Optic Disk

A multi-modality treatment programme, where stereotactic methods were used preferentially, gave results in a consecutive series of craniopharyngiomas, not inferior to those reported after microsurgical removal. Fourty-two patients with a follow-up range of 10-23 years are reported.

The major objective of this study was to test the reproducibility of a new method of estimating the amount of optic disc damage in patients with glaucoma. The Disc Damage Likelihood Scale (DDLS) is based on the appearance of the neuroretinal rim of the optic disc corrected for disc diameter. The eight stages, extending from no damage to far advanced damage, are based on the width of the neuroretinal rim or the circumferential extent of absence of neuroretinal rim. Reproducibility was measured by two masked observers staging 48 optic nerve stereoscopic photographs by two different methods, the cup/disc ratio (c/d) and the DDLS. Also, reproducibility was assessed by three observers examining 34 eyes of 24 patients. With regard to the photographs, the intraobserver and interobserver reproducibility was better using the DDLS than the c/d ratio (98% versus 85% for intraobserver of reproducibility, and 85% versus 74% for interobserver reproducibility). The DDLS correlated better with the ...

To examine early myopia-related optic disc and retinal changes in a Singapore Chinese adolescent sample without confounding ocular or systemic disease. Population-based cross-sectional study. Children aged 12 to 16 years at a follow-up visit for Singapore Cohort Study of Risk Factors for Myopia. Detailed eye examinations, including cycloplegic autorefraction and contact biometry, were performed. Retinal photographs were acquired using nonmydriatic retinal photography among children who attended follow-up examinations in 2006, and were graded for myopia-related optic disc signs and macular changes by a single experienced grader. Optic nerve head parameters were measured adjusting for camera and ocular magnification with appropriate formulae. Optic disc changes (tilt, beta peripapillary atrophy [β-PPA], and optic nerve parameters) and macular changes (staphyloma, lacquer cracks, Fuchs' spot, and chorioretinal atrophy). Retinal photography data were available for 1227 children (median age, 14 years; range 12-16). Tilted optic discs were found in 454 subjects (37%), and were associated with myopic spherical equivalent refractions (-3.6 diopters [D] vs -1.3 D; P<0.0001), higher cylindrical error (0.9 vs 0.7 D; P = 0.0001) and longer axial length (24.93 vs 23.96 mm; P<0.0001). The pattern of distribution of the axes of the tilted discs and corneal curvature were similar (P = 0.4). All linear optic nerve parameters, except vertical disc diameter (P = 0.15), were significantly smaller in eyes with than without tilted discs (P <0.001) after adjusting for confounders. Apart from 20 cases, all eyes with tilted optic discs had associated β-PPA. We identified only 1 case each (0.1% prevalence) of staphyloma and lacquer cracks in this sample. In this Asian adolescent population, tilted optic discs were highly prevalent, in contrast with the lower prevalence reported in Caucasian populations. Eyes with tilted discs tended to have smaller optic cups with smaller cup-to-disc ratios, and were associated with myopic refraction, higher astigmatism, and longer axial length. There were similar patterns of distribution between the axis of disc tilt and the axis of corneal curvature, which could have embryologic origins. In contrast with optic disc changes, myopic macular changes were rare in this age group, suggesting that these changes may develop later in life. The authors have no proprietary or commercial interest in any of the materials discussed in this article.

An analysis of data from the Advanced Glaucoma Intervention Study (AGIS) has found eyes reported to have partial optic disc rim notching (not to the edge) at baseline to have less risk of subsequent visual field loss than eyes with no notching. Because this is counterintuitive and because classification of notching had not been defined in the AGIS protocol, we have assessed AGIS ophthalmologists interobserver and intraobserver agreement on notching. Fourteen glaucoma subspecialists classified notching in 26 pairs of stereoscopic disc photographs of eyes with mild to severe glaucomatous optic neuropathy. They classified images as showing either no notching, notching not to the edge, or notching to the edge. Several hours later, 10 of them classified the same images a second time. In an analysis of interobserver agreement, of 26 stereoscopic images, a plurality of ophthalmologists classified notching as absent in 9 (35%), as present but not to the edge in 7 (27%), and as present and n...

Within a development project for the characterization of sputtered thin films for phase change optical disks, amorphous and crystalline phases of Ge2Sb2Te5 (GST) and AgInSbTe (AIST) phase change materials have been investigated. Sputtered thin films (200nm) on polycarbonate were characterized before and after laser initialization using X-ray diffraction methods. The crystalline phase of GST was identified as fcc rock-salt like

Every clinician has at one time or another examined a patient who was misdiagnosed as having glaucoma or whose diagnosis of glaucoma was missed. Although glaucoma can exist with normal intraocular pressures, clinicians often rely on the presence of visual-field defects and the degree of optic disk cupping to direct care. However, assessment of cupping is but one small part of optic disk evaluation in glaucoma, and other features of the optic nerve head and retinal nerve fiber layer must be closely inspected to help diagnose borderline cases. In addition, glaucoma can exist without visual-field loss. High-tech devices offer an added dimension in the objective assessment of structure when subjective tests of function and/or ophthalmoscopic observations are equivocal. This article details the various parameters of optic disk and retinal nerve fiber layer evaluation and their significance in the assessment of glaucoma. In addition, the role of four high-tech devices is evaluated for their utility in the assessment and progression of glaucomatous damage. When one attempts to classify a patient as having glaucoma, the degree of cupping and the presence or absence of visual field loss can be misleading. Prior to definitive diagnosis, a thorough evaluation of the optic disk and retinal nerve fiber layer, and appropriate use of high-tech devices, should help reduce the under-diagnosis and overdiagnosis of this disease.

