49.1 Features
Optic disc pits (ODPs) are a congenital deformity of the optic pit that affects men and women equally, with a prevalence of 1 in 11,000 people. Structural defects in the optic nerve head cause a disruption of the physiologic opening where the vitreous cavity and subarachnoid space meet each other. Thus, vitreous and/or cerebrospinal fluid can migrate into the subretinal space or within the retina and cause optic pit-related maculopathy.
49.1.1 Common Symptoms
Often asymptomatic and detected incidentally. When ODPs are complicated by macular changes such as intraretinal fluid accumulation, serous retinal detachment, and/or retinal pigment changes, they may be accompanied with more significant vision loss: metamorphopsia, micropsia, blurred vision, and/or central scotoma. Peripheral visual field loss may also be present.
49.1.2 Exam Findings
ODPs may resemble hypo- or hyperpigmented, oval-shaped excavations in the optic nerve during routine fundus examinations (▶ Fig. 49.1). Typically, these pits are solitary and gray, although multiple ODPs may also be detected in the optic nerve as yellow or black.
Fig. 49.1 Color fundus photograph of an optic disc pit in the left eye, showing a hypopigmented, oval-shaped excavation in the optic nerve.
49.2 Key Diagnostic Tests and Findings
49.2.1 Optical Coherence Tomography
A schisis-like separation between the inner and outer retina due to fluid accumulation from the ODP. Fluid accumulation may also result in a serous retinal detachment characterized by hyporeflective subretinal fluid (▶ Fig. 49.2).
Fig. 49.2 (a) Swept-source optical coherence tomography (OCT) of a left eye with an optic disc pit (ODP) maculopathy, showing a schisis-like separation between the inner and outer retinal layers. (b) Swept-source OCT angiography of the left eye, indicating decreased vascular perfusion to the area of the ODP.
49.2.2 Fluorescein Angiography or Ultra-Widefield Fluorescein Angiography
Typically, early hypofluorescence and late hyperfluorescence of the ODP (▶ Fig. 49.3) with often minimal leakage in the area of retinal edema/detachment.
Fig. 49.3 (a–c) Fluorescein angiography of a patient with an optic disc pit demonstrating progressive staining of the pit as the study progresses but no leakage or hyperfluorescence within the retina.
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