Optic disc

Optic disc
Interior of posterior half of bulb of left eye. The veins are darker in appearance than the arteries.
The terminal portion of the optic nerve and its entrance into the eyeball, in horizontal section.
Gray's	subject #225 1015
MeSH	Optic+Disk

The optic disc or optic nerve head is the location where ganglion cell axons exit the eye to form the optic nerve. There are no light sensitive rods or cones to respond to a light stimulus at this point. This causes a break in the visual field called "the blind spot" or the "physiological blind spot". The optic nerve head in a normal human eye carries from 1 to 1.2 million neurons from the eye towards the brain.

Anatomy

The optic disc is placed 3 to 4 mm to the nasal side of the fovea. It is a vertical oval, with average dimensions of 1.76mm horizontally by 1.92mm vertically.^[1] There is a central depression, of variable size, called the optic cup.

Clinical examination

The eye is unique because of the transparency of its optical media. Almost all eye structures can be examined with appropriate optical equipment and lenses. Using a modern direct ophthalmoscope gives a view of the optic disc using the principle of reversibility of light. A slit lamp biomicroscopic examination along with an appropriate aspheric focusing lens (+66D, +78D or +90D) is required for a detailed stereoscopic view of the optic disc and structures inside the eye. Inspection of the optic disc by ophthalmoscopy or biomicroscopy can give an indication of the health of the optic nerve. In particular, the eye care physician notes the colour, cupping size (as a cup-to-disc ratio), sharpness of edge, swelling, hemorrhages, notching in the optic disc and any other unusual anomalies. It is useful for finding evidence corroborating the diagnosis of glaucoma and other optic neuropathies, optic neuritis, anterior ischemic optic neuropathy or papilledema (i.e. optic disc swelling produced by raised intracranial pressure), and optic disc drusen. Women in advanced stage of pregnancy with pre-eclampsia should be screened by an ophthalmoscopic examination of the optic disc for early evidence of rise in intracranial pressure.

Schematic diagram of the human eye, with the optical disc, or blind spot, at the bottom.

Imaging of the optic disc

Traditional colour-film camera images are the gold standard in imaging, requiring an expert ophthalmic photographer, ophthalmic technician, optometrist or an ophthalmologist for taking standardised pictures of the optic disc. Stereoscopic images offer an excellent investigative tool for serial follow-up of suspected changes in the hands of an expert optometrist or ophthalmologist. Automated techniques have also been developed to allow for more efficient and less expensive imaging. Heidelberg Retinal Tomography (HRT-II), GDx-VCC and optical coherence tomography (Stratus-OCT 3) are the currently available computerised techniques for imaging various structures of the eyes, including the optic disc. They quantitate the nerve fiber layer of disc and surrounding retina and statistically correlate the findings with a database of previously screened population of normals. They are useful for baseline and serial follow-up to monitor minute changes in optic disc morphology. It should be noted that imaging won't provide conclusive evidence for clinical diagnosis however, and the evidence needs to be supplanted by serial physiological testing for functional changes. Such tests may include visual field charting, and final clinical interpretation of the complete eye examination by an eye care physician. Ophthalmologists and Optometrists are able to provide this service.

Retinography photograph showing the optic disc as a bright area on the right where blood vessels converge.

References

1. ^ Duane's Ophthalmology (2006). Ch. 4 Anatomy of the Visual Sensory System

External links

• Diagram at Moorfields Eye Hospital
• Diagram at Ballard Optical

v • d • e Sensory system – visual system – globe of eye (TA A15.2.1-6, GA 10.1005) Fibrous tunic (outer) Conjunctiva • Sclera/Episclera • Schlemm's canal • Trabecular meshwork • Limbus Cornea (Epithelium, Bowman's, Stroma (keratocytes), Descemet's, Endothelium) Uvea (middle) Choroid (Ciliary processes, Choriocapillaris, Bruch's membrane) • Iris (Stroma) • Pupil • Ciliary body Retina (inner) Macula • Foveola • Fovea • Optic disc (Cup) Anterior segment Anterior chamber • Aqueous humour • Posterior chamber • Lens Posterior segment Vitreous humour • Zonule of Zinn Intraocular muscles parasympathetic (Ciliary muscle, Iris sphincter muscle) • sympathetic (Iris dilator muscle) Other Tenon's capsule • Ocular immune system • Tapetum lucidum eye navs: anat/adnexa anat/pathways/physio/dev, noncongen/congen/neoplasia, eponymous signs, proc