Microstructure of the Optic Disc Pit in Open-Angle Glaucoma

Purpose: To investigate the structural and clinical characteristics of the optic disc pit (ODP) in primary open-angle glaucoma (POAG) via enhanced depth imaging (EDI) spectral-domain optical coherence tomography (SD-OCT). Design: Prospective, observational case series. Participants: Seventy POAG eyes clinically diagnosed with an ODP via stereo disc photography. Methods: Optic discs were scanned using EDI SD-OCT. Serial horizontal and vertical B-scan images covering the optic discs were obtained from each eye. The structural characteristics of the ODP were investigated via 3-dimensional images constructed from the serial B-scans, focusing on the presence of alterations in the contour of the lamina cribrosa (LC) or prelaminar tissue (PLT), in conjunction with associated clinical characteristics. Main Outcome Measures: The structural characteristics of the ODP and associated clinical characteristics. Results: In the EDI SD-OCT images, the ODP was viewed as an isolated alteration of the LC (n = 14, 20.0%) or PLT (n = 16, 22.9%) or an alteration of both the LC and PLT (n = 40, 57.1%). Alterations of the LC were located at the mid-periphery near the LC insertion (n = 17) or far periphery adjacent to the LC insertion (n = 37), and the depth of alteration was deep (n = 23), involving nearly full-thickness LC, or shallow (n = 31), with partially visible LC at the base. Fifty-four eyes (77.1%) exhibited parafoveal visual field (VF) defect within 10 degrees of fixation, and in 98.1% of these eyes (53/54) it was spatially associated with the location of ODP. The parafoveal VF defect was more prevalent in eyes with LC alteration than those without (83.3% vs. 56.2%, P = 0.023) and in eyes with deep LC defect than those with shallow defect (95.7% vs. 74.2%, P = 0.036). Disc hemorrhage (32.4% vs. 0.0%, P = 0.008) and peripapillary retinoschisis (18.9 vs. 0.0%, P = 0.055) were more strongly associated with LC alterations located at the far periphery than at the mid-periphery. Conclusions: Enhanced depth imaging SD-OCT facilitated visualization of the varied structure of the ODP, which presented as alteration of the LC or PLT or both. The clinical significance of differing characteristics of ODP microstructure remains to be determined. (C) 2014 by the American Academy of Ophthalmology.