Developmental Abnormalities of the Optic Nerve Head These
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure Megalo-… --Abnormally large diameter of disc and cup --VF testing may reveal an enlarged blind spot Optic Nerve… Coloboma 1) May resemble… deep cupping 2) Can be… bilateral, asymmetric 3) Part of the…CHARGE association Myelinated… --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic… --Associated with serous RD in adulthood Morning-Glory. Disc [Two-words] --DFE reveals: 1) Funnel-shaped… 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve… --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) [Two-words] Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction 1
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure Megalopapilla --Abnormally large diameter of disc and cup --VF testing may reveal an enlarged blind spot Optic Nerve Coloboma 1) May resemble… deep cupping 2) Can be… bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) Funnel-shaped… 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction 2
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure Megalopapilla --Abnormally large diameter of disc and cup --VF testing may reveal an enlarged blind spot Optic Nerve Coloboma 1) May resemble… deep cupping 2) Can be… bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) Funnel-shaped… 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction 3
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure Megalopapilla --Abnormally large diameter of disc and cup --VF testing may reveal an enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) Funnel-shaped… 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction 4
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure Megalopapilla --Abnormally large diameter of disc and cup --VF testing may reveal an enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping [laterality]asymmetric 2) Can be… bilateral, 3) Part of the…CHARGE association Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) Funnel-shaped… 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction 5
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure Megalopapilla --Abnormally large diameter of disc and cup --VF testing may reveal an enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) Funnel-shaped… 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction 6
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure Megalopapilla --Abnormally large diameter of disc and cup --VF testing may reveal an enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric [battle cry? ] association 3) Part of the…CHARGE Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) Funnel-shaped… 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction 7
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure Megalopapilla --Abnormally large diameter of disc and cup --VF testing may reveal an enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) Funnel-shaped… 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction 8
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure Megalopapilla --Abnormally large diameter of disc and cup --VF testing may reveal an enlarged blind spot What is the CHARGE association? Optic Nerve Coloboma Myelinated RNFL 1) May resemble…deep cupping --Myelin normally starts at LGN, ends at lamina cribrosa H eart abnormalities 2) Can be…bilateral, asymmetric --Can be patchy, discontinuous 3) Part of the…CHARGE association Choanal A tresia --Corresponding VF has absolute scotoma R etardation Optic Pit/Hole G enitouri nary abnormalitie --Associated with serous RD E ar abnormalities. Optic Nerve Hypoplasia in adulthood Morning-Glory Disc --DFE reveals: 1) Funnel-shaped… 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction 9
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 10 Megalopapilla --Abnormally large diameter of disc and cup --VF testing may reveal an enlarged blind spot What is the CHARGE association? Optic Nerve Coloboma Myelinated RNFL 1) May resemble…deep cupping --Myelin normally starts at LGN, ends at lamina cribrosa Heart abnormalities 2) Can be…bilateral, asymmetric --Can be patchy, discontinuous 3) Part of the…CHARGE association Choanal Atresia --Corresponding VF has absolute scotoma Retardation Optic Pit/Hole Genitourinary abnormalities --Associated with serous RD Ear abnormalities Optic Nerve Hypoplasia in adulthood Morning-Glory Disc --DFE reveals: 1) Funnel-shaped… 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 11 Megalopapilla --Abnormally large diameter of disc and cup --VF testing may reveal an enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with…serous RD [retinal condition, and age] in adulthood Morning-Glory Disc --DFE reveals: 1) Funnel-shaped… 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 12 Megalopapilla --Abnormally large diameter of disc and cup --VF testing may reveal an enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) Funnel-shaped… 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 13 Megalopapilla --Abnormally large diameter of disc and cup --VF testing may reveal an enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped… [classic term] 2) Number of vessels crossing the rim seems abnormally… --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 14 Megalopapilla --Abnormally large diameter of disc and cup --VF testing may reveal an enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 15 Megalopapilla --Abnormally large diameter of disc and cup --VF testing may reveal an enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally… [high v low] --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 16 Megalopapilla --Abnormally large diameter of disc and cup --VF testing may reveal an enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 17 Megalopapilla --Abnormally large diameter of disc and cup --VF testing may reveal an enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, [descriptor] so cup seems [type of change] to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 18 Megalopapilla --Abnormally large diameter of disc and cup --VF testing may reveal an enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 19 Megalopapilla --Abnormally large diameter of disc and cup --VF testing may reveal an enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) [#/#] but can be… --VA usually… 20/200, [range] 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 20 Megalopapilla --Abnormally large diameter of disc and cup --VF testing may reveal an enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 21 Megalopapilla --Abnormally large diameter of disc and cup --VF testing may reveal an enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP [retinal condition] --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 22 Megalopapilla --Abnormally large diameter of disc and cup --VF testing may reveal an enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 23 Megalopapilla [? and 1) Abnormally large diameter of…disc and? ]cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 24 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 25 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot [specific VF finding] Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 26 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL --Myelin normally starts at LGN, ends at lamina cribrosa --Can be patchy, discontinuous --Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 