| Identifier |
Optic_Atrophy_Disc_Morphology_Lee |
| Title |
Optic Atrophy and Disc Morphology |
| Creator |
Andrew G. Lee, MD |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York |
| Subject |
Papilledema; Cupping; Atrophy |
| Description |
Dr. Lee lectures medical students on optic atrophy. |
| Transcript |
"Today we're going to be talking about optic atrophy, but not the causes or the workup. We're going to be talking about the morphology and that's basically "Can you look at an optic nerve and tell what the cause was for the optic atrophy?". And in general, you can't because the optic nerve really only has two pathologic responses to disease: it can either swell or it can be pale. However, there are some clues that can be gotten from just looking at the disc head. For example, for non-arteritic anterior ischemic optic neuropathy (NAION) that normally is a vascular problem so we can see sector pallor. So, if it's just like the top of the disc that is affected and you would have a corresponding field defect that would be inferior altitudinal so the corresponding sector pallor with the field in the right vasculopathic patient who had sector edema that became sector atrophy, that's kind of a clue that the atrophy was from NAION. The other characteristic feature you're used to is glaucomatous cupping. So cupping is normally a very good sign for glaucomatous type damage to the optic nerve and you want to be looking for rim pallor to differentiate whether the cupping is equal to or disproportionate to the amount of atrophy. So, in glaucomatous optic atrophy, the cupping and the pallor have to be the same and it has to match up to the field. We wouldn't want to have rim pallor in glaucoma even though primary open-angle glaucoma is probably the most common optic neuropathy that we see. And then you got post-papilledema optic atrophy. As you know, papilledema has grades, Frisen grades, one where you just have a c-shaped halo of nasal elevation, two where it's 360 degrees but we don't have obscuration of the blood vessels, three where we have obscuration of blood vessels as they are crossing the margin, four the obscuration is central, and five is you can't see anything. So, in patients who have papilledema, their atrophy might be able to be distinguished from post-NAION atrophy by the presence of what we call the high-water mark. So, the high-water mark is where the edema used to be, so if you have grade 4 or 5 papilledema with surrounding sub-retinal fluid, that fluid will slowly resorb over time so the atrophy we see in chronic papilledema after the resolution has these marks in the retinal pigment epithelium surrounding the nerve where the water used to be. So that is what we would call a high-water mark. In general, however, most cases of optic atrophy are actually based on color and not by what we see on the disc. So, the disc looks pale and that's because there's been a change both in the blood vessels that give a pink color to the disc but also the astrocytes when they're replaced by gliosis and there's no more axon, it makes it look whiter. So optic atrophy can be the result of any process that damages the axon and kills it. It'll change the color; it'll change the blood flow. So, all sorts of optic atrophy end up funneling down to a single ophthalmoscopic appearance which is the nerve looks pale. But you should look out for sector atrophy, cupping, and post-papilledema high water mark to try and determine whether you can tell what the cause of the optic atrophy was. But in general, you can't tell just by looking at a pale nerve." |
| Date |
2022-03 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6tsmaw6 |
| Setname |
ehsl_novel_lee |
| ID |
1751086 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6tsmaw6 |
