The optic disc or optic nerve head is the point of exit for ganglion cell

axon An axon (from Greek ἄξων ''áxōn'', axis) or nerve fiber (or nerve fibre: see American and British English spelling differences#-re, -er, spelling differences) is a long, slender cellular extensions, projection of a nerve cell, or neuron, ...

s leaving the eye. Because there are no rods or cones overlying the optic disc, it corresponds to a small blind spot in each eye. The ganglion cell axons form the

optic nerve In neuroanatomy, the optic nerve, also known as the second cranial nerve, cranial nerve II, or simply CN II, is a paired cranial nerve that transmits visual system, visual information from the retina to the brain. In humans, the optic nerve i ...

after they leave the eye. The optic disc represents the beginning of the optic nerve and is the point where the axons of retinal ganglion cells come together. The optic disc in a normal human eye carries 1–1.2 million

afferent nerve fiber Afferent nerve fibers are axons (nerve fibers) of sensory neurons that carry sensory information from sensory receptors to the central nervous system. Many afferent projections ''arrive'' at a particular brain region. In the peripheral nerv ...

s from the eye toward the brain. The optic disc is also the entry point for the major arteries that supply the

retina The retina (; or retinas) is the innermost, photosensitivity, light-sensitive layer of tissue (biology), tissue of the eye of most vertebrates and some Mollusca, molluscs. The optics of the eye create a focus (optics), focused two-dimensional ...

with blood, and the exit point for the veins from the retina.

Structure

The optic disc is located 3 to 4 mm to the nasal side of the fovea. It is a vertical oval, with average dimensions of 1.76mm horizontally by 1.92mm vertically. There is a central depression, of variable size, called the optic cup. This depression can be a variety of shapes from a shallow indentation to a bean pot—this shape can be significant for diagnosis of some retinal diseases.

Function

The optic disc or optic nerve head is the point of exit for ganglion cell

axons An axon (from Greek ἄξων ''áxōn'', axis) or nerve fiber (or nerve fibre: see spelling differences) is a long, slender projection of a nerve cell, or neuron, in vertebrates, that typically conducts electrical impulses known as action pot ...

leaving the eye. Because there are no rods or cones overlying the optic disc, it corresponds to a small blind spot in each eye.

Clinical significance

Almost all eye structures can be examined with appropriate optical equipment and lenses. Using a modern direct ophthalmoscope gives a view of the optic disc using the principle of reversibility of light. A slit lamp biomicroscopic examination along with an appropriate aspheric focusing lens (+66D, +78D or +90D) is required for a detailed stereoscopic view of the optic disc and structures inside the eye. A biomicroscopic exam can indicate the health of the optic nerve. In particular, the eye care physician notes the colour, cupping size (as a cup-to-disc ratio), sharpness of edge, swelling, hemorrhages, notching in the optic disc and any other unusual anomalies. It is useful for finding evidence corroborating the diagnosis of

glaucoma Glaucoma is a group of eye diseases that can lead to damage of the optic nerve. The optic nerve transmits visual information from the eye to the brain. Glaucoma may cause vision loss if left untreated. It has been called the "silent thief of ...

and other optic neuropathies,

optic neuritis Optic neuritis (ON) is a debilitating condition that is defined as inflammation of cranial nerve II which results in disruption of the neurologic pathways that allow visual sensory information received by the retina to be able to be transmitted to ...

, anterior ischemic optic neuropathy or papilledema (i.e. optic disc swelling produced by raised

intracranial pressure Intracranial pressure (ICP) is the pressure exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue. ICP is measured in millimeters of mercury ( mmHg) and at rest, is normally 7–15 mmHg for a supine adu ...

), and optic disc drusen. Women in an advanced stage of pregnancy with

pre-eclampsia Pre-eclampsia is a multi-system disorder specific to pregnancy, characterized by the new onset of hypertension, high blood pressure and often a significant amount of proteinuria, protein in the urine or by the new onset of high blood pressure a ...

should be screened by an ophthalmoscopic examination of the optic disc for early evidence of a rise in

Pale disc

A normal optic disc is orange to pink in colour and may vary based on ethnicity. A pale disc is an optic disc which varies in colour from a pale pink or orange colour to white. A pale disc is an indication of a disease condition.

