Diagnostic Considerations

Table 1. Various Common Groups of Disorders Presenting with Optic Atrophy (Open Table in a new window)

	Postneuritis	Ischemic Arteritic	Ischemic Nonarteritic	Compressive
Age	15-50 y	Approximately 70 y	Sixth decade	Varies based on cause
Sex	Multiple sclerosis F>M	F>M	F=M	Varies based on cause
Visual acuity	Varies from mild blurring (34%) and moderate loss of acuity (12%) to severe or total loss of light perception (complete blindness) in 54% of cases, to no light perception. The loss of vision is acute and progressive.--Vision usually recovers within 2 mo	< 20/200 (6/60)	>20/200 (6/60)	Varies from mild blurring to no light perception
Color vision	Color vision > vision loss	Color vision loss = vision loss	Color vision loss = vision loss	Color vision = vision loss
RAPD*	+	+	+	+
Motility	Painful movement in cases of retrobulbar neuritis	Normal	Normal	Depends on the site of compression
Nystagmus	In multiple sclerosis, vertical nystagmus (upbeating or downbeating) may be seen	No	No	See-saw nystagmus in optic chiasm compression
Optic disc	Temporal pallor	Pallid disc edema	Segmental disc edema	Bow-tie pallor seen in optic chiasm compression; varies in other instances
Electrophysiologic study	VEP-increased latency < †>	VEP-reduced amplitude	VEP-reduced amplitude	Reduced VEP amplitude
Neuroimaging (CT, MRI)	In multiple sclerosis, hyperechoic lesions are seen in the brain on MRI	-	-	For exact location of compression
Other associations		Headache, scalp tenderness, jaw claudication	Hypertension and diabetes	Headache, vomiting, and focal neurologic deficits
*RAPD - Relative afferent pupil defect < †>VEP - Visual-evoked potential

Differential Diagnoses

Axial myopia
Brighter-than-normal luminosity
Myelinated nerve fibers
Optic disc drusen
Optic nerve hypoplasia
Optic nerve pit
Scleral crescent
Tilted disc

Workup

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Media Gallery

Normal optic nerve histopathology.
Glaucomatous optic atrophy histopathology.
Healthy optic disc.
Nonarteritic anterior ischemic optic neuropathy.
Arteritic anterior ischemic optic neuropathy, cilioretinal artery occlusion.
Primary optic atrophy.
Optic atrophy following papilledema (secondary).
Glaucomatous optic atrophy.
Juvenile open-angle glaucoma (JOAG) with optic pallor.
Consecutive optic atrophy following panretinal photocoagulation (PRP).

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Table 1. Various Common Groups of Disorders Presenting with Optic Atrophy

Table 1. Various Common Groups of Disorders Presenting with Optic Atrophy

	Postneuritis	Ischemic Arteritic	Ischemic Nonarteritic	Compressive
Age	15-50 y	Approximately 70 y	Sixth decade	Varies based on cause
Sex	Multiple sclerosis F>M	F>M	F=M	Varies based on cause
Visual acuity	Varies from mild blurring (34%) and moderate loss of acuity (12%) to severe or total loss of light perception (complete blindness) in 54% of cases, to no light perception. The loss of vision is acute and progressive.--Vision usually recovers within 2 mo	< 20/200 (6/60)	>20/200 (6/60)	Varies from mild blurring to no light perception
Color vision	Color vision > vision loss	Color vision loss = vision loss	Color vision loss = vision loss	Color vision = vision loss
RAPD*	+	+	+	+
Motility	Painful movement in cases of retrobulbar neuritis	Normal	Normal	Depends on the site of compression
Nystagmus	In multiple sclerosis, vertical nystagmus (upbeating or downbeating) may be seen	No	No	See-saw nystagmus in optic chiasm compression
Optic disc	Temporal pallor	Pallid disc edema	Segmental disc edema	Bow-tie pallor seen in optic chiasm compression; varies in other instances
Electrophysiologic study	VEP-increased latency < †>	VEP-reduced amplitude	VEP-reduced amplitude	Reduced VEP amplitude
Neuroimaging (CT, MRI)	In multiple sclerosis, hyperechoic lesions are seen in the brain on MRI	-	-	For exact location of compression
Other associations		Headache, scalp tenderness, jaw claudication	Hypertension and diabetes	Headache, vomiting, and focal neurologic deficits
*RAPD - Relative afferent pupil defect < †>VEP - Visual-evoked potential

Back to List

Author

Gangaprasad Muthaiah Amula, MBBS, DNB, FRCS(Glasg), FICO, FMRF Department of Ophthalmology, Al Ahli Hospital, Doha, Qatar

Gangaprasad Muthaiah Amula, MBBS, DNB, FRCS(Glasg), FICO, FMRF is a member of the following medical societies: All India Ophthalmological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Chief Editor

Edsel B Ing, MD, PhD, MBA, MEd, MPH, MA, FRCSC Professor, Department of Ophthalmology and Vision Sciences, Sunnybrook Hospital, University of Toronto Faculty of Medicine; Incoming Chair of Ophthalmology, University of Alberta Faculty of Medicine and Dentistry, Canada

Edsel B Ing, MD, PhD, MBA, MEd, MPH, MA, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Ophthalmic Plastic and Reconstructive Surgery, Canadian Medical Association, Canadian Ophthalmological Society, Canadian Society of Oculoplastic Surgery, Chinese Canadian Medical Society, European Society of Ophthalmic Plastic and Reconstructive Surgery, North American Neuro-Ophthalmology Society, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Statistical Society of Canada

Disclosure: Nothing to disclose.

Additional Contributors

Rashmin Gandhi, MBBS, FRCS(Edin), FRCS(Glasg) Faculty, Departments of Ocular Physiology and Neuro-ophthalmology, Elite School of Optometry; Faculty, CU Shah Ophthalmic Postgraduate Center, Consulting Staff, Department of Ophthalmology, Sankara Nethralaya Hospital

Rashmin Gandhi, MBBS, FRCS(Edin), FRCS(Glasg) is a member of the following medical societies: American Academy of Ophthalmology, All India Ophthalmological Society

Disclosure: Nothing to disclose.

Acknowledgements

Brian R Younge, MD Professor of Ophthalmology, Mayo Clinic School of Medicine

Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society

Disclosure: Nothing to disclose.