Acquired Optic Nerve and Peripapillary Pits in Pathologic Myopia

Purpose: To examine the incidence and characteristics of pit-like structures around the optic disc and myopic conus in eyes with high myopia. Design: Prospective, observational case series. Participants: We evaluated 198 eyes of 119 patients with pathologic myopia (spherical equivalent >-8 diopters [D]). We also evaluated 32 eyes of 32 subjects with emmetropia (refractive error <=+/- 3 D) as controls. Methods: The papillary and peripapillary areas were examined with a prototype swept-source optical coherence tomography (OCT) system with a center wavelength of 1050 nm. We studied the structural characteristics of pit-like changes. Main Outcome Measures: The incidence and characteristics of the optic nerve (ON) pits in eyes with high myopia. Results: Pit-like clefts were found at the outer border of the ON or within the adjacent scleral crescent in 32 of 198 highly myopic eyes (16.2%) but in none of the emmetropic eyes. The eyes with these pits were more myopic, had significantly longer axial lengths, and had significantly larger optic discs than the highly myopic eyes without pits. The pits were located in the optic disc area (optic disc pits) in 11 of 32 eyes and in the area of the conus outside the optic disc (conus pits) in 22 of 32 eyes. One eye had both optic disc pits and conus pits. The optic disc pits existed in the superior or inferior border of the optic disc. All but 1 eye with conus pits had a type IX staphyloma, and the location of the conus pits were present nasal to the scleral ridge or outside the ridge temporal to the nerve. The optic disc pits were associated with discontinuities of the lamina cribrosa, whereas the conus pits appeared to develop from a scleral stretch-associated schisis or to emissary openings for the short posterior ciliary arteries in the sclera. The nerve fiber tissue overlying the pits was discontinuous at the site of the pits. Conclusions: Optic nerve pits are common in highly myopic eyes. The ON pits are barely visible ophthalmoscopically but can be demonstrated by using swept-source OCT. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. Ophthalmology 2012;119:1685-1692 (c) 2012 by the American Academy of Ophthalmology.