Imaging

Traditional colour-film camera images are the reference standard in imaging, requiring an expert ophthalmic photographer, ophthalmic technician, optometrist or ophthalmologist for taking standardised pictures of the optic disc. Stereoscopic images offer an excellent investigative tool for serial follow-up of suspected changes in the hands of an expert optometrist or ophthalmologist. Automated techniques have also been developed to allow for more efficient and less expensive imaging. Heidelberg retinal tomography (HRT), scanning laser polarimetry and optical coherence tomography are computerised techniques for imaging various structures of the eyes, including the optic disc. They quantify the nerve fiber layer of the disc and surrounding retina and statistically correlate the findings with a database of previously screened population of normals. They are useful for baseline and serial follow-up to monitor minute changes in optic disc morphology. Imaging will not provide conclusive evidence for clinical diagnosis however, and the evidence needs to be supplanted by serial physiological testing for functional changes. Such tests may include visual field charting and final clinical interpretation of the complete

eye examination An eye examination, commonly known as an eye test, is a series of tests performed to assess Visual acuity, vision and ability to Focus (optics), focus on and discern objects. It also includes other tests and examinations of the human eye, eyes. ...

by an eye care physician. Ophthalmologists and optometrists are able to provide this service. Blood flow in the

and choroid in the optic disc region can be revealed non invasively by near-infrared laser Doppler imaging.Puyo, L., M. Paques, M. Fink, J-A. Sahel, and M. Atlan. "In vivo laser Doppler holography of the human retina." Biomedical optics express 9, no. 9 (2018): 4113-4129. Laser Doppler imaging can enable mapping of the local arterial resistivity index, and the possibility to perform unambiguous identification of retinal arteries and veins on the basis of their

systole Systole ( ) is the part of the cardiac cycle during which some chambers of the heart contract after refilling with blood. Its contrasting phase is diastole, the relaxed phase of the cardiac cycle when the chambers of the heart are refilling ...

diastole Diastole ( ) is the relaxed phase of the cardiac cycle when the chambers of the heart are refilling with blood. The contrasting phase is systole when the heart chambers are contracting. Atrial diastole is the relaxing of the atria, and ventricul ...

variations, and reveal ocular hemodynamics in human eyes. Furthermore, the Doppler spectrum asymmetry reveals the local direction of blood flow with respect to the optical axis. This directional information is overlaid on standard grayscale blood flow images to depict flow in the central artery and vein.Puyo, L., M. Paques, and M. Atlan. "Retinal blood flow reversal in out-of-plane vessels imaged with laser Doppler holography" https://arxiv.org/abs/2008.09813 A systematic review of 106 studies and 16,260 eyes compared the performance of the imaging techniques, and found that all three imaging tests performed very similarly when detecting for glaucoma. The review found that in 1,000 patients subjected to imaging tests, with 200 having manifest glaucoma, the best imaging tests would miss 60 cases out of the 200 patients with glaucoma, and incorrectly refer 50 out of 800 patients without glaucoma.

Abnormalities

* Megalopapilla: a non-progressive condition in which the optic disc is enlarged (diameter exceeding 2.1 mm) with no other morphological abnormalities. * Morning glory disc anomaly: a unilateral congenital deformity resulting from failure of the optic nerve to completely form in utero. The term was coined in 1970 by Kindler, noting a resemblance of the malformed optic nerve to the

morning glory Morning glory (also written as morning-glory) is the common name for over 1,000 species of flowering plants in the family Convolvulaceae, whose taxonomy and systematics remain in flux. These species are distributed across numerous genus, gene ...

flower. * Optic pit: congenital excavation of the optic disc resulting from a malformation during development of the eye.

Gallery

File:LDH_ONH_ED.gif, Blood flow in the optic disc revealed by holographic laser Doppler imaging. File:LaserDopplerHolographyRetinaSpectralAsymmetry.gif, Local direction of blood flow with respect to the optical axis revealed by the Doppler spectrum asymmetry in out-of-plane retinal vessels by holographic laser Doppler imaging. File:Optic_cup_and_macula_-_3D_motion_parallax.gif, Three dimensional image of a healthy optic disc in a 24-year-old female. File:Optic disc detail.png, alt=High detail picture of optic disc., Optic disc showing microvasculature. File:Tilted Disc Syndrome.jpg, Tilted optic disc in left eye of a 20-year-old male. File:Optic disc edema and haemorrhage.jpg, Optic disc edema and haemorrhage

References

External links

Diagram at Moorfields Eye HospitalDiagram at Ballard OpticalRetinal Vein Pulsation Is in Phase with Intracranial Pressure and Not Intraocular Pressure
{{Authority control Human eye anatomy