Primary open-angle glaucoma almost certainly develops in a multifactorial manner, with interplay between numerous risk factors affecting the disease. These risk factors, in addition to intraocular pressure, include a number of cardiovascular factors. Some of these factors may determine the appearance of the damaged glaucomatous optic nerve head. Patients with four specific optic disk appearances have been investigated, and differences have been identified in their demographic characteristics, prevalence of certain risk factors, the pattern of visual field damage, and circulatory abnormalities in their retrobulbar vessels. The findings provide evidence of the existence of subgroups of primary open-angle glaucoma with correlations between risk factor and type of optic disk. A reliable method by which the different disk appearances could be distinguished in an objective manner would be clinically valuable, and the scanning laser ophthalmoscope has shown potential promise to achieve this. The results of studies relating to various glaucomatous optic disk appearances are presented and discussed.

Acute zonal occult outer retinopathy (AZOOR) is a rare disease and is part of the white dot syndrome occurring bilaterally and often asymmetrically in young healthy myopic women. Characteristic findings are distinct focal lesions of the outer segments (OS) of the photoreceptor (PR) layer and abnormalities in fundus autofluorescence (FAF) within the lesions. Currently there is a lack of defined disease criteria, such as specific laboratory findings. Also no effective therapy is known which makes it difficult to diagnose, differentiate and treat AZOOR. Supplementation of antioxidants may become part of therapeutic options in AZOOR. A 19-year-old myopic woman presented with unilaterally reduced visual acuity. Due to the clinical features and with the help of FAF, spectral domain optical coherence tomography (SD-OCT) and perimetry the diagnosis of blind spot enlargement syndrome in AZOOR was made. Identification of autoantibodies specific for two retinal antigens (CRALBP and S-Ag) suppo...

AIMTo evaluate the ability of structural parameters (as determined by retinal nerve fibre layer (RNFL) measurements obtained with the scanning laser polarimeter (SLP-NFA/GDx)) and functional parameters (as determined by automated perimetry) to discriminate between normal and glaucomatous eyes.METHODSIn a case-control study, a total of 91 normal subjects and 94 patients with glaucoma underwent automated perimetry and RNFL measurements obtained with

To determine the ability of optic nerve head (ONH) parameters measured with spectral domain Cirrus HD-OCT (Carl Zeiss Meditec, Inc., Dublin, CA) to discriminate between normal and glaucomatous eyes and to compare them with the discriminating ability of peripapillary retinal nerve fiber layer (RNFL) thickness measurements performed with Cirrus HD-OCT. Evaluation of diagnostic test or technology. Seventy-three subjects with glaucoma and 146 age-matched normal subjects. Peripapillary ONH parameters and RNFL thickness were measured in 1 randomly selected eye of each participant within a 200 × 200 pixel A-scan acquired with Cirrus HD-OCT centered on the ONH. Optic nerve head topographic parameters, peripapillary RNFL thickness, and area under receiver operating characteristic curves (AUCs). To distinguish normal from glaucomatous eyes, regardless of disease stage, the 6 best parameters (expressed as AUC) were vertical rim thickness (VRT, 0.963), rim area (0.962), RNFL thickness at clock-...

In a prospective study of untreated ocular hypertension 117 eyes were non-exfoliative and 20 eyes exfoliative. The percentage of optic disc pallor was significantly larger in the exfoliative than in the non-exfoliative group, whereas no significant differences were found in IOP or in the visual field.

The authors previously presented the results of their 2001 field investigation to rural Brazil to investigate a 336-member pedigree of Leber hereditary optic neuropathy (LHON). The present work describes the yearly field investigations 2001 to 2005, utilizing a variety of highly sophisticated psychophysical and electrophysiologic procedures, in asymptomatic LHON carriers, some of whom converted to affected status. Careful, repeated examinations of 75 carriers of homoplasmic 11778 LHON mtDNA J-haplogroup mutants were performed as part of the field investigation of this pedigree. All subjects underwent a detailed neuro-ophthalmologic investigation, including formal visual fields (Humphrey; HVF) and fundus photography. In addition, many subjects underwent rigorous psychophysical examination, including Cambridge Research Systems color vision and contrast sensitivity testing, OCT, GDx, and multifocal visual evoked response (mfVER) and multifocal electroretinogram (mfERG). Two patients fo...