27 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Optic Pit/Hole --Associated with…serous RD in adulthood Myelinated An abnormally large cup RNFL in a preemie with cerebral palsy is --Myelin normally starts at LGN, ends at lamina cribrosa suggestive of--Can whatbecondition? patchy, discontinuous Periventricular leukomalacia. VF has absolute scotoma --Corresponding What is the causative event, and when does it occur? CNS ischemia in the. Optic perinatal period Nerve Hypoplasia --Abnormally low number of axons --DFE: lead Smalltopale with double How does CNS ischemia an disc enlarged cup? ring sign Morning-Glory Disc --VA 20/20<->NLP Via retrograde trans-synaptic degeneration of ganglion cell axons --DFE reveals: --VF defects invariably present 1) A funnel-shaped…excavation --Remember the 4 D’s (more on this shortly) 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems Tilted-Disc Syndrome to…open and close (like its namesake, 1) Superior pole appears…elevated, inferior…recessed the morning-glory flower) 2) Associated with…situs inversus of retinal vessels --VA usually… 20/200, but can be… 3) Fundus abnormality produces…myopicastigmatism astigm 20/20<->NLP 4) VF testing reveals…bitemporal hemianopia that doesn’t --1/3 develop…serous RD doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 28 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Optic Pit/Hole --Associated with…serous RD in adulthood Myelinated An abnormally large cup RNFL in a preemie with cerebral palsy is --Myelin normally starts at LGN, ends at lamina cribrosa suggestive of--Can whatbecondition? patchy, discontinuous Periventricular leukomalacia. VF has absolute scotoma --Corresponding What is the causative event, and when does it occur? CNS ischemia in the. Optic perinatal period Nerve Hypoplasia --Abnormally low number of axons --DFE: lead Smalltopale with double How does CNS ischemia an disc enlarged cup? ring sign Morning-Glory Disc --VA 20/20<->NLP Via retrograde trans-synaptic degeneration of ganglion cell axons --DFE reveals: --VF defects invariably present 1) A funnel-shaped…excavation --Remember the 4 D’s (more on this shortly) 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems Tilted-Disc Syndrome to…open and close (like its namesake, 1) Superior pole appears…elevated, inferior…recessed the morning-glory flower) 2) Associated with…situs inversus of retinal vessels --VA usually… 20/200, but can be… 3) Fundus abnormality produces…myopicastigmatism astigm 20/20<->NLP 4) VF testing reveals…bitemporal hemianopia that doesn’t --1/3 develop…serous RD doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 29 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Optic Pit/Hole --Associated with…serous RD in adulthood Myelinated An abnormally large cup RNFL in a preemie with cerebral palsy is --Myelin normally starts at LGN, ends at lamina cribrosa suggestive of--Can whatbecondition? patchy, discontinuous Periventricular leukomalacia. VF has absolute scotoma --Corresponding What is the causative event, and when does it occur? CNS ischemia in the. Optic perinatal period Nerve Hypoplasia --Abnormally low number of axons --DFE: lead Smalltopale with double How does CNS ischemia an disc enlarged cup? ring sign Morning-Glory Disc --VA 20/20<->NLP Via retrograde trans-synaptic degeneration of ganglion cell axons --DFE reveals: --VF defects invariably present 1) A funnel-shaped…excavation --Remember the 4 D’s (more on this shortly) 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems Tilted-Disc Syndrome to…open and close (like its namesake, 1) Superior pole appears…elevated, inferior…recessed the morning-glory flower) 2) Associated with…situs inversus of retinal vessels --VA usually… 20/200, but can be… 3) Fundus abnormality produces…myopicastigmatism astigm 20/20<->NLP 4) VF testing reveals…bitemporal hemianopia that doesn’t --1/3 develop…serous RD doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 30 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Optic Pit/Hole --Associated with…serous RD in adulthood Myelinated An abnormally large cup RNFL in a preemie with cerebral palsy is --Myelin normally starts at LGN, ends at lamina cribrosa suggestive of--Can whatbecondition? patchy, discontinuous Periventricular leukomalacia. VF has absolute scotoma --Corresponding What is the causative event, and when does it occur? CNS ischemia in the. Optic perinatal period Nerve Hypoplasia --Abnormally low number of axons --DFE: lead Smalltopale with double How does CNS ischemia an disc enlarged cup? ring sign Morning-Glory Disc --VA 20/20<->NLP Via retrograde trans-synaptic degeneration of ganglion cell axons --DFE reveals: --VF defects invariably present 1) A funnel-shaped…excavation --Remember the 4 D’s (more on this shortly) 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems Tilted-Disc Syndrome to…open and close (like its namesake, 1) Superior pole appears…elevated, inferior…recessed the morning-glory flower) 2) Associated with…situs inversus of retinal vessels --VA usually… 20/200, but can be… 3) Fundus abnormality produces…myopicastigmatism astigm 20/20<->NLP 4) VF testing reveals…bitemporal hemianopia that doesn’t --1/3 develop…serous RD doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 31 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Optic Pit/Hole --Associated with…serous RD in adulthood Myelinated An abnormally large cup RNFL in a preemie with cerebral palsy is --Myelin normally starts at LGN, ends at lamina cribrosa suggestive of--Can whatbecondition? patchy, discontinuous Periventricular leukomalacia. VF has absolute scotoma --Corresponding What is the causative event, and when does it occur? CNS ischemia in the. Optic perinatal period Nerve Hypoplasia --Abnormally low number of axons --DFE: lead Smalltopale with double How does CNS ischemia an disc enlarged cup? ring sign Morning-Glory Disc --VA 20/20<->NLP Via retrograde trans-synaptic degeneration of ganglion cell axons --DFE reveals: --VF defects invariably present 1) A funnel-shaped…excavation --Remember the 4 D’s (more on this shortly) 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems Tilted-Disc Syndrome to…open and close (like its namesake, 1) Superior pole appears…elevated, inferior…recessed the morning-glory flower) 2) Associated with…situs inversus of retinal vessels --VA usually… 20/200, but can be… 3) Fundus abnormality produces…myopicastigmatism astigm 20/20<->NLP 4) VF testing reveals…bitemporal hemianopia that doesn’t --1/3 develop…serous RD doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 32 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Optic Pit/Hole --Associated with…serous RD in adulthood Myelinated An abnormally large cup RNFL in a preemie with cerebral palsy is --Myelin normally starts at LGN, ends at lamina cribrosa suggestive of--Can whatbecondition? patchy, discontinuous Periventricular leukomalacia. VF has absolute scotoma --Corresponding What is the causative event, and when does it occur? CNS ischemia in the. Optic perinatal period Nerve Hypoplasia --Abnormally low number of axons --DFE: lead Smalltopale with double How does CNS ischemia an disc enlarged cup? ring sign Morning-Glory Disc --VA 20/20<->NLP Via retrograde trans-synaptic degeneration of ganglion cell axons --DFE reveals: --VF defects invariably present 1) A funnel-shaped…excavation --Remember the 4 D’s (more on this shortly) 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems