Acquired pits of the optic nerve in glaucoma, Prevalence and associated visual field loss

Abstract

ABSTRACT.Purpose: This study was performed to determine the prevalence of acquired pits of the optic nerve (APON) in glaucoma and the characteristics of associated visual field loss. Subjects and Methods: Stereoscopic optic disc photos from 235 patients with a low-tension variety of primary open-angle glaucoma (LTG) and 251 primary open-angle glaucoma patients with intraocular pressures higher than 21 mmHg (HTG) were examined for the presence of typical APON as defined by a standard photograph (Fig 1). Associated visual field loss was evaluated with automated perimetry and patterns of field loss were identified. Results: Out of a total of 486 patients, 63 APON were found in 51 eyes of 44 glaucoma patients. APONs were more prevalent in women. Acquired pits were more frequently (p∞0.001) located inferiorly (70%) than superiorly (30%). There was a significantly higher prevalence (p∞0.001) of APON in LTG patients (12.7%) than in HTG patients (5.6%). Dense visual field defects within five degrees of fixation occurred in 96% of patients with APON. Conclusion: Acquired pits of the optic nerve are more often located at the inferior optic disc than at the superior disc and are nearly always associated with visual field loss close to fixation. In a glaucoma referral center setting, APON are more prevalent in lower pressure glaucoma than in higher pressure glaucoma.

The Prevalence of Optic Disc Pits and Their Relationship to Glaucoma

“…Although our reported prevalence of optic disc pits in high-pressure OAG (2.8%) was similar to a previous clinic-based study, 11 we found no pits in subjects who had never had IOPs above 21 mm Hg. This raises the possibility that the higher prevalence of pits previously reported in normal-tension glaucoma 10,11 may be because of acquisition bias.…”

“…The peripheral pits appear very similar to so-called acquired pits of the optic nerve associated with glaucoma. [9][10][11][12][20][21][22] We have refrained from using the terms congenital and acquired because we have no evidence for the distinction in this population. Our population sample represents a cross-section and historical information concerning optic disc pits was not available.…”

“…9 Subsequently, a number of authors confirmed these findings in clinic-based case-control studies. [10][11][12] There remain, however, no epidemiologic data providing estimates of prevalence or associations of optic disc pits. This study aimed to describe the prevalence and associations of this sign in a well-defined older population.…”

Three-Dimensional Imaging of Lamina Cribrosa Defects in Glaucoma Using Swept-Source Optical Coherence Tomography

“…It was uncertain whether lamina cribrosa defects and APON are identical, different, or overlapped. The APON was reportedly more frequently located inferiorly [34][35][36] and was associated with visual field defects, [33][34][35][36] visual field progression, 34 and disc hemorrhages. 34,36 Thus, focal lamina cribrosa defects and APON appear to have similar clinical characteristics.…”

Lower corneal hysteresis in glaucoma patients with acquired pit of the optic nerve (APON)

“…A localized susceptibility of the optic nerve to glaucomatous damage was suggested, as APON predominantly occurs in Normal Tension Glaucoma (NTG) [4]. Additionally, it was suspected that patients with an APON are at a higher risk for progressive optic disk damage [5] and visual field loss close to fixation [6,7].…”