Optic Nerve Hypoplasia:
51-year-old female referred for consideration of cataract surgery
February 21, 2005
Chief Complaint: 51-year-old female referred for consideration of cataract surgery.
History of Present Illness: Poor vision OS since childhood, and patient having more difficulty with distance vision.
PMH: hypertension, "borderline" diabetes, bipolar disorder, schizophrenia, "glaucoma".
MEDS: Seroquel, Sonata, trazodone, Lexapro, Valium, furosemide, Zaroxylyn, Travoprost.
ALLERGIES: none. FH: cataracts, arthritis, diabetes, thyroid disease.
- Best corrected visual acuities: 20/40 OD (20/60 before mRx of -6.00+3.50X115), HM OS.
- Pupils: 2.7 log unit RAPD OS; VF: full to CF OD, LP OS all quadrants
- EOM: large left exotropia
- IOP: normal OU
- DFE: see below.
- SLE: anterior segments normal with 1+ nuclear sclerosis cataracts OU (mild).
Optic Nerve HypoplasiaThis patient presented with long-standing vision loss OS from optic nerve hypoplasia (OS>>OD), and her cataracts were mild. She was diagnosed with "glaucoma" and started on travoprost by her previous doctor. The appearance of the optic nerves supports optic nerve hypoplasia, most likely since birth. Both optic nerves are small (less than 1.484 mm2 OD) with normal mean disc area being 2.89 mm2. Additionally, the left optic nerve is severly hypoplastic with only a stump of nerve tissue with crowded retinal vessels exiting the nerve. In glaucoma, we see cupping with bayoneting of the vessels. If there is no evidence of glaucoma (increased intraocular pressure, changes in the optic nerve head, or visual field changes), then her glaucoma medications should be stopped. The patient was informed that: she was born with optic nerve hypoplasia, her vision was affected because of this, and her cataracts were not visually significant.
Diagnosis: Optic Nerve Hypoplasia
- Optic nerve hypoplasia
- Optic atrophy, genetic vs tumor
- Other congenital anomaly of optic nerve
- Bennett JL. Developmental neurogenetics and neuro-ophthalmology. J Neuroophthalmol. 2002 Dec;22(4):286-96.
- Blohme J, Bengtsson-Stigmar E, Tornqvist K. Visually impaired Swedish children. Longitudinal comparisons 1980-1999. Acta Ophthalmol Scand. 2000 Aug;78(4):416-20.
- Hellstrom A, Wiklund LM, Svensson E. The clinical and morphologic spectrum of optic nerve hypoplasia. J AAPOS. 1999 Aug;3(4):212-20.
- Tornqvist K, Ericsson A, Kallen B. Optic nerve hypoplasia: Risk factors and epidemiology. Acta Ophthalmol Scand. 2002 Jun;80(3):300-4.
Suggested citation format:
Johnson AT: Optic Nerve Hypoplasia: 51-year-old female referred for consideration of cataract surgery. February 21, 2005; Available from: http://www.EyeRounds.org/cases/case10.htm.