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

ganglion cell {{stack, A ganglion cell is a cell found in a ganglion. Examples of ganglion cells include: * Retinal ganglion cell (RGC) found in the ganglion cell layer of the retina * Cells that reside in the adrenal medulla, where they are involved in the ...

axon 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 po ...

s leaving the eye. Because there are no rods or

cones A cone is a three-dimensional geometric shape that tapers smoothly from a flat base (frequently, though not necessarily, circular) to a point called the apex or vertex. A cone is formed by a set of line segments, half-lines, or lines conn ...

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 information from the retina to the brain. In humans, the optic nerve is derived fro ...

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 A ganglion is a group of neuron cell bodies in the peripheral nervous system. In the somatic nervous system this includes dorsal root ganglia and trigeminal ganglia among a few others. In the autonomic nervous system there are both sympatheti ...

cells come together. The optic disc is also the entry point for the major blood vessels that supply the

retina The retina (from la, rete "net") is the innermost, light-sensitive layer of tissue of the eye of most vertebrates and some molluscs. The optics of the eye create a focused two-dimensional image of the visual world on the retina, which then ...

. The optic disc in a normal human eye carries 1–1.2 million

afferent nerve fiber Afferent nerve fibers are the axons (nerve fibers) carried by a sensory nerve that relay sensory information from sensory receptors to regions of the brain. Afferent projections ''arrive'' at a particular brain region. Efferent nerve fibers a ...

s from the eye towards the brain.

Structure

The optic disc is placed 3 to 4 mm to the nasal side of the

fovea Fovea () (Latin for "pit"; plural foveae ) is a term in anatomy. It refers to a pit or depression in a structure. Human anatomy *Fovea centralis of the retina * Fovea buccalis or Dimple * Fovea of the femoral head * Trochlear fovea of the fr ...

. 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 disease.

Function

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

axons 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 projection of a nerve cell, or neuron, in vertebrates, th ...

leaving the eye. Because there are no rods or

overlying the optic disc, it corresponds to a small blind spot in each eye.

Clinical significance

The eye is unique because of the transparency of its optical media. Almost all eye structures can be examined with appropriate optical equipment and lenses. Using a modern direct

ophthalmoscope Ophthalmoscopy, also called funduscopy, is a test that allows a health professional to see inside the fundus of the eye and other structures using an ophthalmoscope (or funduscope). It is done as part of an eye examination and may be done as part ...

gives a view of the optic disc using the principle of reversibility of light. A slit lamp biomicroscopic examination along with an appropriate

aspheric An aspheric lens or asphere (often labeled ''ASPH'' on eye pieces) is a lens whose surface profiles are not portions of a sphere or cylinder. In photography, a lens assembly that includes an aspheric element is often called an aspherical lens. ...

focusing lens (+66D, +78D or +90D) is required for a detailed

stereoscopic Stereoscopy (also called stereoscopics, or stereo imaging) is a technique for creating or enhancing the depth perception, illusion of depth in an image by means of stereopsis for binocular vision. The word ''stereoscopy'' derives . Any stere ...

view of the optic disc and structures inside the eye. A biomicroscopic exam can give an indication of the health of the optic nerve. In particular, the eye care physician notes the colour, cupping size (as a

cup-to-disc ratio The optic cup is the white, cup-like area in the center of the optic disc. The ratio of the size of the optic cup to the optic disc (cup-to-disc ratio, or C/D) is one measure used in the diagnosis of glaucoma. Different C/Ds can be measured horizo ...

), 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 result in damage to the optic nerve (or retina) and cause vision loss. The most common type is open-angle (wide angle, chronic simple) glaucoma, in which the drainage angle for fluid within the eye rem ...

and other optic neuropathies,

optic neuritis Optic neuritis describes any condition that causes inflammation of the optic nerve; it may be associated with demyelinating diseases, or infectious or inflammatory processes. It is also known as optic papillitis (when the head of the optic nerv ...

, anterior ischemic optic neuropathy or

papilledema Papilledema or papilloedema is optic disc swelling that is caused by increased intracranial pressure due to any cause. The swelling is usually bilateral and can occur over a period of hours to weeks. Unilateral presentation is extremely rare. In ...

(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 Millimeter of mercury, mmHg ...

), and

optic disc drusen Optic disc drusen (ODD) are globules of mucoproteins and mucopolysaccharides that progressively calcify in the optic disc.Golnik, K. (2006). Congenital anomalies and acquired abnormalities of the optic nerve, (Version 14.3). UptoDate (On-Line Seri ...

. Women in advanced stage of pregnancy with

pre-eclampsia Pre-eclampsia is a disorder of pregnancy characterized by the onset of high blood pressure and often a significant amount of protein in the urine. When it arises, the condition begins after 20 weeks of pregnancy. In severe cases of the disease ...

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

Pale disc

A normal optic disc is orange to pink in colour 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 an 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 Optical coherence tomography (OCT) is an imaging technique that uses low-coherence light to capture micrometer-resolution, two- and three-dimensional images from within optical scattering media (e.g., biological tissue). It is used for medical ...

are computerised techniques for imaging various structures of the eyes, including the optic disc. They quantify the nerve fiber layer of 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 Morphology, from the Greek and meaning "study of shape", may refer to: Disciplines * Morphology (archaeology), study of the shapes or forms of artifacts * Morphology (astronomy), study of the shape of astronomical objects such as nebulae, galaxies ...

. 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 is a series of tests performed to assess vision and ability to focus on and discern objects. It also includes other tests and examinations pertaining to the eyes. Eye examinations are primarily performed by an optometrist, op ...

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

and

choroid The choroid, also known as the choroidea or choroid coat, is a part of the uvea, the vascular layer of the eye, and contains connective tissues, and lies between the retina and the sclera. The human choroid is thickest at the far extreme rear ...

in the optic disc region can be revealed non invasively by near-infrared

laser Doppler imaging Laser Doppler imaging (LDI) is an imaging method that uses a laser beam to scan live tissue. When the laser light reaches the tissue, the moving blood cells generate doppler components in the reflected ( backscattered) light. The light that comes ...

.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 Laser Doppler imaging (LDI) is an imaging method that uses a laser beam to scan live tissue. When the laser light reaches the tissue, the moving blood cells generate doppler components in the reflected ( backscattered) light. The light that comes ...

can enable mapping of the local

arterial resistivity index The arterial resistivity index (also called as Resistance index, abbreviated as RI), developed by Léandre Pourcelo is a measure of pulsatile blood flow that reflects the Vascular resistance, resistance to blood flow caused by microvascular bed ...

, 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. The term originates, via New Latin, from Ancient Greek (''sustolē''), from (''sustéllein'' 'to contract'; from ''sun ...

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

variations, and reveal ocular

hemodynamics Hemodynamics or haemodynamics are the dynamics of blood flow. The circulatory system is controlled by homeostatic mechanisms of autoregulation, just as hydraulic circuits are controlled by control systems. The hemodynamic response continuously m ...

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 1000 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 current taxonomy and systematics are in flux. Morning glory species belong to many genera, some of ...

flower. * Optic pit: congenital excavation of the optic disc resulting from a

malformation A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can ...

during development of the eye.

Gallery

File:LDH_ONH_ED.gif, Blood flow in the optic disc revealed by holographic

. 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

. 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