Tilted-Disc Syndrome to…open and close (like its namesake, 1) Superior pole appears…elevated, inferior…recessed the morning-glory flower) 2) Associated with…situs inversus of retinal vessels --VA usually… 20/200, but can be… 3) Fundus abnormality produces…myopicastigmatism astigm 20/20<->NLP 4) VF testing reveals…bitemporal hemianopia that doesn’t --1/3 develop…serous RD doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 33 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFLsaying…What condition must And it (almost) goes without --Myelin normally starts at LGN, ends at lamina cribrosa be considered any individual with an enlarged cup? --Caninbe patchy, discontinuous Glaucoma--Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 34 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFLsaying…What condition must And it (almost) goes without --Myelin normally starts at LGN, ends at lamina cribrosa be considered any individual with an enlarged cup? --Caninbe patchy, discontinuous Glaucoma--Corresponding VF has absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 35 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL [location] 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 36 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 37 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic does Nervemyelination Hypoplasia normally begin? Where --Abnormally low number of axons At--DFE: the lateral geniculate nucleus Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 38 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic does Nervemyelination Hypoplasia normally begin? Where --Abnormally low number of axons At--DFE: the lateral geniculate nucleus Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 39 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic does Nervemyelination Hypoplasia normally begin? Where --Abnormally low number of axons At--DFE: the lateral geniculate nucleus Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present (Note: --Remember Because we’re talking about the axons of the 4 D’s (more on this shortly) retinal ganglion cells, it’s probably better to say that myelination begins at the lamina cribrosa and ends at the LGN. )Syndrome Tilted-Disc 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 40 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa [how confluent/continuous? ] 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 41 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 42 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous [absolute v scotoma 3) Corresponding VF has an…absolute relative] Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 43 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia --Abnormally low number of axons --DFE: Small pale disc with double ring sign --VA 20/20<->NLP --VF defects invariably present --Remember the 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 44 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia 1) Abnormally low number of… [structure? ] 2) DFE: Small pale disc with…double ring sign 3) VA… 4) VF defects… invariably present 5) Remember the… 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 45 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA… 20/20<->NLP 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 46 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia 1) Abnormally low number of…axons [2 -word desc. ] 2) DFE: Small pale disc with…double ring sign 3) VA… 20/20<->NLP 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 47 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA… 20/20<->NLP 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 48 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign Morning-Glory Disc A hypoplastic nerve with double-ring sign 3) VA… 20/20<->NLP --DFE reveals: can easily be mistaken for 4)what? VF defects…invariably present 1) A funnel-shaped…excavation 5) head Remember the… 4 D’s (more on this shortly) A normal sized optic nerve and cup 2) Number of vessels crossing the rim (the outer edge of the ring is interpreted as seems abnormally…high edge of the optic rim) --Tissue is…contractile, so the cup seems Tilted-Disc Syndrome to…open and close (like its namesake, 1) Superior pole appears…elevated, inferior…recessed the morning-glory flower) 2) Associated with…situs inversus of retinal vessels --VA usually… 20/200, but can be… 3) Fundus abnormality produces…myopicastigmatism astigm 20/20<->NLP 4) VF testing reveals…bitemporal hemianopia that doesn’t --1/3 develop…serous RD doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 49 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign Morning-Glory Disc A hypoplastic nerve with double-ring sign 3) VA… 20/20<->NLP --DFE reveals: can easily be mistaken for 4)what? VF defects…invariably present 1) A funnel-shaped…excavation 5) head Remember the… 4 D’s (more on this shortly) A normal sized optic nerve and cup 2) Number of vessels crossing the rim (the outer edge of the ring is interpreted as seems abnormally…high edge of the optic rim) --Tissue is…contractile, so the cup seems Tilted-Disc Syndrome to…open and close (like its namesake, 1) Superior pole appears…elevated, inferior…recessed the morning-glory flower) 2) Associated with…situs inversus of retinal vessels --VA usually… 20/200, but can be… 3) Fundus abnormality produces…myopicastigmatism astigm 20/20<->NLP 4) VF testing reveals…bitemporal hemianopia that doesn’t --1/3 develop…serous RD doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 50 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA…[range] 20/20<->NLP 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 51 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA… 20/15<->NLP 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 52 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA… 20/15<->NLP [how likely? ] 4) VF defects… invariably present 5) Remember the… 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 53 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA… 20/15<->NLP 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 54 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA… 20/15<->NLP 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) Is the VF loss associated with optic nerve hypoplasia Tilted-Discprogressive, Syndrome or nonprogressive? Nonprogressive 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 55 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA… 20/15<->NLP 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) Is the VF loss associated with optic nerve hypoplasia Tilted-Discprogressive, Syndrome or nonprogressive? Nonprogressive 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 56 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA… 20/15<->NLP 4) VF defects…invariably present 5) Remember the… 4[mnemonic] D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 57 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA… 20/15<->NLP 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 58 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA… 20/15<->NLP 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems Tilted-Disc Syndrome to…open and close (like its namesake, 1) Superior pole appears…elevated, inferior…recessed inferior… recessed You see a child with optic nerve hypoplasia. What should you do for her? the morning-glory flower) 2) Associated with…situs inversus of retinal vessels --VA usually… 20/200, but can (various be… Get MRI brain CNS abnormalities are associated with astigmatism optic-nerve 3) Fundus abnormality produces…myopic astigm 20/20<->NLP hypoplasia), and refer for endocrine evaluation (multiple endocrine 4) VF testing reveals…bitemporal hemianopia that doesn’t --1/3 develop…serous RD doesn’twith …respect refract the vertical and may…resolve with refraction deficiencies are associated, especially pituitary-related)
