Optic atrophy describes damage to the optic nerve in which nerve fibres are lost irreversibly. The optic nerve is the "data cable" between the eye and the brain: it transmits visual information from the retina to the visual centres of the brain. If nerve fibres are lost, this can lead to a deterioration of central vision, of the visual field or of colour vision.
Causes
Optic atrophy is not a condition in its own right but the end result of various forms of damage to the optic nerve. Possible causes are:
Raised intracranial pressure (hydrocephalus): sustained pressure on the optic nerve
Tumours: growths that compress the optic nerve directly or indirectly
Reduced blood supply: vascular occlusion or inadequate oxygen supply
Inflammation: optic neuritis
Traumatic damage: head injuries affecting the optic nerve
Toxic effects: certain medicines or toxic substances
Inherited conditions: for example Leber hereditary optic neuropathy (LHON) or dominant optic atrophy
Premature birth: damage to the still immature optic nerve
Glaucoma: chronically raised intraocular pressure, a common cause in adults
In children, optic atrophy can already be present at birth or develop during the first years of life.
Symptoms
The complaints depend on which nerve fibres are affected:
Deterioration of visual acuity, from slight blurring through to blindness
Visual field defects, "blind spots" in the field of vision
Disturbed colour vision, colours appear paler
Reduced pupil reaction to light
Where optic atrophy affects one eye only, reduced vision in children is often noticed late, because the healthy eye compensates.
Pale Optic Nerve: Clarify the Cause and Course
Optic atrophy is the result of other damage to the optic nerve, which is why finding the cause is the main focus. Dr. Stefan Langenegger (focus on neuro-ophthalmology) examines children and adults at our practice on Bahnhofplatz in Zurich, coordinates imaging and other specialists if needed and monitors the course.
The diagnosis is made through a thorough ophthalmological examination:
Examination of the back of the eye: the damaged optic nerve appears strikingly pale
Visual acuity and refraction testing
Pupil reaction: testing for a relative afferent pupillary defect (RAPD)
Visual field testing: to record any defects
Colour vision tests
OCT (optical coherence tomography): measurement of the nerve fibre layer thickness around the optic nerve
MRI: where tumours, inflammation or other structural causes are suspected
Treatment
Nerve fibres that have already died cannot be restored: reversal of the atrophy is not possible. Treatment therefore aims to:
Remove the cause: treating raised intracranial pressure, removing a tumour, treating inflammation
Prevent further damage: close monitoring and early intervention where causes are treatable
Make the most of remaining vision: suitable correction with glasses, magnifiers and other magnifying aids, tinted lenses for sensitivity to glare
Protect the healthy eye: where atrophy affects one eye, the healthy eye should be protected with safety glasses during sport and risky activities
Support for children
Children with marked optic atrophy benefit from:
Early intervention and specialised educational provision
Adapted learning materials (e.g. large print, electronic aids)
Reasonable adjustments at school
Regular ophthalmological care, in order to detect changes early and adapt the aids
Even though optic atrophy itself cannot be cured, thorough care can help affected children make the best possible use of the vision they have and develop in step with their age.
