Optometry case study: Optic disc pit with associated serous macular detachment

1433

by Andrew Kotsos, Optometrist, Specsavers Little Collins Street, Melbourne, Australia

History

A 28 year old male patient presented to the practice for the first time. His previous eye examination was approximately 12 months prior to this.

Presenting complaint

Decreased vision and central floaters in his left eye. He had no previous ocular history and his health was good.

Examination

Best corrected visual acuity RE 6/6
LE 6/38
IOPs R 15mm Hg, LE 15mm Hg at 4.30pm
POH – nil
FOH – nil
PERRLA

Digital retinal photography

RE – normal
LE – optic disc pit at 4 o’clock with associated vitreous traction and serous macular detachment (see digital retinal photograph)

 

 

 

 

 

 

Diagnosis

Provisional diagnosis

Optic disc pit with associated serous macular detachment

Management

Referred for ophthalmological evaluation and management

Ophthalmologist report

Diagnosis confirmed as left optic disc pit with associated serous macular detachment
Refraction showed a hypermetropic shift improving LE VA to 6/15

Ophthalmology management

Referred from general ophthalmology to a vitreo-retinal specialist to discuss the possibility of a vitrectomy to reduce traction. The patient was informed that there is no possibility of spontaneous resolution.

Discussion

An optic pit is a congenital excavation of the optic nerve head resulting from a malformation during the development of the eye.

Prevalence – approximately 1 in 10,000. 85% are unilateral.

Symptoms – generally asymptomatic unless maculopathy occurs.

Complications – maculopathy in 40-50% cases, most frequently in early adulthood. They have also been associated with an increased risk of glaucoma.

Management – optimal management of optic pit–related maculopathy remains to be determined. A combination of photocoagulation, macular buckling, gas tamponade and vitrectomy have all been suggested.

Print