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 59 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA… 20/15<->NLP 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems Tilted-Disc Syndrome to…open and close (like its namesake, 1) Superior pole appears…elevated, inferior…recessed inferior… recessed You see a child with optic nerve hypoplasia. What should you do for her? the morning-glory flower) 2) Associated with…situs inversus of retinal vessels --VA usually… 20/200, but can (various be… Get MRI brain CNS abnormalities are associated with astigmatism optic-nerve 3) Fundus abnormality produces…myopic astigm 20/20<->NLP hypoplasia), and refer for endocrine evaluation (multiple endocrine 4) VF testing reveals…bitemporal hemianopia that doesn’t --1/3 develop…serous RD doesn’twith …respect refract the vertical and may…resolve with refraction deficiencies are associated, especially pituitary-related)
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 60 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA… 20/15<->NLP 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) Tilted-Disc Syndrome [elevated v 1) Superior pole appears…elevated, inferior…recessed inferior… recessed] 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopicastigmatism astigm 4) VF testing reveals…bitemporal hemianopia that doesn’twith …respect refract the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 61 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA… 20/15<->NLP 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopic astigmatism 4) VF testing reveals…bitemporal hemianopia that doesn’t …respect the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 62 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA… 20/15<->NLP 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed [twoinversus words] of retinal vessels 2) Associated with…situs 3) Fundus abnormality produces…myopic astigmatism 4) VF testing reveals…bitemporal hemianopia that doesn’t …respect the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 63 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA… 20/15<->NLP 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopic astigmatism 4) VF testing reveals…bitemporal hemianopia that doesn’t …respect the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 64 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA… 20/15<->NLP 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels [refractive error] 3) Fundus abnormality produces…myopic astigmatism 4) VF testing reveals…bitemporal hemianopia that doesn’t …respect the vertical and may…resolve with refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 65 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA… 20/15<->NLP 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopic astigmatism 4) VF testing reveals…bitemporal hemianopia that doesn’t …respect the vertical and may…resolve with refraction
66 Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA… 20/15<->NLP 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopic astigmatism [specific VF finding] 4) VF testing reveals…bitemporal hemianopia that doesn’t [simple clinical respect the vertical, and may resolve with… refraction maneuver]
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 67 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA… 20/15<->NLP 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopic astigmatism 4) VF testing reveals…bitemporal hemianopia that doesn’t respect the vertical, and may resolve with…refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 68 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia If a patient 1)has tilted discs + difficulty with night vision, Abnormally low number of…axons 2) DFE: should Small pale disc with…double ring sign what diagnosis be considered? 3) VA… 20/20<->NLP Congenital stationary night blindness (CSNB) 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopic astigmatism 4) VF testing reveals…bitemporal hemianopia that doesn’t respect the vertical, and may resolve with…refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 69 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open and close (like its namesake, the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia If a patient 1)has tilted discs + difficulty with night vision, Abnormally low number of…axons 2) DFE: should Small pale disc with…double ring sign what diagnosis be considered? 3) VA… 20/20<->NLP Congenital stationary night blindness (CSNB) 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopic astigmatism 4) VF testing reveals…bitemporal hemianopia that doesn’t respect the vertical, and may resolve with…refraction
Developmental Abnormalities of the Optic Nerve Head These three are all secondary to abnormal closure of the embryonic optic fissure 70 Megalopapilla 1) Abnormally large diameter of…disc and cup 2) VF testing may reveal an…enlarged blind spot Optic Nerve Coloboma 1) May resemble…deep cupping 2) Can be…bilateral, asymmetric 3) Part of the…CHARGE association Myelinated RNFL 1) Myelin normally ends at the…lamina cribrosa 2) Can be…patchy and discontinuous 3) Corresponding VF has an…absolute scotoma Optic Pit/Hole --Associated with…serous RD in adulthood Morning-Glory Disc As for --DFE reveals: 1) A funnel-shaped…excavation 2) Number of vessels crossing the rim seems abnormally…high --Tissue is…contractile, so cup seems to…open close (like its namesake, the four D’s’and of optic nerve hypoplasia… the morning-glory flower) --VA usually… 20/200, but can be… 20/20<->NLP --1/3 develop…serous RD Optic Nerve Hypoplasia 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA… 20/15<->NLP 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) Tilted-Disc Syndrome 1) Superior pole appears…elevated, inferior…recessed 2) Associated with…situs inversus of retinal vessels 3) Fundus abnormality produces…myopic astigmatism 4) VF testing reveals…bitemporal hemianopia that doesn’t respect the vertical, and may resolve with…refraction
Developmental Abnormalities of the Optic Nerve Head What are the 4 D’s of optic nerve hypoplasia? --Drink (heavy Et. OH consumption during pregnancy) --Diabetes (classically causes superior sectoral hypoplasia Hints --Drugs (especially forthcoming… Dilantin or other seizure meds) --De Morsier syndrome 71
Developmental Abnormalities of the Optic Nerve Head What are the 4 D’s of optic nerve hypoplasia? --Drink (heavy Et. OH consumption during pregnancy) Concern mom’s life while she is pregnant w/ the child who will have ON hypoplasia --Diabetes Hints --Drugs (especially forthcoming… A congenital condition with significant CNS findings Dilantin or other seizure meds) --De Morsier syndrome 72
Developmental Abnormalities of the Optic Nerve Head What are the 4 D’s of optic nerve hypoplasia? --Drink (ie, heavy Et. OH consumption during pregnancy) Concern mom’s life while she is pregnant w/ the child who will have ON hypoplasia --Diabetes --Drugs (especially Dilantin or other seizure meds) A congenital condition with significant CNS findings --De Morsier syndrome (5 D’s if you count this one) (should be lower-case, but it looked funny) 73
