Walsh & Hoyt: Differential Diagnosis of Optic Atrophy

When optic atrophy is complete, it is often impossible to determine its etiology solely from its appearance. Trobe et al. viewed 163 color fundus stereophotographs of nine disease entities: glaucoma, central retinal artery occlusion, ischemic optic neuropathy, anterior and retrobulbar optic neuritis, compressive optic neuropathy, traumatic optic neuropathy, Leber's hereditary optic neuropathy, and autosomal dominant optic neuropathy. The atrophy caused by glaucoma, central retinal artery occlusion, and ischemic optic neuropathy was diagnosed by at least one of five observers with an accuracy above 80%; however, the other conditions were correctly identified with less than 50% accuracy. Retinal arteriolar attenuation and sheathing were most helpful in differentiating central retinal artery occlusion and ischemic optic neuropathy from other entities.