesion in 23 eyes (74%), and the optic disc was involved without a retinal or choroidal component in 8 (26%). Other associated findings included some degree of secondary disc edema in all eyes, buried disc blood vessels in 23 (74%), and splinter hemorrhages in 13 (42%). Fine needle aspiration biopsy was useful in establishing the diagnosis in all 5 eyes in which it was performed. Mean survival was 13 months after diagnosis of the disc metastasis. CONCLUSIONS: Metastasis to the optic disc accounts for 5% of all intraocular metastases. It can occur as invasion from a juxtapapillary choroidal metastasis or as isolated optic disc metastasis. Breast and lung cancers are the most common primary neoplasms that account for metastasis to the optic disc. The primary site is never determined in 20% of patients. The characteristic clinical features of optic disc metastasis should help differentiate it from other causes of swollen optic disc. Patient prognosis is poor.

Adult↗

Racial differences in optic disc topography: baseline results from the confocal scanning laser ophthalmoscopy ancillary study to the ocular hypertension treatment study.

OBJECTIVE: To examine racial differences in optic disc topography among ocular hypertensive participants in the Ocular Hypertension Treatment Study. METHODS: Four hundred thirty-nine participants from 7 Ocular Hypertension Treatment Study centers who had good-quality baseline images obtained using a quantitative 3-dimensional confocal scanning laser ophthalmoscope, the Heidelberg Retina Tomograph (Heidelberg Engineering, Dossenheim, Germany), were included in this study. The first 10 degrees- or 15 degrees-field of view mean topographic image acquired was included in all analyses. Differences in Heidelberg Retina Tomograph topographic optic disc parameter measurements by self-identified race were assessed using a mixed-effects linear model to control for confounders and for the use of both eyes in the model. RESULTS: By self-attribution, 74 (17%) of the 439 participants were of African origin, 329 (75%) were white, 24 (5%) were Hispanic, and 12 (3%) were Native American, Native Alaskan, Asian, Pacific Islander, or unknown. The African American participants had statistically significantly (P<.001) larger mean (SD) optic disc areas than the other participants, 2.17 (0.41) mm(2) vs 1.87 (0.38) mm(2), respectively. African American participants had a larger cup area, cup volume, cup depth, neuroretinal rim area, rim volume, and smaller rim-optic disc area ratios than the other participants. No difference between African American and the other participants was found for cup shape and retinal nerve fiber layer thickness. After controlling for optic disc area, none of the differences between African American and the other participants found in the univariate analysis remained statistically significant (P>.10). CONCLUSIONS: This study demonstrated in a large cohort of subjects with ocular hypertension, that African Americans have significantly larger optic discs, optic cups, neuroretinal rims, and cup-disc ratios than other racial groups. Furthermore, this study found that differences in topographic optic disc parameters between African Americans with ocular hypertension and other racial groups are largely explained by the larger optic disc area in the African Americans. These results highlight the need to consider race and optic disc size when evaluating the appearance of the optic disc in glaucoma.

Antihypertensive Agents↗

Simple photogrammetric diagnosis of optic nerve hypoplasia.

It is often clinically important, but also often difficult, to make a definitive morphologic diagnosis of optic nerve hypoplasia in a young child. If, however, one can obtain a photograph of the fundus, including the optic disc, one can make a simple measurement of the horizontal diameter of the optic disc and make this diagnosis. To determine if the horizontal diameter of the optic disc on a 35-mm photographic transparency could be used to separate patients with optic nerve hypoplasia from normal individuals, I measured directly on the transparency the horizontal diameter of the optic disc image taken by a standard 30 degrees field fundus camera with X2.5 magnification in a series of 55 normal eyes, and in 16 eyes with clinically confirmed optic nerve hypoplasia. For the normal series of eyes, the mean optic disc horizontal image diameter was 3.88 mm, with a range of 3.44 to 4.70 mm. For the series of eyes with optic nerve hypoplasia, the mean horizontal diameter was 2.64 mm, with a range of 1.80 to 3.27 mm. There was no overlap between the normal control series and the pathologic series. In subjects with no major ametropia (less than 2.5 diopters of spherical or cylindrical refractive error), a 3.4-mm horizontal diameter optic disc image on a 35-mm transparency can be used as a clinical guide or dividing line for the diagnosis of optic nerve hypoplasia, larger nerves being considered normal and smaller nerves being considered hypoplastic.

Adolescent↗

Influence of optic disc size on parameters of retinal nerve fiber analysis with laser scanning polarimetry.