Developmental Abnormalities of the Optic Nerve Head What are the 4 D’s of optic nerve hypoplasia? --Drink (ie, heavy Et. OH consumption during pregnancy) three words In other words, optic-nerve hypoplasia is part of the fetal alcohol syndrome --Diabetes --Drugs (especially Dilantin or other seizure meds) --De Morsier syndrome 74
Developmental Abnormalities of the Optic Nerve Head What are the 4 D’s of optic nerve hypoplasia? --Drink (ie, heavy Et. OH consumption during pregnancy) In other words, optic-nerve hypoplasia is part of the fetal alcohol syndrome --Diabetes --Drugs (especially Dilantin or other seizure meds) --De Morsier syndrome 75
Developmental Abnormalities of the Optic Nerve Head What are the 4 D’s of optic nerve hypoplasia? --Drink (ie, heavy Et. OH consumption during pregnancy) --Diabetes --Drugs (especially Dilantin or other seizure meds) --De Morsier syndrome What triad constitutes de Morsier syndrome? ---- 76
Developmental Abnormalities of the Optic Nerve Head What are the 4 D’s of optic nerve hypoplasia? --Drink (ie, heavy Et. OH consumption during pregnancy) --Diabetes --Drugs (especially Dilantin or other seizure meds) --De Morsier syndrome What triad constitutes de Morsier syndrome? --Optic nerve hypoplasia (duh) words --Absence of the septumtwopellucidum --Agenesis of the corpus two callosum diff words 77
Developmental Abnormalities of the Optic Nerve Head What are the 4 D’s of optic nerve hypoplasia? --Drink (ie, heavy Et. OH consumption during pregnancy) --Diabetes --Drugs (especially Dilantin or other seizure meds) --De Morsier syndrome What triad constitutes de Morsier syndrome? --Optic nerve hypoplasia (duh) --Absence of the septum pellucidum --Agenesis of the corpus callosum 78
Developmental Abnormalities of the Optic Nerve Head What are the 4 D’s of optic nerve hypoplasia? --Drink (ie, heavy Et. OH consumption during pregnancy) --Diabetes --Drugs (especially Dilantin or other seizure meds) --De Morsier syndrome What triad constitutes de Morsier syndrome? --Optic nerve hypoplasia (duh) --Absence of the septum pellucidum --Agenesis of the corpus callosum What is the noneponymous name of de Morsier syndrome? Septo-optic dysplasia 79
Developmental Abnormalities of the Optic Nerve Head What are the 4 D’s of optic nerve hypoplasia? --Drink (ie, heavy Et. OH consumption during pregnancy) --Diabetes --Drugs (especially Dilantin or other seizure meds) --De Morsier syndrome What triad constitutes de Morsier syndrome? --Optic nerve hypoplasia (duh) --Absence of the septum pellucidum --Agenesis of the corpus callosum What is the noneponymous name of de Morsier syndrome? Septo- 80
Developmental Abnormalities of the Optic Nerve Head What are the 4 D’s of optic nerve hypoplasia? --Drink (ie, heavy Et. OH consumption during pregnancy) --Diabetes --Drugs (especially Dilantin or other seizure meds) --De Morsier syndrome What triad constitutes de Morsier syndrome? --Optic nerve hypoplasia (duh) --Absence of the septum pellucidum --Agenesis of the corpus callosum What is the noneponymous name of de Morsier syndrome? Septo-optic 81
Developmental Abnormalities of the Optic Nerve Head What are the 4 D’s of optic nerve hypoplasia? --Drink (ie, heavy Et. OH consumption during pregnancy) --Diabetes --Drugs (especially Dilantin or other seizure meds) --De Morsier syndrome What triad constitutes de Morsier syndrome? --Optic nerve hypoplasia (duh) --Absence of the septum pellucidum --Agenesis of the corpus callosum What is the noneponymous name of de Morsier syndrome? Septo-optic dysplasia 82
Developmental Abnormalities of the Optic Nerve Head What are the 4 D’s of optic nerve hypoplasia? --Drink (ie, heavy Et. OH consumption during pregnancy) --Diabetes --Drugs (especially Dilantin or other seizure meds) --De Morsier syndrome What triad constitutes de Morsier syndrome? --Optic nerve hypoplasia (duh) --Absence of the septum pellucidum --Agenesis of the corpus callosum --Pituitary dwarfism Note: The listed triad is from the BCSC Peds book. Per the Neuro book, the triad includes pituitary dwarfism, not corpus callosum agenesis (although it states that “the corpus callosum may be thinned or absent”) 83
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) --Drink (ie, heavy Et. OH consumption during pregnancy) --Diabetes --Drugs (especially Dilantin or other seizure meds) --De Morsier syndrome 84
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) --Drink (ie, heavy Et. OH consumption during pregnancy) --Diabetes --Drugs (especially Dilantin or other seizure meds) --De Morsier syndrome 85
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) --Drink (ie, heavy Et. OH consumption during pregnancy) --Diabetes --Drugs (especially Dilantin or other seizure meds) --De Morsier syndrome 86
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) --Drink (ie, heavy Et. OH consumption during pregnancy) --Diabetes --Drugs (especially Dilantin or other seizure meds) --De Morsier syndrome 87
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) D -- ofrink (ie, heavy Et. OH consumption What is the appearance the nerve head in SSONH? Pretty much what you would expect based on the name-mom’s life nerve save for a thin superior rim, with a. Concern normal-appearing while she is pregnant associated thinning superior nerve fiber layer -- theiabetes w/ the child who will of have ON hypoplasia during pregnancy) D Does DM-induced SSONH tend to be unilateral, or bilateral? Bilateral --Drugs (especially Dilantin or other seizure meds) According to the Optic Nerve Hypoplasia discussion earlier, is associated with nonprogressive VF defects. Ahypoplasia congenital condition with significant CNS What pattern of VF loss SSONH? -- iseassociated Morsierwith syndrome findings Bitemporal inferior loss that doesn’t respect the vertical midline D 88
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) D -- ofrink (ie, heavy Et. OH consumption What is the appearance the nerve head in SSONH? Pretty much what you would expect based on the name-mom’s life nerve save for a thin superior rim, with a. Concern normal-appearing while she is pregnant associated thinning superior nerve fiber layer -- theiabetes w/ the child who will of have ON hypoplasia during pregnancy) D Does DM-induced SSONH tend to be unilateral, or bilateral? Bilateral --Drugs (especially Dilantin or other seizure meds) According to the Optic Nerve Hypoplasia discussion earlier, is associated with nonprogressive VF defects. Ahypoplasia congenital condition with significant CNS What pattern of VF loss SSONH? -- iseassociated Morsierwith syndrome findings Bitemporal inferior loss that doesn’t respect the vertical midline D 89
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) D -- ofrink (ie, heavy Et. OH consumption What is the appearance the nerve head in SSONH? Pretty much what you would expect based on the name-mom’s life nerve save for a thin superior rim, with a. Concern normal-appearing while she is pregnant associated thinning superior nerve fiber layer -- theiabetes w/ the child who will of have ON hypoplasia during pregnancy) D Does DM-induced SSONH tend to be unilateral, or bilateral? Bilateral --Drugs (especially Dilantin or other seizure meds) According to the Optic Nerve Hypoplasia discussion earlier, is associated with nonprogressive VF defects. Ahypoplasia congenital condition with significant CNS What pattern of VF loss SSONH? -- iseassociated Morsierwith syndrome findings Bitemporal inferior loss that doesn’t respect the vertical midline D 90
