[Skip to Content]
[Skip to Content Landing]
June 1980

Optic AtrophyDifferential Diagnosis by Fundus Observation Alone

Author Affiliations

From the Department of Ophthalmology, College of Medicine, University of Florida, Gainesville (Dr Trobe), Bascom Palmer Eye Institute, University of Miami (Fla) (Dr Glaser), and Department of Biostatistics, University of Miami (Ms Cassady).

Arch Ophthalmol. 1980;98(6):1040-1045. doi:10.1001/archopht.1980.01020031030003

• In order to assess the contribution of fundus examination to the differential diagnosis of acquired optic neuropathy, five ophthalmologists viewed 163 fundus stereophotographs of nine disease entities as "unknowns." Glaucoma, central retinal artery occlusion (CRAO), and ischemic optic neuropathy (ION) were diagnosed by at least one observer with an accuracy above 80%. The remaining conditions (optic neuritis; compressive, traumatic, and hereditary optic neuropathies) were correctly identified with less than 50% accuracy. Retinal arteriolar attenuation and sheathing were most helpful in differentiating CRAO and ION. Although pathologic disc cupping often identified glaucoma, it was also seen in 20% of eyes with optic atrophy not associated with glaucoma. Excavation was more profound in glaucoma than in nonglaucomatous optic atrophy, the latter demonstrating relatively greater neuroretinal rim pallor. In 6% of nonglaucomatous optic atrophy eyes, however, disc cupping was misdiagnosed as "glaucomatous." Only 11% of eyes with previously documented papillitis or ION left clues that allowed observers to identify preexisting disc swelling.

Walsh FB, Hoyt WF: Clinical Neuro-ophthalmology , ed 3. Baltimore, Williams & Wilkins, 1969.
Boghen DR, Glaser JS:  Ischaemic optic neuropathy: The clinical profile and natural history . Brain 98:689-708, 1975.Article
Nikoskelainen E, Sogg RL, Rosenthal AR, et al:  The early phase in Leber hereditary optic atrophy . Arch Ophthalmol 95:969-978, 1977.Article
Quigley HA, Anderson DR:  The histologic basis of optic disc pallor in experimental optic atrophy . Am J Ophthalmol 83:709-717, 1977.
Henkind P, Bellhorn R, Rabkin M, et al:  Optic nerve transection in cats: II. Effect on vessels of optic nervehead and lamina cribrosa . Invest Ophthalmol Vis Sci 16:442-447, 1977.
Douglas GR, Drance SM, Schulzer M:  A correlation of visual fields and discs in open angle glaucoma . Can J Ophthalmol 9:391-398, 1974.
Hoskins HE Jr, Gelber EC:  Optic disc topography and visual field defects in patients with increased intra-ocular pressure . Am J Ophthalmol 80:284-290, 1975.
Dalsgaard-Nielsen E:  Glaucoma-like cupping of the optic disc and its etiology . Acta Ophthalmol 15:151-178, 1937.Article
Blazar HA, Scheie HG:  Pseudoglaucoma . Arch Ophthalmol 44:499-513, 1950.Article
Portney GL, Roth AM:  Optic cupping caused by an intra-cranial aneurysm . Am J Ophthalmol 84:98-103, 1977.
Miller S:  The enigma of glaucoma simplex . Trans Ophthalmol Soc UK 92:563-584, 1972.
Hayreh SS:  Pathogenesis of cupping of the optic disc . Br J Ophthalmol 58:863-876, 1974.Article
Eagling EM, Saunders MD, Miller SJH:  Ischaemic papillopathy: Clinical and fluorescein angiographic review of 40 cases . Br J Ophthalmol 58:990-1008, 1974.Article
Quigley H, Anderson DR:  Cupping of the optic disc in ischemic optic neuropathy . Trans Am Acad Ophthalmol Otolaryngol 83:775-782, 1977.
Radius RL, Maumenee AE:  Optic atrophy and glaucomatous cupping . Am J Ophthalmol 85:145-153, 1978.
Elliott RH: A Treatise on Glaucoma , ed 2. London, Henry Frowde & Hodder & Stroughton Ltd, 1922, pp 195-218.