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  • Review Article
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The optic nerve head in acquired optic neuropathies

Nature Reviews Neurology volume 6, pages 221–236 (2010)Cite this article

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Abstract

Acquired optic neuropathies are a common cause of blindness in adults, and are associated with characteristic morphological changes at the optic nerve head. Accurate and prompt clinical diagnosis, supplemented with imaging where appropriate, is essential to optimize management of the optic neuropathy and to counsel the patient appropriately on its natural history. History taking, optic disc findings, visual field assessment and imaging of the nerve head and surrounding retinal nerve fiber layer are all paramount to achieving the correct diagnosis. This Review highlights the optic nerve head features that are common to the acquired optic neuropathies, and describes the features that can be used to differentiate these various conditions.

Key Points

  • Acquired optic neuropathies are a group of disorders in which the optic neuropathy can be vascular, inflammatory, toxic, nutritional, compressive, infiltrative or traumatic

  • Accurate and precise examination of optic nerve head morphology, correlated with clinical presentation and optic nerve functional assessment, is paramount to prompt and accurate diagnosis

  • This article describes the unique and shared morphological features of the optic nerve head in the various acquired optic neuropathies

  • Objective methods for assessing the optic nerve head and retinal nerve fiber layer are an adjunct in the diagnosis and management of these conditions

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Figure 1: The normal optic nerve head.
Figure 2: The optic nerve head in patients with ischemic optic neuropathies.
Figure 3: Optical coherence tomography and optic nerve head photographs from a patient with NAION in the right eye.
Figure 4: Fundus photographs showing the optic nerve head in patients with inflammatory and infective optic neuropathies.
Figure 5: Fundus photographs showing the optic nerve head in various acquired optic neuropathies.
Figure 6: Optic nerve head photographs and OCT imaging from a patient with a compressive optic neuropathy due to a pituitary adenoma.

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Acknowledgements

This work was supported with funding from the Australian National Health and Medical Research Council and the Ophthalmic Research Institute of Australia, Cranbourne Trust and Operational Infrastructure Support (OIS) grants program, Victoria, Australia. We gratefully acknowledge the Medical Photographic Imaging Center at The Royal Victorian Eye and Ear Hospital for assistance in obtaining some of the images used for this publication.

Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, 32 Gisborne Street, East Melbourne, 3002, Vic, Australia

    Evelyn C. O'Neill, Paul P. Connell, Ian A. Trounce, Michael A. Coote & Jonathan G. Crowston

  2. Department of Ophthalmology, University of Auckland, Private Bag 92019, Auckland Mail Center, Auckland, 1142, New Zealand

    Helen V. Danesh-Meyer

  3. Lions Eye Institute, 2 Verdun Street, Nedlands, 6009, WA, Australia

    David A. Mackey

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  1. Evelyn C. O'Neill
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O'Neill, E., Danesh-Meyer, H., Connell, P. et al. The optic nerve head in acquired optic neuropathies. Nat Rev Neurol 6, 221–236 (2010). https://doi.org/10.1038/nrneurol.2010.5

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