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) D -- ofrink (ie, heavy Et. OH consumption What is the appearance the nerve head in SSONH? Pretty much what you would expect based on the name-mom’s life nerve save for a thin superior rim, with a. Concern normal-appearing while she is pregnant associated thinning superior nerve fiber layer -- theiabetes w/ the child who will of have ON hypoplasia during pregnancy) D Does DM-induced SSONH tend to be unilateral, or bilateral? Bilateral --Drugs (especially Dilantin or other seizure meds) According to the Optic Nerve Hypoplasia discussion earlier, is associated with nonprogressive VF defects. Ahypoplasia congenital condition with significant CNS What pattern of VF loss SSONH? -- iseassociated Morsierwith syndrome findings Bitemporal inferior loss that doesn’t respect the vertical midline D 91
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) D -- ofrink (ie, heavy Et. OH consumption during pregnancy) What is the appearance the nerve head in SSONH? Pretty much what you would expect based on the name-mom’s life nerve save for a thin superior rim, with a. Concern normal-appearing while she is pregnant associated thinning superior nerve fiber layer -- theiabetes w/ the child who will of Optic Nerve Hypoplasia have ON hypoplasia D Does DM-induced SSONH tend to be unilateral, or bilateral? Bilateral 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA… 20/15<->NLP 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) --Drugs (especially Dilantin or other seizure meds) According to the Optic Nerve Hypoplasia discussion earlier, is associated with nonprogressive VF defects. What Ahypoplasia congenital condition with significant CNS is -pattern of VF loss associated with SSONH? e Morsier syndrome findings Bitemporal inferior loss that doesn’t respect the vertical midline D 92
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) D -- ofrink (ie, heavy Et. OH consumption during pregnancy) What is the appearance the nerve head in SSONH? Pretty much what you would expect based on the name-mom’s life nerve save for a thin superior rim, with a. Concern normal-appearing while she is pregnant associated thinning superior nerve fiber layer -- theiabetes w/ the child who will of Optic Nerve Hypoplasia have ON hypoplasia D Does DM-induced SSONH tend to be unilateral, or bilateral? Bilateral 1) Abnormally low number of…axons 2) DFE: Small pale disc with…double ring sign 3) VA… 20/15<->NLP 4) VF defects…invariably present 5) Remember the… 4 D’s (more on this shortly) --Drugs (especially Dilantin or other seizure meds) According to the Optic Nerve Hypoplasia discussion earlier, is associated with nonprogressive VF defects. What Ahypoplasia congenital condition with significant CNS is -pattern of VF loss associated with SSONH? e Morsier syndrome findings Bitemporal inferior loss that doesn’t respect the vertical midline D 93
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) D -- ofrink (ie, heavy Et. OH consumption What is the appearance the nerve head in SSONH? Pretty much what you would expect based on the name-mom’s life nerve save for a thin superior rim, with a. Concern normal-appearing while she is pregnant associated thinning superior nerve fiber layer -- theiabetes w/ the child who will of during pregnancy) D have ON hypoplasia Does DM-induced SSONH tend to be unilateral, or bilateral? Bilateral --Drugs (especially Dilantin or other seizure meds) According to the Optic Nerve Hypoplasia discussion earlier, is associated with nonprogressive VF defects. Ahypoplasia congenital condition with significant CNS What pattern of VF loss SSONH? -- iseassociated Morsierwith syndrome superior findings Bitemporal inferior loss that doesn’t respect the vertical midline D ^ There is another optic-nerve condition that presents with nonprogressive bitemporal superior loss that doesn’t respect the vertical midline. What is it? Fuch’s coloboma 94
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) D -- ofrink (ie, heavy Et. OH consumption What is the appearance the nerve head in SSONH? Pretty much what you would expect based on the name-mom’s life nerve save for a thin superior rim, with a. Concern normal-appearing while she is pregnant associated thinning superior nerve fiber layer -- theiabetes w/ the child who will of during pregnancy) D have ON hypoplasia Does DM-induced SSONH tend to be unilateral, or bilateral? Bilateral --Drugs (especially Dilantin or other seizure meds) According to the Optic Nerve Hypoplasia discussion earlier, is associated with nonprogressive VF defects. Ahypoplasia congenital condition with significant CNS What pattern of VF loss SSONH? -- iseassociated Morsierwith syndrome superior findings Bitemporal inferior loss that doesn’t respect the vertical midline D ^ There is another optic-nerve condition that presents with nonprogressive bitemporal superior loss that doesn’t respect the vertical midline. What is it? Fuch’s coloboma 95
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) D -- ofrink (ie, heavy Et. OH consumption What is the appearance the nerve head in SSONH? Pretty much what you would expect based on the name-mom’s life nerve save for a thin superior rim, with a. Concern normal-appearing while she is pregnant associated thinning superior nerve fiber layer -- theiabetes w/ the child who will of have ON hypoplasia during pregnancy) D Does DM-induced SSONH tend to be unilateral, or bilateral? Bilateral Pituitary adenoma compressing the optic chiasm causes bitemporal superior VF. Would that be --Drugs (especially Dilantin or other seizure meds) an acceptable alternative answer? According Nerve Hypoplasia discussion earlier, Not really, to forthe two. Optic reasons: istoassociated with nonprogressive VF defects. Ahypoplasia congenital condition --As alluded in the question, it is an optic chiasm condition, not an optic nerve condition; with significant CNS What pattern of VF loss is associated with SSONH? -e Morsier syndrome superior and findings Bitemporal inferior loss that doesn’t respect vertical midline --VF loss secondary^to chiasmal compression is the progressive--as the tumor enlarges, so too do the VF cuts There is another optic-nerve condition that presents with nonprogressive bitemporal superior loss that doesn’t respect the vertical midline. What is it? Fuch’s coloboma Pituitary asdenoma? D 96
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) D -- ofrink (ie, heavy Et. OH consumption What is the appearance the nerve head in SSONH? Pretty much what you would expect based on the name-mom’s life nerve save for a thin superior rim, with a. Concern normal-appearing while she is pregnant associated thinning superior nerve fiber layer -- theiabetes w/ the child who will of have ON hypoplasia during pregnancy) D Does DM-induced SSONH tend to be unilateral, or bilateral? Bilateral Pituitary adenoma compressing the optic chiasm causes bitemporal superior VF. Would that be --Drugs (especially Dilantin or other seizure meds) an acceptable alternative answer? According Nerve Hypoplasia discussion earlier, Not really, to forthe two. Optic reasons: istoassociated with nonprogressive VF defects. Ahypoplasia congenital condition --As alluded in the question, it is an optic chiasm condition, not an optic nerve condition; with significant CNS What pattern of VF loss is associated with SSONH? -e Morsier syndrome superior and findings Bitemporal inferior loss that doesn’t respect vertical midline --VF loss secondary^to chiasmal compression is the progressive--as the tumor enlarges, so too do the VF cuts There is another optic-nerve condition that presents with nonprogressive bitemporal superior loss that doesn’t respect the vertical midline. What is it? Fuch’s coloboma Pituitary asdenoma? No! D 97