PURPOSE: The aim of the study was to evaluate the influence of optic disc size on the variables of laser scanning polarimetry (GDx). PATIENTS AND METHODS: One hundred and nineteen healthy controls and 161 patients with ocular hypertension (OHT) received detailed ophthalmologic investigation with respect to glaucoma including retinal nerve fiber analysis with GDx (Version 3.0.05x1; Laser Diagnostic Technologies Europe). Optic disc size was measured with planimetry using 15 degrees optic disc photographs. With respect to frequency of optic disc size in the normal population patients were divided in quartiles of equal sample size. RESULTS: The ratio between retinal nerve fiber layer thickness in the superior and inferior areas in relation to the nasal and temporal regions decreases significantly with increasing optic disc size and the difference between the highest and lowest retinal nerve fiber layer thickness decreases significantly with increasing optic disc size. The results of multivariate neural network analysis increased with larger optic disc size in controls as well as in patients with OHT. Linear regression analysis showed an increase of 9 units (the Number) per 1 mm(2) of optic disc size. A Number above 30, which indicates suspected glaucoma, was detected in more than a third of the normal population investigated if the optic disc area was larger than 3.5 mm(2). Overall, patients with OHT had a higher Number than controls (20.5+/-11.5 vs. 18.1+/-10.4; p>0.05), but the difference between the two groups did not reach a significant level. CONCLUSIONS: Retinal nerve fiber analysis in patients with an optic disc size larger than 3.5 mm(2) should be interpreted carefully; the Number in particular requires corrections for optic disc size.

Adolescent↗

Structure and function evaluation (SAFE): II. Comparison of optic disk and visual field characteristics.

PURPOSE: To evaluate the relationship between glaucomatous structural damage to the optic nerve and development of visual field loss with standard automated perimetry (SAP) and short wavelength automated perimetry (SWAP). DESIGN: Cohort study. METHODS: Patients with elevated intraocular pressure and normal SAP visual fields were enrolled in this prospective study. Stereo optic disk photographs, SAP, and SWAP visual fields were obtained annually over a period of 4 or more years. Trained readers evaluated baseline and follow-up optic disk photographs for evidence of glaucomatous damage. Standard automated perimetry and SWAP examinations were evaluated according to previously validated criteria for development of confirmed visual field changes. RESULTS: Two-hundred ninety-five subjects (479 eyes) were enrolled. Following masked assessment of stereo photographs by an optic disk reading center, 272 of the 479 eyes were judged to have glaucomatous optic neuropathy at the time of study entry. Depending on the criteria employed, approximately 10% to 17.5% of all eyes developed confirmed visual field loss for SAP (conversions). Of the conversions, 75% to 80% had baseline glaucomatous optic disk damage, whereas normal and glaucomatous optic disks were equally divided (50%) among the nonconversion eyes. This difference was statistically significant (P <.003). Depending on the criteria employed, 4% to 12% of the eyes had confirmed SWAP deficits at baseline, and 4% to 8% developed confirmed SWAP defects at a follow-up examination. There was a greater percentage of eyes with a glaucomatous optic neuropathy in the group with SWAP deficits (75%-100%) than for those eyes in which SWAP remained normal (45%-60%). Some of these differences were statistically significant (P <.05). CONCLUSIONS: A strong relationship exists between glaucomatous optic disk damage at study entry and the subsequent development of a confirmed glaucomatous SAP visual field defect. A higher percentage of glaucomatous optic disks were also found in patients with SWAP deficits at baseline and in those who later developed SWAP deficits. These findings support the premise that a glaucomatous optic disk is predictive of the subsequent development of glaucomatous visual field loss.

Follow-Up Studies↗

Echographic measurement of optic nerve thickness correlated with neuroretinal rim area and visual field defect in glaucoma.

PURPOSE: To determine whether echographic measurements of the pial diameter of the optic nerve are significantly correlated with glaucomatous changes of the optic disk and retinal nerve fiber layer. METHODS: In 31 patients with primary open-angle glaucoma and 16 normal control subjects, optic nerve thickness was determined by measuring the maximal pial diameter of the optic nerve using standardized A-scan echography. The optic disks were morphometrically examined using color stereo photographs, and the retinal nerve fiber layer was assessed using wide-angle red-free fundus photographs. RESULTS: Optic nerve thickness as measured echographically decreased significantly (P < .001) with decreasing neuroretinal rim area, diminishing visibility of the retinal nerve fiber layer, narrowing of the retinal arterioles, enlarging parapapillary atrophy, and increasing mean visual field defect. In an intraindividual bilateral comparison, side differences in the optic nerve thickness were significantly correlated with side differences in neuroretinal rim area (P < .0001), diameter of retinal arterioles (P = .003), and visual field defect (P < .0001). In the differentiation of normal and glaucomatous eyes, sensitivity and specificity were higher for echographic measurements of the optic nerve thickness than for parapapillary atrophy and diameter of retinal arterioles but worse than for determination of the neuroretinal rim area. CONCLUSIONS: Echographic measurements of optic nerve thickness are significantly correlated with glaucomatous changes of the optic disk and retinal nerve fiber layer. In patients with opaque media, echographic measurement of optic nerve thickness may be helpful in distinguishing among normal eyes, eyes with medium advanced glaucoma, and eyes with markedly progressed glaucoma.

Adult↗