Structure and clinical significance of central optic disc pits.

OBJECTIVE: To assess the structure of central optic disc pits (ODPs) using enhanced-depth imaging optical coherence tomography (EDI OCT) and to ascertain their clinical significance. DESIGN: Prospective, cross-sectional study. PARTICIPANTS: Patients with an ophthalmoscopically visible central ODP in either eye, irrespective of accompanying ocular disease, were enrolled from the neuro-ophthalmology and glaucoma referral practices. Each subject with a central ODP was matched with 2 healthy subjects with normal-appearing optic disc within 5 years of age. METHODS: Each participant received a complete ophthalmologic examination including standard automated perimetry, retinal nerve fiber layer (RNFL) thickness measurement by OCT, and serial horizontal and vertical cross-sectional EDI OCT of the optic nerve head. MAIN OUTCOME MEASURES: Structure of the lamina cribrosa (LC) in relation to the central ODP in EDI OCT images. RESULTS: Eighteen eyes (13 subjects) with a central ODP and 52 healthy eyes (26 controls) were included. Four eyes (2 subjects) with a central ODP were otherwise normal with intact macula, neuroretinal rim, RNFL, and visual field. Fourteen eyes (11 subjects) with a central ODP had glaucoma with glaucomatous neuroretinal rim thinning, RNFL loss, and corresponding visual field defect. No eye had associated maculopathy. On EDI OCT, the central ODP corresponded with a full-thickness defect in the LC center with no serous retinal detachment or herniation of neural tissue through the LC defect. Central ODPs were separated from (type 1) or merged with (type 2) the LC opening for the central retinal vascular trunk. In control eyes, no LC defect was detected. CONCLUSIONS: Central ODPs are full-thickness LC defects unassociated with maculopathy and different from glaucomatous acquired pits of the optic nerve, which represent focal laminar defect adjacent to the disc edge.