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) D -- ofrink (ie, heavy Et. OH consumption What is the appearance the nerve head in SSONH? Pretty much what you would expect based on the name-mom’s life nerve save for a thin superior rim, with a. Concern normal-appearing while she is pregnant associated thinning superior nerve fiber layer -- theiabetes w/ the child who will of have ON hypoplasia during pregnancy) D Does DM-induced SSONH tend to be unilateral, or bilateral? Bilateral Pituitary adenoma compressing the optic chiasm causes bitemporal superior VF. Would that be --Drugs (especially Dilantin or other seizure meds) an acceptable alternative answer? According Nerve Hypoplasia discussion earlier, Not really, to forthe two. Optic reasons: istoassociated with nonprogressive VF defects. Ahypoplasia congenital condition --As alluded in the question, it is an optic chiasm condition, not an optic nerve condition; with significant CNS What pattern of VF loss is associated with SSONH? -e Morsier syndrome superior and findings Bitemporal inferior loss that doesn’t respect vertical midline --VF loss secondary^to chiasmal compression is the progressive--as the tumor enlarges, so too do the VF cuts There is another optic-nerve condition that presents with nonprogressive bitemporal superior loss that doesn’t respect the vertical midline. What is it? Fuch’s coloboma Pituitary asdenoma? No! D 98
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) D -- ofrink (ie, heavy Et. OH consumption What is the appearance the nerve head in SSONH? Pretty much what you would expect based on the name-mom’s life nerve save for a thin superior rim, with a. Concern normal-appearing while she is pregnant associated thinning superior nerve fiber layer -- theiabetes w/ the child who will of during pregnancy) D have ON hypoplasia Does DM-induced SSONH tend to be unilateral, or bilateral? Bilateral --Drugs (especially Dilantin or other seizure meds) According to the Optic Nerve Hypoplasia discussion earlier, is associated with nonprogressive VF defects. Ahypoplasia congenital condition with significant CNS What pattern of VF loss SSONH? -- iseassociated Morsierwith syndrome superior findings Bitemporal inferior loss that doesn’t respect the vertical midline D ^ There is another optic-nerve condition that presents with nonprogressive What is the basic pathology in Fuch’s coloboma? (shouldthe be vertical lower-case, but it. What looked funny) bitemporal superior loss that doesn’t respect midline. is it? The optic nerve head is tilted such that it is deeply depressed Fuch’s coloboma inferonasally--almost staphyloma-ish 99
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) D -- ofrink (ie, heavy Et. OH consumption What is the appearance the nerve head in SSONH? Pretty much what you would expect based on the name-mom’s life nerve save for a thin superior rim, with a. Concern normal-appearing while she is pregnant associated thinning superior nerve fiber layer -- theiabetes w/ the child who will of during pregnancy) D have ON hypoplasia Does DM-induced SSONH tend to be unilateral, or bilateral? Bilateral --Drugs (especially Dilantin or other seizure meds) According to the Optic Nerve Hypoplasia discussion earlier, is associated with nonprogressive VF defects. Ahypoplasia congenital condition with significant CNS What pattern of VF loss SSONH? -- iseassociated Morsierwith syndrome superior findings Bitemporal inferior loss that doesn’t respect the vertical midline D ^ There is another optic-nerve condition that presents with nonprogressive What is the basic pathology in Fuch’s coloboma? (shouldthe be vertical lower-case, but it. What looked funny) bitemporal superior loss that doesn’t respect midline. is it? The optic nerve head is tilted such that it is deeply depressed Fuch’s coloboma inferonasally--almost staphyloma-ish 100
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) D -- ofrink (ie, heavy Et. OH consumption What is the appearance the nerve head in SSONH? Pretty much what you would expect based on the name-mom’s life nerve save for a thin superior rim, with a. Concern normal-appearing while she is pregnant associated thinning superior nerve fiber layer -- theiabetes w/ the child who will of have ON hypoplasia during pregnancy) D Does DM-induced SSONH tend to be unilateral, or bilateral? Bilateral --Drugs (especially Dilantin or other seizure meds) According to the Optic Nerve Hypoplasia discussion earlier, is associated with nonprogressive VF defects. Ahypoplasia congenital condition with significant CNS What pattern of VF loss SSONH? -- iseassociated Morsierwith syndrome superior findings Bitemporal inferior loss that doesn’t respect the vertical What midline is the noneponymous name for Fuch’s coloboma? ^ Tilted disc syndrome D There is another optic-nerve condition that presents with nonprogressive What is the basic pathology in Fuch’s coloboma? (shouldthe be vertical lower-case, but it. What looked funny) bitemporal superior loss that doesn’t respect midline. is it? The optic nerve head is tilted such that it is deeply depressed Fuch’s coloboma inferonasally--almost staphyloma-ish 101
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) D -- ofrink (ie, heavy Et. OH consumption What is the appearance the nerve head in SSONH? Pretty much what you would expect based on the name-mom’s life nerve save for a thin superior rim, with a. Concern normal-appearing while she is pregnant associated thinning superior nerve fiber layer -- theiabetes w/ the child who will of have ON hypoplasia during pregnancy) D Does DM-induced SSONH tend to be unilateral, or bilateral? Bilateral --Drugs (especially Dilantin or other seizure meds) According to the Optic Nerve Hypoplasia discussion earlier, is associated with nonprogressive VF defects. Ahypoplasia congenital condition with significant CNS What pattern of VF loss SSONH? -- iseassociated Morsierwith syndrome superior findings Bitemporal inferior loss that doesn’t respect the vertical What midline is the noneponymous name for Fuch’s coloboma? ^ Tilted disc syndrome D There is another optic-nerve condition that presents with nonprogressive What is the basic pathology in Fuch’s coloboma? (shouldthe be vertical lower-case, but it. What looked funny) bitemporal superior loss that doesn’t respect midline. is it? The optic nerve head is tilted such that it is deeply depressed Fuch’s coloboma inferonasally--almost staphyloma-ish 102
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) D OK, but why on do (ie, theseheavy pts get a. Et. OH VF defect? -- earth rink consumption during pregnancy) What is. It’s theactually appearance of the nerve head in SSONH? pretty simple. Pretty much what you would expect based on the name-- inferonasally. Thus, the ‘axial length’ As indicated below, these eyes are staphyloma-ish mom’s life nerve save for a thin superior rim, with a. Concern normal-appearing inferonasally while she is pregnant is longer than it is in other regions. Because of this extra axial length, the refractive associated thinning of superior nerve fiber layer -- the iabetes w/ the child who willused correction during the performance of a visual-field test--a correction based on the non- D have ON hypoplasia staphylomatous fovea--is not myopic enough for the inferonasal retina. The subsequent uncorrected Does DM-induced SSONH tend atorefractive be unilateral, or bilateral? refractive error produces scotoma in the superotemporal VF. Bilateral --Drugs (especially Dilantin or other seizure meds) This implies that the VF defect will resolve if the ‘proper’ refractive correction is employed. Does it? According to the Optic Nerve Hypoplasia discussion earlier, Indeed it does is associated with nonprogressive VF defects. Ahypoplasia congenital condition with significant CNS What pattern of VF loss SSONH? -- iseassociated Morsierwith syndrome superior findings Bitemporal inferior loss that doesn’t respect the vertical midline D ^ There is another optic-nerve condition that presents with nonprogressive What is the basic pathology in Fuch’s coloboma? (shouldthe be vertical lower-case, but it. What looked funny) bitemporal superior loss that doesn’t respect midline. is it? The optic nerve head is tilted such that it is deeply depressed Fuch’s coloboma inferonasally--almost staphyloma-ish 103
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) D OK, but why on do (ie, theseheavy pts get a. Et. OH VF defect? -- earth rink consumption during pregnancy) What is. It’s theactually appearance of the nerve head in SSONH? pretty simple. Pretty much what you would expect based on the name-- inferonasally. Thus, the ‘axial length’ As indicated below, these eyes are staphyloma-ish mom’s life nerve save for a thin superior rim, with a. Concern normal-appearing inferonasally while she is pregnant is longer than it is in other regions. Because of this extra axial length, the refractive associated thinning of superior nerve fiber layer -- the iabetes w/ the child who willused correction during the performance of a visual-field test--a correction based on the non- D have ON hypoplasia staphylomatous fovea--is not myopic enough for the inferonasal retina. The subsequent uncorrected Does DM-induced SSONH tend atorefractive be unilateral, or bilateral? refractive error produces scotoma in the superotemporal VF. Bilateral --Drugs (especially Dilantin or other seizure meds) This implies that the VF defect will resolve if the ‘proper’ refractive correction is employed. Does it? According to the Optic Nerve Hypoplasia discussion earlier, Indeed it does is associated with nonprogressive VF defects. Ahypoplasia congenital condition with significant CNS What pattern of VF loss SSONH? -- iseassociated Morsierwith syndrome superior findings Bitemporal inferior loss that doesn’t respect the vertical midline D ^ There is another optic-nerve condition that presents with nonprogressive What is the basic pathology in Fuch’s coloboma? (shouldthe be vertical lower-case, but it. What looked funny) bitemporal superior loss that doesn’t respect midline. is it? The optic nerve head is tilted such that it is deeply depressed Fuch’s coloboma inferonasally--almost staphyloma-ish 104
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) D OK, but why on do (ie, theseheavy pts get a. Et. OH VF defect? -- earth rink consumption during pregnancy) What is. It’s theactually appearance of the nerve head in SSONH? pretty simple. Pretty much what you would expect based on the name-- inferonasally. Thus, the ‘axial length’ As indicated below, these eyes are staphyloma-ish mom’s life nerve save for a thin superior rim, with a. Concern normal-appearing inferonasally while she is pregnant is longer than it is in other regions. Because of this extra axial length, the refractive associated thinning of superior nerve fiber layer -- the iabetes w/ the child who willused correction during the performance of a visual-field test--a correction based on the non- D have ON hypoplasia staphylomatous fovea--is not myopic enough for the inferonasal retina. The subsequent uncorrected Does DM-induced SSONH tend atorefractive be unilateral, or bilateral? refractive error produces scotoma in the superotemporal VF. Bilateral --Drugs (especially Dilantin or other seizure meds) This implies that the VF defect will resolve if the ‘proper’ refractive correction is employed. Does it? According to the Optic Nerve Hypoplasia discussion earlier, Indeed it does is associated with nonprogressive VF defects. Ahypoplasia congenital condition with significant CNS What pattern of VF loss SSONH? -- iseassociated Morsierwith syndrome superior findings Bitemporal inferior loss that doesn’t respect the vertical midline D ^ There is another optic-nerve condition that presents with nonprogressive What is the basic pathology in Fuch’s coloboma? (shouldthe be vertical lower-case, but it. What looked funny) bitemporal superior loss that doesn’t respect midline. is it? The optic nerve head is tilted such that it is deeply depressed Fuch’s coloboma inferonasally--almost staphyloma-ish 105
Developmental Abnormalities of the Optic Nerve Head Of the four, which is the most common cause of optic nerve hypoplasia? Diabetes 4 D’s Maternal diabetes is notorious for causing a specific pattern of optic What are the is it? of optic nerve hypoplasia? nerve hypoplasia--what Superior segmental optic nerve hypoplasia (SSONH) D OK, but why on do (ie, theseheavy pts get a. Et. OH VF defect? -- earth rink consumption during pregnancy) What is. It’s theactually appearance of the nerve head in SSONH? pretty simple. Pretty much what you would expect based on the name-- inferonasally. Thus, the ‘axial length’ As indicated below, these eyes are staphyloma-ish mom’s life nerve save for a thin superior rim, with a. Concern normal-appearing inferonasally while she is pregnant is longer than it is in other regions. Because of this extra axial length, the refractive associated thinning of superior nerve fiber layer -- the iabetes w/ the child who willused correction during the performance of a visual-field test--a correction based on the non- D have ON hypoplasia staphylomatous fovea--is not myopic enough for the inferonasal retina. The subsequent uncorrected Does DM-induced SSONH tend atorefractive be unilateral, or bilateral? refractive error produces scotoma in the superotemporal VF. Bilateral --Drugs (especially Dilantin or other seizure meds) This implies that the VF defect will resolve if the ‘proper’ refractive correction is employed. Does it? According to the Optic Nerve Hypoplasia discussion earlier, Indeed it does is associated with nonprogressive VF defects. Ahypoplasia congenital condition with significant CNS What pattern of VF loss SSONH? -- iseassociated Morsierwith syndrome superior findings Bitemporal inferior loss that doesn’t respect the vertical midline D ^ There is another optic-nerve condition that presents with nonprogressive What is the basic pathology in Fuch’s coloboma? (shouldthe be vertical lower-case, but it. What looked funny) bitemporal superior loss that doesn’t respect midline. is it? The optic nerve head is tilted such that it is deeply depressed Fuch’s coloboma inferonasally--almost staphyloma-ish 106
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